Bulletin
Editors: Karen Snow, M.D. | Erica Huffman, Executive Director
www.escambiacms.org
MARCH/APRIL 2016 VOLUME 46, NO. 2
PRESIDENT’S MESSAGE This January I’m proud to say we had the most attended ball in the history of our medical society with nearly 160 people in attendance. We heard from Dr. John Fogarty, the dean of the FSU College of medicine as well as Dr. Ralph Nobo, the President of the FMA. The final $50,000 dollar check for our endowment to FSU COM was given and I got to get my picture in the paper which showed me how much more hair I’ve lost in the last year. Finally we presented the We Care Doctor the year award to Dr. Ranjith Dissanayake who provided over $41,000 in uncompensated care and treatments in 2015. I’m sure this is when you’re thinking, “Oh no, this is where he tried to get me to sign up for We Care again.” Well, you are right, but I also would like to tell you more about the program and honor others who participated as well. We Care was established here in 1992 by our medical society. It now functions throughout the state. The program now has 115 participating specialist and has ancillary support from all 3 hospitals. In 2015 the physicians provided nearly $770,000 in care with over 1,200 visits. The most visits/treatments this year was 64 provided by Dr. Donald Dewey, Orthopedics who I am proud to call my friend and partner. The top 5 physicians were: Dr. Ranjith Dissanayake, Dr. Luther Carter, Dr. Ian Weisberg, Dr. Norman Haines, and Dr. Donald Dewey. We Care is unique in that it provides you the ability to provide charity care in your office and incorporate it into your daily schedule. Malpractice is covered under state sovereign immunity which provides peace of mind. Those physicians that participate are eligible for free license renewal and 25% CME credit towards renewal.
CONTENTS There is no pressure to take patients. There is no minimum or maximum number of visits. Referrals are sent to your office and it is up to you which ones you accept. I have been participating in We Care for the last four years. My experience has been nothing but positive. My We Care patient are the most appreciative and compliant patients in my practice. As an added bonus, I don’t have to worry about needles documentation, PQRS and meaningful use. I can write a straight forward note, and actually feel like a physician again. While there are challenges, We Care is one of the most rewarding programs in which I have participated. If you currently participate in We Care, Thank You, this program is only as strong as the physicians that support it. If you aren’t, please consider, the commitment is small and the reward is great. If you would like to get more information please talk to me, Erica at the Medical Society, Dr. John Lanza, or call We Care at 850-595-6500 x1081. The next meeting is the legislative update which is one of the most informative of the year. Representatives Broxson and Hill will be there to update us and answer your questions. I look forward to seeing all of you there.
Page 3 & 5 - Membership Page 4 & 5 - Events Page 6 - Practice Mgmt. Page 10 - Medical/Legal Page 14 - Foundation Page 15 - In the Community
SAVE THE DATE Thursday, April 14, 2016 Pensacola Wahoos Game Time: TBD General Membership Meeting Doctors Day Celebration Thursday, May 5, 2016 | Hilton Garden Inn Airport Boulevard | 5:30p General Membership Meeting Mini Health Vendor Fair & physician speed networking event Tuesday, August 9, 2016 | V.Paul’s Italian Ristorante | 5:30pm Young Physicians Section Meeting- “Direct Patient Care” Founded in 1873
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ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY
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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.
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.
Ad placement Contact Erica Huffman at 478-0706 x2 Ad rates 1/2 page: $350 · 1/4 page: $200 · 1/8 page: $150
Membership Beau Aldridge, M.D. Surgery Baptist Medical Group Surgery 1717 North “E” Street, Suite 425 Pensacola, FL 32501 (P) 850-437-8810 (F) 850-437-8809 www.baptistmedicalgroup.org
Ryan Miyamoto, M.D. Urology Baptist Medical Group Urology 1717 North ”E” Street, Suite 430 Pensacola, FL 32501 (P) 850-437-8711 (F) 850-437-8719 www.ebaptisthealthcare.org
Krystin Baker, M.D. Neurology Baptist Medical Group Neuro Hospitalist 1000 West Moreno Street Pensacola, FL 32501 (P) 850-437-8600 (F) 850-469-2352 www. baptistmedicalgroup.org
Erica J. Peart, D.O. Rheumatology Baptist Medical Group Rheumatology 1717 North “E” Street, Suite 425 Pensacola, FL 32501 (P) 850-437-8640 (F) 850-437-8649 www.baptistmedicalgroup.org
Sean Branch, D.O. Dermatology Henghold Skin Health & Surgery Group 530 Fontaine Street Pensacola, FL 32503 (P) 850-474-4775 (F) 850-484-8223 www.henghold.com
Keena Risola, D.O. Neurology, Hospitalist Baptist Medical Group Neuro Hospitalist 1000 West Moreno Street Pensacola, FL 32501 (P) 850-469-7406 (F) 850-437-8283 www.baptistmedicalgroup.org
David Gibbons, D.O. Family Practice Florida Department of Health in Escambia County 1295 West Fairfield Drive Pensacola, FL 32501 (P) 850-595-6500 # 1609 (F) 850-595-6577 Michael Milligan, M.D. Sports Medicine, Family Medicine Andrews Institute Orthopaedics & Sports Medicine – 9400 University Parkway, Suite 407 Pensacola, FL 32514 (P) 850-916-8700 (F) 850-208-6489 www.theandrewsinstitute.com
Michael J. Simpson, III, M.D. Internal Medicine Baptist Medical Group 1000 West Moreno Street Pensacola, FL 32501 (P) (850) 469-7406 (F) (850) 437-8283 www.baptistmedicalgroup.org Zheng Topp, M.D. Hematology Oncology Baptist Medical Group – Hematology Oncology 1717 North “E” Street, Suite 231 Pensacola, FL 32501 (P) 850-437-8600 (F) 850-469-2113 www.baptistmedicalgroup.org
Continued on page 5
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. ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY
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Events On Saturday, January 30, 2016 ECMS hosted the 2016 Annual Inaugural Ball at the Pensacola Yacht Club with a record breaking turn out. Guest enjoyed a cocktail hour with aphoto booth and DJ. Dr. Ralph Nobo, FMA President joined us for the Installation of ECMS Officers and gave a charge about the legislative session. “The 2016 ECMS ball was the biggest and best I have attended. What a great time of physician networking and fellowship to start the year. Looking forward to what the rest of the year has to offer.” – Kristin Davis, MD “My husband and I enjoyed attending the ECMS 2016 Annual Inaugural Ball. How exciting to see a young talent such as Dr. Kirby promoted to this prestigious position of ECMS President! He brings enthusiasm and innovation to the society and will represent us well in the chaotic arena of medicine in 2016. We are very proud to have him as a partner in Rheumatology at Medical Center Clinic.” Nancy Morris, MD “A wonderful affair to be sure. I enjoyed excellent food and company. Dr Kirby had an inspirational message of coming together to deal with issues of concern to the medical community”- Casey Mickler, M.D. “I was delighted to see the FSU College of Medicine have such a visible role at the ECMS Inaugural Ball. We greatly appreciate the generous support and partnership of the ECMS with the Pensacola campus there and recognize that the work of your members as our faculty is what makes our program so successful. Thank you for the invitation and the support.” - John P. Fogarty, M.D., Dean, Florida State University College of Medicine
2016 ECMS Slate of Officers President- Brian Kirby, M.D. President-Elect- Hillary Hultstrand, M.D. Vice-president- Ellen W. McKnight, M.D. Secretary/Treasurer- Karen Snow, M.D. Members at Large Stephanie Duggan, M.D. Jennifer Miley, M.D. Brett Parra, M.D. SAVE THE DATE 2017 ECMS Inaugural Ball Saturday, January 21, 2017 Pensacola Yacht Club
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ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY
Events
A special thank you to our event sponsors who helped make this event possible:
Laura Tunke, M.D. Pain Management Arron B. Stein, M.D. PLLC 1549 Airport Boulevard, Ste. 440 Pensacola, FL 32504 (P) 850-475-2668 (F) 850-475-2669
Vinay Wayal, M.D. Internal Medicine Baptist Medical Group Hospitalist 1000 West Moreno Street, Suite 403 Pensacola, FL 32501 (P) (850) 437-8600 (F) (850) 437-8283 www.baptistmedicalgroup.org
Trevor Turner M.D. Physical Medicine and Rehabilitation Baptist Medical Group Physical Medicine and Rehabilitation 1717 North “E” Street Suite 530 Pensacola, FL 32501 (P) (850) 437-8670 (F) (850) 437-8679 www.baptistmedicalgroup.org
Ming Zhang, M.D. General Surgery Baptist Medical Group - Surgery 1717 North “E” Street, Suite 205 Pensacola, FL 32501 (P) 850-434-1863 (F) 850-432-9090 Moved/Relocated Karen Pennington, M.D. Internal Medicine Baptist Medical Group Hospitalist 1000 West Moreno Street Pensacola, FL 32501 (P) 850 469-7406 (F) 850-437-8283 www.baptistmedicalgroup.org
ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY
Rejoining George C. Rees, M.D. Surgery Baptist Medical Group - Surgery 1717 North “E” Street Ste. 205 Pensacola, FL 32501 (P) 850-434-1863 (F) 850-432-9090 www.baptistmedicalgroup.org E. Coy Irvin M.D., M.B.A., F.A.A.F.P. Family Practice, Administrative Medicine 65 Dauphin Street Suite 200, 3290 Dauphin Street Mobile, AL 36606 (P) 251-327-4585 Munria Mian, M.D. Pediatrics, Family Practice Scenic Primary Care Medical Clinic 8105 Scenic Highway Pensacola, FL 32514 (P) 850-477-8080 (F) 866-377-0742 5 | ECMS
Practice Management TOP 3 PATIENT SAFETY TIPS OF 2015: REDUCING TECHNOLOGY RISKS by Carol Murray, RHIA, CPHRM, CPPS, Patient Safety Risk Manager, The Doctors Company
The adoption of electronic tools in the patient care setting has grown exponentially in recent years. Although new technologies bring many benefits, they also bring new liability risks—and 2015 could be considered a high-water mark for both new risks and increased prevalence of previously identified risks. The top three patient safety tips of 2015 addressed these risks. 1. Telemedicine: Comply with HIPAA, HITECH, and state-specific laws when transmitting patient health information and follow state licensing requirements. While the benefits of telemedicine are vast, its use and adoption must be tempered with caution. Physicians must be aware of the risks associated with access, such as patient and staff privacy, inaccuracies in self-reporting, and symptoms that may only be caught in person. Additional legal considerations for online interactions, such as licensure compliance and professional liability coverage for out-of-state interactions, must be addressed for the protection of the physician and the patient. According to the Federation of State Medical Boards, only 12 states have provided specialpurpose licenses to allow for cross-border telemedicine, while most states require complete licensing if the patient is in their jurisdiction. To reduce these liability risks and enhance patient safety: • Comply with all laws when transmitting all personal health information. Train staff on how to protect and secure your data. • Clearly define proper protocols for webcams and web-based portals. • Use mechanisms to protect the privacy of individuals who do not want to be seen on camera (including staff members, other patients, or patients’ families). • Ensure robust and reliable high-speed broadband connectivity to support clinical functions. • Check practice requirements and legal limitations in states where you anticipate providing care to patients. • Understand reimbursement practices for telemedicine services. • Make certain that your professional liability policy extends coverage to all jurisdictions where you provide services. 2. Medical equipment alarms: Enact policies to ensure alarms are never silenced. Concerns about the adequacy and effectiveness of medical equipment alarms have been a focus for The Joint Commission’s National Patient Safety Goals. Issues with alarms have also appeared frequently in analyses of unanticipated outcomes. A main patient safety risk is alarm fatigue, where too-frequent alarms cause providers to override or disable them. When alarms are silenced or eliminated, a significant change in a patient’s condition may go undetected. If there is a resultant harm to a patient, it is extremely difficult to mount an effective defense. The Joint Commission emphasizes policies that can help reduce the risks: • Policies should be in place and communicated to staff to never silence an alarm and should discourage the use of patient-owned medical equipment without alarms in clinical settings. • Any medical device equipped with an alarm should be evaluated annually for preventive maintenance. 3. Electronic health records (EHRs): Ensure that implementation includes thorough staff and provider training. More than 80 percent of doctors have adopted an EHR.1 There is a lag time between adopting a new technology and identifying risks, but in 2015, EHR issues were increasingly apparent. Weaknesses include inaccurate entries that are repeated throughout the record; faulty interfaces between companion systems; greater potential for breaches, resulting in loss of patient privacy; over-reliance on the system by staff, leaving less time to spend with patients; changes in medical record information due to system updates; and difficulty in standardizing the legal medical record for consistency in response to requests for records. Audit trails requested during litigation may not accurately reflect the activity or may be undecipherable. Some systems allow changes in record entries long after a patient is seen—if that is discovered, this could be interpreted as spoliation of evidence.
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ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY
Practice Management To reduce exposure to EHR risks: Ensure implementation includes thorough staff and provider training. Establish guiding policies and procedures, especially a policy defining the legal medical record, and designate an ongoing workgroup or individual to address problems in either support systems or the software itself. • Maintain an ongoing relationship with the vendor to communicate software issues and to thoroughly understand the impact of each software update. • Conduct a periodic review of metadata reports that identify name, date, and time of access—a useful way to monitor inappropriate access to the record by staff. • Train staff to be observant and report any inconsistencies, including a near-miss or incident. • Conduct medical record audits at least quarterly to look for any possible problems. Increasing attention is also directed at the integrity (accuracy) of data entries in the EHR. Weaknesses in data integrity can and have resulted in erroneous treatment or delays in the discovery of new and vital information. More and more related systems have an interface with the EHR, such as laboratory or imaging information, other healthcare encounters, medication history, and even basic demographic information. It is not uncommon for data in the EHR to be inaccurate or missing. Problems such as errors in entering treatment regimens can have far-reaching outcomes. While there is a strong emphasis on interoperability of systems, there are also many problems in perfecting the interface. As the assimilation of medical technology increases at a faster rate, all providers and organizations must closely scrutinize these systems to discover issues and problems before they reach the patient. Training staff and physicians and ensuring solid communication models are the most valuable ways to reduce patient safety risks. _________ Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/ patientsafety. Reference 1 More than 80 percent of docs use EHRs. Healthcare IT News. September 18, 2015. http://www.healthcareitnews. com/news/more-80-percent-docs-use-ehrs. Accessed November 23, 2015. • •
ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY
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ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY 2/23/16 9:51 A
Practice Management THERE’S AN APP FOR THAT: BENEFITS AND RISKS OF USING MOBILE APPS FOR HEALTHCARE by Robin Diamond, MSN, JD, RN, Senior Vice President, Patient Safety and Risk Management, The Doctors Company
With over 100,000 mobile health apps now available—in addition to many new tools that allow physicians to remotely monitor their patients’ conditions—physicians now have to handle an increasing amount of constant data and patient information that they did not have in the past. Patients are using mobile apps to monitor their activity levels, track weight loss, improve medication adherence, and even track their blood pressure or blood sugar levels. Only 16 percent of healthcare professionals currently use mobile apps with their patients, but 46 percent plan to do so in the next five years.1 Mobile apps offer many potential benefits to doctors and patients: • Mobile apps can help patients self-monitor their conditions and can alert them and their physicians to problems before they become serious medical issues. • Some of these apps are regulated by the FDA. For example, patients can monitor their heart rhythms with an FDAapproved device that wraps around their iPhone. • Mobile apps can be a tool for patient education: • A better-informed patient is more likely to understand risks and, if there is an adverse event, may be less likely to file a lawsuit. • Mobile apps help patients remember important information about their healthcare. Patient pamphlets and other educational materials are often lost or forgotten. Patients forget 80 percent of the information they are told and inaccurately remember an additional 10 percent, leaving patients with just 10 percent of the information remembered correctly. • Mobile apps can engage patients in their healthcare: • Many patients today are interested in becoming as involved in their care as possible. • One patient engagement platform that connects patients and physicians, Healthloop, markets its product as a way to have very satisfied patients who will publicly share their experience. This platform monitors compliance and adherence to the treatment plan; checks in with patients, thus eliminating phone calls; collects outcome data; educates and reinforces education; and identifies at-risk patients quickly to reduce readmissions. But not all of the apps currently on the market are approved or regulated by the FDA, and the use of mobile apps does not come without liability risks. The Doctors Company has not yet seen malpractice suits that involve mobile apps because the use of these apps to monitor patients is fairly new. Malpractice lawsuits may not be filed for several years after the adverse event, so with the increased use of mobile apps for healthcare, we expect there will be lawsuits involving mobile apps in the future. Physicians could face allegations of failing to educate the patient/family about the risks and limitations of the app or failing to act appropriately if the app goes offline or malfunctions. Product liability, negligence, contract law, and even malpractice tort law could be applied to possible causes of action in lawsuits brought because of an injury connected to use of a mobile app. Injuries could occur if: • The physician receives information from a mobile app and does not act on this information. Physicians have a legal duty to review real-time data direct from the patient and respond. Mobile apps raise patient’s expectations of how a physician will act—the patient/family expect that the patient is monitored 24/7 and the physician will respond “within a moment’s notice.” When an adverse event occurs, if a patient believes the physician failed to act on information from a mobile device, the patient might sue. If physicians don’t respond to information from an app, this will be recorded in the metadata, which can be used in court. • The readings received from a mobile device are wrong and treatment is prescribed based on the wrong data. There are a lot of untested apps on the market that may be unreliable or even dangerous. Apps are also vulnerable to being hacked, resulting not only in potential loss of personal health information (PHI) but also in potential malfunctioning of the app. • Patients rely on technology alone, leading to decreased phone contact with the physician when symptoms arise or there are changes in the condition that require immediate action. These apps can be useful tools to support a comprehensive care plan, but physicians need to be knowledgeable about
ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY
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Practice Management these apps so they can educate their patients about the apps’ limitations and potential risks. Consider limiting your patients to one mobile app that you agree to monitor. This will make it easier to control the incoming data and help make the best use of the app. Other important considerations include: • Consider whether the two-way communication between you and your patient is secure and, therefore, HIPAA/ HITECH compliant. Ask the vendor for assurance that the app is HIPAA-compliant and that data is encrypted for security. • Know the app: • Vendor information, such as updates, downtime, and critical value alerts. • How will it interface with your EHR? • Is the device regulated by the FDA as a medical device? • Will you get alerts by e-mail or a phone call from the vendor when the app isn’t working? • Beware of the possibility of lack of security when using public Wi-Fi with the app. • Clearly communicate and educate the patient/family about the purpose of the app and how and when the data is transmitted to the clinician. • Avoid assuring the patient that the app will “take care of everything.” Educate the patient/family about the limitations of app, with specific examples of instructions for the patient to follow. For example, can the algorithm be changed for specific patient needs? • Identify a contact person within your organization to troubleshoot and be available to address technical problems. • Have the patient/family sign a consent form that describes the risks, benefits, and purpose of the app. • Do not do this alone! Avoid utilizing medical apps without support from your organization. References 1Easy on those mobile apps: Mobile medical apps gain support, but many lack clinical evidence. Modern Healthcare. November 28, 2015. http://www.modernhealthcare.com/article/20151128/MAGAZINE/311289981/easy-on-thoseapps-mobile-medical-apps-gain-support-but-many-lack. Accessed December 16, 2015. _________ Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/ patientsafety.
MARK YOUR CALENDAR 2016 ECMS Doctors Day Celebration Thursday, April 14th, 6:30pm Invitation to follow The 2016 ECMS Pictorial Directory will be handed out at the 2016 Annual ECMS Doctors Day Celebration on April 14th.
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ESCAMBIA ESCAMBIA COUNTY COUNTY MEDICAL MEDICAL SOCIETY SOCIETY IN IN CONJUNCTION CONJUNCTION WITH WITH SANTA SANTA ROSA ROSA COUNTY COUNTY
Medical/Legal PHYSICIANS’ RESPONSIBILITY TO OBTAIN INFORMED CONSENT by: Jeremy Wale, JD, Risk Resource Advisor
A patient’s absolute right to make informed decisions regarding his or her medical care is the foundation of informed consent. The American Medical Association states, “Physicians should sensitively and respectfully disclose all relevant medical information to patients. The quantity and specificity of this information should be tailored to meet the preferences and needs of individual patients.” Informed consent as a legal requirement began in earnest with a New York lawsuit back in the early 1900s. Justice Cardozo of the New York Court of Appeals stated, “[e]very human being of adult years and sound mind has a right to determine what shall be done with his own body…” This Appeals Court decision laid the framework for our modern-day informed consent laws and rules. Over the years, case law relating to informed consent has evolved—with some states introducing statutes governing consent requirements for healthcare providers. Informed consent laws differ by state in the amount of information a healthcare provider is required to disclose to the patient. Some states employ a “reasonable physician” standard, meaning a healthcare provider must provide the amount of information a reasonably prudent physician would provide in the same or similar circumstances. Other states use a “reasonable patient” standard, requiring that a physician provide information that a reasonable patient would need to make an informed decision. Generally speaking, physicians do well to provide patients with enough information to be able to make a fully informed decision about medical care. Exceptions to the informed consent requirement can be made for emergencies where the patient is unconscious and arrives at a facility needing a life-saving procedure. Be sure to check your state’s laws so you know what is required for your informed consent discussions with patients. Pediatric Patients A parent may consent to treatment for his or her own child. There are certain instances where a minor (under age 18) may consent to his or her own treatment. These instances differ by state, but generally include treatment for drugs/alcohol abuse, sexually transmitted diseases, HIV/AIDS testing, and reproductive health. Be sure to check your state’s laws before allowing a minor to be treated without parental consent. Practices routinely ask our Risk Resource Department what to do in situations of children with divorced parents. Typically, each parent maintains his or her right to consent to medical treatment for the child. When you encounter a divorce decree granting full legal and/or physical custody to one parent, he or she has the sole right to make healthcare decisions for the child. If one parent has sole physical custody but legal custody is joint, then both parents maintain the right to make healthcare decisions for their child. These guidelines may not hold true in all situations. Please consult an attorney when you have questions regarding the ability of a divorced parent to consent to treatment for a child. You also may encounter situations where a parent’s rights have been terminated by the court. Then the guardian of the child will
ESCAMBIA ESCAMBIA COUNTY COUNTY MEDICAL MEDICAL SOCIETY SOCIETY IN IN CONJUNCTION CONJUNCTION WITH WITH SANTA SANTA ROSA ROSA COUNTY COUNTY
have related documentation. We encourage you to keep a copy of this documentation in the patient’s record so healthcare providers with access to the record know who is allowed to consent to treatment for the child. Consent to Treat Foster Children Foster children present a unique dilemma for many practices. Often, foster parent(s) will have documentation from the court giving them permission to make decisions on behalf of the child for routine healthcare. Birth parents do maintain parental rights with most foster care situations. Usually the foster parent or guardian will have authority to consent to routine healthcare for a child, whether via court order or the birth parent(s) signing a document giving the foster parent this right. Questions also arise as to whether the parent maintains a right to request the child’s medical record when the child is under the care of a foster parent. A birth parent’s right to review a foster child’s medical record is a tenuous situation best handled on a case-by-case basis. Please contact our Risk Resource Department with questions. If your practice treats foster children, consider contacting your state or local foster care agency to determine your legal obligations when treating these children. You also may wish to contact a local attorney to assist you in determining protocols to ensure that the proper person is consenting for a child’s treatment. The Vaccination Challenge When parents decide not to vaccinate their children, some practices have made the decision to refuse to provide healthcare to those pediatric patients. That said, how do you handle patients whose parents have decided to cease their children’s vaccinations? You have two options: continue to treat the patients or terminate them from the practice. Termination from the practice is best handled delicately and by the physician. If you decide to terminate, consider having several conversations to determine if the parents are willing to reconsider before acting. If the parents hold their position, proceed to share your decision to end your care, explaining you will continue care until such time the parents are able to find another physician. This may require more than 30 days of care. Offer any assistance you have available to help these parents find another pediatrician. If you decide to continue caring for patients whose parents refuse to allow vaccinations, document all conversations you have with the parents regarding risks related to the refusal. If you strongly advocate for vaccinations, you may want to counsel parents to consider vaccinating. It may be helpful to obtain input from all healthcare providers and staff before implementing a practice-wide policy refusing to treat patients whose parents refuse vaccinations. It is important that all healthcare providers are on the same page and agree on such a policy.
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Medical/Legal Recurring Treatments Treatments such as allergy shots, certain trigger point injections, dialysis, radiation, and chemotherapy are just a few examples of treatments that may continue over time. How should consent be handled for such treatments? When a patient agrees to undergo this type of treatment, the initial informed consent process ideally covers the entire course of treatment. Patients are told they may question the treatment process, as well as each individual treatment. Informed consent may require more than one conversation, especially in the case of chemotherapy, radiation, or dialysis. Consider having an in-depth, detailed informed consent discussion with each patient before you begin recurring treatments. Have the patient sign an informed consent document acknowledging that discussion and the patient’s consent to the course of treatment. Verifying with the patient at each visit that he or she wishes to continue the course of treatment is a good idea—as is noting that verification in the medical record. Elderly Patients Elderly patients may present consent issues not routinely encountered. Examples include powers of attorney (POA), guardianships, mental competence, etc. Who, if not the patient, do you need to obtain consent from for an elderly patient’s medical care? Powers of attorney come in various forms; limited, general, durable, and healthcare are the most common. A POA is a document where a “principal” names an attorney-in-fact (“agent”) to act on his or her behalf. The POA will usually outline the breadth of the agent’s decision-making authority. Depending on how it is drafted and the type of POA, the agent may have very limited or virtually unlimited authority to make decisions on behalf of the principal. The type of POA provided to your practice will have a large impact on whether the individual named in the POA has the authority to make healthcare decisions on behalf of the patient. A healthcare POA is the most straight-forward type of POA. This document specifically outlines healthcare decision-making authority granted to the agent by the principal. We encourage you to read healthcare POAs carefully to determine the authority granted to the agent. If you are unsure, contact the ProAssurance Risk Resource department or a local attorney to assist you. Non-healthcare POAs typically do not give the agent the authority to make healthcare decisions. Exceptions exist. Outside of a healthcare POA, if healthcare decision-making authority is not specifically granted within a POA, do not make presumptions. You also may encounter patients who lack the mental capacity to continue to make healthcare decisions. Patients with dementia or Alzheimer’s present consent issues you should be ready to address. You may be confronted with family disputes, court orders, conflicting POAs, or other documents that cloud the consent issue for a mentally incapacitated patient. One of the best ways to avoid the confusion of consent for an elderly patient is to establish consent when the patient is still of sound mind. Ask your elderly patients if they have executed any type of POA, living will, or other document outlining who has decision-making authority in the event they become incapacitated or otherwise unable to make decisions. Request a copy of documentation outlining decision-making authority for your ECMS | 12
patients. Maintain this documentation in the medical record. Consider reviewing this with the patient periodically to ensure it is still current. Refusing Consent Due to Lack of Funds or Reimbursement Payment concerns are becoming more prevalent today due to high deductible health plans, uninsured patients, and lower reimbursement rates. What do you need to consider in these situations? If you have self-pay patients, you may implement a pre-pay policy to ensure payment prior to rendering services. Difficulty may present when a patient requires an expensive diagnostic test or procedure that they cannot afford. Depending on the situation, consider establishing a policy addressing financial hardship and an associated payment plan for expenses that cannot be paid in one lump sum. If you choose to do this, be sure payment arrangements are in writing; this will help if you have issues with receiving payments. A more challenging scenario occurs when a patient refuses to consent to a test or procedure because he or she cannot afford it. These are particularly challenging in potentially life-threatening situations. An example is a woman in labor who adamantly refuses a C-section because she cannot afford it—even after being told she, or her baby, may die if vaginal delivery is continued. Medical battery is a very real issue with real consequences. The most likely scenario for a medical battery claim is when the patient expressly refuses treatment and the physician performs the treatment over the patient’s objection. The C-section situation above is an excellent example. If a patient is asked to consent to a C-section and expressly refuses, the physician’s hands are effectively tied unless he or she can get the patient to change her mind. Certain situations require you or your practice to obtain pre-approval for a test or procedure from a third-party payer. These pre-approvals will sometimes be denied. If a third-party payer denies a pre-approval, you are left with two options: either appeal the denial or ask the patient to pay for the test or procedure. If you decide to appeal the denial, each third-party payer has an appeals process you must follow. If the appeal is unsuccessful, you may try calling the payer directly, asking to speak with a physician reviewer. Once all efforts are exhausted, it’s time for a documented conversation with the patient to explain the situation. If a patient accepts responsibility for the cost of a test or procedure, consider putting that in writing. If your practice offers financing arrangements, you may wish to have a written document outlining both parties’ expectations. ----------------------------------------Consent issues are some of the most frequently asked questions that ProAssurance’s Risk Resource Department receives. If you are faced with an uncertain situation or something new, call our Risk Resource line at 844-223-9648 and speak with one of our Advisors. About the author: Mr. Wale is a licensed attorney in Michigan where he works as a Risk Resource Advisor for ProAssurance. He has authored numerous articles about mitigating medical professional liability risk. Mr. Wale also conducts loss prevention seminars to educate physicians about new and emerging risks.
ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY
Medical/Legal
providing
educational loans for studies in
medicine, nursing, medical technology and the ministry. For more information, visit
www.fellowsfund.org MS1461 Fellows Med Soc. 2015.indd 1
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ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY
13 | ECMS
Foundation 2015 BELL-SHIPPEY WE CARE DOCTOR OF THE YEAR Dr. Ranjith Dissanayke was awarded the 2015 Bell-
donate your services to We Care, including a free renewal
Shippey We Care Doctor of the Year award for his in-
of your medical license if you provide 80 hours per year
kind donation of $41, 538 in oncology services. Dr. Kurt
of care over the biennium for licensure renewal. There are
Krueger, ECMS Foundation President is see in the picture
some CME benefits, too.
below presenting him with the award. For 2015 almost $2.2 million was contributed by
Interested physicians should contact Dr. Lanza at the Florida Department of Health in Escambia County to sign
physicians, and more than $3 million donated by
up, or for more information about the We Care specialty-
hospitals and other organizations. Total contributions
referral program.
were more than $5.2 million. The Escambia County Medical Society Foundation is always looking for new physicians to add to its specialty referral program. Physicians: There are benefits when you
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ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY
In the Community SACRED HEART NEWS Sacred Heart to Open New Medical Facilities in Perdido Key and Tiger Point Residents of southwest Escambia County and south Santa Rosa County will have convenient access to diagnostic medical tests and physician services thanks to two new medical facilities to be built by Sacred Heart Health System. Both projects will be complete by the end of 2017. The new outpatient medical centers near Perdido Bay and Tiger Point will offer the latest in diagnostic imaging technologies – including mammography services, rehabilitation services and physicians’ offices. Construction is scheduled to begin in March for the Perdido Bay facility and in April for Tiger Point.
The Perdido Bay building will be home to six full-time physicians in the specialties of family medicine, obstetrics and gynecology, and pediatrics. The Tiger Point building will also be home to six full-time family and internal medicine physicians. Both outpatient centers will provide walk-in clinics for minor illnesses and injuries plus outreach services from different specialists (cardiology, orthopedics, OB/GYN, endocrinology, etc.) within Sacred Heart Medical Group on a routine basis. Each of the new facilities will be 28,000 square feet in size and built on land already owned by Sacred Heart Health System.
BAPTIST HEALTH CARE NEWS Baptist Health Care Building $6 Million Medical Park Baptist Health Care (BHC) is constructing a new $6 million medical park to better serve the Greater Pensacola area. Baptist Medical Park – Airport will be Baptist’s third medical park and will be located near the entrance of the Pensacola International Airport at 5100 North 12th Avenue in Pensacola, Fla. Baptist Medical Park - Airport will be a two-story complex featuring more than 24,000 square feet of services including Andrews Institute for Orthopaedics & Sports Medicine, Baptist Heart & Vascular Institute, as well as Baptist Medical Group primary and specialty physicians. The facility will also offer clinical laboratory and imaging services. Urgent care for minor illnesses and injuries will be a key service offering on the campus. With connectivity to the Andrews Institute, patients with orthopaedic injuries will have on-site access for a more seamless transition to specialty care when necessary.
ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY
Baptist Medical Group Welcomes General Surgeons George Rees, M.D., FACS and Ming Zhang, M.D. Baptist Medical Group is pleased to welcome experienced, general surgeons George Rees, M.D., FACS, and Ming Zhang, M.D., to its multispecialty physician network. Both physicians are local to Pensacola and offer comprehensive surgery services. Dr. Rees, board certified general surgeon, earned his medical degree and completed his residency at Tulane University School of Medicine in New Orleans, La. Dr. Zhang, board certified general surgeon, earned his medical degree at Duke University School of Medicine in Durham, NC. He completed his residency at West Virginia University School of Medicine in Morgantown, WV. Baptist Medical Group Urologist Elizabeth Cruit M.D. Receives Board Certification Baptist Medical Group urologist Elizabeth Cruit, M.D., received board certification from the American Board of Urology in Female Pelvic Medicine and Reconstructive Surgery. Dr. Cruit earned her medical degree at the University of Alabama, in Birmingham, Ala., and completed residency training in urology at Louisiana State University, in Shreveport, La.
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YOU TEND TO YOUR PATIENTS, WE TEND TO YOUR FINANCIAL WELL-BEING.
Announcing the establishment of a new financial planning and wealth management team that specializes in the unique needs of physicians in the Pensacola area. With a CERTIFIED FINANCIAL PLANNER™ professional and a team that has 28 years of combined investment industry experience, we have the skills you need to help navigate your financial goals.
OUR TEAM’S EXPERTISE INCLUDES Asset Protection
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We’re also able to create business retirement plans (including 401(k) and defined benefit plans) and succession plans (including buy/sell agreements, key person insurance and other catastrophic risk considerations). So whether you’re affiliated with a hospital or have your own practice, we have solutions for you. We know you work long hours and that it’s not always convenient to meet during the business day; therefore, we are happy to meet at a time and location that’s convenient for you. Our technology allows us to meet with you virtually anywhere.
RICK LAMBERT, MBA, CFP® Wealth Strategist rick@ironhorsews.com 3000 Langley Avenue, Suite 200 // Pensacola, FL 32504 O 850.361.4978 // F 850.466.3382 // ironhorsews.com Securities offered through Raymond James Financial Services, Inc., member FINRA/SIPC. Certified Financial Planner Board of Standards Inc. owns the certification marks CFP®, CERTIFIED FINANCIAL PLANNER™ and federally registered in the U.S., which it awards to individuals who successfully complete CFP Board’s initial and ongoing certification requirements.
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ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY