Doctor's Life Magazine, Tampa Bay Vol.2 Issue 2, 2014

DOCTOR’SLife www.doctorslifetampabay.com

MAGAZINE

Business Lifestyles and Opportunities Vol. 2, Issue 2, 2014 Tampa Bay Edition

WORLD’S SMALLEST

MICROSCOPE DETECTS CANCER EARLY AT MOFFITT

Issue 2, 2014

Doctor’s Life Tampa Bay

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Doctor’s Life Tampa Bay

• Seating for four with plenty of room for luggage, wheelchair storage in rear hatch back. Issue 2, 2014

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Doctor’s Life Tampa Bay

What’s Inside Detecting Cancer Early at Moffitt

Page 12

From the Publisher

Introducing Two New Features Page 8

Physician Spotlight Dr. Cynthia Harris

Page 14

The Legal Corner

Are You Ready for a Meaningful Use Audit? Page 10

The Doctor Whisperer: Thinking Outside the Box

Page 20

Advertisers Ciminelli Real Estate Services Flex Sedans

Efficient Investing

Increasing Your Income

Page 22

Page 16

Doctor’s Life Tampa Bay

17 2-3

Florida Rx Card

Gunster Law Firm

The Meridian Club

Moffitt Cancer Center

Old Bahama Bay

PNC Bank

Rita Shepard

Sipco 17 SunTrust Mortgage

Tampa Testosterone

23 Issue 2, 2014

A four-year-old hugged me today for making him feel “all better.” Those moments are why I wouldn’t choose any other life. I’ve paid my dues: med school, residency, endless packing and moving. Finally, I’m putting down roots. I wasn’t sure I could do it, until I found the right mortgage specialist. He introduced me to affordable home financing exclusively for physicians. Now I feel all better, too. Because I’m truly where I was meant to be.

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Contact me today to learn more about the Doctor Loan Program1, featuring 100% financing2 and no monthly mortgage insurance.

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Rx Card is an important and valuable “Florida program for the residents of our state. ”

- Dr. Ronald F. Giffler, M.D., J.D. Florida Medical Association Treasurer

common in many health savings accounts (HSA) and high deductible health plans. Another unique component of the program is their preferred pharmacy option. Florida Rx Card has chosen CVS/pharmacy as their preferred pharmacy so that residents who don’t have access to a computer and can’t obtain a hard card, can visit any CVS/pharmacy to have their prescriptions processed through Florida Rx Card. Residents can simply reference “Florida Rx Card” to have their prescription processed through the program. Florida Rx Card is accepted at over 56,000 participating regional and national pharmacies. “We strongly believe that this is an easy and innovative way to help the residents of Florida find affordable prescription options,” states Program Development Director, Brandon Knox.

More Floridians Have Access to Prescription Savings Statewide Prescription Assistance Program Offers a Prescription to High Healthcare Costs he Centers for Disease Control reports that Americans spend more on prescription drugs than people in any other country: some $45 billion in out-of-pocket dollars in the last year alone. With that in mind, the Florida Rx Card is reminding physicians that their patients who aren’t insured or who take prescription drugs that aren’t covered by their health insurance plans, can use the Florida Rx Card to obtain discounts of up to 80 percent off the retail price for brand and generic FDA-approved medications.

Florida Medical Association has been working closely with Florida Rx Card to distribute free discount prescription cards to all Floridians. The goal of the partnership is to provide additional card distribution channels and create awareness so that all residents will have access to this free statewide prescription assistance program. Florida Rx Card was launched to help the uninsured and underinsured residents afford their prescription medications. The program can also be used by people that have health insurance coverage with no prescription benefits, which is

Florida Rx Card has helped residents save over $63 million since its inception in August 2007. You can help by encouraging your patients to print a free card at www.FloridaRxCard.com or www.flmedical.org. Florida Rx Card is also available as an app for iPhone and Android. You can search “Free Rx iCard” in the app store.

Any physicians who are interested in ordering free cards for their clinic/hospital can email Brandon Knox, Program Development Director, at bknox@floridarxcard.com.

IT WORKS! Florida residents have saved over $63 Million through the Florida Rx Card Florida Rx Card offers free prescription assistance cards and is open to all residents of Florida. There are no applications, no waiting periods, and no enrollment forms to fill out. Save up to 75% on rx medications at more than 56,000 pharmacies nationwide. Both brands and generics are included.

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From the Publisher

www.doctorslifetampabay.com

octor’s Life Magazine welcomes new editorial contributors that will be contributing writers for two new editorial sections and both debut in this issue.

First, we welcome Sharon Fekete, The Doctor Whisperer. Sharon has over 15 years’ experience managing, marketing and supervising successful medical practices from New York to Florida. She is the co-author of a new book “Things I Never Learned in Medical School, or How I Found My Doctor Whisperer” which she co-wrote with Dr. Greg Savel. Sharon will be the contributing writer for the new DLM section entitled The Doctor Whisperer. We are excited to have Sharon as part of the DLM team. She is a successful, out-of-the-box thinking, marketing machine. Second we welcome Bruce D. Lamb from Gunster, Yoakley & Stewart, P.A. Bruce serves as a shareholder and leader of the healthcare practice. He is Board Certified by the Florida Bar in State and Federal Government and Administrative Practice. He has extensive experience in healthcare litigation for physicians and other healthcare providers. Prior to entering the private practice of law, Mr. Lamb served 10 years with the Florida Department of Professional Regulation in such capacities as general counsel, director of the division of regulation, chief medical attorney, and chief trial attorney. We welcome Mr. Lamb and his firm’s insight and professional opinions. They will be producing articles for the new DLM section entitled The Legal Corner. With recognitions like Tampa Best Lawyers Health Care Lawyer of the Year, Best Lawyers in America and Florida Super Lawyers to name a few, we are confident and excited about this new section. In this issue’s cover story we highlight an incredible organization, a phenomenal physician and an extraordinary new technology that is detecting cancer early in a big way. The organization is The Moffitt Cancer Center, the physician is Dr. Cynthia Harris and the technology is the Cellvizio System. The world’s smallest microscope is having a big impact at Moffitt Cancer Center. Dr. Harris goes in depth about the technology, why early detection is so crucial and the success that Cellvizio brings to Moffitt. As someone who has several cancer survivors in my life, as most of us do, this was a pleasure to bring this story to DLM. Special thanks to Patty Kim, PR Manager for Moffitt and Andrea Coan with the NYC public relations firm BERRY & COMPANY. We welcome back Timonthy McIntosh, Chief Investment Officer for SIPCO for his take on Efficient Investing Utilizing Individually Managed Accounts or otherwise known as IMAs, and Don Jones, President and CEO, Physicians Business Group with a method that could increase your income, without seeing more patients. I and the entire DLM team hope you enjoy this issue as much as we did in creating it. Thank you to everyone that played a role with this issue…especially you, the readership. Be well,

-Ed

MAGAZINE

Business Lifestyles and Opportunities Vol. 2, Issue 2, 2014 Tampa Bay Edition

WORLD’S

SMALLEST

MICROSCOPE

DETECTS CANCER

EARLY AT MOFFITT

Issue 2, 2014

Doctor’s Life Tampa Bay

TAMPA BAY Tampa Headquarters 1208 East Kennedy Blvd. #1029 Tampa Fl, 33602 813-444-9204 Group Publisher Ed Suyak publisher@doctorslifetampabay.com Creative Director Bryan Clapper Editorial Director Ed Suyak Assistant Editorial Director Danielle Topper Advertising Account Executive CJ Cooper Contributing Writers Cynthia L. Harris, M.D Timothy McIntosh, CFP, MBA, MPH Bruce D. Lamb Don Jones Sharon Fekete Doctor’s Life Magazine, Tampa Bay is always seeking events, stories and remarkable physicians. Please email the publisher if you have an event, an editorial idea or you know of a doctor or dentist who may have done something extraordinary. We want your suggestions and feedback. publisher@doctorslifetampabay.com Doctor’s Life Magazine, Tampa Bay does not assume responsibility for the advertisements, nor any representation made therein, nor the quality or deliverability of the products themselves. Reproduction of articles and photographs, in whole or in part, contained herein is prohibited without expressed written consent of the publisher, with the exception of reprinting for news media use. Printed in the United States of America.

Ed Suyak Group Publisher publisher@doctorslifetampabay.com 8

DOCTOR’SLife

www.doctorslifetampabay.com

Doctor’s Life Tampa Bay

Issue 2, 2014

Gunster, Florida’s law firm for business, provides full-service legal counsel to leading organizations and individuals from our 11 offices across the state. Our health law practice includes lawyers that are Board Certified in State and Federal Government and Administrative Law, certified Health Care Risk Managers and others with medical and scientific backgrounds. This gives our healthcare team a unique perspective and knowledge when counseling our clients. When appropriate, our team of attorneys draws upon the comprehensive experience of other practices within the firm, including tax, corporate, labor and employment, immigration and real estate. Working together across a network of practices makes Gunster statewide and state wise.

For more information contact Bruce D. Lamb, Health Law Practice Leader 401 E. Jackson Street, Ste. 2500, Tampa, FL 33602 | blamb@gunster.com

Gunster attorneys provide representation in most areas of healthcare law, including: • Professional licensure defense and applications • Medicaid and Medicare audits • Interactions with government agencies including DEA, CMS, OIG, HHS and FDA • Mergers & Acquisitions of physician practices • Peer review and credentialing issues • Shareholder agreements, non-competes and restrictive covenants

Gunster.com | (813) 228-9080

The Legal Corner

Are You Ready for a Meaningful Use Audit? By Bruce D. Lamb Board Certified in State and Federal Government and Administrative Law Health Law Practice Group Leader Gunster

lthough audits began over a year ago, the frequency of stage one meaningful use audits has accelerated. The Department of Health and Human Services (HHS) has retained an accounting firm, Figloiozzi and Company, to perform audits. As you should be aware, by attesting to having implemented meaningful use of electronic health records (EHR) and accepting an incentive payment, you have subjected yourself to an audit by the Center for Medicare and Medicaid (CMS) and its contractors. In addition, states may audit Medicaid providers. Notice of the initiation of the initial phase of the audit process includes a letter to a provider requesting that documentation of the implementation of EHR be provided. Typically the documentation requested includes the following: 1. Documentation demonstrating that the provider used a certified EHR system. 2. Supporting documentation used by the provider to attest for the core-set for meaningful use criteria; 3. Supporting documentation used by the provider to attest for the menu-set for meaningful use criteria; and, 4. The numerators and denominators for the measures.

The level of audit review can vary. Typically, you are provided two weeks to respond by submitting the required documentation. The submission of this documentation may be followed by an on-site review. In addition, auditors may require proof that Clinical Decision Support (CDS) alerts were “turned on” during the entire reporting period. If the auditor does not receive satisfactory documentation, more detailed information will likely be requested. Since providers were required to attest that they would maintain documentation of continuous compliance, a lack of documentation for any time period can lead to an assertion of noncompliance. One requirement that is often overlooked by providers is the requirement to perform a security risk analysis. If the auditor determines that the provider has failed to comply with any requirements, CMS may contact the provider by mail and provide 30 days to refund all monies received for the implementation of meaningful use of EHR. There is a right to appeal. It appears that the auditors are very picky, and require total compliance. Initially, most audits were focused on hospitals and other licensed facilities. However, auditors are now turning their attention to group practices and individual physicians. Since the federal government considers each attestation to constitute a “claim” to the federal government, an individual or organization submitting such an attestation has potential liability under 10

the federal False Claims Act. In addition, there is a 1 percent adjustment to Medicare reimbursements effective January 1, 2015, which increases annually until 2017 when it becomes 3 percent. Since over $12 billion in payments have been made for implanmentation of EHR there is a great deal of incentive to assure compliance. CMS intends to audit approximately 5 percent of participants this year. To ensure that you are prepared for an audit make sure to save all documentation that supports attestations that have been made. This may include “screen shots” at various times intervals. In addition, you should maintain documentation to support your payment calculations. You should consider performing or obtaining a compliance review. You should also consider utilizing the CMS Attestation WorkSheet for Eligible Professionals to verify your compliance with previous attestations. The attestation work-sheet can be found at: http://www.cms.gov/Regulations-and-Guidance/Legislation/ EHRIncentivePrograms/downloads/EP_Attestation_Worksheet.pdf

Doctor’s Life Tampa Bay

Issue 2, 2014

REFER2MOFFITT.COM ACCESS REAL-TIME RECORDS AND PATIENT UPDATES

AN ALL-IN-ONE RESOURCE SITE NOW THE ONLY AVAILABLE FOR PHYSICIAN PRACTICES

NCI COMPREHENSIVE CANCER CENTER BASED IN FLORIDA

Moffitt Medical Group considers it a great privilege to participate in the care of your patients and to complement the services you provide in the community. Therefore, we have developed a new site to assist you and your staff in accessing Moffitt’s resources and services. Now you can follow patient progress and stay informed from anywhere.

To schedule an appointment, call 1-888-MOFFITT or visit REFER2MOFFITT.COM MOFFITT CANCER CENTER 12902 MAGNOLIA DRIVE, TAMPA, FL MOFFITT CANCER CENTER AT INTERNATIONAL PLAZA 4101 JIM WALTER BOULEVARD, TAMPA, FL H. LEE MOFFITT CANCER CENTER & RESEARCH INSTITUTE AN NCI COMPREHENSIVE CANCER CENTER | TAMPA, FL | 1-888-MOFFITT

CLOSER TO OUR PATIENTS. CLOSER TO A CURE.®

World’s Smallest Microscope

FINDING CANCER

at Moffitt

Doctor’s Life Tampa Bay

Issue 2, 2014

By Cynthia L. Harris, M.D. Gastroenterologist, Division of Endoscopic Oncology Moffitt Cancer Center

ancreatic and esophageal cancers are associated with a very high mortality rate, which can be markedly improved through early diagnosis. In addition, the development of these cancers is a stepwise process. Therefore, advances in technology that can permit physicians to image and identify the early stages of these cancers can have a significant impact in the outcomes of such patients. The world’s smallest microscope is having a big impact at Moffitt Cancer Center, assisting our gastroenterology team in the identification of early esophageal cancer arising in Barrett esophagus and differentiating benign from precancerous cysts that might lead to pancreatic cancer. The technology is called confocal laser endomicroscopy (CLE) with Cellvizio as the trade name. It is a welcome addition to our experience in biopsy and cytology with the potential to reduce the risk of misdiagnosis and to help make real-time treatment decisions. Moffitt Cancer Center is the first hospital in the Tampa Bay region to offer “optical biopsy,” whereby a very small microscope probe is threaded through a traditional endoscope to assess the esophageal mucosa, or through a needle used to puncture pancreatic cysts for real-time cellular analysis to detect early cancer. Although currently an adjunct to traditional surgical biopsies, this technology has the potential to replace traditional surgical biopsies, making it less invasive. This technology is helping our team improve detection time, supporting more rapid and often less invasive intervention in the treatment of precancerous conditions and early cancers.

OPENING UP A MICROSCOPIC VIEW

In a standard endoscopic procedure, gastroenterologists use endoscopy to analyze the surface of the mucosa (GI tract lining) at a tissue level. As a result, multiple traditional biopsies of the mucosa are often taken in an effort to capture any diseased tissue. Even with tissue from multiple locations, there is a risk that a biopsy will fail to provide an adequate sample and that analysis could result in a “false negative” or missed confirmation of cancer. Optical biopsy allows physicians to do a real-time assessment of the mucosa at a cellular level, providing immediate and precise visual cellular images during the procedure. The microcellular structure of the esophagus or the lining of a pancreatic cyst appears on a screen, allowing the physician to identify and assess features that can indicate healthy or diseased tissue. The integration of Cellvizio is seamless, as it fits directly through the endoscope or through a needle through the endoscope, without interrupting the standard endoscopic procedure or significantly lengthening the time of the procedure. This technology has a proven safety record in over 15,000 cases.

Issue 2, 2014

DETECTING CANCER FASTER

A growing body of published clinical data shows that by adding Cellvizio to gastrointestinal endoscopy procedures, physicians are often able to differentiate cancerous and pre-cancerous changes in tissue in real time. This is because certain criteria, indicative of cancer, are easily identifiable at the cellular level than at the tissue level. In Barrett esophagus, optical biopsy has the potential to detect more malignant lesions through better sampling, especially

Moffitt Cancer Center is the first hospital in the Tampa Bay region to offer “optical biopsy,” whereby a very small microscope probe is threaded through a traditional endoscope to assess the esophageal mucosa, or through a needle used to puncture pancreatic cysts for real-time cellular analysis to detect early cancer. in tissue that appears normal under endoscopic examination. Simple image recognition allows physicians to differentiate between benign mucosa from pre-malignant changes and cancer. Current sampling methods involve taking multiple biopsies from random areas in the esophagus, which takes time and adds cost. In a clinical study that included 101 patients with Barrett esophagus who underwent both surgical biopsy and optical biopsy with endoscopy visualization using high-definition white light endoscopy and narrow band imaging, the addition of Cellvizio doubled sensitivity.

Doctor’s Life Tampa Bay

Physician Spotlight

Dr. Cynthia Harris How long have you lived in the Tampa Bay area? I have lived here since 2006 (but I moved away for one year in 2008 to Indianapolis, Ind. What is your favorite Tampa Bay restaurant? There are so many great restaurants in Tampa Bay that offer a tremendous variety including the Columbia, Bern’s, Malio’s and Grille One Sixteen. But I really enjoy Seasons 52, which offers fresh, seasonally inspired, and healthy choices. Where is your favorite place in Tampa Bay to relax? Any of our beautiful beaches. What is your favorite event to attend in Tampa Bay? The Mainsail Art Festival held in April at Vinoy Park in downtown St. Petersburg. If you had never become a physician, what would’ve been your plan B or second career choice? My second career choice would have likely involved business or finance. How important is it today for physicians to be involved with the community, and how important is it to you personally? I think it is very important for physicians to be involved with the community as we have the opportunity to act as positive role models to children, teens and young adults, sharing the benefits of education. Physicians also have inherent and learned leadership skills that can be used to exert positive change in the community. How Long have you been with Moffitt Cancer Center? I have been at Moffitt Cancer Center for 4 ½ years. I joined Moffitt in 2009, completing an advanced endoscopy fellowship (one year of extra training), and became a faculty member in 2010. What has been the most rewarding accolade from working at Moffitt Cancer Center? The most rewarding part of my job is being able to offer excellent patient care at a world-class center by working with phenomenally talented colleagues, striving to reach our mission of contributing to the prevention and cure of cancer. What is The Cellvizio System, a new technology you are using for cancer detection? The Cellvizio System is a technology, also known as confocal laser endomicroscopy, that allows a physician to look at tissue on a cellular level much like a pathologist would. However, we are able to see the tissue in real time so that we may detect and treat cancer in its earliest stage, and at the time of the procedure, instead of waiting on a biopsy result. How is Cellvizio reducing health care costs? Cellvizio has the potential to reduce overall health care costs as it relates to cancer care by finding cancer earlier. If cancer is found in its earliest stage, this potentially could result in less extensive and invasive treatment. In addition, it helps me make immediate treatment decisions at the first procedure instead of having to 14

Dr. Cynthia Harris is a gastroenterologist in the Division of Endoscopic Oncology in the Gastrointestinal Oncology Program at Moffitt Cancer Center. Dr. Harris is an assistant professor at the University of South Florida College of Medicine’s Department of Oncologic Sciences.

Dr. Harris received her medical degree from the University of Tennessee College of Medicine and completed an internal medicine residency at University of Miami/ Jackson Memorial Hospital in Miami, FL. She pursued additional training through a gastroenterology fellowship at the University of Kentucky and an advanced endoscopic fellowship at USF/Moffitt.

repeat a procedure in the future for treatment. Tell us briefly what this new technology Cellvizio means to you and how it is benefiting your department and patients. Cellvizio is another valuable tool used in our fight against cancer. It helps supplement our other techniques and has changed how we manage patients in several instances. One of its roles is in pancreatic cyst work. Some of these pancreatic cysts are benign, some are precancerous, and others are cancerous. Most recently, I evaluated a woman with a cyst in the pancreas. Cellvizio confirmed a precancerous cyst when the other usual diagnostic methods were not clear. I was able to offer her surgery for a high-risk condition that, if not addressed, might have led to pancreatic cancer. In your opinion has recent technology improved the fight against cancer and why? I think that recent technology, drug development and patient education have all improved our fight against cancer. Early detection of many types of cancer has led to improved survival and decreased mortality. For instance, we have seen a decline in the incidence of colorectal cancer and colorectal cancer death due to improved screening such as with colonoscopy. Also, we have improved cancer awareness and the need for screening and prevention through various educational programs, celebrity endorsements, and the work of many not-for-profit groups who have made it their sole mission to prevent various cancers.

Doctor’s Life Tampa Bay

Issue 2, 2014

Incidental pancreatic cysts are being found more commonly due to increased imaging use such as CAT scan (CT) or magnetic resonance imaging (MRI). Many of these cysts can be precursors to pancreatic cancer, but differentiating a benign cyst from a premalignant one can sometimes be challenging given our standard technology such as using endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasound (EUS) plus or minus fine needle aspiration (FNA). In a clinical study of 40 patients with malignant biliary or pancreatic structures, physicians using standard diagnostic methods detected only 18 of 40 malignancies while physicians using Cellvizio were able to identity malignancy in 39 of 40 patients.i Because of the limitations of standard FNA such as paucity of cellular material and confounding cyst fluid analysis, use of optical biopsy can help clinicians identify more patients with intraductal papillary mucinous neoplasm (IPMN), thus confirming a premalignant or malignant mucinous cyst that may require surgical intervention. Cellvizio also showed 100% specificity when diagnosing serous cystadenomas, a benign pancreatic cyst that typically requires no further intervention or follow-up for the patient. Accordingly, our team at Moffitt Cancer Center is using Cellvizio to support diagnosis and treatment of premalignant or malignant pancreatic cysts and Barrett esophagus, a primary risk factor for developing esophageal cancer, as well as early esophageal cancer already within that Barrett esophagus segment.

certain types of brain tumors. Our team will also play a key role in educating visiting physicians from other top U.S. medical centers on the clinical and investigative use of this technology during training programs held at Moffitt. Cellvizio is an important technology, supplementing and enhancing our current methods of cancer detection in the gastrointestinal and pulmonary tracts. The hope is that by finding cancers earlier, we will decrease disease burden that will help reduce overall health care costs and improve survival from these particular types of cancer. It is a wonderful technological advance, adding another weapon to our armamentarium in the fight against cancer.

REDUCING UNNECESSARY PROCEDURES

During an endoscopy for evaluating a Barrett esophagus segment, Cellvizio can help identify areas of early cancer at the time of an initial procedure meant for surveillance. If a suspicious area is seen, treatment can commence at the same setting, thereby, potentially decreasing the need for a repeat procedure for treatment. Regarding pancreatic cysts, current imaging and sampling techniques are sometimes unable to confirm if a pancreatic cyst is malignant or pre-malignant and so some patients may have to undergo surgery before their diagnosis is confirmed. The ability to view tissue in real time using Cellvizio allows doctors to help patients with pancreatic cysts avoid unnecessary surgery, and associated time and costs. The use of Cellvizio can also potentially help reduce the incidence of repeat procedures.

IMPACTING PATIENT CARE

Our experience with Cellvizio has been very valuable thus far in patients with Barrett esophagus and pancreatic cysts. In one scenario, through Cellvizio we were confidently able to make the diagnosis of Barrett esophagus without dysplasia in a patient who was previously diagnosed with early esophageal cancer in the setting of Barrett through conventional endoscopy. In another application of Cellvizio, we were able to confirm the absence of residual or recurrent disease in a patient who had been treated for an early esophageal cancer lesion in the setting of Barrett esophagus. We have also demonstrated feasibility of Cellvizio in diagnosing precancerous pancreatic cysts from indeterminate cysts. In one particular instance, we recommended surgery, which was ultimately confirmatory for malignancy. Moffitt is one of about 80 centers in the United States using Cellvizio. With initial indications for use in the GI tract and lung, we plan to investigate a range of potential applications for this innovative technology. Based on this platform, we can explore potential applications in multiple areas including urology and neurosurgery. This small probe could potentially be used to study the genitourinary tract to detect early bladder, urethral, and ureteral cancers and in the brain to ensure a complete surgical resection for Issue 2, 2014

Doctorâ&#x20AC;&#x2122;s Life Tampa Bay

By Don Jones President and CEO PhysiciansBusinessGroup www.physiciansbusinessgroup.com

Increase Your Income

Without Seeing More Patients? M

eet Dr. Bill. He’s an office-based practicing physician who is good at his job. He works hard and generates a great income. Unfortunately, he doesn’t receive all he earns. He has $750,000 in long-term accounts receivable. When he first became aware of the condition of his business financials, he of course demanded answers from his in-house biller. The response was, “Don’t worry, we’ll get it. And what’s the big deal? You’re making plenty of money.” That was true. The problem is that he “made” that $750,000 also, but just couldn’t get his hands on it. And when he discovered that he had unnecessarily lost revenue not even reflected in his AR, he was furious! Dr. Bill’s in-practice billing problems included the following SEVEN DEADLY REVENUE-ROBBING SINS: »» uncollected co-pays, »» missed filing deadlines, »» ignored claims returned by carriers, »» insurance claims without follow-up, »» incorrectly coded claims, »» inaccurate insurance carrier submissions, and »» delinquent patient balances. Some would say, “shame on him” for allowing such a thing to happen. “He must be blindly practicing medicine without adequate 16

regard for his business.” Or is he? Are you entirely sure that your trusted billing staffers are not dropping the ball and committing one or more of those seven deadly sins? Are you sure you’re getting all you’ve earned? Most office-based practitioners may not be! But those who know and understand the often frenetic nature of running their own practice are not so quick to indict this troubled colleague. A practicing physician simply cannot dot all the administrative “I’s” and cross all the “T’s.” Even with a proficient office manager supervising the staff, it is difficult to guarantee that this critical business component, in-practice revenue cycle management, is well managed. Why is this true?

Doctor’s Life Tampa Bay

Continued on Page 17 Issue 2, 2014

Comprehensive Financial Planning

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Investment Management Services For Physicians Strategic Investment Partners LLC, (SIPCO) is an independent, investment management services firm for individuals, family trusts, charities, foundations & retirement plans. We are accountable to an RIA fiduciary standard (we sell no products & will accept no investment commission). We strongly believe in conservative & long term wealth preservation strategies using portfolio diversification, dividend reinvestment, & efficient/direct low cost investing (eliminating layers of financial industry fees). We provide our client’s the added safety of non-custodial asset management, GIPS compliant & audited portfolios, & Morningstar rated investment composites. ~ Named “Best Financial Advisers for Doctors” by Medical Economics magazine each year since 2004 ~ Conservative Investment Philosophy

Schedule a consultation: 800-805-5309 ext 14 via email: tlangston@investipco.com Strategic Investment Partners LLC, 10300 49th Street North Suite 133, Clearwater, FL 33762 727-898-7700

Remember that medical billing translates a health care service into a billing claim. The responsibility of the medical biller in a health care facility is to follow that claim to ensure the practice receives reimbursement for the work the providers perform. Without superior accountability, your biller is likely to let some things slide. The longer they have done the job, the more shortcuts they develop. They know how to bury their mistakes and omissions. You will likely never know about things like: uncollected copays; write-offs which were made simply because the biller became too busy to “fuss” over them; and missed deadlines with resulting dead-filed insurance company claims. Often business owners manage their billers by observing the level of their AR. Of course, the AR could be manipulated to $0 if all the claims creating the AR were just eliminated from sight. Ask yourself how outside companies can purchase private practices, continue operating successfully while providing great patient experiences, STILL PAY the providers the salaries they were taking before the acquisition, AND make a significant profit for the purchaser. The answer is very common. The original doctor/owner had his in-house billing clerks doing his billing and leaving 30-50 percent on the table with sloppy billing procedures and follow-up. It is ridiculously common! Medical billing is no longer the job for just another staffer or mini-department within a medical practice. It is a demanding specialty akin to the practice’s legal and tax matters. What competent business-owner would hire a $40,000 a year employee off the street to oversee and manage the matters normally relegated to an attorney or a tax accountant? Yet some doctors still trust their revenue cycle to a largely unsupervised in-practice billing clerk with limited proficiency. There are some practices which have had the same billing staff for many years. Those employees certainly have experience. They’ve been doing it for years. The physician often feels a sense of security with and loyalty to those whom he/she has employed for a long period. Because of that, the doc is less likely to feel the need for close staff supervision. But these questions linger. »» Is my staff really consistently collecting co-pays before the OV? »» How would I know if they are missing filing deadlines?

»» Are they promptly following up with the insurance companies to push payments through?

»» Do I really have denied or returned claims because of incorrect coding?

»» Are they submitting scrubbed claims that avoid unnecessary denials?

»» Are patient balances being pursued or written off too easily? Is your employees’ tenure a sufficient reason to allow substandard revenue cycle management? The cost of those employees can be exponentially greater that their salary and benefits? Let’s face it, your underperforming billing employees can very expensive. But there is the matter of the physician’s loyalty to long-term staffers. In many cases, it is possible to redeploy an underperforming billing staffer to another position. In fact, if the biller is not performing well, there is a great chance that he/she already has some sense of the problem. It may even be a source of private frustration. Moving the employee to a position in which he/she can flourish is a win-win for all. Considering rising personnel/staffing costs and missed revenue opportunities, it is unlikely that doctors’ in-house billing can compete with the margin that can be achieved by outsourcing to a well-priced and high-performing billing company.

Doctor’s Life Tampa Bay

Issue 2, 2014

Extra WidE WatErWay 3/2/2 HomE WitH Extra LargE SEcLudEd Lot 86x146 $1,399m

indian rockS BEacH HomE. StEpS to BEacH. onLy $369k

THINKING OUTSIDE THE BOX I

By Sharon Fekete The Doctor Whisperer www.thedoctorwhisperer.com

remember the day I was talking to my previous physician employers about Facebook marketing. We all had the same hesitation because there was concern about derogatory commentary from unhappy clients. Almost instantly, we both realized that 95 percent of our patients actually loved us so what were we really concerned about?! Then the research began…how were we going to create a Facebook page that would generate good morale and insight a buzz about our office? We watched the video from Jeffrey Gitomer called “OH NOOOOOO NOT FACEBOOK!” It was truly eye opening for my physicians to watch, since I already understood that social media was about to take off and truly HELP businesses like ours. I was lucky in the sense that my physician employers kept an open mind and could overcome the “unprofessionalism” stigma that was going around in the medical community about Facebook. Now all you have to do is hire a reputation management company! Here is the video that became the game changer for us: https://www.youtube.com/ watch?v=cdyTO_UI0uM The decision was made and we started our journey into the taboo social media land for our medical practice. Our staff was so excited to introduce our medical family and I began creating a buzz! I posted signs in the waiting room to “LIKE” us on Facebook and then I requested everyone’s email signature to host our link. It was all very exciting! We began by posting educational information about maintaining good health in the hopes it would create value to our patients. Then I began reviewing our “likes” and I swore I could hear crickets in the background. It was pathetic; a mere THREE people liked our content. AARGH! What could possibly be wrong? My physicians were providing insightful information that had been researched before posting?! So I began thinking about what I personally enjoyed looking at on Facebook and a big ole light bulb went off…FUNNY, anything humorous was worth 20

Doctor’s Life Tampa Bay

Issue 2, 2014

LIKING! It wasn’t long before we began ENGAGING with our audience and accumulating more “likes” to our page. I am not proud of the cheesy sign I had in the waiting room about our new and exciting information about our FB page…LAME!! The way to engage people is to do just that, show your imperfections & connect to their humanness. Next we pondered about how we were going to stand out! Have you asked yourself that question? What makes YOUR practice stand out! Well, we decided to make a music video. That’s right, a MUSIC video. How many medical offices do YOU know that have one? I mean a GOOD one?! I started looking at our competition and any medical office that had a video attached to it. WOW, talk about snoozers! I could not believe how BAD they were so standing out was NOT going to be a problem for us. The next hurdle was to convince a medical staff to buy into my vision. It was crazy enough for everyone to get a kick out of and off we went to the planning stages. The timing was perfect because we were opening nights and a great opportunity to DISRUPT the industry. I am proud to say it got over 5,000 YouTube views, not viral but certainly worthy of it! It was easy from there on out to get the word out because everyone was talking about it and it generated a TON of new patients into our practice. So what could we do to top this? Well, how about a REMIX?! That’s in the works for later this year. In the meantime, it’s vital to stay relevant in this competitive industry. How are you keeping up with the market and causing disruption to stay on page one of Google? How are you monitoring your marketing efforts? Do you consider how Fortune 500 companies operate to get to the top? Why can’t your medical office run like the Ritz Carlton? Have you spent any time in your waiting room to encounter what your patients endure? Do you know if your answering service has competent staff representing your practice after hours? These questions are vital to ponder if you are a business owner. You are missing the mark entirely if you do not have someone constantly bragging about your services. Why shouldn’t you brag about that medical degree? I would tattoo it across my head if I had to endure all of those years of schooling coupled with outrageous loans to pay back!! Tell everyone how awesome you are or HIRE someone to do it for you! I never encourage my physicians to market their office because an employee should be promoting the doctor. I proudly speak of the contributions they make to our lives, tireless hours they endure and sell their STORY. There are many simple solutions that can improve the value of the service you provide. You went to medical school, not business school. As a practicing physician you are not suppose to know the about Google Helpouts (but SOMEone in your organization should). I will leave you with my insights about growth. Top 10 issues that will prevent you from doubling your growth in the next 12 months 1. Lack strategic growth thinking 2. Growth can only be backed by facts, numbers, & statistics 3. Growth occurs when you lead, manage, delegate, & focus on what you are greatest at 4. Growth comes from a strong back office 5. Growth comes from building a ‘FAMILY FIRST’ culture 6. Growth comes from continuous and constant training 7. Growth has no fear 8. Growth comes from coaching 9. Growth comes from hiring the best 10.Growth comes from a business model Issue 2, 2014

Doctor’s Life Tampa Bay

Efficient Investing Utilizing Individually Managed Accounts E

liminating unnecessary fees and expense layers between you and your investment portfolio are two critical factors impacting the accumulation of wealth. The entire financial industry counts on most investors ignoring these two mathematical certainties. If you think of your retirement portfolio as a bank vault which holds your various assets until you withdraw them, an efficient investor would purchase a diverse portfolio of assets like stocks, bonds, CDs, treasuries and precious metals in their own name over time and store them in the vault. You would maintain 100 percent ownership and there would be no intermediaries, cost layers, or fees. It’s a bit old fashioned and it’s also how most ultra high net worth investors manage their wealth. Through the creation and selling of products, most advisors and insurance brokers today become a middleman Timothy McIntosh between investors and their assets (in the vault). Selling products allows salespersons to take a fraction of these assets through the generation of commissions, 12b-1 fees, loads, administrative costs, “spreads,” and profits from gains on assets over what they have to pay out (with annuities). Even if an investor avoids a “commissioned” advisor, utilizing mutual funds in your account also leads to excessive fees. This occurs because if an advisor recommends mutual funds, two fees will be charged. One by the advisor managing the account, and one by the mutual fund company for managing the actual investments within their fund.

“BACK TO THE FUTURE”

An Individually Managed Account (IMA) is an investment vehicle in which your advisor purchases a diversified portfolio of assets on your behalf in accordance with your strictly defined investment objectives. You the investor own 100 percent of the securities in the portfolio in your own name. By contrast, with a mutual fund you only own shares of a registered investment company who in turn actually owns the various assets which they keep in their own “vault.” By owning the securities directly, there are no additional fees associated with the selections of actual investments.

IMAs can provide a variety of advantages over financial industry products besides reduced fees and direct ownership such as tax efficiency. Direct ownership and control over your assets enables the timing of tax gains/losses optimizing “after tax” investment return. If you own mutual funds, you have no control over the timing of the buys/sells within the fund. IMAs may also be funded with low cost basis assets. Direct ownership of assets is a critical facet of individually managed accounts. IMAs provide advantages and customization not possible with mutual funds. The “individual” in individually managed accounts means asset allocation, risk tolerance, tax brackets, marital status, estate planning, practice succession, longterm investment goals and time horizons can all be considered in asset selection. Utilizing a non-custodial investment manager can add yet another level of safety by separating the management of assets in the IMA from the assets in the individual’s “vault.” The precision and efficiency of an IMA enables a more personalized, lower cost, tax sensitive and effective asset allocation strategy. It’s one of the oldest methods of investing and can lead to more consistent returns, lower fees, lower volatility, and a greater opportunity of achieving your financial objectives. Timothy McIntosh, CFP, MBA, MPH is Chief Investment Officer at SIPCO, an independent veteranowned investment firm. He has over a decade of experience working with physicians. He has been named as a “Best Financial Advisor for Physicians” by Medical Economics Magazine since 2004. He can be reached at 727-898-7700 or tmcintosh@sipllc.com

Doctor’s Life Tampa Bay

Issue 2, 2014

Doctorâ&#x20AC;&#x2122;s Life Tampa Bay

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ome call it “Cast Away meets Wolfgang Puck” where “shoes are optional” (Hideaways Collection), while others call it “an authentic tropical getaway” (Andrew Harper) and bestow awards (Trip Advisor Readers Choice), but regardless of how it’s defined, it’s clear The Meridian Club staff enjoy hosting guests on this private hidden gem. Beautifully positioned on a two-mile stretch of talcum-powder beach - considered by many as the finest in the Caribbean - The Meridian Club is an environmentally-sensitive private island resort ideally suited for those seeking an unspoiled, upscale but unpretentious retreat. With no automobiles, televisions, radios or telephones, guests unwind and enjoy the island’s natural beauty. Soothing trade winds ensure comfortable temperatures and low humidity while surrounding waters teem with marine life. Underwater visibility often exceeds 100 feet and there are miles of coral gardens within a five minute boat ride. Ashore, Pine Cay remains a pristine natural haven with vast open space and seven freshwater ponds, a perfect habitat for the abundant local fauna and flora. Aside from the obvious – bask in the sun on a deserted beach – guests can enjoy a variety of activities such as snorkeling, kayaking, paddle boarding, biking, playing basketball or tennis, and the most popular … taking golf carts out to explore the island. Culinary Adventures Mornings begin with freshly brewed coffee, fresh-baked pastries and breakfast on a private screened porch, with the option to join other guests at outdoor tables on the pool terrace. In the afternoon visitors have the option of a tasty buffet lunch, often off the grill, or a more adventurous picnic lunch (prepared upon request.) The club offers only the freshest seafood - locally caught ocean fish, lobster and conch prepared in various styles. There are other options, such as steak, chops, rack of lamb, duck and Cornish hen, and the award-winning chef prepares vegetarian meals upon request. With an new pastry chef this season, the club is excited to continue the tradition of fine desserts, beautifully presented with coffee or cordials.

Spa Offerings The Sand Dollar Spa, staffed by a Balinese masseuse, offers specialty spa techniques, including massage, hot stone treatment, manicures, pedicures, and facials. Balinese massage is a highly evolved, distinctive form employing a combination of gentle stretches, deep tissue kneading, acupressure and aromatherapy oils to stimulate the flow of blood, oxygen and “qi” (energy) around your body, bringing relaxation and a sense of wellness. An ancient technique, related to the Ayurveda, the Indian holistic medical system, this type of massage is known to help with a wide range of ailments, including migraine, muscle and joint pain, sleep disorder, anxiety and depression, as well as allergies and breathing problems such as asthma which often are worsened by stress. The use of oils is calming and sensual and leaves guests feeling tranquil and serene. Fishing With great fishing only 20 minutes off shore and a boat ride that in itself is an memorable excursion, many who visit Pine Cay come for the fishing or include fishing in their visit to the island. From deep sea fishing to fishing in the flats, there is always something interesting for any level fisherman. Some take their catch back to our chef and have it prepared for the next meal, while others enjoy “catch and release” for the sport of it. Whatever your pleasure, if you plan to fish during your Caribbean vacation, many say Pine Cay is the best option. For more information, call The Meridian Club at 866.746.3229 or visit www.meridianclub.com.