Doctor's Life Magazine, Tampa Bay Vol. 2 Issue 4, 2014

DOCTOR’SLife www.doctorslifetampabay.com

MAGAZINE

Business Lifestyles and Opportunities Vol. 2, Issue 4, 2014 Tampa Bay Edition

THESE DOCS GOT

YOUR

BACK

DR. FRANK BONO AND DR. JAMES RONZO, BIOSPINE INSTITUTE

Issue 4, 2014

AHA AND BAYCARE TEAM UP TO MAKE TAMPA BAY A

Doctor’s Life Tampa Bay

HEALTHIER PLACE 1

What’s Inside These Docs Got Your Back

From the Publisher Highlighting Great Organizations in Tampa

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Page 8

3D Mammography from the Physician’s Perspective

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Physician Spotlight Dr. Robert Sanchez

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The Legal Corner Changes in Medicare

Page 14

Advertisers American Heart Association

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BioSpine Institute

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Ciminelli Real Estate Services

17

The Doctor Whisperer

12

Gunster 3 KB Healthcare Consultants

AHA and BayCare Team Up 2

Keep Your Dream Alive

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Page 10 Doctor’s Life Tampa Bay

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The Meridian Club

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Old Bahama Bay

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Physicians Business Group

18

PNC Bank

28

Rita Shepard

19

Virginia Street Dermatology

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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

FO RT L AU D E R DA L E | JAC KS O N V I L L E | M I A M I | O R L A N D O | PA L M B E AC H | ST UA RT TA L L A H A S S E E | TA M PA | T H E F L O R I D A K E YS | V E R O B E A C H | W E S T PA L M B E A C H

From the Publisher

www.doctorslifetampabay.com

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his issue of Doctor’s Life Magazine is special for so many reasons. We showcase two extraordinary Tampa Bay organizations, Moffitt Cancer Center and American Heart Association. We start our commitment to bring awareness to the AHA 2014 Tampa Bay Heart Walk. DLM was honored to be the official magazine sponsor for this year’s Heart Walk. Save the date, November, 15, 2014 and if you can’t participate, you can always donate. The American Heart Association is the largest voluntary health organization working to prevent, treat and defeat heart disease, stroke and other cardiovascular diseases.

We welcome back Moffitt Cancer Center and say thank you to Dr. Drukteinis and the very brave patient Amy Greer for participating. Dr. Drukteinis is a Radiologist at Moffitt who specializes in the detection of breast cancer and Amy Greer was a patient with fears of getting a mammogram. They both give their perspective on what is being expressed as the most promising and exciting new technology in the detection of breast cancer, 3D mammography.

Moffitt Cancer Center makes a lasting commitment here in Tampa Bay to the prevention and cure of cancer and we are always grateful and proud to share their stories and successes.

The Legal Corner written by Paula Bentley, Attorney and Licensed Health Care Risk Manager with Gunster, goes into detail how Medicare Ends Improper “Improvement Standard” for Coverage of Skilled Care. Don Jones, CEO with Physician Business Group shows the hard numbers on why some practices could be saving hard earned profits by out-sourcing their billing and Mary A. Brown, CPC/CPMA with Kerkering Barberio explains the Proposed Policy and Payment changes to the Medicare Physician Fee Schedule for 2015. Doctor’s Life provides a warm welcome to the neighborhood with our feature cover story introducing two rock-star surgeons that have devoted their entire professional careers to performing minimally invasive spine surgery with success numbers that speak for themselves. Yes, BioSpine Institute is open, located in Tampa and Dr. Bono and Dr. Ronzo want to help your patients.

Our Physician Spotlight in this issue is with Dr. Robert Sanchez, MD, FACC, a cardiologist at The Heart Institute in St. Petersburg, Director of Cardiovascular Medicine at Northside Hospital & Tampa Bay Heart Institute and the active AHA Tampa Bay Metro Board President.

I hope you enjoy this issue. The best ways to show your appreciation for DLM is to reach out to our advertising and contributing writing partners. They are eager to help in any way they can. I personally dedicate this issue to the Slocum, Topper and Magarelli families, all cancer survivors and fallen heroes.

Be Well,

-Edd

™

Tampa Headquarters 1208 East Kennedy Blvd. #1029 Tampa Fl, 33602 813-444-9204 Group Publisher Edd Suyak publisher@doctorslifetampabay.com Creative Director Bryan Clapper Editorial Director Edd Suyak Assistant Editorial Director Danielle Topper Associate Publisher CJ Cooper Contributing Writers Paula Bentley Mary A. Brown Sharon Fekete Amy Greer Don Jones Lily Reisman Dr. Jennifer S. Drukteinis 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.

Edd Suyak Group Publisher publisher@doctorslifetampabay.com 4

TAMPA BAY

Doctor’s Life Tampa Bay

Issue 4, 2014

What’s Next...

The healthcare industry is continually responding to regulatory changes, technological advances and economic pressures.

Our Healthcare Consultants can keep you ahead of the curve.

Call us today.

(813) 675-8800

(941) 365-4617

www.kbgrp.com 4830 W. Kennedy Boulevard, Suite 600, Tampa, Florida 33609 1990 Main Street, Suite 801, Sarasota, Florida 34236 6320 Venture Drive, Suite 203, Lakewood Ranch, FL 34202

Physician Spotlight

Dr. Robert Sanchez How long have you lived in the Tampa Bay area?

23 years What is your favorite Tampa Bay restaurant?

That is a tough one. Tampa Bay has so many great restaurants. I have so many restaurants that I love, it is hard for me to just pick one.

Where is your favorite place in Tampa Bay to relax?

I like to relax at home with my family.

How important is it for physicians to be involved with their communities and how important is it to you personally?

I think it is extremely important for my colleagues and I to be involved in our local communities. Physicians are involved on a daily basis in the direct care of patients with cardiovascular diseases. We have a keen understanding of the healthcare issues involved and what needs to be done to overcome the challenges before us. Physicians can play a very important role at the community level in advocating for policies that improve health behaviors and health outcomes. This can be accomplished through policy change, improvement in health care systems and environmental changes.

High Blood pressure is considered the silent killer due to patients being unaware and not diagnosed. What are some of the current methods used for early detection and do you have any suggestions for primary care physicians that are on the healthcare front line?

High blood pressure is a significant risk factor for cardiovascular disease, especially stroke. The best method to detect high blood pressure is to have it monitored regularly. Blood pressure can be measured by a health care provider, at a pharmacy, or patients can purchase a blood pressure monitor and monitor it themselves at home. Primary care physicians are critical to the recognition and management of high blood pressure. Through adherence to treatment guidelines and aggressive management of the disease primary care physicians are instrumental in improving patient outcomes.

How have advances in technology impacted the field of cardiology? What advancement excites you the most?

Over the past 23 years I have seen many technological advances that have tremendously improved how we care for our patients.

These have included coronary stents, defibrillators, ventricular assist devices, Trans-catheter valve replacement to name a few. I am particularly excited about the advances in genetics/genomics that will one day allow for personalized therapy based on one’s genetic profile. Not only will this genetic information allow for personalized therapies, this information will also allow for the identification of future risk factors that will then lead to genetically determined personalized prevention.

You are involved with the cardiac fellowship program. What kind of advice do you give to new physicians?

Physicians today face tremendous challenges from multiple sources.

The doctor-patient relationship is being strained. These challenges unfortunately are creating a significant amount of job dissatisfaction amongst currently practicing physicians. As new physicians navigate these challenges it is important that they never forget why they chose medicine as a career in the first place. If they remain focused on the “why” they will be able to more successfully navigate through these difficult times. Our patients are counting on that.

Why is it necessary that we educate the community about 6

Dr. Robert Sanchez, MD, FACC, is a cardiologist at The Heart Institute in St. Petersburg, Fla., and the Director of Cardiovascular Medicine at Northside Hospital & Tampa Bay Heart Institute. Dr. Sanchez has been affiliated with the American Heart Association for more than 10 years. He’s been on the Greater Southeast Affiliate board for the past year, and on the Tampa Bay Metro Board of Directors for three years, most recently serving as the Board President. Additionally, Sanchez is board certified by the American Board of Internal Medicine in both Internal Medicine and Cardiovascular Diseases; he is a fellow of the American College of Cardiology; and he is a member of the National Lipid Association, and the American Society of Echocardiography. heart disease and stroke, and the importance of prevention?

It is very simple, if we don’t effectively communicate to the community the importance of cardiovascular disease prevention as well as the importance of early detection and prompt treatment of heart disease and stroke, we will begin to see a reversal in the significant advances we have made over the past several decades.

In fact we may see the next generation and future generations live shorter lifespans than the current.

The American Heart Association awarded the Tampa Bay Heart Institute at Northside Hospital the Get with the Guidelines™ Silver Award for Cardiac Care. How do you apply these guidelines with heart diseases like atrial fibrillation?

The AHA Get With The Guidelines supports our hospitals in a variety of ways. These guidelines allow us to access the most up-todate research and evidence based recommendations, professional education opportunities, clinical tools and resources, patient education resources, and performance feedback which will allow for continuous quality improvement.

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DR. FRANK BONO and DR. JAMES RONZO Board Certified // Fellowship Trained

TAKE YOUR BACK KCAB Minimally invasive spine care

Over 30,000 patients treated, more than 12,000 surgeries performed.

IN ASSOCIATION WITH GULFCOAST SPINE

WITH FIVE OFFICES SERVING CENTRAL FLORIDA

BioSpineInstitute.com 844-222-SPINE

5301 AVION PARK DR. TAMPA, FL 33607 ACROSS FROM INTERNATIONAL MALL

Dr. Frank S. Bono & Dr. James J. Ronzo

And Their Back Story I

n the last few years, minimally invasive has become “the story” in back surgery. It’s been their story from the very beginning…

Quite simply, their story is in results of their patients. The experience, skill, and the relentless passion for perfection is what drives the two founders, Dr. Frank Bono and Dr. James Ronzo.

Gulfcoast Spine and the BioSpine Institute have helped ease the back pain of over 30,000 patients.

The new BioSpine Institute located in the WestShore business district in Tampa is an extension of Gulfcoast Spine. Both promoting the very latest breakthroughs in minimally invasive technology. They also emphasize more natural strategies that encourage the body’s own miraculous natural healing response.

The central focus of both the Gulfcoast Spine and the BioSpine Institute is an unrelenting commitment to improve patients’ lives and restore them to an active lifestyle.

The process begins with an extensive & thorough interview where they listen carefully and address all of the patient’s concerns, followed by a detailed physical exam—combined with the use of studies (MRI, CT-scan, X-rays, etc). Next, they create an individualized care plan built around obtaining the best possible results for the patient. The plan will be monitored and implemented by their nationally-renowned minimally invasive spine surgeons, Dr. Frank Bono and Dr. James Ronzo. Few can match their extensive experience or their superior standard of care.

Dr. Frank Bono and Dr. James Ronzo have devoted their entire professional lives to performing minimally invasive spine surgery and are recognized by Consumer Reports, Newsweek, and ProPublica as being among the very best in the nation.

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MEET THE DOCS

FRANK S. BONO, D.O. is a highly skilled and much sought after orthopedic surgeon who specializes in disorders of the spine. Attending the University of Central Florida and Nova Southeastern University in Fort Lauderdale where he earned his degree in Osteopathic Medicine. He performed both his internship and residency at Botsford General Hospital in Farmington Hills, Michigan and completed a neurosurgical and orthopedic surgery fellowship in the Department of Spinal Surgery at St. Joseph Mercy Hospital in Ann Arbor, Michigan.

• Board certified and fellowship-trained orthopedic surgeon specializing in disorders of the spine • Winner of multiple research awards from the American College of Osteopathic Surgeons and the Michigan Osteopathic Association • Published author and speaker on spinal reconstruction JAMES J. RONZO, D.O. is nationally recognized as a leader in minimally invasive spine surgery and regularly shares his expertise in the operating room with visiting spine surgeons from around the country. A graduate of the University of Central Florida and Nova Southeastern University College of Osteopathic Medicine in Miami where he received his medical degree. He spent five years in Grand Blanc, Michigan, where he fulfilled his orthopaedic surgery residency and internship. Followed by the completion of his orthopedic surgery fellowship at Tampa General Hospital.

• Board-certified and fellowship-trained in orthopedics • Teaches minimally invasive techniques to visiting spine surgeons from around the country • Mentor to spine and neuro surgeons in the art of minimal access spine techniques in spinal fusions • National and international lecturer on bone morphogenetic protein and minimally invasive spine fusions

THEIR NUMBERS BACK IT UP

Results are arguably the most important “numbers” and Drs. Bono and Ronzo have some of the best numbers in the country for successful minimally invasive spine surgery.

Both doctors form a formidable team that has been able to bring relief from back pain and debility to over 30,000 patients.

They’re responsible for over 12,400 procedures between just the two of them. And, in an era of aggressive marketing tactics and

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Issue 4, 2014

“optimistic” statistics, those are true numbers. In comparison, other clinics may tout longer practices, more patients and ultimately higher numbers. But dig deeper and you’ll discover they’re counting results spread across multiple locations and more significantly, contributions from a continually revolving turnstile of physicians.

BioSpine is Dr. Bono and Dr. Ronzo. And the results attributed to GulfCoast Spine and the BioSpine Institute are 100% theirs.

Their statistics only add to the overwhelming conclusion that for experience and successful outcomes, Drs. Bono and Ronzo are well-deserving of their national reputation for excellence.

One reason among many is that 100% of their practice involves the spine. Spine surgery is not simply one more choice on a long menu of surgical “specialties.” Its all they do. Here’s another number. Most—95%—of their patients go home the same day or the next. An important statistic for patients concerned about time Issue 4, 2014

away from home or a job. Here’s a tiny number—the actual size of most incisions will measure ¾ of an inch. That’s the width of a penny and really helps put “minimally invasive” in perspective.

As they say, the best advertising is always “word of mouth” and that is certainly true for their practice. With 92% of their patients coming by direct physician referral or word of mouth from satisfied patients—this may be one of the numbers they are most proud of.

Back surgery is major surgery, whether it is minimally invasive or not. As such, it should never be something considered impulsively or as a result of any advertising or magazine article.

Patients should do their research, talk to as many people as they can about their own experiences. Dr. Bono and Dr. Ronzo have extended an open invitation to all Tampa Bay physicians to come by and see the new facility, meet the staff or just welcome them to the neighborhood. These Docs have your Back.

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The American Heart Association and BayCare Team Up to Make Tampa Bay a Healthier Place D id you know that heart disease is the No. 1 killer of Americans and stroke is No. 4? In 2011, in Hillsborough and Pinellas Counties, cardiovascular diseases killed more than 5,000 people.

The staff members and volunteers of the American Heart Association and American Stroke Association are tirelessly working to fight cardiovascular diseases in the Tampa Bay community.

Through campaigns like Go Red For Women, Together to End Stroke, My Heart. My Life. and Fit-Friendly, the American Heart Association is helping to educate people year round about heart disease and stroke prevention through awareness. And through strategic partnerships with organizations like BayCare, they are able to make an even bigger impact.

“Both organizations share very similar cultures and mission statements, and are uniquely positioned to help each other. As a result, there are great synergies when we team up and work together to improve the health and wellness of the Tampa Bay community,” said Stewart Schaffer, the vice president of marketing and communications at BayCare.

BayCare – a health system composed of a network of 11 not-forprofit hospitals, outpatient facilities, and services – is the American Heart Association’s My Heart. My Life. cause sponsor.

Launched in the spring of 2011, My Heart. My Life. is a national healthy living initiative designed to guide and influence healthy eating and physical activity, and ultimately improve the health of Americans. It’s an important component of the American Heart Association’s sweeping 2020 impact goal: to improve the 10

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cardiovascular health of all Americans by 20 percent, while reducing deaths from cardiovascular diseases and stroke by 20 percent, all by the year 2020.

In an American Heart Association survey, 39 percent of the population rated themselves as being in ideal health. But in reality, less than 1 percent of the population meets the American Heart Association’s criteria for ideal cardiovascular health. A key goal of My Heart. My Life. is to increase the number of people who understand the link between their health and their risk of heart disease and stroke, as well as extend their life-span and enhance their quality of life.

Designed to be a catalyst for positive change in American business, the Fit-Friendly Worksites program recognizes employers who champion the health of their employees by creating wellness in the workplace. Companies earn Fit-Friendly recognition by showing compliance in three areas: physical activity, nutrition and culture.

More than 90 companies in Tampa Bay are recognized as FitFriendly.

According to Schaffer, BayCare’s near term goal is to screen and provide wellness programs to as many medium and large employers in Tampa Bay as possible. And so far, they’ve been successful.

“Since the inception of our My Heart. My Life. sponsorship with the American Heart Association in January 2013, we have screened and provided a number of wellness programs to 39 employers in coordination with the American Heart Association’s Fit-Friendly program,” said Schaffer.

In 2014, BayCare has engaged with 21 new employers in the Tampa Bay area by providing onsite wellness programs and screenings such as biometric screenings, health education seminars, and health promotion programs on sleep and stress.

Also falling under the My Heart. My Life. umbrella are American Heart Association events like National Walking Day, National Eating Healthy Day, and the signature Heart Walk, which has taken place in Tampa Bay for more than 15 years.

“Heart Walk gives many team members of BayCare the opportunity to actively participate in one of the most important fundraising events that benefits heart health in the country,” said Schaffer.

BayCare team members’ involvement in the Heart Walk is apparent in the funds they’ve raised over the years. In 2013, approximately 1,600 team members participated in the walk, raising more than $220,000. Since 2005, they have raised more than $1,337,000.

Donations raised for the Tampa Bay Heart Walk go toward heart disease and stroke research, community programs, and advocacy efforts. Since 1990, the American Heart Association has funded more than $17 million worth of research at local institutions like All Children’s Hospital, Tampa Bay Research Institute, and the University of South Florida.

This year’s Tampa Bay Heart Walk takes place on Saturday, Nov. 15, at Raymond James Stadium. More than 30,000 people are expected to attend. The Heart Walk chair and CEO of Raymond James, Paul Reilly, is encouraging walkers to join him in achieving a record-setting fundraising goal of $3 million. More than $1,289,000 has already been raised. For more information about the Heart Walk, please visit www.

TampaBayHeartWalk.org.

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Doctor’s Life Tampa Bay

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Things I Never Learned in Medical School How I Found My Doctor Whisperer

By Sharon Fekete The Doctor Whisperer www.thedoctorwhisperer.com

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hy hire The Doctor Whisperer? Well, let’s be blunt, you need help. There is just simply NO way you can see patients, run a practice, deal with HR issues, market, stay on top of trends, AND tell everyone how fabulous you are without help. Unless you have an Administrator that runs the operation, handles all the HR, the financials, saves you money, and works on growing your practice...then you need help. To be perfectly honest, I NEEDED ME when I was an Administrator of a large practice for 8 years. It is virtually impossible to do everything WELL without help. It has been clear throughout my 15 years of working in the medical field that physicians simply need HELP! Not in a clinical sense (thankfully there are nurses, ARNP’s, and Physician Assistants for that) I mean HELP in the business of running your practice!

I have included below a sneak peek from the book I have written with a physician colleague of mine that I was proud to work with for over eight years. The book is entitled, Things I Never Learned In Medical School, or: How I Found My Doctor Whisperer.

It was my honor to write alongside this successful physician, and I am ecstatic to tell you it will be available to purchase in January of 2015.

This excerpt is featured in chapter 2, ‘Know What You Don’t Know’, written by Greg Savel, M.D. Perhaps it is for self-preservation alone that we should find the right people to help run our business so we can get back to just seeing patients.

Perhaps the most important thing is to know what you don’t know. Hire the people who DO know so you can just do what you wanted in the first place & get back in the exam room.

I went to a wonderful medical school & was well trained to be a successful physician in private practice. As the years went by I realize there were so many things that I want to know more about but that it wasn’t possible to take care of patients and learn those things in a practice that fortunately kept growing. I want to be the best doctor for my city, the kind of person everyone who works there would be proud to talk about. I need to be able to sign 33 paychecks every two weeks and make sure they won’t bounce. I needed someone who would help me & I am proud to be able to write this book with that person. People wonder where we came up with the term 12

doctor whisperer. The term is actually quite wonderful because it really describes that I hired a person who will stand by my side and help me run my business as my equal. Someone to help guide me through all the things I don’t understand and appreciates what it is I go through on a day-to-day basis. Of course it wasn’t easy to find that person. First of all I have to trust this person essentially with my life. I spent all those years of schooling just to take care of patients.

I now needed to find the right person to help me do just that AND act in my best interest.

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The Legal Corner

Medicare Ends Improper “Improvement Standard” for Coverage of Skilled Care

By Paula Bentley Attorney and Licensed Health Care Risk Manager Gunster

F

or several decades, Medicare beneficiaries with chronic conditions have been denied coverage for skilled nursing and therapy services provided by home health care agencies (HHAs) and skilled nursing facilities (SNFs) based on application of an improper “Improvement Standard” by Medicare contractors and providers. After several Medicare beneficiaries and Medicare advocacy groups filed a class action lawsuit in the case of Jimmo v. Sebelius, the U.S. District Court for the District of Vermont approved a settlement agreement (the “Settlement”) that required the Centers for Medicare & Medicaid Services (CMS) to take specific steps to correct the widespread misapprehension among Medicare contractors that coverage for skilled services is dependent on a patient’s improvement potential.

The Settlement, which became effective on January 24, 2013, required CMS to clarify that when skilled services are required to prevent or slow further deterioration, Medicare coverage cannot be denied simply because the beneficiary lacks the potential for improvement or restoration. Among other things, the Settlement required CMS to revise portions of its Medicare Benefit Policy 14

Manual (MBPM); implement a nationwide educational campaign for contractors, providers, suppliers, and adjudicators; and engage in accountability measures to ensure claims determinations are being made in accordance with the correct standards.

The MBPM revisions, which became effective on January 7, 2014, clarify that skilled care may be necessary: 1) to improve

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a patient’s current condition; 2) to maintain a patient’s current condition; or 3) to prevent or slow further deterioration of a patient’s condition. The revisions also address inpatient rehabilitation facility (“IRF”) claims, clarifying that an IRF claim can never be denied because a patient is unable to achieve complete independence or is unable to return to his or her prior level of functioning.

One of the key aspects of the manual clarifications addresses the important distinction between restorative/rehabilitative therapy and maintenance therapy. The purpose of restorative or rehabilitative therapy is “to reverse, in whole or in part, a previous loss of function.” Therefore, it is appropriate to consider the potential for improvement when evaluating a claim for skilled therapy that is restorative or rehabilitative in nature. Similarly, in the IRF or comprehensive outpatient rehabilitation facility (“CORF”) setting, potential for improvement must be considered because skilled therapy in those settings will only be covered if it is reasonably expected to improve the patient’s functional capacity or adaptation to impairments.

On the other hand, coverage for “maintenance therapy” should not be dependent on a beneficiary’s potential for improvement. The MBPM indicates that maintenance therapy is warranted when an individualized assessment of a patient’s condition demonstrates that skilled care is necessary to design, establish or perform a safe and effective program to maintain a patient’s current condition or prevent or slow further deterioration. Simply demonstrating the need for a maintenance program is not enough; it must also be shown that skilled care is necessary for the safe and effective performance of that program. Skilled care will only be covered by Medicare Issue 4, 2014

if it is determined that: 1) the particular patient’s special medical complications require the skills of a qualified therapist or nurse to perform a type of service that would otherwise be considered nonskilled; or 2) the needed services are of such complexity that the skills of a qualified therapist or nurse are required to perform the procedure.

If a service can be safely and effectively performed by an unskilled individual, including the patient or a family member, the service will not be considered a skilled service.

The revised MBPM also provides enhanced guidance on documentation to assist providers in their efforts to identify and include the type of clinical information that will allow Medicare contractors to confirm that the patient’s needs are complicated and that skilled care is, in fact, needed in a certain case. CMS advises that documentation should include objective measurements of physical outcomes of treatment or a clear description of the changed patient behavior due to education programs.

The Settlement also required CMS to engage in a nationwide educational campaign to communicate the clarified maintenance coverage standards to contractors, adjudicators, providers, and suppliers. In addition to distributing written materials, CMS agreed to conduct “National Calls” to communicate the policy clarifications to these stakeholders. The Settlement also required CMS to revise relevant 1-800-MEDICARE customer service scripts to ensure consistency with the revised MBPM provisions.

In the final phase of compliance with the Jimmo Settlement, CMS agreed to implement accountability measures to ensure that maintenance therapy claims are being decided in conformance with the manual clarifications. During this phase, CMS is required to provide a “re-review” process for individual claim denials that may not have been made in accordance with the clarified maintenance coverage standards. Re-review is available through application by the beneficiary. If the review confirms that the claim was denied in error, the beneficiary will be reimbursed for those services, subject to applicable Medicare reimbursement limits. Beneficiaries may only receive re-review of claims on their own behalf; providers and suppliers may not receive re-review on behalf of a beneficiary. The Center for Medicare Advocacy has made available on its website free “Self-Help Packets” to assist beneficiaries in understanding the clarified Medicare coverage standards and how to file a request for re-review.

It is important to note that Jimmo does not change any other eligibility requirements or legal limitations on Medicare Part A or Part B coverage. For example, the 100-day limit for Medicare coverage of a SNF admission remains in place, as well as the requirement for an SNF admission to occur within 30 days of a hospitalization that has lasted at least three days. Likewise, a physician’s certification of need is still required for HH skilled care services. In addition, the scope of the Settlement extends beyond Medicare Part A and B, as Medicare Advantage plans are required to offer at a minimum the same maintenance benefits as fee-for-service Medicare.

Unfortunately, the Jimmo Settlement Agreement did not require CMS to notify or educate Medicare beneficiaries regarding the clarifications to Medicare coverage standards. Thus, from a patient advocacy standpoint, it is imperative that physicians and other health care providers understand the revised coverage standards so they can accurately educate patients and their families regarding whether a recommended skilled service will be eligible for reimbursement under Medicare.

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Making Changes to Keep Your Dream Alive

By Don Jones President & CEO PhysiciansBusinessGroup

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ake a trip back in time for just a minute. Go back 10 years, 20 years, 30 years or even more to the time when you dreamed of being a physician. You likely envisioned the rewards and challenges of having your own medical practice. You wanted control of your life and business to care for patients, support a loyal staff, and have the ability to generate a great income commensurate with your developed expertise and hard work.

It was not the goal of many young men and women in med school to spend their careers as small cogs in a big corporate machine controlled by others.

Many intended, and still want, the relative autonomy of owning and operating their own medical practice.

They still want to care for their patients in a way that is satisfying to them, provides an excellent patient experience, and is financially rewarding. But how is the small to medium practice to stay viable in today’s environment? To answer that, look first at the successful operational tactics of the large corporates.

Many practices with inadequately supervised billing staff suffer from a complete disconnect between their billing load and their staffing level. If billing is understaffed, employees are stressed and make mistakes or take expensive shortcuts in an effort

to keep up. The financial loss to the practice is often more than the cost of additional staffing.

If billing is overstaffed, the physician-owner is paying for unnecessary hours but may never know it. It has been said that “work expands to the time allowed for it”. Because of this, the practice is paying for staff hours that are simply being squandered by a staffer’s slow pace filling his/ her hours with inefficient work practices. A great example of this is one area practice paying its fulltime in-house biller in excessive of $30,000 per year.

That practice’s actual billing load is small enough to be done in about three hours per day by a professional billing service. The additional five hours per day for which the practice is paying the full-time employee is simply being wasted. The out-source billing company’s charge is $12,000 – an $18,000 per year

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Doctor’s Life Tampa Bay

REVENUE CYCLE MANAGEMENT

Many large corporate groups have fully developed departments for all their needs – including billing.

They are staffed and managed to accommodate their work load. More revenue is collected and it is collected faster due to solid billing practices closely supervised by qualified management staff. How is a small to medium-size practice to compete with that?

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savings to that practice for out-sourcing!

CONTROL AND SUPERVISION

Some doctors work under the assumption that having their billing done within the practice gives them a larger measure of control. This was true before today’s technology and current billing software. However, practice owners are often even better informed through a professional out-source billing service. They may have 24/7 access to their billing activity with the ability to check the status of any and all claims, review charge and payment posting, monitor aging of claims, etc. The outsource billing company’s accountability is very high. This is true because of technology, but also because of an appropriate staffing structure.

The billing company should have layers of management providing oversight for its billers’ work. The typical medical office having one or two in-house billers without a billing management tier is vulnerable to errors or theft by those poorly supervised or essentially unsupervised staffers. An example of this is a Tampabased physician who, after years of working with his trusted office manager/biller, called in an outside billing company to check the status of his billing. It was discovered that his employee had been stealing for some time. She found ways to pocket cash and divert payments for her personal use. Of course, her theft was only the tip of the iceberg. Her incompetence had cost the physician much more than she had personally stolen. The potential of this is minimized with the technological accountability available through today’s billing technology.

When the facts and economics are fully considered, it is virtually impossible for the small to medium-sized practice to financially or functionally justify its own in-house billing over outsourcing.

Medical Office Space Available - August 2014.pdf 1 8/13/2014 10:15:47 AM

Combining the applicable methods and administrative procedures of “big corporate medicine” WITH the personal and relational care of the independent physician and his/ her team is still a winner in today’s environment. An independent physician who wants to live out his/her dream of owning and operating a private practice can do just that.

In addition, consider other management techniques that the independent doc can employ to have the edge.

1. RELATIONAL CARE There is an old saying. “They don’t care how much you know until they know how much you care.” Here is where the

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physician-owned practice can win the game! It is not enough to care. The doc must show that he/she cares; eye contact, a caring touch, concern for a patient’s life as well as his/her illness are all very important to the development of loyalty.

2. WAIT TIMES MANAGEMENT Many patients simply won’t tolerate long wait times today.

Anyone can understand an anomaly, but the practice that routinely schedules appointments knowing that patients are likely to wait longer than 30 minutes has just pitched “strike one”.

3. REGULAR PATIENT SURVEYS If you want to know what patients think, ask them. Obtain regular feedback on matters related to their experience and their regard for you and your care of them. This can be managed with simple surveys allowing patients to express both their frustrations AND their appreciation. If patients have complaints, it is far better for the practice to take the edge off of the patient’s frustration by allowing those expressions in a survey than to send the unhappy patient out to spread the negative word.

4. COURTEOUS STAFF There is absolutely no room today for surly employees. The practice owner must ensure that every patient encounter is kind, caring, unrushed and highly relational. And when patients’ negative comments surface, both physicians and employees must be braced and prepared to handle those in a non-defensive and caring manner.

5. OUTSOURCE In addition to outsourcing billing, consider doing the same with IT support, HR management and compliance, and marketing and/ or PR. Obtain these competitive necessities by outsourcing and pay only for the services and time you require.

6. AUTOMATE While use of EMR systems still has mixed reviews from physicians and staff, the fact remains that, when fully implemented, they can be a huge time-saver. For the independent to remain profit- able and to compete with the conglomerates, this is a feature that must be embraced and maximized. The inefficiencies of functions such as the use of paper superbills and administrative procedures that require subsequent data entry of office visit information will continue to erode the viability of the physician-owned practice.

7. VALUE ADDED The smaller practice can further distinguish itself with courtesies that the patient did not expect. Simple things like automated follow-up calls and newsy emails about the practice create a family-feel and further bond a patient to a practice.

Combining the applicable methods and administrative procedures of “big corporate medicine” WITH the personal and relational care of the independent physician and his/her team is still a winner in today’s environment. An independent physician who wants to live out his/her dream of owning and operating a private practice can do just that. He/she just has to be gutsy enough to realistically evaluate the practice’s methods and be willing to make the changes that can provide for its long-term success.

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Demystifying 3D Mammography A Radiologist’s Perspective

By Dr. Jennifer Drukteinis Moffitt Cancer Center

I

magine trying to look through the cover of a book to determine what is inside, versus turning each individual page to better understand what the book actually says. Tomosynthesis or 3D mammography, as many call it, is making my job a lot easier. As a radiologist who specializes in the detection of breast cancer, 3D mammography is the most exciting and promising new technology in our field.

Mammography is a success story, but not without limitations.

Since the widespread introduction of mammography in the United States in the mid 1980s, breast cancer related mortality has declined by a third. However, even when performed optimally, mammography does not detect all cancers. Up to 20% of breast cancers may be missed. This necessitates better methods for breast cancer screening; and hence, the development of 3D mammography In 2011, the FDA approved the use of 3D mammography and recognized it as superior to standard 2D digital mammography.

Studies in both the United States and in Europe have shown 3D mammography increases the ability to detect invasive breast cancer by at least 40%. It also reduces the number of patients called back for additional imaging after a screening mammogram, eliminating some of the anxiety, cost, and inconvenience of additional testing. Lastly, since the introduction of 3D mammography, more biopsies are positive for cancer, which means we are eliminating many of the unnecessary biopsies on benign findings.

So how does it work? During your annual mammogram, most likely, you won’t notice a difference. The breast is placed in compression, and instead of a single image, multiple images or slices of the compressed breast are obtained as the x-ray tube moves over the breast. These images are then reconstructed into smaller slices, 1 millimeter thick, similar to a CT scan. These images are then reviewed by the radiologist; looking for masses, 20

Doctor’s Life Tampa Bay

Issue 4, 2014

MY EXPERIENCE WITH 3D MAMMOGRAPHY

By Amy Greer

M

y decision to get a mammogram was a difficult one.

I had a family history and knew I was at risk, but I was also breastfeeding my children, which could lead to a false positive screening.

Dr. Jennifer Drukteinis

suspicious calcifications, or distortion in the breast, which may be a sign of breast cancer.

The particular advantage of 3D mammography is that much of the overlapping tissue is eliminated, allowing us to see abnormalities more clearly, without anything “in the way.” This is particularly advantageous in women with dense breasts, for whom mammograms have been shown to be less efficacious.

All of these advantages come without much downside. The radiation dose associated with a 3D mammogram is extremely low, similar to that of a standard digital 2D mammogram. The FDA has also recently stated that 3D mammography can be performed alone without an additional 2D digital mammogram, as many centers are able to reconstruct the 3D images to a 2D image, equivalent to the standard mammogram.

As a radiologist, as a woman, and as a patient, I would encourage all women ages 40 and older to consider 3D mammography as their annual breast cancer screening method. Regardless of your age or breast density, 3D mammography has been shown to detect more cancers than standard 2D mammography. However, if 3D mammography is not yet available in your area, continue with your annual 2D mammogram. Time and experience have proven that it may save your life.

Issue 4, 2014

In fall of 2012, I attempted to get a mammogram after having weaned my daughter four months prior. I was in the mammo room about to have the exam, and I mentioned that I had finished breastfeeding four months prior. I was then denied the mammogram because I could still express milk. Shortly afterwards, I became pregnant again so didn’t want to have a screening mammogram. Then, I was breastfeeding and decided to at least wait until the baby was feeding much less so there would be a better chance of accuracy.

I eventually got a mammogram because I am 41, and my mother had Ductal Carcinoma in Situ, which is a type of breast cancer, at age 63. I decided to have my mammogram done at Moffitt’s Screening and Prevention office, who was thankfully able to perform a breastfeeding mammogram.

When I scheduled my mammogram, I had a few concerns. I wondered if the procedure would hurt. I worried, especially due to my family history that there would be a positive finding. I was also worried there would be a false positive and I would have to go through another mammogram and/or biopsy and could lose the ability to breastfeed my children.

Despite my fears, I decided to move forward and schedule my 3D mammography at Moffitt’s Screening and Prevention office after debating for about a year whether to proceed. Ultimately, it was important to me to have a mammogram because of my mother’s history of breast cancer. I had heard over and over about woman my age getting breast cancer.

When I scheduled my 3D mammography I felt confident it was more likely to give me a clear answer. I knew I was at risk of having a false positive reading because I am currently breastfeeding. I was so glad that the 3D mammography cut the risk of a false positive and additional testing. My radiographer explained the procedure thoroughly and explained the benefits of 3D mammography, which was that the pathologists have a more comprehensive view of the breast.

As soon as I finished my mammogram, I called my grandmother right away. She had not had a mammogram in years because she was afraid it would hurt and be uncomfortable. I told her my 3D mammogram was quick, relatively painless and was not uncomfortable at all. I encouraged her to have hers done right away.

Doctor’s Life Tampa Bay

21

Proposed Policy and Payment changes to the Medicare Physician Fee Schedule for Calendar Year 2015

By Mary A. Brown Senior Medical Consultant Kerkering Barberio

O

n July 3, 2014, the Centers for Medicare & Medicaid Services (CMS) issued proposed changes that would update payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2015.

Below are some highlights of the proposed changes for 2015: Sustainable Growth Rate (SGR). The Protecting Access to Medicare Act (PAMA) of 2014 provided for a zero percent PFS update for services furnished between January 1, 2015 and March 31, 2015. This prevented the predicted 20.9 percent decrease in the PFS. The proposed rule does not include any proposal on the PFS update or SGR as these calculations are determined under a prescribed statutory formula that cannot be changed by CMS. The Administration continues to support legislation to permanently change to the SGR. Primary Care and Complex Care Management. In continued support of the primary care management services initiative, CMS is proposing to make separate payment for Chronic Care Management (CCM) services beginning in 2015.

CMS proposes a payment rate of $41.92 for the code that cannot be billed more frequently than once per month per qualified patient.

Misvalued Codes. CMS is proposing to add about 80 codes to the list of potentially misvalued codes. Most of these codes are identified by CMS by reviewing high-expenditure services by specialty that have not been recently reviewed.

Global Surgery. Under the misvalued code initiative, CMS is proposing to transform all 10- and 90-day global codes to 0-day global code beginning in calendar year 2017. The proposed rule would pay separately for visits and services actually furnished after the day of the procedure.

22

Application of Beneficiary Cost Sharing to Anesthesia Related to Screening Colonoscopies. The screening colonoscopy benefit with Medicare Part B waives deductible and coinsurance amounts. Moderate sedation provided intravenously by the endoscopist is considered a bundled service with the screening colonoscopy. There has been a trend of anesthesia provided by an anesthesia professional in conjunction with the screening colonoscopy. These anesthesia services are subject to deductible and coinsurance amounts. The proposed rule would bring these anesthesia services within the scope of the provision that Part B pays 100 percent of the Medicare payment amount established under the PFS for certain screening tests.

The proposed rule was published in the Federal Register on July 11, 2014. CMS will accept comments on the proposed rule until September 2, 2014.

Mary A. Brown, CPC®/CPMA® joined Kerkering Barberio in 2011 as a Senior Medical Consultant. She provides clients in the healthcare industry advisory and compliance assurance services in a variety of practice areas, including: revenue cycle management, credentialing with insurance carriers, financial reporting, operations, procedure design and implementation, and compliance with third party regulatory requirements. She has worked with physician specialty groups, laboratories, hospitals and radiology facilities.

Doctor’s Life Tampa Bay

Issue 4, 2014

s o c i a C & A PRIVATE ISLAND s k r u T HIDEAWAY

S

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.

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