Doctor's Life Magazine, Tampa Bay Vol. 2 Issue 5, 2014

DOCTOR’SLife www.doctorslifetampabay.com

MAGAZINE

Business Lifestyles and Opportunities Vol. 2, Issue 5, 2014 Tampa Bay Edition

SUPER GROUPS! SCOTT JARRED,

CEO OF JARRED BUNCH CONSULTING

YOUR WEALTH

CHECK-UP

What’s Inside Super Groups

From the Publisher Holidays are right around the corner

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Is It Time for a Total Wealth Check-up?

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Physician Spotlight Dr. Scott Powell

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The Legal Corner

Hospital Fair Hearing Process Page 12

Advertisers

American Heart Association

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BioSpine Institute

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Gunster 21 Jarred Bunch

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JW Marriott

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KB Healthcare Consultants Meridian Club Moffitt Cancer Center Physicians Business Group

Standing Up to Heart Disease and Stroke

Fit Corner: Managing a Busy Schedule

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Doctor’s Life Tampa Bay

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PNC Bank

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Point Grace

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Rita Shepard

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Issue 5, 2014

From the Publisher

www.doctorslifetampabay.com

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t is that time of the year already. The holidays are right around the corner and before you know it, we will be celebrating another New Year. We wish everyone a safe and happy holiday season. This issue of Doctor’s Life explores the advantages of joining a Super Group, we discussed with Jabil’s COO, Bill Muir about his passion to stand up against heart disease and why Jabil continues to support the AHA and their yearly Heart Walk. If you have not signed up, there is still time to do so. The 2014 AHA Annual Heart Walk is Saturday, November 15th at The Raymond James Stadium. DLM is proud to be one this year’s media sponsors and hope to see many of you there.

The Legal Corner with Bruce D. Lamb, Gunster’s Health Law Practice Group Leader, takes a look into the Hospital Fair Hearing Process and by your request we brought back the Fit Corner. Fit Corner provides a few steps on how to remain in shape while maintaining a busy schedule.

We sat down with Dr. Scott Powell for the Physician Spotlight. Dr. Powell was kind enough to share his thoughts on the importance of having a strong wealth management plan early on in his career and how he chose who to work with.

This brings us to our featured cover article with Scott Jarred, CEO of Jarred Bunch Consulting. For most of us, family is our number one priority. When keeping family as our top priority, long term financial protection and planning becomes part of our strategy. After reading the Physician Spotlight and our feature cover article, you will know why Scott’s team and clients are amazed by his approach to building, protecting and growing your wealth.

As always, we thank our readership and welcome your ideas, comments and suggestions.

The best way to thank DLM back is to reach out to one of our advertising and or content partners. I hope you enjoy this issue as much as we did in creating it.

MAGAZINE

Business Lifestyles and Opportunities Vol. 2, Issue 5, 2014 Tampa Bay Edition

SUPER GROUPS! SCOTT JARRED,

CEO OF JARRED BUNCH CONSULTING

YOUR WEALTH CHECK-UP

TAMPA BAY

™

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 Brittany Miller Kathleen Hargreaves Bruce D. Lamb Lily Reisman Edd Suyak Cover Photo Photographer Johan Roetz

Be Well,

-Edd

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

Edd Suyak Group Publisher publisher@doctorslifetampabay.com

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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.

Doctor’s Life Tampa Bay

Issue 5, 2014

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Physician Spotlight

Dr. Scott Powell How long have you lived in the Tampa Bay area?

I’m originally from Valrico, then we moved to Jacksonville and returned to the Tampa Bay in 1997 after graduating at the University of Florida.

What is your favorite Tampa Bay restaurant?

Council Oaks. Best steak in town!

Where is your favorite place in Tampa Bay to relax?

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

Physicians should stay involved whether that is with their children’s extra curricular sports/activities or general community activity. It is very important for us as physicians to be visible in the community. Despite some of the negative press toward the medical field, we need maintain positivity and community enrichment. I find great satisfaction in staying involved and doing whatever I can to improve my community.

Was finding a financial advisor/ consultant important to you when you first came out of residency and if so why?

During my Residency training I had little knowledge of how the process of financial planners worked. Although I obtained my MBA while getting my MD degree, there was so much more I didn’t know.

I think that finding someone to work with during the last phase of one’s Residency is important and even more so once someone graduates. There is so much happening once a physician in trying to start a practice. There are so many financial decisions to make and having someone looking over your shoulder and “watching the hen house” is very advantageous.

How did you first learn about Jarred Bunch Consulting?

Scott Jarred and his team came and gave a talk during my residency to have an open discussion about all things financial.

I know from our conversation that you met with several firms but ultimately decided to work with Scott and his team at Jarred Bunch Consulting. What was the deciding factor?

As I mentioned, he came and talked to the residents in my program here at USF. When I graduated, I asked all of my partners and those I trusted who they used as their financial planner and I went around and met with all of them. They were all polite, but some told me to come back and talk to them once I was making a certain level of income. I immediately realized that I needed someone that was willing to grow with me. I reached back out to Scott Jarred to continue our dialogue.

I had also asked others in the financial business how best to choose someone as a financial planner. The best advice I could find was to trust my gut. Scott was willing to work with me when I was still a resident with nearly no income, so that meant something to me. His philosophy really hit home with me.

How was their approach or methods any different than other financial firms you met with?

I really like their comprehensive approach. They really emphasize starting with getting protection from all things that are out of one’s control. No one likes to talk about life insurance or disability insurance, but until you are secure it is difficult to move on to the investment/ wealth building conversation. Once my base was secure, they focus on making your money make money. It is a very efficient and successful strategy for wealth building. In addition, he helps set up additional professional contacts to round out the team. Whether a CPA that understands physician’s issues or an asset protection attorney to set 6

Dr. Scott Powell grew up in Florida, starting in Valrico and then moving to Jacksonville. He started his education at the University of Florida where his obsession with the Florida Gators began. After graduation, he moved back to the Tampa Bay area for medical school at the University of South Florida College of Medicine where he also obtained his Masters of Business Administration. He stayed at USF for his residency in the Department of Otolaryngology-Head and Neck Surgery.

Following his training, he joined Tampa Bay E.N.T. In addition, he also joined the USF faculty as a clinical faculty member at the James A Haley VA Hospital where he continues to help train residents. He is a member of the American Academy of Otolaryngology-HNS, American Academy of Otolaryngic Allergy, American Academy of Facial Plastics Surgery, FMA, FSO, and HCMA. up a trust, he has the system to cover all the bases.

Do you believe the methods and strategies that Scott and his team use could be a benefit to other physicians and why?

As physicians we always have to be aware of the potential of litigation. Asset protection is key to any physician’s plan. Scott and his team emphasize the asset protection side while simultaneously setting up the insurance protection. For example, by using whole life policies vs. term life, I am able to use the life insurance as not only asset protection and security, but also as an investment vehicle.

This is not necessarily considered “mainstream” but he took the time to show the benefits and once it sank in, it made complete sense.

Once all the above is in place, they pivot to help to use one’s money to make money. Scott is active in the business and investment community to opens investment doors that would otherwise not be open.

As physicians we spend countless hours at our craft and have little to no time to focus on these very important issues. I find great comfort in knowing they are constantly keeping watch on my financial goals and also provide robust support when called upon.

Doctor’s Life Tampa Bay

Issue 5, 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

Is It Time For a

Total Wealth Check-up?

I

t’s safe to say that the world of finance is changing. But, the hard truth remains that while money is easy to make, it’s even harder to keep. This is because money is a dynamic object that feels and responds to multiple pressures. A traditional needs based approach is outdated; “How much do you need to retire,” and “How much does your family need to sustain their lifestyle” are no longer sufficient questions. This is your life. It’s time to focus on what you want from it.

Incorporated in 2003 by CEO and founder Scott Jarred, Jarred Bunch Consulting is a firm that has prided itself on flipping the traditional hierarchy, and paving the way to the future of wealth management.

Specializing in risk management, asset protection, and investments, Jarred Bunch’s core philosophy is to take a dynamic approach to wealth management; an allinclusive, family office strategy that is here to educate, guide, and counsel you toward reaching your full financial potential.

In the beginning years of the company, Scott and his team noticed a special need among physicians for a family office strategy. “Taking this vow to care for and protect human life is something extraordinary,” says Scott. “Often times though, this can cause them to lose sight of doing what’s good for them. Providing them with our comprehensive, family office strategy gives them a team that can ensure their well-being is looked after now and well into the future.”

This mindset led to the development of Jarred Bunch’s financial education program for residents and fellows, presenting it in hospitals all over the Tampa Bay and surrounding areas. As the program grew, so did the firm’s focus on helping to provide physicians with specialized strategies for wealth management. And thus, their niche in the medical community was born.

DLM: Why do you think finance is something that physicians don’t necessarily take the time to address regularly?

Scott Jarred: I think that it comes from the pledge they take early on; to care for the well-being of others. Not just anyone can go and be a doctor. It takes a special kind of person, someone who genuinely cares about taking care of people. Once they get into practicing, they become so busy with their careers and families, that looking after themselves financially is one of the last things on their minds. But 8

Scott Jarred, CFP, CEO of Jarred Bunch Consulting Scott Jarred is a 2014 recipient of the Five Star Wealth Management Award and was a keynote speaker at the 2014 national winter medical conference for the Young Physicians Section of AAPI (American Association of Physicians of Indian Origin).

Doctor’s Life Tampa Bay

Issue 5, 2014

in all honesty, that’s part of why most go into this field; not only is it rewarding on a personal level, but also on a monetary level.

This is where we decided to develop a family office strategy, a team designed to put the physician and their family first, creating a balancing act between caring for others while simultaneously caring for themselves. A balancing act that I have found can be hard to achieve when you don’t have that supportive team around you taking care of it.

DLM: Is there a common problem that you see when you first start to work with physicians?

Scott Jarred: Yes, there are definitely common themes that I have seen over the years. For example, when I meet with a physician, one of the first things that I talk about is the “junk drawer;” the place where all things financial in their lives end up, IRAs, 401(k)s, insurance policies, bank statements, investment accounts. And I get it. They are so busy with their day to day lives, that they just don’t have time to sit down and look at what they really have going on. This can be a big problem, because if you can’t connect the pieces of the puzzle correctly, how are you ever going to see the big picture? So, I thought, why not give them a way to do this. Our technology, the Living Balance Sheet®, can allow them to aggregate and organize all of their financial information onto a digital platform, and give them a daily, realtime picture of their current financial position. I like to call it their financial x-ray. Then, we can see the big picture of how every component is working together, and really diagnose their overall financial health. Physicians are some of the most intelligent people in our world today. It’s just a matter of giving them the right tools so that they can make effective, smart financial decisions.

DLM: How did you get your start in the medical community?

Scott Jarred: Well, it really started with the residency and fellow programs. When we first started the company, we had no physicians as clientele – and no clientele for that matter, so we really tried to focus on an area where we thought there was a true need for financial education. My partner happened to find a financial curriculum that was being given to residents at a teaching hospital in Boston, and it all kind of hit me. Finance isn’t usually something that is discussed or talked about early on in physician’s careers, so I felt that there was a strong need for someone to come in as an educational resource for them, and to develop specialized strategies that would speak to people in their profession specifically. We adopted our own residency program, and after building it up, we were able to help educate hundreds of residents and fellows in hospitals around the area. And from here, things just grew, and our team really decided to focus on how to help these professionals, who have one of the most unique careers. Today, about 85% of our clientele are physicians or are in the medical field, and we still continue to provide our educational residency and fellow program to this day.

DLM: Why do you think Jarred Bunch Consulting stands apart from other firms when it comes to a specialization in physicians?

Scott Jarred: I think one of the main reasons is because we offer a comprehensive strategy, and a family office strategy at that. And when I say family office, I mean that you literally have a team of people, including myself, tracking your financial well-being every single day. Today, so many people in my industry are focused on just one aspect, like just investments or just insurance. But it’s not usually one tool that makes up a physician’s financial life, there are multiple tools. And, it’s not uncommon for a physician to be interacting with a dozen different advisors or financial institutions at any given time.

While this may be the norm, it can also create a large disadvantage Issue 5, 2014

for them. When was the last time that their CPA, investment manager, estate planning attorney, and insurance agent all sat down together on their behalf, to see if everything is working to accomplish their goals? Hardly ever do I have someone answer yes to this question, simply because they don’t have the time, and quite frankly neither do their advisors. This is where we come in. We treat our physicians as the CEO of their household. Our job is to be their CFO. Today, information and knowledge are power; our job as their CFO is to harness all of that information and knowledge from their outside advisors, and put it into one, comprehensive wealth management strategy that we foster and nurture for them. In my experience, the best CEOs are the ones who understand what is being done on their behalf, and who make the critical financial decisions in their own

“As a physician, my passion has always been to help others. Finding Jarred Bunch’s financial team has allowed me to focus on my passion and at the same time ensure that my best interests, and those of my family, are always protected, respected, and heard.”

– Dr. Shalin Shah, D.O., Florida Cancer Specialists interest. Thus, as their personal CFO, we give them tools to do this.

DLM: You said that you can “manage” the information being given to physicians by their outside advisors. Can Jarred Bunch develop and implement a complete financial strategy for a physician as well?

Scott Jarred: Of course. I come in as the lead on strategy design, and then our team supports the implementation and maintenance of that strategy. Most times, physicians who come to us already have a CPA in place, or even already have their money invested somewhere else. We will give them a complimentary financial analysis showing them where they are at, and the strategy recommendation that we would make, and let them decide for themselves how they want to proceed. Basically, we give them a way to keep current advisors they may already be working with, but can still manage and implement an overall strategy for them. Or, they may come to us with no financial strategy in place whatsoever, so we will put one together for them, and get them in touch with all of the right people. We have CPAs, Attorneys, Property and Casualty Brokers, Mortgage Officers, and more that we have developed strong strategic alliances with, and who provide exceptional service to our clients.

DLM: What unique features or tools are you able to offer your clients?

Scott Jarred: Definitely our wealth management platform, and

Doctor’s Life Tampa Bay

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our investment platform. As I said, the Living Balance Sheet® that can aggregate all of their financial information, and give them a live feed of their current financial position. A huge factor in maintaining financial balance. This platform then breaks up the information into four components: assets, liabilities, protection, and cash flow, letting them see how it all fits together. Essentially, this lets them see how their decisions play out across all of these areas, because one decision usually affects all four. Take a 401(k) plan for example; you have protection in that it’s protected from creditors, you have an asset in your portfolio, you increased cash flow because contributions go in pre-tax, and then you have a deferred liability which will come into play when you start to pull that money out, and pay tax. Most people don’t think about their decisions this way, so our platform allows them to do this, and to weigh the pros and cons before they make decisions. We have a unique investment platform as well, in that we can offer our clients direct access to institutional money managers. Something the majority of people aren’t able to access, because typically you need a lot of zeros in your portfolio to do so. But, we can give every client this access; whether they have $100 or $100 million. Another key component on this platform is that we make protecting their assets a top priority, by ensuring their assets never go onto someone else’s – or institution’s – balance sheet. Their assets are held in their name and their name alone.

Securities products and advisory services offered through Park Avenue Securities LLC (PAS), member FINRA, SIPC. Financial Representative of The Guardian Life Insurance Company of America (Guardian), New York, NY. PAS is an indirect, wholly-owned subsidiary of Guardian. Jarred Bunch is not an affiliate or subsidiary of PAS or Guardian.

The Living Balance Sheet® (LBS) is a registered service mark of Guardian. © Copyright 2005-2014. 2014-12603

One of the things I appreciate most about Jarred Bunch consulting is their personal touch... they are always interested in knowing what is going on in my life, not just my finances. I know they consider me more than one of many clients or portfolios.

– Dr. Sheetal Patel, MD, President & CEO, S K Imaging, PLLC

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The Legal Corner

Hospital Fair Hearing Process An examination of peer review systems in hospitals

A

By Bruce D. Lamb Board Certified in State and Federal Government and Administrative Law Gunster Health Law Practice Group Leader

lthough impacted by federal and state regulations and Joint Commission requirements, hospital bylaws and credentials policies (hereinafter “Bylaws”) are the primary source of procedural rules controlling peer review investigations and hearings in most hospitals and other health care facilities. The structure of the Bylaws can have a significant impact on the scope and subject matter of the issues presented in a peer review hearing. Having represented both hospitals (and their medical staffs) and practitioners, and having served as a hearing officer in peer review hearings, I have concluded that hospitals should carefully examine their Bylaws to assure that the hearing process provided is appropriate.

The Health Care Quality Improvement Act of 1986 (“HCQIA”) provides qualified immunity to professional review bodies and participants if the action is taken: (1) in the reasonable belief that the action was the in furtherance of quality health care; (2) after a reasonable effort to obtain the facts; (3) after adequate notice and hearing procedures are afforded to the physician or after such other procedures as are fair to the physician under the circumstances; and (4) in the reasonable belief that the action was warranted by the facts known after such reasonable effort to obtain the facts and meeting the requirements for adequate notice and hearing. The Joint Commission evaluates medical facilities based on a focused set of core “standards” for quality patient care. To acquire and maintain Joint Commission accreditation hospitals are subject to an on-site review which includes a review of Bylaws and policies. The Joint Commission standards are intended to assure that practitioners are properly qualified to provide the services that they are credentialed to perform. This requires an ongoing assessment of quality including a recredentialing process.

Joint Commission standards also require that Bylaws provide for a hearing process that provides a fair hearing to practitioners when concerns have been identified that may result in adverse decisions for existing medical staff members and other individuals holding clinical privileges. Generally, Joint Commission standards require that the Bylaws provide for a fair hearing process that: is designed to provide a fair process; has a mechanism to schedule a hearing if requested; identifies the procedures for the hearing; identifies the composition of an impartial hearing committee of peers; and provides a mechanism to appeal adverse decisions to the governing board of the facility.

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Other guidance regarding peer review fair hearings is found in the statutes of most states. For example, Florida law requires that each licensed facility provide for peer review of physicians who deliver health care services at the facility. Each facility is required to develop written binding procedures under which such peer review shall be conducted. Such procedures must include a mechanism for choosing membership of the body or bodies that conduct peer review; the adoption of rules of order; a fair review of the case with the physician; a mechanism to identify and avoid conflicts of interest; the recording of agendas and minutes that may be reviewed by the Agency for Health Care Administration; an annual review of the procedures by the governing board of the licensed facility; and a focus of the peer review process on the review of professional continued on page 14

Doctor’s Life Tampa Bay

Issue 5, 2014

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continued from page 12 practices at the facility to reduce morbidity and mortality and improve patient care. Florida law also requires that a peer review investigation be undertaken if there is a reasonable belief that a staff member has committed acts that constitute grounds for discipline including medical negligence or the failure to comply with the policies, procedures, or directives of the risk management program or any quality assurance committee of the facility. The final decision in a peer review matter must be made by the governing board of the facility, after considering the recommendations of its peer review panel. Florida Statutes also provide that there will be no monetary liability on the part of, and no cause of action for damages against a facility, its governing board, peer review panel, and others involved in the peer review process for any action taken in a peer review proceeding without intentional fraud. It is well settled in Florida, that if a facility and its peer review panels act without intentional fraud, and in a manner consistent with its written peer review process, no liability will be imposed.

The aforementioned regulations and standards merely set minimum due process requirements. It is the Bylaws that provide the specific procedures for investigations and hearings. A failure to follow the Bylaws may give rise to an action for civil damages and a waiver of immunity.

In this article, we will examine the manner in which the peer review process is conducted in various facilities. It has been my experience that there are two basic forms or “models” of Bylaws utilized to conduct peer review proceedings in most facilities. One of these models provides for procedures that are similar to those utilized in criminal justice and professional regulatory systems.

I will characterize this as the “de novo review” model. The other model places more emphasis and responsibility on the first peer review committee recommendation, and shifts the burden to the physician in a hearing process to establish that the initial recommendation is improper. I will characterize this as the “appeal model.”

For purposes of illustration, I will utilize a typical issue relating to a concern regarding the quality of care rendered by a physician at a facility. In most instances a concern relating to the quality of care rendered by a physician will first be considered by a quality improvement committee. Typically, the physician is notified of a concern relating to the quality of care and invited to meet with the quality improvement committee to discuss the concern. If the quality improvement committee is satisfied with the physician’s explanation the matter will not typically proceed further. However, if the quality improvement committee continues to have concerns relating to the quality of care, those concerns are elevated for review by another committee. These committees have various titles. In some instances this review is conducted by the facility’s medical executive committee. This “peer review committee” will typically review the materials and recommendation of the quality improvement committee. If it agrees that there is a concern regarding the quality of care it may make a recommendation. For purposes of this illustration, we will assume that this committee recommends that the practitioner be restricted from performing certain procedures in the hospital. The physician is then notified of this decision. If the physician is in agreement, the restriction is implemented. If the physician disagrees, the formal disciplinary process is engaged.

In both models the physician will be notified of the specific 14

Facilities and organized medical staffs should carefully review their bylaws so that they are the aware of the due process procedures to assure they are comfortable with the system that has been created. criticisms and patients involved. The physician will also be notified of the due process rights available under the Bylaws. In addition, an ad hoc hearing panel will be appointed for the purpose of conducting a hearing. From this point forward the two models differ.

In the de novo review model, the burden is placed on the hospital or its organized medical staff to prove the allegations made against a physician at the hearing. The hearing panel is given the responsibility to determine whether the allegations have been proven, and if so, make a recommendation as to the sanction or remedial action to be imposed. In the appeal model, the recommendation of the peer review committee is presumed to be appropriate. The physician has the burden of establishing that the recommendation of the peer review committee is not appropriate.

In many instances the appeal model requires that the physician bear an enhanced burden of proof such as “clear and convincing evidence.” The physician may be required to prove that the peer review’s committee’s recommendation was arbitrary, capricious, or not supported by facts. The appeal model does place a significant burden on the physician and thus “favors” the facility and its organized medical staff. However, this model may have significant unintended consequences.

Under the appeal model, the subject matter of the hearing is potentially expanded. Since the burden is on the physician to show that the peer review committee’s recommendation was arbitrary, capricious, or not supported by fact, evidence of the manner in which the peer review committee proceeded, along with any motive, or bias of any member of the peer review committee, or others providing evidence or services to the peer review committee, become relevant issues for consideration. The affected physician can change the focus of the hearing from his or her quality of care, to an attack of the peer review process and its participants.

Thus although the appeal model shifts the burden of proof to the physician it may also expand the scope of the issues to be litigated, creating an opportunity for the physician to attack the preliminary process and subjecting members of the medical staff leadership to attacks on their motives and competency. This can have a negative impact on the willingness of members of the medical staff to participate in leadership positions. Facilities and organized medical staffs should carefully review their bylaws so that they are the aware of the due process procedures to assure they are comfortable with the system that has been created. The review should also confirm that the Bylaws meet the requirements of HCQIA, the Joint Commission and any applicable state regulations.

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Issue 5, 2014

s p u o r G r e p Su FINDING YOUR SUPER POWER

By Kathleen A. Hargreaves CPA Kerkering Barberio

W

ith the continued evolution of the healthcare industry under the Affordable Care Act, many private practice physicians find themselves in situations where they are being removed from insurance panels due to exclusive contracts being executed with larger practice groups. This scenario has played out with several of my clients recently, and it is certainly a daunting situation to be in.

That, coupled with the increased costs of running a solo practice, has caused many physicians to begin seeking new opportunities to do business. One such opportunity that presents itself to many, particularly in single specialty groups, is the formation of a “super group” practice.

When built effectively, the super group model enables physicians to retain some autonomy, while presenting new opportunities for revenue and cost savings. The primary benefit of the super group is the centralization of services like billing, human resources, accounts payable and information technology, and the ability to scale more efficiently. Super groups are typically set up under a single Tax ID for contracting and billing, and are generally able to negotiate better rates with insurance companies, as well as providing increased opportunities to get on panels and become exclusive providers in the particular practice area where they serve.

Larger-scale operations also benefit from lower collective costs for business expenses like malpractice insurance, information technology, employee payroll and healthcare benefits, along with the ability to secure better pricing from suppliers for medical supplies.

Merging several practices together is not an easy task. Here are some key elements to consider for super group success:

COMMON PURPOSE AND SHARED VISION

To ensure the successful implementation of a super group, there should be a clear purpose for the merger that everyone understands and agrees to. Reasons typically involve making more money or, with the advent of the Affordable Care Act, not making less money. Transparency and trust are critical when multiple entities are involved. The team of physicians must be aligned, not only from a clinical perspective, but a philosophical one, as well.

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SUPER GROUP CHAMPION

A successful super group will be led by a champion, who is typically a physician or key executive who is well respected and willing to devote substantial time to the successful launch of the business (much of which is without pay). The ideal candidate for this role will be effective in engaging with other physicians to bring them onboard and keep communications flowing, and will also serve as the point person for the professional management team required to form the business component of the super group.

PROFESSIONAL MANAGEMENT TEAM

The goal of any merger must be to have a great start-up and seamless transition. Essential to achieving this goal is a team of experienced, knowledgeable professionals who will work in concert to develop a plan that emphasizes growth, stability and profitability. The focus of this team is to get the medical practice on the road to thinking and running like a business.

The critical areas of involvement are as follows:

INFRASTRUCTURE - LEGAL AND ACCOUNTING

Naturally, medical mergers must be carefully planned from a legal and compliance perspective, and it is important to select attorneys and accountants who specialize in corporate matters, health care law and health care accounting. They will provide the organizational framework for the entity.

The legal and accounting team is responsible for creating the budget and timeline, obtaining financing, and will work with other teams, such as operations and human resources, providing specialty services.

OPERATIONS

The operations team is responsible for setting up the systems and procedures for the new organization. This includes the set up of the revenue cycle (including the EHR) and accounting system.

HUMAN RESOURCES

While personnel policies and procedures will need to be written for the new entity, the HR team will need to survey offices pre-merger in order to assess staffing positions, levels, salaries and benefits.

Forming a super group is not a swift process; it can take up to a year or more to complete the transition. Depending on the size of your new group, it may also be helpful to bring in a consultant to assist with merger activities and manage all of the intricacies of the transition. There are many details to work out when bringing separate practices together to form a new entity, but laying the groundwork with a shared vision, a champion practitioner and an experienced professional management team will give you the power you need to make your super group a success.

Kathleen Hargreaves joined Kerkering Barberio in 1992 and was admitted as shareholder in 1997. She leads the firm’s Healthcare Advisory Services practice and specializes in individual and business tax consulting. Kathleen and her team provide best practice service solutions to healthcare industry organizations, including all physician specialties, laboratories, hospitals and ambulatory surgery centers.

Issue 5, 2014

Doctor’s Life Tampa Bay

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Standing up in the Fight Against Heart Disease and Stroke J

abil might be known globally for supply chain management and electronic manufacturing, but in Tampa Bay they stand out for their community involvement, charitable giving, and lively work culture.

Last year, Jabil president Bill Peters was the American Heart Association Tampa Bay Heart Walk chair. Jabil — a 2014 Tampa Bay Heart Walk signature sponsor — was the No. 1 fundraising company for the 2013 Tampa Bay Heart Walk, raising more than $260,000.

This year, Jabil’s COO and American Heart Association Heart Walk cabinet member Bill Muir is championing the fight against heart disease and stroke — and having fun while doing it.

Why do you support the American Heart Association?

What motivated you to become a Heart Walk cabinet member?

Bill Muir: At first, it was largely around continuing to 18

contribute to a great cause and a cause that our employees at Jabil passionately embrace. It’s been a fun way for us to energize our folks and it’s great for our culture. In the last few months, it’s become much more personal as my dad has encountered a few health concerns. He’s had a pacemaker inserted for arrhythmia and subsequently an aortic valve replacement. I have now seen firsthand the incredible advancements that have taken place in cardiovascular health, and the direct contributions the American Heart Association makes to science and research. I like contributing to that.

How does Jabil encourage its associates to embrace health and wellness? Do you offer any wellness initiatives or incentives in the workplace?

Bill Muir: We try to create an environment that encourages healthy activity through numerous onsite programs like yoga, boot camps and CrossFit. We also help sponsor employees for local triathlons, duathlons and cycling events. This past April, we

Doctor’s Life Tampa Bay

Issue 5, 2014

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participated in the American Heart Association’s National Walking Day where we encouraged our associates to get outside and walk as a team during their lunch break. We’re supportive of anything that fosters good teamwork and rewards an active lifestyle.

Raymond James Financial CEO and American Heart Association Heart Walk Chair Paul Reilly set this year’s Tampa Bay Heart Walk fundraising goal at $3 million. What is Jabil doing as a company to fundraise for this year’s Heart Walk? How much money has the company raised to date?

Bill Muir: We try to do a lot of things to make fundraising fun for our employees, and just a bit competitive. This year we had our first ever Heart Walk Draft, which we ran like a mock NFL Draft.

We have a Bucs tailgating and game outing later this month that should draw 120 to 150 folks.

At Jabil, it’s also important that we lead by example. This year, as part of our internal Executive Challenge – where executives pledge to individually raise $5,000 for the Tampa Bay Heart Walk – we will have a 40-yard dash competition. It’s a running joke that some guys are faster than others, so now is the time for everyone to put their money where their mouth is! The teams are excited to see their managers compete. We also host a golf tournament that brings together some of our global partners.

Jabil committed to raising $100,000 this year and we’re working hard to clear that hurdle.

Where is your favorite place in Tampa Bay to exercise?

What other ways do you stay healthy?

Bill Muir: I’m fortunate to live in the perfect place to exercise.

I love running and riding my bike on Bayshore and around Davis Island. I try to do a few triathlons, 5Ks and half-marathons each year. I’m pretty careful with my diet, too.

On Aug. 1, 2014, the American Heart Association launched a new national brand called Life is Why. Everyone has a reason to live a healthier, longer life. What is your Why? Bill Muir: My dad is why.

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Bill Muir, COO, Jabil

Doctor’s Life Tampa Bay

Issue 5, 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.

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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

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Fit Corner

How to Stay Healthy While Maintaining a Busy Schedule -hour days and busy weekends with family and friends can consume your calendar. Maintaining a 18 healthy diet and a regular fitness program are most likely the last thing on your mind. Here are a few strategies that will help keep your health goals on track and time manageable.

1. BECOME A MORNING EXERCISER OR DON’T SIT DOWN WHEN YOU GET HOME Morning exercising does take a little discipline and requires the obvious of getting up earlier. However, it checks your workout off your list for the day and allows you to start your day feeling accomplished. If morning workouts are just not an option then it is best to bring your workout clothes to work so you can exercise prior to going home. If you are like most of us after a long day, once we get home and take a second to relax, the couch potato syndrome sits in and a nap sounds a lot better than exercise.

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2. USE A DAILY PLANNER AND SCHEDULE FOR YOUR WORK OUTS AND MEALS

Like most people with busy schedules we rely on calendars, daily planners and scheduled events to keep our work day commitments. Use the same systematic techniques to maintain a healthy diet and fitness program. Schedule your meals and snacks just like you schedule a meeting. It is easy to overlook a meal when your day becomes overwhelmingly busy. Do the same with your workouts. Make them part of your schedule. One of the best attributes of successful people is time management. The time management part you most likely have down to a science, now just add healthy eating and fitness into your schedule.

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Issue 5, 2014

3. PLAN WORKOUT DATES WITH OTHERS

You are more likely not to skip a planned workout when someone else is relying on you. Having a fitness partner keeps you accountable and social.

4. PACK YOUR LUNCH AND SNACKS

One of the best practices to maintain a healthy weight is to pack your meals and snacks ahead of time. When you pack your lunch and carry your own snacks, you aren’t as tempted to eat out or to reach for something that’s unhealthy. Keep your healthy snacks visible and displayed on your desk. This will eliminate the urge to visit the vending machine. It is also a good idea to keep healthy breakfast choices at work for the days you forget to eat breakfast before going to the office. It is no different than how you succeed in your business. Having a plan and being prepared to follow the plan brings successful results.

5. STICK TO A ONE DRINK RULE

Although it may be tempting, try to stick to a one drink minimum per week. Moderation is best when it comes to alcohol consumption. Most people often turn to alcohol for a stress-reliever and for relaxation, but this can spell trouble for your waistline if you are having a drink every day. To savor your drink more, choose a beverage that will take you longer to consume. Red wine is a good

Issue 5, 2014

option, as well as some varieties of white wine, like a dry Riesling.

6. MAINTAIN A FOOD AND EXERCISE JOURNAL

Keeping a journal keeps you honest with yourself. It also shows your accomplishments. At the end of a week, your journal will show how you maintained your healthy eating and fitness plan or how you didn’t. Both are great to see. Think of it as getting a weekly spreadsheet on yourself.

7. KEEP WHATEVER YOU DO FUN AND FRESH

If you do the exact same workout and eat the exact same healthy food every week, you will become bored and be tempted to take days off and pursue unhealthy food choices. Change it up.

Look at it as a journey of new experiences. Try new healthy food choices and look for new fitness activities. This will keep your interest and allow you to explore.

8. FINALLY, HAVE A REWARD DAY

Reward days are not cheat days. However, if you kept to your plan all week, reward yourself. Take your family out dinner, or go have ice cream with your kids. It does not mean to gorge on everything unhealthy all day. Take some time and pick something you can share with family or friends. It will keep you in check.

Doctor’s Life Tampa Bay

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Imagine a private island with a spectacular two-mile, white sand beach and the only footprints are yours.

Such a place really exists.

Just 13 beachfront units and several private rental homes.

No cars, no crowds, no hassles.

It will win your heart.

Elegant cuisine and as much or as little as you want to do.

Daily Snorkeling Trips Bone, Reef, Deep Sea Fishing Off-Island Excursions New Spa Services

The Meridian Club on Pine Cay Turks and CaiCos islands For inFormation 649.941.7011 reservations@meridianclub.com meridianclub.com

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.

Luxury getaway on the world’s best beach What do you need in a vacation? Comfort without fuss? Warmth mixed with refreshing trade winds? Natural beauty? Excellence in service performed at a relaxed pace with a certain charm? Then make some time for the Turks & Caicos Islands, where your pulse rate is sure to slow down.

Turks and Caicos is actually made up of over 40 islands and cays east south east of the Bahamas, spanning a distance of less than 100 miles from east to west and even fewer north to south. Just eight are inhabited, each reflecting distinct natural beauty, history and culture. Most visitors spend their time on Providenciales, the perfect place to unwind, but trips to the outer islands are highly recommended if you are looking to get a better impression of this small lively nation. Scheduled air flights and well organized excursions are readily available.

Providenciales’ Grace Bay Beach consistently receives accolades as the world’s best beach. It was named after Grace Hutchings, an early visitor in 1892, in honor of her beauty, style and of course grace.

This pristine 12 mile beach seems to have that perfect combination of fine white powder sand, expansive vistas, constant breezes and yet no crowds. The sea colors will stay with you forever; shades of Tiffany blue, turquoise, cobalt and more; and the sunsets are not to be missed. Many of the country’s most luxurious resorts are here, making for easy movement between one world class refreshment experience to another. Of course there’s nothing like becoming a ‘local’ in your own luxury resort, and one that has received the World Travel Award for the Caribbean’s Leading Boutique Hotel from 2005 to 2010 is Point Grace, Luxury Resort & Spa. The resort is appropriately named as it sits on the ‘point’ half way along Grace Bay Beach where with it’s expanse of white sand and untamed beauty you feel like you are on your own desert island. The resort’s magnificent suites, restaurants and spa are all inspired by classic turn-of-the-century British Colonial architecture creating a West Indian setting untouched by time.

The islands are a divers feast with close to shore wall drops of up to 8,000 feet. Humpback whales pass by during Spring whaling season. Nature can be found in many forms from turtles to osprey eagles. Fitness lovers will find quality gyms, classes and watersports with expert tuition. Kite-boarding, triathlons, 5/10K runs, sea-swims are all pursuits to join in. Tennis, golf and horse-back riding are all catered for, again with experts on hand. Fishing from bone fishing to deep sea fishing is world class. There is plenty to do if you are looking to be active.

World class chefs seek to impress you with their signature dishes creating a cosmopolitan fare, but Caribbean and nativestyle dishes abound with the fresh catch of the day and the country’s own Conch.

Dining is everything from a simple to luxurious experience. You’ll find a huge selection of wines and drinks on offer too. Point Grace’s elegant gourmet restaurant, Grace’s Cottage, has specialized in pairing fine wines with inspired cuisine for many years now. Come, take time to enjoy cuisine at it’s best, in the best possible settings.

Your body and soul have already entered a new dimension, where you feel energized but utterly peaceful. The Point Grace Thalasso Spa is all you need to further the restoration process. Treatments are European in style; Thalassotherapy using the islands natural resources and Thalgo products. The setting is truly West Indian; white washed exquisite cottages just set back from the natural beach dunes with inspiring sea views and breezes.

Turks and Caicos is very accessible with many international flights.

It’s just over an hour from Miami and two and a half hours from New York amongst many routes. Your first vision of the islands from the plane will be awe inspiring. You’ll finally know you are on vacation.

Getting through the soon to be expanded small airport terminal is fine but a discrete courteous fast track VIP Flyers service is available; Turks and Caicos will give you the luxury you desire at every step.

Those that live in the islands keep their history and culture close to their hearts, but they also move with the times and going-green, ecotourism and government-reform are all hot topics. There is certainly a pride in the islands that we do things our way, we don’t just follow others, and that gives the islands a spirit all to their own.

If you chose to visit Turks and Caicos you’d very likely become one of our many return visitors, so we hope to see you very soon.

AFRICA

ASIA

EUROPE

LATIN AMERICA

MIDDLE EAST

NORTH AMERICA

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