San Antonio Medicine December 2016

SAN ANTONIO

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The Business of Medicine

Marketing a medical practice online today requires social media engagement

By Joey Berlin, Reporter ......................................18

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BCMS President’s Message ...........................................................................................................8 UTHSCSA Gala........................................................................................................................................12 Healthy Aging from San Antonio OASIS. .................................................................................................27 Feature: Thoughts on Painting the Porch Railing By Fred H. Olin, MD ...................................................28 Book Review: When Breath Becomes Air By Paul Kalanithi, MD, Reviewed by Rajam Ramamurthy, MD .................................................................................................30 BCMS Legislative News ..........................................................................................................................32 BCMS Auto Show ....................................................................................................................................34 UTHSCSA Dean’s Message By Francisco González-Scarano, MD ........................................................36 BCMS Circle of Friends Services Directory .............................................................................................38 In the Driver’s Seat...................................................................................................................................43 Auto Review: 2017 Audi Q7 By Steve Schutz, MD .................................................................................44

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4 San Antonio Medicine • December 2016

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VOLUME 69 NO. 12

EDITORIAL CORRESPONDENCE: Bexar County Medical Society 4334 N Loop 1604 W, Ste. 200 San Antonio, TX 78249 Email: editor@bcms.org

The Precision of Attention

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If you can’t beat them, join them: What can primary care physicians learn from retail clinics? By Amer Kaissi, PhD ..............................14

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BCMS BOARD OF DIRECTORS ELECTED OFFICERS Jayesh B. Shah, MD, President Sheldon Gross, MD, Vice President Leah Jacobson, MD, President-elect James L. Humphreys, MD, Immediate Past President Gerald Q. Greenfield Jr., MD, PA, Secretary Adam V. Ratner, MD, Treasurer

DIRECTORS Rajaram Bala, MD, Member Jorge Miguel Cavazos, MD, Member Josie Ann Cigarroa, MD, Member Kristi G. Clark, MD, Member John W. Hinchey, MD, Member John Robert Holcomb, MD, Member John Joseph Nava, MD, Member Bernard T. Swift, Jr., DO, MPH, Member Francisco Gonzalez-Scarano, MD, Medical School Representative Carlos Alberto Rosende, MD, Medical School Representative Carlayne E. Jackson, MD, Medical School Representative Jennifer Lewis, BCMS Alliance President Roberto Trevino Jr., MD, Board of Censors Chair Jesse Moss Jr., MD, Board of Mediations Chair George F. "Rick" Evans Jr., General Counsel

CEO/EXECUTIVE DIRECTOR Stephen C. Fitzer

CHIEF OPERATING OFFICER Melody Newsom Mike W. Thomas, Director of Communications August Trevino, Development Director Brissa Vela, Membership Director Alice Sutton, Controller

COMMUNICATIONS/ PUBLICATIONS COMMITTEE Rajam S. Ramamurthy, MD, Chair Kenneth C.Y. Yu, MD, Vice Chair Fred H. Olin, MD, Member Esmeralda Perez, Community Member Jaime Pankowsky, MD, Member David Schultz, Community Member J.J. Waller Jr., MD, Member Adam Ratner, MD, Member Alan Preston, Community Member Lewis Greenberg, MD, Member Sara Noble, Medical Student Lauren Michael, Medical Student Jane Yoon, Medical Student

6 San Antonio Medicine • December 2016

PRESIDENT’S MESSAGE

Holiday Greetings from the President!

By Dr. Jayesh Shah, 2016 BCMS President

I am humbled and honored by the opportunity that was bestowed on me to serve as the President of this esteemed organization. Years may come and go but whatever changes we as physicians collectively make should have a positive impact on the future of health care. The issues physicians faced yesterday will be different from what they will face tomorrow and such issues can only be addressed if young physicians realize the importance of their involvement in organized medicine so they can make their voices heard and can recommend changes that are in favor of both the physicians and their patients.

the first few years, followed by a 2 percent decrease last year.

As we wind up the year, I would like to highlight what we accom-

The six major chronic diseases responsible for 75 percent of all

plished at BCMS in 2016. But first, I would like to share a program

health care costs are; high cholesterol, high blood pressure, excess

called “Healthy Choice” developed by the Cleveland Clinic to im-

weight, diabetes, asthma, and tobacco use. In the Cleveland Clinic

prove the future of health care.

program, workers saw a physician or a mid-level provider who mon-

Each individual should be responsible for their own health and

itored weight, cholesterol, etc., and offered education and counseling

for shaping their own future. Obesity is one of the biggest drivers

for a healthy lifestyle. The Healthy Choice program was voluntary,

of preventable chronic diseases and associated health care costs in

but because incentives were huge (i.e. workers who met the goal

the United States. Health care costs in the U.S. are 20 percent more

could save 28 percent in health insurance premiums) many workers

per capita than the rest of the world and the bottom line is that

participated in the program. Since 2010, almost 66 percent of work-

health care costs are higher because people are sicker. Many have

ers with one or more of the six major chronic conditions managed

chronic conditions because of poor lifestyle choices (the problem of

to get them under control, with a majority of them continuing to

plenty). Even though people know maintaining a healthy weight

keep them under control. The incentive system succeeded in chang-

and eating healthy are important, it is hard to put this thought into

ing behavior. Cleveland Clinic also made changes such as removing

practice. If we can incentivize healthy behavior, we can control some

unhealthy options and reducing portion sizes in their cafeteria, re-

chronic conditions and decrease health care costs.

moving high sugar snacks and drinks from their vending machines,

“Healthy Choice” was started by the Cleveland Clinic for its employees in 2010. The key idea was to give employees incentives to

adding an onsite fitness center, and providing yoga classes along with other health boosting activities.

avoid six chronic medical conditions and, in return, see a decrease

A few employers across the nation are following this program de-

in their insurance premium rates. This program has been a huge suc-

signed by Cleveland Clinic and are developing work place wellness

cess. Cleveland Clinic showed a flat-lining of health care costs for

programs for their employees to decrease health care insurance costs. continued on page 10

8 San Antonio Medicine • December 2016

PRESIDENT’S MESSAGE continued from page 8

Incentivizing employees by decreasing their health insurance premi-

and engaged in many media interactions on Zika, the TMB and

ums is in turn making employees healthier and happier.

vaccine safety.

Can we implement Cleveland Clinic’s Healthy Choice program

BCMS continues to support many active committees serving its

in all health care systems throughout the U.S.? Can we incentivize

membership, including legislative and socio-economic, physician

patients and change their behaviors? At some point, with health

health and rehabilitation, public health, emergency preparedness,

care costs skyrocketing and the Medicare system not able to handle

communications and publications, caduceus, medical-legal liaison,

the cost, is it fair to ask citizens to pay more for their healthcare if

as well as mediations and censors. A new leadership committee was

they do not choose to participate in healthy lifestyle choices? Once

formed to encourage and mentor physicians to participate in the

consumers of healthcare buy into this incentive system, people’s be-

governance of TMA and BCMS.

havior will change and that will also change the food industry. The food industry will ultimately have to change and provide more healthy choices at affordable costs.

The BCMS Foundation gave $15,000 in scholarships in 2016 to graduating high school senior entering healthcare.

BCMS held many events throughout the year including CME

In the same way CMS has developed incentives for physicians to

events, New Member Welcome Social, Women in Medicine Event,

participate in quality measures, is it possible for CMS to develop in-

general membership meetings, the annual automobile show, the an-

centives for patients to follow healthy lifestyle choices? The future

nual installation of new BCMS officers, and a variety of seminars

of healthcare will require the redesign of primary care and develop-

and socials. Some of these events were fundraisers and contributed

ment of incentives for healthy behavior.

to BCMS’ overall financial success and helped to keep the cost of

And now some of the accomplishments in 2016 at BCMS:

dues reasonable.

Probably the most significant accomplishment of 2016 was the

BCMS continued the information flow to its members through

completion of the new BCMS building on Loop 1604. The building

the San Antonio Medicine magazine, The Weekly Dose newsletter, reg-

was dedicated in May 2016 and was named “Project of the Year” by

ular email updates and announcements, and has added social media

the American Subcontractors Association. The BCMS building

to physicians and the public with at least five posts per day. The

houses the society’s staff and is used for all society committee and

number of users that friended BCMS in 2016 is now over 330.

board meetings, special events, community events, health fairs and

BCMS will continue to face challenges as the delivery of health-

automobile show, but is also used by several physician and commu-

care changes. I am confident that BCMS has a solid foundation and

nity groups and organizations. Feedback about the new building re-

will continue to deliver future leadership to strengthen organized

ceived from BCMS members, their friends and supporters has been

medicine. I would like to thank the Executive Committee, the Board

extremely positive. BCMS also prepared a historical souvenir booklet

of Directors, CEO Steve Fitzer, and all the staff at BCMS for their

about the history of BCMS buildings in Bexar County and provides

outstanding support throughout this year.

some basic information about BCMS services and membership.

Thank you,

BCMS members all contributed to the new building and many

With warm regards and wishing you a Happy Holiday Season!

community businesses contributed as well – thank you!

Dr. Jayesh Shah

Advocacy on behalf of physicians and medicine is always the number one initiative of BCMS, and it was no different in 2016. During the year, BCMS participated in over 20 legislative meetings and events, responded to several calls for action advising federal and state agencies on issues such as MACRA, the TMB, and the VA system,

10 San Antonio Medicine • December 2016

Cleveland Clinic program reference: http://www.mauldineconomics.com/frontlinethoughts/how-torebuild-healthcare-right

UTHSCSA GALA

Ninth Annual

UT Health Science Center PRESIDENT’S GALA The UT Health Science Center's ninth President's Gala Sept. 24 celebrated the military and the important collaborations the Health Science Center shares with the military. More than 1,100 community leaders attended. William L. Henrich, M.D., MACP, president of the Health Science Center, announced that gala proceeds will establish The Maj. Gen. (USA Ret.) Joe and Patty Robles Chair in Military Health Research.

TOP: Shown at the President's Gala of the UT Health Science Center San Antonio are (left to right) retired U.S. Air Force Maj. Gen. Byron C. Hepburn, M.D.; Debby Hepburn; UT Health Science Center President William L. Henrich, M.D., MACP; UT System Chancellor Bill McRaven and Georgeann McRaven. Chancellor McRaven is a retired four-star U.S. Navy admiral.

The gala was held Sept. 24.

MIDDLE: (Left to right) President William L. Henrich, M.D., MACP, host of the UT Health Science Center's President's Gala, and Mary Henrich visit with gala honorees Patty Robles and retired U.S. Army Maj. Gen. Joe Robles. Following his military retirement, Gen. Robles served as president and CEO of USAA from 2007 until 2015. The gala established The Maj. Gen. (USA Ret.) Joe and Patty Robles Chair in Military Health Research at the Health Science Center.

BOTTOM: (Left to right) Retired Air Force Col. Donald Jenkins, M.D., and Elaine Jenkins, visit with Jill Cancio and Army Col. Lee Cancio, M.D., at the UT Health Science Center San Antonio President's Gala Sept. 24. Dr. Jenkins is associate deputy director of the Military Health Institute and clinical professor of surgery at the Health Science Center. Dr. Cancio is a critical care fellow in the Department of Surgery's Division of Trauma & Emergency Surgery at the Health Science Center.

12 San Antonio Medicine • December 2016

BUSINESS OF MEDICINE

IF YOU CAN’T BEAT THEM,

JOIN THEM:

What can primary care physicians learn from retail clinics?

By Amer Kaissi, PhD Convenient care models are new ways of healthcare delivery that are designed around patient preferences and located in areas that are easily accessible to them. Retail clinics in pharmacy chains and grocery stores treat minor conditions such as upper respiratory infections, urinary tract infections and minor rashes, and offer physicals and vaccinations (1). They are the prime example of innovative delivery models that cater to patients’ needs of convenience, price 14 San Antonio Medicine • December 2016

transparency, and short wait times (2).

When retail clinics first appeared in 2000, primary care physicians (PCPs) were quick to dismiss them as a low-quality alternative to rigorous physician care. As the clinics started to gain popularity between 2008 and 2012, physician groups and professional associations expressed their strong opposition to them. The American Medical Association (AMA) and its state affiliates, the American

BUSINESS OF MEDICINE Academy of Family Physicians (AAFP), and especially the American Academy of Pediatrics (AAP) warned about the episodic nature of

Non-physician providers such as nurse practitioners and physician assistants can provide high quality care at lower costs with or without

retail clinic visits and their potential negative impacts on patient continuity of care (3-7).

With more than 2,000 locations and 10.5 million patient visits

physician supervision (20-21).

nationwide, retail clinics are now considered a common feature of the American healthcare landscape (8). While the majority of PCPs still do not endorse them and privately lament the competition that they have brought on, some have reluctantly accepted their presence, especially with strong scientific evidence backing them up. Numerous peer-reviewed studies to date have shown that retail clinics provide care that is of comparable quality to that provided in physician offices and urgent care centers (9-12), and represent significant costsavings over Emergency Room use (9). Patient satisfaction is very high, especially with no appointments required, short wait times and after-hours availability (13).

Experts predict that retail clinics are here to stay: their numbers are expected to keep increasing in the next few years, especially with the Affordable Care Act (ACA) providing new insurance coverage to millions of Americans (14). The evidence shows that many patients, especially middle-aged men, do not have a PCP relationship to start with (1). Even patients with a regular source of physician care appreciate convenience and accessibility and sometimes use retail clinics in addition to their PCP. As importantly, hospitals and health systems looking to increase their access points and reduce their per-patient costs have invested in partnering with or developing their own retail clinics (15-19).

In the face of this new reality, what should PCPs do to stay competitive and relevant? Here are some suggestions that forward-looking physician practices could benefit from considering:

Get out of busy medical centers and closer to where patients live and work Most physician offices are located in busy medical centers where parking is problematic and access is reduced. The majority of patients prefer to have their primary care physician within five miles of where they live and/or work. Retail clinics in San Antonio for example are located inside CVS, Walgreens and H-E-B stores — places that are very close to home and that the patient already frequents several times per week.

Bring on a nurse practitioner or physician assistant Busy practices with large patient panels cannot meet the demands of their patients, and adding new physicians can be cost-prohibitive.

Offer after-hours care on weekdays and weekends Most physician offices are open on Mondays-Fridays from 9 a.m. to 5 p.m., with some variations. The majority of people are at work or school during these regular business hours. Therefore, the very act of going to a physician’s office presents inconvenience. When patients need primary care on evenings or weekends, the only available options other than retail clinics are expensive Emergency Rooms and unpredictable urgent care centers. PCP practices should consider offering evening and weekend hours that meet patient needs and preferences.

Reduce wait times Retail clinics keep wait times to a minimum through the automation of medical records and the use of efficient processes. Electronics kiosks provide a quick and easy way for patients to check-in while the provider is seeing another patient. Parents of teenagers, for example, do not want to wait two hours in a busy PCP practice just to get a sport or camp physical. Physician practices should take a hard look at their processes and identify bottle-necks and obstacles that increase wait time.

Without doubt, most patients still prefer to seek care at their PCP office and value the relationship they have with him/her (22). But faced with long delays in appointment times, long wait times, and limited hours, many are using retail clinics in addition to or instead of their PCP office. PCPs that want to compete in the new healthcare environment of consumerism and value-based care should consider changing some of their practices.

Amer Kaissi is Professor and Director of the Executive Master’s Program in Healthcare Administration at Trinity University. He is the author of the book “Flipping Health Care through Retail Clinics and Convenient Care Models” published in 2014.

The Executive Master’s Program at Trinity is ranked in the Top 10 programs nationally. The part-time, hybrid-learning format is designed for physicians and managers currently working in a healthcare setting who have decided to pursue a graduate degree while continuing to work full-time. continued on page 16

visit us at www.bcms.org

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BUSINESS OF MEDICINE continued from page 15

References 1. Mehrotra, A., Wang, M. C., Lave, J. R., Adams, J. L., & McGlynn, E. A. (2008).

Retail clinics, primary care physicians, and emergency departments: A comparison of patients’ visits. Health Affairs, 27(5), 1272-1282.

2. Kaissi, A. (2014). Flipping Health Care through Retail Clinics and Convenient Care Models. IGI Global Publishers.

3. American Academy of Family Physicians. (2010). AAFP board revises retail health clinic policy academy opposes ongoing expansions in scope of service. Retrieved from http://www.aafp.org/news-now/inside-aafp/20100224retail-policy.html 4. American Academy of Family Physicians. (2013). Retrieved from http://www.aafp.org/home.html 5. American Academy of Pediatrics. (2006). AAP principles concerning retail-based clinics. Retail-Based Clinic Policy Work Group. Pediatrics, 118, 2561 6. American Academy of Pediatrics. (2013). Retrieved from http://www.aap.org/enus/Pages/Default.aspx 7. American Medical Association. (2013). Retrieved from http://www.ama-assn.org/ama 8. Bachrach, D., Frohlich, J., Garcimonde, A., Nevitt, K. (2015). Building a Culture of Health: The Value Proposition of Retail Clinics. Robert Wood Johnson Foundation Report.

9. Mehrotra, A., Liu, H., Adams, J. L., Wang, M. C., Lave, J. R., Thygeson, M., McGlynn, E. A. (2009). Comparing costs & quality of care at retail clinics with that of other medical settings for 3 common illnesses. Annals of Internal Medicine, 151, 321-328.

10. Rohrer, J. E., Yapuncich, K. M., Adamson, S. C., & Angstam, K. B. (2008). Do retail clinics increase early return visits for pediatric clinics? Journal of the American Board of Family Medicine, 21, 475-476.

11. Rohrer, J. E., Angstam, K. B., & Furst, J. W. (2009). Impact of retail walk-in care on early return visits by adult primary care patients. Quality Management in Health Care, 1, 18-23.

12. Rohrer, J. E., Garrison, G. M., Angstam, K. B. (2012). Early Return Visits by Pediatric Primary Care Patients with Otitis Media: A Retail Nurse Practitioner Clinic vs. Standard

16 San Antonio Medicine • December 2016

Medical Officer Care. Quality Management in Healthcare, 21(1): 44-47.

13. Hunter, L. P., Weber, C. E., Morreale, A. P., & Wall, J. H. (2009). Patient satisfaction with retail health clinic care. Journal of the American Academy of Nurse Practitioners, 21(10), 565-570.

14. Accenture. (2015). US Retail Health Clinics Expected to Nearly Double by 2017 According to Accenture Analysis. Retrieved from https://www.ahip.org//wp-content/uploads/2016/06/accenture-retail-health-clinics-pov.pdf 15. Kaissi, A. (2010). Hospital- affiliated and hospital-owned retail clinics: Strategic considerations and operational challenges. Journal of Health Care Management, 55(5), 325329.

16. Kaissi A. & Charland, T. (2013). Hospital-owned retail clinics in the United States: Operations, patients and marketing. Primary Health Care, 3(1).

17. Kaissi, A., & Charland, T. (2013). How satisfied are hospital systems with their ownership of retail clinics? Journal of Healthcare Management, 58(2), 143-153.

18. Kaissi, A. (2015). Dealing with the Challenges of Healthcare Reform: American Hospital Systems Strive to Improve Access & Value through Retail Clinics” In Pedersen, A.; Waldorff, S.; Ferlie E., and Fitzgerald, L. (Eds.), Managing Change-From Health Policy to Practice. 2015.

19. Kaissi, A. Shay, P., Roscoe, C. (2016). Hospital Systems, Convenient Care Strategies, and Healthcare Reform.” Journal of Healthcare Management. 61(2), 148-163.

20. Mundinger, M.O., Kane, R.L., Lenz, E.R., Totten, A.M., Tsai, W.Y., Cleary, P.D., et al. (2000). Primary care outcomes in patients treated by nurse practitioners or physicians: a randomized trial. JAMA, 283(1), 59–68.

21. Lenz, E., Mundinger, M., Kane, R., Hopkins, S. Lin, S. (2004). Primary care outcomes in patients treated by nurse practitioners or physicians: Two-year follow-up. Medical Care Research and Review, 61(3), 332-351.

22. Merchant Medicine. (2015). Patient & Customer Perspectives on Walk-In Medicine: A Merchant Medicine Research Report conducted by Sparks Research and sponsored by DX Marketing.

BUSINESS OF MEDICINE

Marketing a Medical Practice Online Today Requires

SOCIAL MEDIA ENGAGEMENT

By Joey Berlin, Reporter, Texas Medical Association

The brief but evolving history of social media has already given physicians some valuable lessons on how they should and shouldn’t use it to generate more exposure for their practice and image.

One good rule of thumb involves generating and circulating content that has real meaning to patients, referring physicians, or whatever audience you’re trying to reach. Steer clear of posting xrays of gunshot victims online and joking about it. A Kansas physician actually did just that prior to losing a U.S. Senate primary election in 2014.

Beyond those do’s and don’ts, doctors have a lot more to think about when building a modern online presence for their practice.

The explosion of social media and the expectations of frequently refreshed content have changed the rules for physicians and practices looking to market themselves and bolster their online reputation.

Just as static websites have become a relatively archaic part of the online equation, the marketing expectations for physician and practice websites have changed substantially.

“The doctors who want to avoid social media should know it’s here, and the majority of physicians will be using it,” said emergency physician Carrie de Moor, MD, a member of the Texas Medical As18 San Antonio Medicine • December 2016

sociation Council on Practice Management Services. “So they’re going to lose out on that market share if they’re not promoting their business in that venue. It’s going to [look like] you’re not up to date.”

Social Science The Woodlands pediatric gastroenterologist Bryan Vartabedian, MD, says physicians shouldn’t resist having a public presence through digital channels like social media. Dr. Vartabedian is the author of the e-book The Public Physician: Practical Wisdom for Life in a Connected, Always-On World.

Dr. Vartabedian says the perception was that physicians who wanted to avoid Facebook or Twitter could “hide beneath their exam room table, and things would just pass them by.”

“If people search for you and they can’t find anything meaningful or anything good, it’s potentially a liability,” he said. “I think the market forces are such that for doctors to be competitive, they have to have some presence in public.”

BUSINESS OF MEDICINE

TMA’s book Get Social: Put Your Practice on the Social Media Map says any physicians building a social media presence need to start by developing their content strategy. That starts with figuring out what audience you want to reach — prospective patients, referring colleagues, or the news media — then considering what you know about that audience.

Get Social is one of the publications TMA offers that helps physicians improve their business acumen with new marketing tools.

Business Basics for Physicians informs physicians about accounting and financial management basics, long- and short-term business planning, marketing fundamentals, and more.

Dr. Vartabedian says the best way for physicians to market themselves or their practices is to create enduring content that has value to the target audience. That can be as simple as creating and posting a two-minute video or a 300-word blog post on a subject that is helpful for the targeted viewers or readers. Local hospital blogs are often the best outlet for that kind of content, he says.

“Hospitals are always desperate for content for their blogs,” Dr. Vartabedian said. “So if you can write an expert position on some health [issue], people are going to read that, and they’re going to want to come and see you.”

While physicians can reach new patients with Facebook and Twitter, Dr. Vartabedian says doctors can help themselves greatly by setting up profiles on the professional social media network LinkedIn, or Doximity, an online social network specifically for doctors.

Facebook and Twitter are useful for doctors to promote content.

For Facebook, Get Social advises, “Look for news articles or blog posts that match the topics in which you want to establish your expertise. Add a comment with your own thoughts on links to the latest research findings your patients might care about. Share worthwhile posts you find on others’ Facebook pages. Announce an upcoming special event or patient education activity that your practice is hosting, like a flu shot clinic or prenatal class.”

But Get Social also warns physicians to moderate the self-promocontinued on page 20

visit us at www.bcms.org

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BUSINESS OF MEDICINE continued from page 19

tion that appears on their feeds, advising, “Share content your target audience will find valuable in its own right far more frequently than the ‘hey, look at me’ posts.”

Website Essentials Dr. de Moor, chief executive officer of The ER at Craig Ranch in McKinney, says physicians don’t have to shell out huge amounts of money to meet expectations for what a medical practice website should look like.

“It doesn’t have to be a million-dollar website,” she said. “It just needs to be a little bit more functional [so it’s] something that doesn’t look like it came out of 1992. It needs to look clean, professional, have some information that you think patients are going to want to know.”

In September, TMA’s Council on Practice Management Services voted to approve a new endorsed vendor, Officite, to assist physicians with website design, social networking, and more. (See “Marketing Help Is Here.”)

Kevin Rach, Officite’s marketing communications manager, says the company stresses four basic must-have ingredients for every medical practice’s website: • It should showcase the most basic information about the practice, such as the names of the physicians, the practice’s address and phone number, and ways in which someone can schedule an appointment.

• It should work on any device. A report by Internet research company comScore showed between February 2013 and May 2014, users spent 60 percent of their digital media time on smartphones and tablets.

• It should be customized — for example, it should display photos of the actual practice setting and staff, rather than placeholder images. “People can smell stock photos from a mile away, and they don’t like them,” Mr. Rach said. “They want to see you, they want to see the care that they will be getting.”

• It should look attractive. “You don’t need to be a website fashionista by any stretch of the imagination,” Mr. Rach said. But, make sure your site ditches the primitive staples of the early years of the Internet, such as scrolling marquees and website hit counters.

“If you look outdated on the website, then that suspicion tends to creep in about the rest of the practice,” Mr. Rach said. “That assumption isn’t usually true, but it’s the kind of connection that consumers often make.”

The ER at Craig Ranch website features physician photos, detailed biographies, and a link for patient payments.

“We’re in emergency medicine, so people don’t have a whole lot 20 San Antonio Medicine • December 2016

of time [to research us],” Dr. de Moor said. “But we’re hoping that people get to know us a little bit better than they would a typical ER doctor. We do have people that come in and say, ‘Oh, I’ve seen you.’ They actually get to know the person who’s treating them and learn a little bit more about us.”

Mr. Rach says staff pages on medical practice websites should strike a balance between the personal and the professional.

“You definitely want credentials, such as education information, but there also needs to be a little bit of [the] personal,” he said. “Patients need to feel like they’re getting to know the doctor a little bit.

It makes it easier for them to see you as something more than a list of degrees that they don’t fully understand.”

Patient portals on a practice website can offer online bill pay and other features, such as access to test results. Mr. Rach says not all practices have to have patient portals on their websites. Practices with an older, less technologically savvy patient base may not need one, for instance. Physicians who are participating in the Centers for Medicare & Medicaid Services meaningful use program must have a patient portal as part of their patient-engagement measures.

For questions about patient portals and other information related to health information technology (HIT), contact TMA’s HIT Helpline at (800) 880-5720 or by email.

Building an effective website hinges on identifying the target audience, says Don McKenzie, Officite’s director of business development.

Officite, a new TMA endorsed vendor, offers website and Internet marketing services for medical practices.

Officite helps physicians build their web presence and connect with patients.

Services include website design, search engine optimization, social networking, and management of patients’ online practice reviews. For more information, or to learn more about discounted TMA member pricing and packages, visit www.officite.com or call (888) 817-4010.

BUSINESS OF MEDICINE

“Your primary audience will be new and existing patients,” he said.

“But great website messaging speaks to all your audiences, including referring physicians, spouses, staff, Google, etc. Perhaps consider addressing your charitable organizations and community outreach on site. Figure out all of your audiences and then work backward to create a winning website experience for your website visitors.”

What Not to Do The Public Physician says two things define a doctor’s public presence: conversations and content. While “conversations are great,” Dr. Vartabedian says, “content is better.”

Get Social encourages physicians to join ongoing Twitter discussions to express agreement or disagreement or to provide information that can add to the discussion, for example.

“Be wary, though,” the book warns. “Far too many tweeters are hypersensitive to anyone who disagrees with them, especially on controversial topics (and that can be anything from politics to college football). You’ll rarely win an argument on Twitter.”

Complaining about patients online is forbidden, and even mentioning anything about a patient in an online post is risky. In 2010, Westerly Hospital in Rhode Island fired Alexandra Thran, MD, after she posted a comment online about an emergency department patient, according to a report in The Boston Globe. Although Dr. Thran didn’t mention the patient by name, the Globe reported, the state medical board filing said her post contained enough identifying information that others in the community could figure out the patient’s identity. The board reprimanded Dr. Thran and fined her $500.

St. Louis obstetrician-gynecologist Amy Dunbar, MD, drew calls for her firing from St. John’s Mercy Medical Center in early 2013 after she vented on Facebook about an unnamed mother-to-be who Dr. Dunbar said was three hours late for her induction. Dr. Dunbar ended her post by asking Facebook readers, “May I show up late to her delivery?” She later added a comment that she was tolerating the patient’s lateness because the patient had a “prior stillbirth.”

Dr. Dunbar’s posts generated anger from other social media users, some of whom argued her disclosure of a previous failed pregnancy violated patient privacy. St. John’s Mercy condemned her comments as “definitely inappropriate,” according to reports, but later released a statement saying it had confirmed she hadn’t violated privacy laws.

Kansas radiologist Milton Wolf, MD, a candidate for U.S. Senate in 2014, got busted by The Topeka Capital-Journal for previously posting x-ray images of gunshot victims on his Facebook page, “along with jokes about the deceased.” Dr. Wolf later apologized for the posts but lost in the primary to incumbent Sen. Pat Roberts (RKan.).

Last August, Dr. Wolf claimed on his former campaign website that the state Board of Healing Arts had ended an investigation into the posts “without any findings of wrongdoing.” Confidentiality prevented the ethics board from confirming to the CapitalJournal whether it had exonerated Dr. Wolf, according to a story the paper published later that month.

Online reviews of physicians or practices on sites like Yelp or Health Grades may tempt some physicians into negative online engagement. But Mr. Rach says one of the biggest mistakes physicians can make is to discount those reviews.

BrightLocal’s 2015 Local Consumer Review survey showed as many as 80 percent of respondents trust an online review as much as a personal recommendation.

“It can be easy for a doctor, especially an experienced one, to dismiss reviews they don’t agree with. They may see an ill-informed review and say something like ‘This isn’t the full story’ or ‘This person doesn’t understand the situation,’ or ‘This is unfair and nobody should listen to this.’” Mr. Rach said. “To an extent, obviously, that’s true, but that’s not the way it’s perceived in patients’ minds.”

Instead of discounting a scathing online review, he says, physicians should respond and do so apologetically. And Get Social notes it’s a good idea for physicians to encourage satisfied patients to post positive reviews online.

“If there is some kind of perceived grievance, no matter how vitriolic the comments get, no matter how viciously they come after you — respond. Respond courteously, and whatever you do, don’t retaliate,” he said. “Say something like, ‘I’m sorry you feel this way; we’re doing everything we can to make [your] experience better.’

And then say something specific, like ‘If you like, we’d love to try and make this right. Here’s our number; please call us. We’ll do whatever we can.’”

Physicians also have to be aware of Texas Medical Board restrictions on advertising their practices. (See “TMB’s Advertising Rules.”) continued on page 22

visit us at www.bcms.org

21

BUSINESS OF MEDICINE continued from page 21

Image Evolution Why should physicians be so mindful of how they craft their online image?

“It’s important for them to understand that there is a conversation happening about them out in the infosphere,” Dr. Vartabedian said. “And you can either let somebody else create your story for you, or you can do it yourself.”

The days of maintaining an effective online presence simply with a practice website are over. Dr. Vartabedian says he didn’t focus on practice websites in The Public Physician because “they’ve kind of gone the way of the dinosaur.”

Get Social says a well-built Facebook page “can substitute for a practice website.” Social media, content generation, reputation monitoring, and other components are now a crucial part of the equation.

“People are using the words Internet presence or web presence, but it’s more than just a website now,” Mr. Rach said. “If you leave a website out there on its own, you’re not really going to get the results you want to see from it. It needs to be a unified effort, and if you don’t have the time available to coordinate that kind of thing, then you should look into investing in the well-being of your practice by finding people who do.”

Joey Berlin can be reached by phone at (800) 880-1300, ext. 1393, or (512) 370-1393.

22 San Antonio Medicine • December 2016

TMB’s Advertising Rules State law and Texas Medical Board (TMB) rules restrict the way physicians can advertise their practices. TMB can discipline physicians for inappropriate advertising with license revocation, criminal penalties, and civil penalties of up to $1,000 per violation.

The statutes and rules prohibit all false, misleading, or deceptive advertising. TMB’s rules contain 18 criteria for advertising that fits that description.

Examples of advertising TMB would deem false, misleading, or deceptive, include ads that: Contain false claims or misrepresentations of material facts that can’t be substantiated; Make a representation likely to create unjustified expectations about the results of a procedure; Contain a testimonial with false, deceptive, or misleading statements or don’t include disclaimers or warnings about the credentials of the person delivering the testimonial; and Include photographs of models or actors but don’t identify them as being models or actors, rather than actual patients.

View TMB’s rules on medical practice advertising.

BUSINESS OF MEDICINE

The Precision of Attention

By Eric Kala CFP, AEP, CLU, ChFC Wealth Management & Business Planning Advisor

It’s not a stretch to recognize that our thinking follows our attention. What we mull over, stew over, research or dwell on governs, or at least certainly influences, our thoughts, our attitudes, and ultimately our decisions. This can work for you or against you.

For example, if your attention is on the roller coaster ride of the markets, it won’t take long to experience the swings of emotion that come with up-markets and down-markets, and for your thoughts to be fixated on the ticker. It’s not a problem to be aware of it, but it usually doesn’t serve you to be checking it minute by minute.

When you’re making financial plans, or managing your plan, attention becomes even more important. Here’s a fundamental that needs to be understood: Planning is not about advice, it’s about decisions.

It’s tempting to put a lot of attention on advice; indeed, many financial advisors put a lot of attention there. But what we’ve found is that, while having good advice is critical, it’s secondary to clarity about the decisions that need to be made. That means

24 San Antonio Medicine • December 2016

paying to have someone at the planning table who can objectively and supportively help you develop the plan you need.

Plans need to be based on one thing, and one thing only: how you want your life to look in the future. That’s called a “vision.”

It doesn’t have to be some benign statement on a plaque, but it’s important to have some sort of picture, idea, story or concept for what the future will be like. That is what a plan needs to address.

If it doesn’t, your attention may not be quite right.

But with a clear vision for the future, you can then start looking forward in a meaningful way. The next place to look is how you want things to happen. For example, we spend time with clients helping them not only articulate their vision, but to name the values, or rules, that need to be respected along the way. Ultimately, only by understanding someone’s vision and values can meaningful goals be created.

Goals are the steps you take that move you closer to your vision in a way that respects your values. When those are clear, then advice can be brought into the mix. Trying to get advice without clarity might feel soothing, but it risks the development of a mis-

BUSINESS OF MEDICINE

guided financial plan.

And how does this connect to attention? It’s this simple: keep your attention on your vision, on the desired future state that matters to you. Work with an advisor who knows how to help you name it and articulate it, because then your attention will be well-placed, and your plans can be well-guided.

Certified Financial Planner Board of Standards Inc. owns the certification marks CFP, CERTIFIED FINANCIAL PLANNER CFP (with plaque design) and CFP (with flame design) in the U.S., which it awards to individuals who successfully complete CFP Board’s initial and ongoing certification requirements.

Eric Kala is a San Antonio based advisor that works extensively with physicians and business owners on their financial wellness and their specific needs around protecting and growing their assets.

Contact Info: 17802 W Interstate 10, Ste. 114, San Antonio, TX 78257 | 210.445.5755 | erickala.com

visit us at www.bcms.org

25

BUSINESS OF MEDICINE

USB=

Universal Security Bust?

A broad window of vulnerability for doctors, clinics and hospitals

By David Schulz, cipp & Ray Sims, cissp

How is your office like Iran’s nuclear program? Both can be brought down by a simple thumb drive. For doctors, clinics and hospitals, this threat can be a matter of life or death.

Saboteurs used USB flash drives to infect Iran’s military computers with malware that destroyed nuclear enrichment centrifuges, spinning them out of control. Just recently, 18 such thumb drives were scattered in a U.S. hospital where they were likely to be found. Within 24 hours, at least one of them was plugged into the network, delivering a payload of malware. Catastrophe was a single keystroke away.

Fortunately, it was a dry run, a test of the hospital’s safeguards to help guide personnel training. It should guide our own as well. As patients increasingly responsible for our own health records, there should be more guidance on maintaining and safeguarding these valuable data.

Doctors, clinics and hospitals have a much broader window of vulnerability which puts patient records at risk as well. With so much digital information flowing in and out of providers’ facilities, regarding patient treatment, payment, or office operations, it may seem convenient for patients to have their records on a thumb drive.

But convenience costs. In today’s world of cyber threat, “honey pots” abound, traps that tempt users with convenience or cost-savings but instead deliver misery in the form of malware. And a USB port taps into some of the deepest, most subterranean aspects of a computer’s control system and is a bullseye for cyber criminals.

Just in the first week of September, two brand new USB vulnerabilities were discovered. First, even a locked computer can be tricked into giving up sensitive information such as usernames and passwords from an unprotected USB port. A special device is used that hoodwinks the computer into believing that it is a network 26 San Antonio Medicine • December 2016

adapter. The computer happily then starts sending all of its network traffic to the rogue device. These types of devices have existed for more than a decade but new software allows them to convince the computer to send even more sensitive information. As the researcher who discovered the vulnerability said, “this is dead simple and shouldn’t work, but it does.” This device is available online for less than $50. (https://lanturtle.com) Scarier, still, a saboteur can now plug in a USB device that electrocutes the equipment to which it’s connected. Brags the manufacturer, “Almost all consumer level hardware fails when tested against the USB Kill 2.0. — Our tests reveal that more than 95 percent of all devices using USB ports will be damaged permanently or completely destroyed by a USB power surge attack.” Again this device is available online for less $50. (https://www.usbkill.com/) It isn’t hard to imagine disgruntled employees or patients, with medical records in hand, or on thumb, wreaking havoc on a provider’s computers and networks. It is important to disable USB ports that are not needed, we recommend physical blockers as they can stop the power surge attack. While USB has brought a previously unknown convenience to the conveyance of information, it is not without its drawbacks. Providers need to stay informed of new challenges and maintain a risk management program that helps them focus their efforts.

David Schulz, information privacy professional, is executive director of Cyber Risk Associates. Ray Sims, information systems security professional, is managing consultant for Decypher Technologies. They collaborate to provide managed compliance services for HIPAA covered entities, assuring both information privacy and data security safeguards are in place and working.

HEALTHY AGING

The Secret to Healthy Aging — Keeping Seniors ACTIVE

It is widely known that staying mentally and physically active helps keep the brain and muscles alert. But there’s more to healthy aging.

Socialization is also crucial to help aging seniors stay young.

That is the principle on which San Antonio OASIS was founded.

At San Antonio OASIS, “we offer educational classes and volunteer opportunities to promote successful aging through lifelong learning.” executive director Brenda Schmachtenberger said.

OASIS founder, Marylen Mann originally established OASIS in 1982 in St. Louis. It was a time when many programs for older adults were oriented around games and passive activities. OASIS pioneered stimulating educational, wellness and volunteer programs that helped older adults stay healthy and engaged within their communities. The OASIS program is now in 9 cities throughout the country.

San Antonio OASIS was founded in 1991, and boasts over 23,000 members. Membership is free with the only requirement being that members are over the age of 50. Classes are offered in 25 locations across Bexar County, and include classes in Arts and Humanities, Health, Fitness, Consumer Interest and Technology. OASIS also offers educational day trips and overnight trips as well.

Another vital component to the OASIS program is volunteerism.

San Antonio OASIS has over 250 volunteers locally. Volunteer opportunities include: office staff, group exercise leaders, class instructors, various committees, as well as the intergenerational tutoring program.

The tutoring program is the largest volunteer program that San Antonio OASIS offers. Over 120 tutors work with 150 children in 4 school districts. The program gives volunteers the opportunity to work one-on-one with first, second and third grade students who the school has identified as needing help in reading.

Researchers Rowe and Kahn found that the key ingredients for a high quality of life are maintaining a low risk for disease, a high level of engagement with the community and high physical and cognitive function. “It is the combination of all three that represents the concept of successful aging fully.” That is the philosophy behind San Antonio OASIS. For more information, call San Antonio OASIS at (210) 2365954, or visit their website at www.oasisnet.org/sanantonio. visit us at www.bcms.org

27

FEATURE

Thoughts on painting the porch railing Fred H. Olin, MD

Our front porch railing needed painting. We had had to re-

took the job of making it look good again. My first mistake was

place it 10 or 15 years ago because the original had been con-

waiting until the rainiest August in 102 years. I got the loose

structed of untreated wood and had rotted out. The new one

paint scraped off fairly efficiently, and then the rains came. My

was made of pressure-treated lumber, which was fine, but it was

next chore was to sand the remaining paint and bare wood to

then painted before the wood treatment had completely dried.

a reasonable smoothness and get ready to paint. This left me

Over the years the paint flaked off and it got so ugly I decided

with some really bad looking railings, balusters and balustrades

to repaint it. That way I knew it would be done correctly.

(yes, I had to look up what the various parts of the railing were

My stepfather, Paul W. Berg (1914-1980), was a house

called.) There were visible margins where the bare wood met

painter…but that understates reality. He was a master at the

the paint that had stayed stuck. I didn’t want to sand it down

trade back when there were no spectrophotometers in every

all the way to bare wood: it would have removed too much ma-

paint store and big-box hardware emporium to help you dupli-

terial. Additionally, there were cracks in the wood where the

cate the color of your grandmother’s favorite shawl. He did it

grain had split a bit and miscellaneous dents and places splin-

with linseed-oil-based paint, concentrated colors in oil and an

ters had broken off. Here’s a picture of how the wood looked

amazing eye. He taught me how to paint and even (sort of )

as I got ready to paint it.

hang wallpaper. Here’s a direct quote: “Anyone can slap paint

OK, here come the unsolicited testimonials: First came choos-

on a wall but it takes a painter to get ready to paint.” And

ing paint, and thank goodness for the internet. It turns out that

therein lies the story of my porch railing.

Sherwin-Williams has a product designed to make deteriorating

It was a mess. There were paint flakes all over the porch and

wood siding look good again. It’s primer and acrylic paint all in

more was hanging on, flapping in the breeze and looking just

one, it’s called “Rejuvenate,” and it does what they says it does:

plain ugly. Some paint, however, had adhered well and wasn’t

sort of levels out irregularities, small cracks and divots, and gives

going anywhere. So, after a year or two of contemplation, med-

what they call a “low-sheen” finish (that’s PR for “flat”). At the

itation, consideration, procrastination and planning, I under-

top of page 29 you can see how it looked before and after I started.

28 San Antonio Medicine • December 2016

FEATURE

before

after

For my next product endorsement, here’s an inexpensive plas-

back. And an old lesson from Dad: when you stop for the day,

tic gadget called a “Can Holster” that I purchased at Lowe’s. It

clean all your tools, especially the brush. One unforgivable sin

solves the problem of the edge of a 1-gallon can getting filled

when I was a kid was to “heel” the brush, which meant leaving

up with paint as you strip excess off of the brush while painting.

a lot of paint to harden in the bristles up near the handle.

You can then replace the lid cleanly by tapping it into place

I had compulsively calculated the total square-footage of the

with a hammer (I used a rubber mallet) and it doesn’t get glued

parts needing painting: there are 123 balusters, each 30 inches tall

down. Below the edge on the near side in this view there’s a

and 1½ inches on each of four sides, six railings and balusters,

ledge for stripping the brush, and the pocket is convenient to

104 inches long, whose tops and two sides’ measurements were a

hold a brush, as illustrated. A picture of their product is repro-

total of about four inches in width in height. It appeared that the

duced at the top of page 28.

estimated coverage of the gallon of paint would be enough. How-

Here are a few things I have learned during this project. The

ever, here’s something that almost any home-handyman knows:

most important is this: as you do the painting, do the top rail

any project worth the title will require at least a couple of trips to

last. It’s tempting to do it first because it’s right there, easy to

the hardware store. Sure enough, I underestimated how much

see and easy to get to. But unless you are young, flexible and

sandpaper I’d need and I couldn’t find the paint mixer that fits

agile (none of which describe me) and it’s wet, you don’t have

into an electric drill and that I had last seen about 35 years ago, I

anything to grab onto to help you get up off of your knees. Do

didn’t have any disposable gloves, and as of this writing, I still have

you have to ask how I happen to have figured this out? Next, if

two sections to paint. We shall see…

you’re using a water-based paint, keep a bucket of water nearby into which you can dunk, dip, drop, slosh or throw whatever

Fred H. Olin, M.D. is a retired orthopaedic sur-

needs it. That way you can break for lunch and whatever tools

geon who is blessed that he doesn’t have to prove to

you’re using can go into the bucket for the duration and you

you that he’s the best inside-the-house painter you’ve

will be able to clean them up and keep working when you get

ever met…but he is.

visit us at www.bcms.org

29

BOOK REVIEW

When Breath Becomes Air By. Paul Kalanithi, MD Reviewed by Rajam Ramamurthy, MD

You that seek what life is in death, Now find it in air that was once breath.

New names unknown, old names gone: Till time end bodies, but souls none.

Reader! Then make time, while you be, But steps to your eternity.

-Baron Brooke Fulke Greville. “Caelica 83” Randomly browsing through the shelves — could have been at the airport — I picked up a book titled ‘When Breath Becomes Air.’ Recently my eyes seem to focus on topics that deal with ‘end of life,’ like a magnet wand that snaps on metal objects at the beach as the sweeper scans the sand. We do choose our reading very often to feed our intimate thoughts. Thoughts I could not or would not share as I stood at my husband’s bedside day after day that fateful month, April 2016.

Breath Becomes Air, a New York Times Best Seller, was written

by Dr. Paul Kalanithi, a surgeon who was in his final year of training in neurosurgery when he was diagnosed with lung cancer. Paul’s richness of language surprised me for we in medicine generally chuckle when we speak of notes surgeons write. The depth of his thoughts reflect his vast reading of serious writings. There is almost a cadence to his style like this one I quote; “I lay there in the dirt, awash in sunlight and memory, feeling the shrinking size of this town of fifteen thousand, six hundred miles from my new college dormitory at Stanford and all its promise.” I almost felt ashamed and kept apologizing to Paul for deriving this vicarious pleasure of reading his beautiful writing when he was laying his life open as the ravaging lung cancer was greedily robbing him of life and all that could have been.

The book throbs in your hands as though Paul has infused his life into its pages. Paul goes to visit a close friend in New York City.

Lucy, his wife, refuses to go. She has to sort out many things about how their relationship is moving; Paul not sharing with her his concerns about the diagnosis of what is happening with his health is one of them. Tears welled up in my eyes as I read the part where Paul was going to talk to Lucy about the X-ray report. “Lucy picked me up from the airport, but I waited until we were home to tell her.

We sat on the couch and when I told her, she knew. She leaned her head on my shoulder and the distance between us vanished.”

The book is the third in a row of books that I read that bring to 30 San Antonio Medicine • December 2016

our conscience the topic of death that we physicians avoid. What makes life meaningful enough to go on living? It is a question each one of us gracefully donning our senior citizen cloak have to give some serious thought to. There is one prognosis in life that is so easy to pronounce yet we never do. Most of all we in the medical profession don’t. That is the eventuality of death. Everyone dies.

The physician’s knowledge and experience should place them in the best possible position to guide each patient through their illness and recovery or sometimes through illness and death with as much compassion and guidance. As per Paul “when there is no place for the scalpel, words are the surgeons only tool.”

Oh! There is so much more that Paul expounds that I read and reread. This passage about god really answered some questions that arise and nag my scientific thinking. “Science may provide the most useful way to organize empirical, reproducible data, but its power to do so is predicated on its inability to grasp the most central aspect of human life: hope, fear, hate, beauty, envy, honor, weakness, striving, suffering, virtue.” His writing touches upon so many aspects of humanity as though he, in his death, has comforted many.

There are aspects of Paul’s story that I do not comprehend, I never have. It has always troubled me when terminally ill patients begot children. Who am I to judge a soul standing at the edge of life. I so want to move away from such thoughts and leave those of you daring enough to pick up and read a book such as this that will awaken your feelings in so many spheres of life.

Rajam Ramamurthy, MD, Professor Emeritus. Pediatrics/ Neonatology, UTHSCSA. The late Dr. Paul Kalanithi’s widow, Dr. Lucy Kalanithi, will be speaking at an event hosted by UT Medicine San Antonio’s Center for Medical Humanities and Ethics in March 2017. For details, please visit texashumanities.org.

visit us at www.bcms.org

31

BCMS LEGISLATIVE NEWS

BCMS MEMBERS VISIT WITH ELECTED OFFICIALS Many thanks once again to Michael Battista, MD and Pamela Ray, DDS, for hosting a reception in their home in honor of State Representative Justin Rodriguez (House Dist 125). BCMS physicians attending the TEXPAC-sponsored event, took the opportunity to discuss the upcoming legislative session, the state budget and medicine’s issues.

TOP: (l-r) Pamela Ray, DDS; Mark Welborn, MD; Mary Wearden, MD; Rep. Justin Rodriguez; Jesse Moss, Jr., MD; Michael Battista, MD and John Holcomb, MD pause for a photo during a reception honoring Rep. Rodriguez on Nov. 2.

MIDDLE: Members of the BCMS Legislative and Socioeconomics Committee met with State Representative Ina Minjarez (House Dist 124) on Oct. 24 to discuss medicine’s issues in preparation for the upcoming session.

BOTTOM: Committee members met with Congressman Will Hurd (TX-23) on Oct. 26 and discussion centered on a number of federal issues, including: the Veterans Administration, electronic health records, health information exchanges, medical clearing houses, MACRA, health care access, Obamacare, the Appropriations budget and cyber security.

32 San Antonio Medicine • December 2016

BCMS LEGISLATIVE NEWS TOP: Mayor Ivy Taylor (in orange suit) addresses attendees at a reception held in her honor on Oct. 11 at the home of Drs. Leah Gross and Zach Stinson.

BOTTOM: (l-r) Dr. Buddy Swift, event host; Sen. Donna Campbell (District 25); and Dr. Alex Kenton visit during a TEXPAC-sponsored event honoring Sen. Campbell on Oct. 12 at the home of Dr. Buddy and Kathy Swift.

Mark your calendars now to join us for the First Tuesdays visits to the Capitol on Feb. 7, March 7, April 4 and May 2, 2017. To register, go to www.texmed.org/firsttuesdays.

BCMS LEGISLATIVE AND SOCIOECONOMICS COMMITTEE – YEAR IN REVIEW 2016

by Mary E. Nava, MBA, chief government affairs officer With 2016 being an election year, and with the 85th Legislative Session beginning in January, physician members of the BCMS Legislative and Socioeconomics Committee, led by chairman, Alex Kenton, MD and co-chairman, Ashok Kumar, MD, were busy all year long visiting with our elected officials during monthly meetings of this committee to discuss medicine’s issues; assisting TEXPAC with candidate visits; attending and/or hosting legislative receptions and also participating in media interviews on various advocacy topics. The following is a re-cap of this year’s activities: •

•

Participated in over 20 legislative meetings and events, including several TEXPAC-sponsored receptions with elected officials Participated in several calls to action to advise federal and state agencies on medicine’s position on topics such as MACRA proposed rules, TMB proposed rules and scope concerns in the VA system

•

Organized CME presentation with the TMB to discuss legislative updates during the 84th legislative session, in addition to the role and process of the TMB

•

Participated in numerous media interviews on various advocacy topics, including: Zika, TMB and vaccine safety

•

Developed a strategic plan to establish committee goals and activities, to include: development and recruitment of physician key contacts by legislative district For local discussion on these and other legislative advocacy topics, consider joining the BCMS Legislative and Socioeconomics Committee by contacting Mary Nava at mary.nava@bcms.org.

visit us at www.bcms.org

33

BCMS AUTO SHOW

THE BEXAR COUNTY MEDICAL SOCIETY

30TH ANNUAL

AUTO SHOW The Bexar County Medical Society held its 30th annual Auto Show on Oct. 20th at its new building at 4334 N. Loop 1604 West. About 350 people turned out for the event to enjoy the food provided by Corporate Caterers and the smooth jazz music

by BillyRay Sheppard and The Main Event Band. There were more than 100 new cars on display from 25 local dealerships and a number of door prizes were given away throughout the evening. The new building provided ample parking space and lighting for the event.

BCMS Executive Director Steve Fitzer, COO Melody Newsom and Dr. Bernard Swift.

Drs. Ubaldo (Jun) Beato and Maria Tiamson Beato stand next to their new car.

34 San Antonio Medicine • December 2016

BCMS AUTO SHOW

visit us at www.bcms.org

35

UTHSCSA DEAN’S MESSAGE

UT HEALTH SCIENCE CENTER:

MD ANDERSON CANCER CENTER ANNOUNCE AFFILIATION AGREEMENT TO OFFER WORLD-CLASS CANCER CARE TO PATIENTS CLOSE TO HOME

By Francisco González-Scarano, MD

The University of Texas Health Science Center at San Antonio

translational research in San Antonio. Patients also will have access

and The University of Texas MD Anderson Cancer Center are an-

to the MD Anderson model of patient-centered, comprehensive care

nouncing an affiliation to create a comprehensive and clinically in-

provided by multidisciplinary teams that will provide a new dimen-

tegrated cancer care program in San Antonio.

sion in innovative care and treatment options. Through joint tumor

Beginning in mid-2017, the UT Health San Antonio MD Anderson Cancer Center will provide adult cancer patients in South Texas greater access to the most advanced oncology care available.

Through this affiliation, the Cancer Therapy & Research Center

boards, MD Anderson physicians will provide additional multidisciplinary opinions for diagnosis and treatment.

The agreement also will bring new funding from the UT System and private sources to improve the infrastructure at the CTRC, in-

(CTRC) of the UT Health Science Center will collaborate as part

cluding a newly renovated Patient and Family Welcome Center, and

of MD Anderson's international network of hospitals and health

an expanded and more efficient pharmacy, an infusion center de-

care systems dedicated to ending cancer globally. The affiliation will

signed around the patient experience, a diagnostic suite and a

build on MD Anderson's world-class knowledge and capabilities

wayfinding system to help patients more easily navigate. "These im-

along with the UT Health Science Center's expertise and renowned

provements will take time, which is why we will not offer the col-

Institute for Drug Development to benefit patients in the 38 South

laborative services until the middle of next year," said UT Health

Texas counties served by the UT Health Science Center.

Science Center President William L. Henrich, M.D., MACP.

The agreement aligns with the vision of UT System Chancellor

He explained: "We have looked at the projected need for cancer

Bill McRaven to create a "quantum leap" by building collaborative

care in our region, and over the next 10 years we are expecting a sig-

teams of UT System institutions based on the respective strengths

nificant growth in population. Unfortunately, with that growth will

and expertise of the institutions within the UT System.

come many more cancer cases. For example, San Antonio is a very

"MD Anderson is the top-ranked cancer center in America, with

popular place for people to retire, especially from the military. Aging

unparalleled experience, resources and expertise," Chancellor

is one of the biggest risk factors for getting cancer. This affiliation

McRaven said. "This is a fine example of how we can leverage the

will help us improve our facility and patient care to be ready to serve

expertise of our individual institutions with the size and excellence

the needs of our region with the best care possible."

of the UT System to better serve people in our region, the state and beyond," he said.

Ronald A. DePinho, M.D., president of MD Anderson, said, "We are proud to partner with the UT Health Science Center. Through

The affiliation will provide increased access to MD Anderson's

this affiliation, we are working to deliver groundbreaking clinical

treatment protocols, standards of care, extensive clinical trials and

advances focused on prevention, early detection, treatment and re-

36 San Antonio Medicine • December 2016

UTHSCSA DEAN’S MESSAGE

search. Together we have the opportunity to dramatically reduce the pain and suffering caused by cancer for many people and for generations to come."

Partnering with a powerhouse Celebrating its 75th anniversary year in 2016, MD Anderson is a global leader in cancer care, research, prevention and education. It

The two organizations will jointly recruit future cancer physicians

was ranked the No. 1 cancer hospital in 2016 by U.S. News &

and allied health staff members. A national search is underway to

World Report's annual "Best Hospitals" rankings and the leading

hire a medical director to lead the new program.

cancer hospital for nine of the past 10 years.

"Beyond all of these obvious advantages is that we will be able to

MD Anderson is home to the largest cancer clinical trials program

offer our region the very best care close to home," Dr. Henrich said.

in the nation. Last year, more than 9,400 patients were enrolled in

"I know firsthand what it is like to leave my home for treatment,

trials exploring innovative treatments.

away from family and friends at a crucial time. This is why we want this affiliation for South Texas," Dr. Henrich said.

The University of Texas Health Science Center at San Antonio, with missions of teaching, research and healing, is one of the country's leading health sciences universities. Its schools of medicine,

UT Health Science Center expertise

nursing, dentistry, health professions and graduate biomedical sci-

One of only four National Cancer Institute-designated Cancer

ences have more than 33,000 alumni who are advancing their fields

Cancers in Texas (along with MD Anderson), the UT Health Sci-

throughout the world. With four campuses in San Antonio and

ence Center's Cancer Therapy & Research Center brings to the re-

Laredo, the university has a FY 2016 revenue operating budget of

lationship its Institute for Drug Development, one of the largest

$801.8 million and is the primary driver of its community's $30.6

early phase drug development programs in the world. IDD scientists

billion biomedical and health care industry.

work with researchers from the UT Health Science Center, other institutions and cancer centers, as well as the National Cancer In-

For more information on the many ways "We make lives better(r)," visit www.uthscsa.edu<http://www.uthscsa.edu>.

stitute, to evaluate investigational news drugs for U.S. Food and Drug Administration approval.

About MD Anderson

Also brought into the relationship is the San Antonio Breast Can-

The University of Texas MD Anderson Cancer Center in Hous-

cer Symposium, to be held this year Dec. 6-10. Initiated by the

ton ranks as one of the world's most respected centers focused on

CTRC in 1978, the symposium is one of the largest breast cancer

cancer patient care, research, education and prevention. The insti-

research meetings in the world and is now co-sponsored by the

tution's sole mission is to end cancer for patients and their families

CTRC, the American Association of Cancer Research and Baylor

around the world. MD Anderson is one of only 45 comprehensive

College of Medicine. In 2015, the meeting drew 7,576 attendees,

cancer centers designated by the National Cancer Institute (NCI).

with 50 percent coming from countries outside the U.S.

MD Anderson is ranked No.1 for cancer care in U.S. News & World

The Health Science Center is conducting first-in-human brain

Report's "Best Hospitals" survey. It has ranked as one of the nation's

cancer research led by Andrew Brenner, M.D., Ph.D. Through clin-

top two hospitals since the survey began in 1990, and has ranked

ical trials, patients are already benefitting from this new approach

first for nine of the past 10 years. MD Anderson receives a cancer

in which Health Science Center neurosurgeon John R. Floyd II,

center support grant from the NCI of the National Institutes of

M.D., inserts nano-sized radioactive fat particles directly into brain

Health (P30 CA016672).

tumors with very promising results.

In addition, the CTRC's breast cancer team, led by Virginia Kak-

Francisco GonzĂĄlez-Scarano, Dean, School of Medicine,

lamani, M.D., is well known for developing genomic tests that allow

Executive

doctors to predict which treatment will best benefit individual breast

University of Texas Health Science Center San Antonio

cancer patients. CTRC breast cancer researchers also are using drugs

Professor of Neurology

Vice

President

for

Medical

Affairs

to target breast cancer stem cells, believed by researchers to be the first step in preventing breast cancer. visit us at www.bcms.org

37

BCMS CIRCLe OF FRIeNdS SeRvICeS dIReCTORy Please support our sponsors with your patronage; our sponsors support us.

ACCOUNTING FIRMS Padgett Stratemann & Co., LLP (HH Silver Sponsor) Padgett Stratemann is one of Texas’ largest, locally owned CPA firms, providing sophisticated accounting, audit, tax and business consulting services.

Vicky Martin, CPA 210-828-6281 Vicky.Martin@Padgett-CPA.com www.Padgett-CPA.com “Offering service more than expected — on every engagement.”

Sol Schwartz & Associates P.C. (HH Silver Sponsor) We specialize in areas that are most critical to a company’s fiscal well-being in today’s competitive markets.

Jim Rice, CPA 210-384-8000, ext. 112 jprice@ssacpa.com www.ssacpa.com “Dedicated to working with physicians and physician groups.”

ACO/IPA

ASSET MANAGEMENT

Intercontinental Wealth Advisors LLC. (HHH Gold Sponsor) Your money’s worth is in the things it can do for you, things that are as unique and personal as your heart and mind. We craft customized solutions to meet investment challenges and help achieve financial objectives.

Vice President Jaime Chavez, RFC® 210-271-7947 ext. 109 jchavez@intercontl.com Wealth Manager David K. Alvarez, CFP® 210-271-7947 ext. 119 dalvarez@intercontl.com Vice President John Hennessy, ChFC® 210-271-7947 ext. 112 jhennessy@intercontl.com www.intercontl.com “Advice, Planning and Execution that goes beyond portfolio management”

ATTORNEYS IntegraNet Health (HHHH 10K Platinum Sponsor) IntegraNet Health is an Independent Physician Association that helps physicians achieve higher reimbursements from insurance companies whereby some of our higher performing physicians are able to achieve up to 200% of Medicare FFS. Executive Director Alan Preston, MHA, Sc.D. 1-832-705-5674 Apreston@IntegrNetHealth.com www.integraNetHealth.com

ARMY HEALTHCARE 5th Medical Recruiting BN (HH Silver Sponsor) We recruit quality men and women who would like to be a part of our team.

SFC Cherie Kirk 210-692-7376 Cherie.k.kirk.mil@mail.mil www.youtube.com/watch?v=kweqi 3TelO8 "Serving to heal, Honored to serve"

38 San Antonio Medicine • December 2016

Kreager Mitchell (HHH Gold Sponsor) At Kreager Mitchell, our healthcare practice works with physicians to offer the best representation possible in providing industry specific solutions.

From business transactions to physician contracts, our team can help you in making the right decision for your practice.

Michael L. Kreager 210-283-6227 mkreager@kreagermitchell.com Bruce M. Mitchell 210-283-6228 bmitchell@kreagermitchell.com www.kreagermitchell.com “Client-centered legal counsel with integrity and inspired solutions”

BANKING

Amegy Bank of Texas (HHH Gold Sponsor) We believe that any great relationship starts with five core values: Attention, Accountability,

Appreciation, Adaptability and Attainability. We work hard and together with our clients to accomplish great things.

Jeanne Bennett 210- 343-4556 jeanne.bennett@amegybank.com Karen Leckie 210-343-4558 karen.leckie@amegybank.com www.amegybank.com “Community banking partnership”

BB&T (HHH Gold Sponsor) Checking, savings, investments, insurance — BB&T offers banking services to help you reach your financial goals and plan for a sound financial future.

Stephanie Dick Vice President- Commercial Banking 210-247-2979 sdick@bbandt.com Ben Pressentin 210-762-3175 bpressentin@bbandt.com www.bbt.com

Broadway Bank (HHH Gold Sponsor) Healthcare banking experts with a private banking team committed to supporting the medical community.

Ken Herring 210-283-4026 kherring@broadwaybank.com www.broadwaybank.com “We’re here for good.”

Frost (HHH Gold Sponsor) As one of the largest Texas-based banks, Frost has helped Texans with their financial needs since 1868, offering award-winning customer service and a range of banking, investment and insurance services to individuals and businesses.

Lewis Thorne 210-220-6513 lthorne@frostbank.com

www.frostbank.com “Frost@Work provides your employees with free personalized banking services.”

IBC Bank (HHH Gold Sponsor) IBC Bank is a $12.4 billion multibank financial company, with over 212 facilities and more than 325 ATMs serving 90 communities in Texas and Oklahoma. IBC BankSan Antonio has been serving the Alamo City community since 1986 and has a retail branch network of 30 locations throughout the area.

Markham Benn 210-518-2500, ext. 26921 MarkhamBenn@ibc.com www.ibc.com “Leader in commercial lending.”

Ozona Bank (HHH Gold Sponsor) Ozona National Bank is a full-service commercial bank specializing in commercial real estate, construction (owner and non-owner occupied), business lines of credit and equipment loans.

Lydia Gonzales 210-319-3501 lydiag@ozonabank.com www.ozonabank.com

Regions Bank (HHH Gold Sponsor) VP Physician Lending Group Moses D. Luevano, 512-663-7743 phone moses.luevano@regions.com

The Bank of San Antonio (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians.

Our local insurance professionals are some of the few agents in the state who specialize in medical malpractice and all lines of insurance for the medical community.

Brandi Vitier

BCMS CIRCLe OF FRIeNdS SeRvICeS dIReCTORy 210-807-5581 brandi.vitier@ thebankofsa.com www.thebankofsa.com

SSFCU (HHH Gold Sponsor) Founded in 1956, Security Service provides medical professionals with exceptional service and competitive rates on a line of mortgage products including one-time close construction, unimproved lot/land, jumbo, and specialized adjustable-rate mortgage loans.

Commercial Services Luis Rosales 210-476-4426 lrosales@ssfcu.org Investment Services John Dallahan 210-476-4410 jdallahan@ssfcu.org Mortgage Services Glynis Miller 210-476-4833 gmiller@ssfcu.org Bank of America (HH Silver Sponsor) Bank of America provides people, companies and institutional investors the financial products and services they need to help achieve their goals at every stage of their financial lives.

Courtney Martinez 210-270-5494 courtney.martinez@baml.com Denise Smith 210-270-5058 Denise.C.Smith@baml.com bankofamerica.com Making financial lives better — one connection at a time Firstmark Credit Union (HH Silver Sponsor) Address your office needs: Upgrading your equipment or technology? Expanding your office space? We offer loans to meet your business or personal needs.

Competitive rates, favorable terms and local decisions.

Gregg Thorne SVP Lending 210-308-7819 greggt@firstmarkcu.org www.firstmarkcu.org RBFCU (HH Silver Sponsor) 210-945-3800 nallen@rbfcu.org www.rbfcu.org

CONTRACTORS/BUILDERS /COMMERCIAL

Huffman developments (HHH Gold Sponsor) Premier medical and professional office condominium developer.

Our model allows you to own your own office space as opposed to leasing.

Steve Huffman 210-979-2500 Shawn Huffman 210-979-2500 www.huffmandev.com

RC Page Construction, LLC (HHH Gold Sponsor) Commercial general contractor specializing in ground-up & interior finish out projects. Services include conceptual & final pricing, design-build & construction management. Single-source management from concept to completion ensures continuity through all phases of the project.

Clay Page 210-375-9150 clay@rcpageconstruction.com www.rcpageconstruction.com

ELECTRONIC DOCUMENTATION AND TRANSCRIPTION SERVICES Med MT, Inc. (HH Silver Sponsor) Narrative transcription is physicians’ preferred way to create patient documents and populate electronic medical records.

Ray Branson 512-331-4669 branson@medmt.com www.medmt.com “The Med MT solution allows physicians to keep practicing just the way they like.”

EMPLOYEE BENEFITS

e-eSI (HHH Gold Sponsor) Locally owned since 1999, we believe it’s all about relationships. We keep our partners compliant assisting with human resource administration/management, workers’ compensation/risk management, benefit administration, and payroll.

We help our partners concentrate

on what they do best...Service their customers.

Lisa Mochel (210) 495-1171 lmochel@eesipeo.com www.eesipeo.com

FINANCIAL SERVICES

Northwestern Mutual Wealth Management (HHHH 10K Platinum Sponsor) Our mission is to help you enjoy a lifetime of financial security with greater certainty and clarity. Our outcomebased planning approach involves defining your objectives, creating a plan to maximize potential and inspiring action towards your goals.

Fee-based financial plans offered at discount for BCMS members.

Eric Kala CFP®, AEP®, CLU®, ChFC® Wealth Management Advisor | Estate & Business Planning Advisor 210.446.5755 eric.kala@nm.com www.erickala.com “Inspiring Action, Maximizing Potential”

Aspect Wealth Management (HHH Gold Sponsor) We believe wealth is more than money, which is why we improve and simplify the lives of our clients, granting them greater satisfaction, confidence and freedom to achieve more in life.

Jeffrey Allison 210-268-1530 jallison@ aspectwealth.com www.aspectwealth.com “Get what you deserve … maximize your Social Security benefit!”

e3 Wealth, LLC (HHH Gold Sponsor) Over $550 million in assets under management, e3 Wealth delivers truly customized solutions to individuals and businesses while placing heavy emphasis on risk minimization, tax diversification, proper utilization and protection for each client's unique financial purpose.

Managing Partner Joseph Quartucci, ChFC® 512-268-9220 jquartucci@e3wealth.com

165 Elmhurst, Suite B Kyle, TX 78640 Senior Partner Terry Taylor 512-268-9220 ttaylor@e3wealth.com Senior Partner Jennifer Taylor 512-268-9220 jtaylor@e3wealth.com www.e3wealth.com

Frost Leasing (HHH Gold Sponsor) As one of the largest Texas-based banks, Frost has helped Texans with their financial needs since 1868, offering award-winning customer service and a range of banking, investment and insurance services to individuals and businesses.

Laura Elrod Eckhardt 210-220-4135 laura.eckhardt@frostbank.com www.frostbank.com “Commercial leasing for a doctor’s business equipment and vehicle.”

Intercontinental Wealth Advisors LLC. (HHH Gold Sponsor) Your money’s worth is in the things it can do for you, things that are as unique and personal as your heart and mind. We craft customized solutions to meet investment challenges and help achieve financial objectives.

Vice President Jaime Chavez, RFC® 210-271-7947 ext. 109 jchavez@intercontl.com Wealth Manager David K. Alvarez, CFP® 210-271-7947 ext. 119 dalvarez@intercontl.com Vice President John Hennessy, ChFC® 210-271-7947 ext. 112 jhennessy@intercontl.com www.intercontl.com “Advice, Planning and Execution that goes beyond portfolio management” First Command Financial Services (HH Silver Sponsor) Nigel Davies 210-824-9894 njdavies@firstcommand.com www.firstcommand.com

continued on page 40

visit us at www.bcms.org

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BCMS CIRCLe OF FRIeNdS SeRvICeS dIReCTORy continued from page 39

GRADUATE PROGRAMS Trinity University (HH Silver Sponsor) The Executive Master’s Program in Healthcare Administration is ranked in the Top 10 programs nationally. A part-time, hybrid-learning program designed for physicians and healthcare managers to pursue a graduate degree while continuing to work full-time.

Amer Kaissi, Ph.D. Professor and Executive Program Director 210-999-8132 amer.kaissi@trinity.edu https://new.trinity.edu/academics/departments/health-careadministration

HEALTHCARE REAL ESTATE

SAN ANTONIO COMMeRCIAL AdvISORS (HHH Gold Sponsor) Jon Wiegand advises healthcare professionals on their real estate decisions. These include investment sales- acquisitions and dispositions, tenant representation, leasing, sale leasebacks, site selection and development projects Jon Wiegand 210-585-4911 jwiegand@sacadvisors.com www.sacadvisors.com “Call today for a free real estate analysis, valued at $5,000”

HOME HEALTH SERVICES Abbie Health Care Inc. (HH Silver Sponsor) Our goal at Abbie health care inc. is to promote independence, healing and comfort through quality, competent and compassionate care provided by skilled nurses, therapists, medical social worker and home health aides at home.

Sr. Clinical Account Executive Gloria Duke, RN 210-273-7482 Gloria@abbiehealthcare.com "New Way of Thinking, Caring & Living"

HOSPITALS/ HEALTHCARE SERVICES

Southwest General Hospital (HHH Gold Sponsor) Southwest General is a full-service

40 San Antonio Medicine • December 2016

hospital, accredited by DNV, serving San Antonio for over 30 years.

Quality awards include accredited centers in: Chest Pain, Primary Stroke, Wound Care, and Bariatric Surgery.

Director of Business Development Barbara Urrabazo 210.921.3521 Burrabazo@Iasishealthcare.com Community Relations Liaison Sonia Imperial 210-364-7536 www.swgeneralhospital.com “Quality healthcare with you in mind.”

Warm Springs Medical Center Thousand Oaks Westover Hills (HHH Gold Sponsor) Our mission is to serve people with disabilities by providing compassionate, expert care during the rehabilitation process, and support recovery through education and research.

Central referral line 210-592-5350 “Joint Commission COE.” Methodist Healthcare System (HH Silver Sponsor) Palmira Arellano 210-575-0172 palmira.arellano@mhshealth.com http://sahealth.com/ Select Rehabilitation of San Antonio (HH Silver Sponsor) We provide specialized rehabilitation programs and services for individuals with medical, physical and functional challenges.

Miranda Peck 210-482-3000 Jana Raschbaum 210-478-6633 JRaschbaum@selectmedical.com mipeck@selectmedical.com http://sanantonio-rehab.com “The highest degree of excellence in medical rehabilitation.”

HUMAN RESOURCES

e-eSI (HHH Gold Sponsor) Locally owned since 1999, we believe it’s all about relationships. We keep our partners compliant assisting with human resource administration/management, workers’ compensation/risk man-

agement, benefit administration, and payroll. We help our partners concentrate on what they do best...Service their customers.

Lisa Mochel (210) 495-1171 lmochel@eesipeo.com www.eesipeo.com

employer Flexible (HHH Gold Sponsor) Employer Flexible doesn’t simply lessen the burden of HR administration. We provide HR solutions to help you sleep at night and get everyone in the practice on the same page.

John Seybold 210-447-6518 jseybold@employerflexible.com www.employerflexible.com “BCMS members get a free HR assessment valued at $2,500.”

INFORMATION AND TECHNOLOGIES

Henced (HHH Gold Sponsor) Henced is a customer communications platform that provides businesses with communication solutions. We’ll help you build longlast customer relationships by effectively communicating using our text and email messaging system.

Rainey Threadgill 210-647-6350 Rainey@henced.com www.henced.com Henced offers BCMS members custom pricing.

INSURANCE

TMA Insurance Trust (HHHH 10K Platinum Sponsor) Created and endorsed by the Texas Medical Association (TMA), the TMA Insurance Trust helps physicians, their families and their employees get the insurance coverage they need.

Wendell England 512-370-1746 wengland@tmait.org James Prescott 512-370-1776 jprescott@tmait.org John Isgitt 512-370-1776 www.tmait.org “We offer BCMS members a free

insurance portfolio review.”

Frost Insurance (HHH Gold Sponsor) As one of the largest Texas-based banks, Frost has helped Texans with their financial needs since 1868, offering award-winning customer service and a range of banking, investment and insurance services to individuals and businesses.

Bob Farish 210-220-6412 bob.farish@frostbank.com www.frostbank.com “Business and personal insurance tailored to meet your unique needs.”

Humana (HHH Gold Sponsor) Humana is a leading health and well-being company focused on making it easy for people to achieve their best health with clinical excellence through coordinated care.

Jon Buss: 512-338-6167 Jbuss1@humana.com Shamayne Kotfas: 512-338-6103 skotfas@humana.com www.humana.com

SWBC (HHH Gold Sponsor) SWBC is a financial services company offering a wide range of insurance, mortgage, PEO, Ad Valorem and investment services. We focus dedicated attention on our clients to ensure their lasting satisfaction and long-term relationships.

VP Community Relations Deborah Gray Marino 210-525-1241 DMarino@swbc.com Wealth Advisor Gil Castillo, CRPC® 210-321-7258 Gcastillo@swbc.com SWBC Mortgage Jon M. Tober 210-317-7431 JTober@swbc.com www.swbc.com Mortgages, investments, personal and commercial insurance, benefits, PEO, ad valorem tax services Catto & Catto (HH Silver Sponsor) Providing insurance, employee benefits and risk-management products and services to thousands of businesses and individuals in Texas and the United States.

James L. Hayne Jr.

BCMS CIRCLe OF FRIeNdS SeRvICeS dIReCTORy 210-222-2161 jhaynejr@catto.com Corey Huffman 210-298-7123 chuffman@catto.com www.catto.com

INSURANCE/MEDICAL MALPRACTICE

Texas Medical Liability Trust (HHHH 10K Platinum Sponsor) Texas Medical Liability Trust is a not-for-profit health care liability claim trust providing malpractice insurance products to the physicians of Texas. Currently, we protect more than 18,000 physicians in all specialties who practice in all areas of the state. TMLT is a recommended partner of the Bexar County Medical Society and is endorsed by the Texas Medical Association, the Texas Academy of Family Physicians, and the Dallas, Harris, Tarrant and Travis county medical societies.

Patty Spann 512-425-5932 patty-spann@tmlt.org www.tmlt.org Recommended partner of the Bexar County Medical Society

MedPro Group (HHH Gold Sponsor) Medical Protective is the nation's oldest and only AAA-rated provider of healthcare malpractice insurance.

Kirsten Baze 512-375-3972 Kirsten.Baze@medpro.com www.medpro.com

The Bank of San Antonio Insurance Group, Inc. (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians.

Our local insurance professionals are some of the few agents in the state who specialize in medical malpractice and all lines of insurance for the medical community.

Katy Brooks, CIC 210-807-5593 katy.brooks@bosainsurance.com www.thebankofsa.com “Serving the medical community.”

The doctors Company (HH Silver Sponsor) The Doctors Company is fiercely

committed to defending, protecting, and rewarding the practice of good medicine. With 78,000 members, we are the nation’s largest physician-owned medical malpractice insurer. Learn more at www.thedoctors.com.

Susan Speed Senior Account Executive (512) 275-1874 Susan.speed@thedoctors.com Marcy Nicholson Director, Business Development (512) 275-1845 mnicholson@thedoctors.com “With 78,000 members, we are the nation’s largest physician-owned medical malpractice insurer” NORCAL Mutual Insurance Co. (HH Silver Sponsor) Since 1975, NORCAL Mutual has offered medical professional liability coverage to physicians and is “A” (Excellent) rated by A.M. Best.

Patrick Flanagan 844-4-NORCAL pflanagan@norcal-group.com www.norcalmutual.com ProAssurance (HH Silver Sponsor) Group (rated A+ (Superior) by A.M. Best) helps you protect your important identity and navigate today’s medical environment with greater ease—that’s only fair.

Keith Askew Market Manager kaskew@proassurance.com Mark Keeney Director, Sales mkeeney@proassurance.com 800.282.6242 www.proassurance.com

MARKETING ADVERTISING SEO

www.cmcs-sa.com “Make us the solution for your account receivables.”

Henced (HHH Gold Sponsor) Henced is a customer communications platform that provides businesses with communication solutions. We’ll help you build longlast customer relationships by effectively communicating using our text and email messaging system.

Rainey Threadgill 210-647-6350 Rainey@henced.com www.henced.com Henced offers BCMS members custom pricing.

MEDICAL SUPPLIES AND EQUIPMENT

MARKETING SERVICES

digital Marketing Sapiens (HHH Gold Sponsor) Healthcare marketing professionals with proven experience and solid understanding of compliance issues. We deliver innovative marketing solutions that drive results.

Irma Woodruff 210-410-1214 irma@dmsapiens.com Ajay Tejwani 210- 913-9233 ajay@dmsapiens.com www.DMSapiens.com

MEDICAL BILLING AND COLLECTIONS SERVICES

INTERNET/ TELECOMMUNICATIONS

Time Warner Cable Business Class (HHH Gold Sponsor) When you partner with Time Warner Cable Business Class, you get the advantage of enterpriseclass technology and communications that are highly reliable, flexible and priced specifically for the medical community.

Enterprise Account Executive West Region - Healthcare Sales Leader Medical Market Rick Garza 210-582-9597 rick.garza@charter.com “Time Warner Cable Business Class offers custom pricing for BCMS Members.”

Kareo (HHH Gold Sponsor) The only cloud-based medical office software and services platform purpose-built for small practices. Our practice management software, medical billing solution, practice marketing tools and free, fully certified EHR has helped 30,000+ medical providers more efficiently manage their practice.

Regional Solutions Consultant Lilly Ibarra: 210.714.9815 lilly.ibarra@kareo.com www.kareo.com Commercial & Medical Credit Services (HH Silver Sponsor) A bonded and fully insured San Antonio-based collection agency.

Henry Miranda 210-340-9515 hcmiranda@sbcglobal.net

Henry Schein Medical (HHHH 10K Platinum Sponsor) From alcohol pads and bandages to EKGs and ultrasounds, we are the largest worldwide distributor of medical supplies, equipment, vaccines and pharmaceuticals serving office-based practitioners in 20 countries. Recognized as one of the world’s most ethical companies by Ethisphere.

Tom Rosol 210-413-8079 tom.rosol@henryschein.com www.henryschein.com “BCMS members receive GPO discounts of 15 percent to 50 percent.”

CASA Physicians Alliance (HHH Gold Sponsor) Locally owned, nationwide MultiSpecialty Physicians Buying Group which provides significant savings on Pediatric, Adolescent and Adult vaccines as well as other products.

Physician’s memberships are free.

Shari Smith 866-434-9974 shari@casaalliance.net Chris Dixon 866-434-9974 chris@casaalliance.net www.casaalliance.net “Providing meaningful vaccine discount programs, products and services.”

MERCHANT CARD/CHECK PROCESSING Firstdata/Telecheck (HH Silver Sponsor) We stand at the center of the fastpaced payments ecosystem, collaborating to deliver nextgeneration technology and help our clients grow their businesses.

Sandra Torres-Lynum SR. Business Consultant 25 years of dedicated service 210-387-8505 Sandra.TorresLynum@FirstData.com ‘The true leader in the payments processing industry’

continued on page 42

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BCMS CIRCLe OF FRIeNdS SeRvICeS dIReCTORy continued from page 41

MERCHANT PAYMENT SYSTEMS/CARD PROCESSING Heartland Payment Systems (HH Silver Sponsor) Heartland Payments is a true cost payment processor exclusively endorsed by over 250 business associations.

Tanner Wollard 979-219-9636 tanner.wollard@e-hps.com www.heartlandpaymentsystems.com “Lowered cost for American Express; next day funding.”

OFFICE EQUIPMENT/ TECHNOLOGIES

dahill (HHH Gold Sponsor) Dahill offers comprehensive document workflow solutions to help healthcare providers apply, manage and use technology that simplifies caregiver workloads. The results: Improved access to patient data, tighter regulatory compliance, operational efficiencies, reduced administrative costs and better health outcomes.

Major Account Executive Wayne Parker 210-326-8054 WParker@dahill.com Major Account Executive Bradley Shill 210-332-4911 BShill@dahill.com Add footer: www.dahill.com “Work Smarter”

STAFFING SERVICES SWBC (HHH Gold Sponsor) Our clients gain a team of employment experts providing solutions in all areas of human capital – Payroll, HR, Compliance, Performance Management, Workers’ Compensation, Risk Management and Employee Benefits.

Kristine Edge Sales Manager 830-980-1207 Kedge@swbc.com Working together to help our clients achieve their business objectives.

Robbie Casey Commercial Realty (HHH Gold Sponsor) Robbie Casey Commercial Realty was founded on the principles of providing thorough market strategies, innovative advertising, superior service, and uncompromising integrity. Robbie is dedicated to each of her clients. She brings enthusiasm and creativity to each project and knows how to get the job done.

Robbie Casey 210-872-8453 robbie@robbiecaseyrealty.com http://robbiecaseyrealty.com

PHYSICIANS BUYING GROUP

REAL ESTATE/RESIDENTIAL

CASA Physicians Alliance (HHH Gold Sponsor) Locally owned, nationwide MultiSpecialty Physicians Buying Group which provides significant savings on Pediatric, Adolescent and Adult vaccines as well as other products.

Physician’s memberships are free.

Shari Smith 866-434-9974 shari@casaalliance.net Chris Dixon 866-434-9974 chris@casaalliance.net www.casaalliance.net “Providing meaningful vaccine discount programs, products and services.”

REAL ESTATE/ COMMERCIAL

PAYROLL SERVICES

employer Flexible (HHH Gold Sponsor) Employer Flexible doesn’t simply lessen the burden of HR administration. We provide HR solutions to help you sleep at night and get everyone in the practice on the same page.

John Seybold 210-447-6518 jseybold@employerflexible.com www.employerflexible.com “BCMS members get a free HR assessment valued at $2,500.”

CUSHMAN & WAKeFIeLd (HHH Gold Sponsor) Jon Wiegand advises healthcare professionals on their real estate decisions. These include investment sales- acquisitions and dispositions, tenant representation, leasing, sale leasebacks, site selection and development projects Jon Wiegand 210-585-4911 jwiegand@sacadvisors.com www.sacadvisors.com “Call today for a free real estate analysis, valued at $5,000”

Roslyn Casey Realty (HHH Gold Sponsor) My extensive experience and expertise in the San Antonio, Alamo Heights and Terrell Hills real estate market will benefit you whether you are looking to buy or sell a home in the area.

Realtor, ABS, ILHM, ALMS Roslyn Casey 210-710-3024 Roslyn@roslyncasey.com http://roslyncasey.kwrealty.com “Communication is key”

Favorite Healthcare Staffing (HHHH 10K Platinum Sponsor) Serving the Texas healthcare community since 1981, Favorite Healthcare Staffing is proud to be the exclusive provider of staffing services for the BCMS. In addition to traditional staffing solutions, Favorite offers a comprehensive range of staffing services to help members improve cost control, increase efficiency and protect their revenue cycle.

Brody Whitley Branch Director 210-301-4362 bwhitley@ favoritestaffing.com www.favoritestaffing.com “Favorite Healthcare Staffing offers preferred pricing for BCMS members.”

SENIOR LIVING Legacy at Forest Ridge (HH Silver Sponsor) Legacy at Forest Ridge provides residents with top-tier care while maintaining their privacy and independence, in a luxurious resortquality environment.

Shane Brown Executive Director 210-305-5713

To join the Circle of Friends program or for more information,

call 210-301-4366 or email August.Trevino@bcms.org hello@legacyatforestridge.com www.LegacyAtForestRidge.com “Assisted living like you’ve never seen before.”

Visit www.bcms.org

42 San Antonio Medicine • December 2016

RECOMMENDED AUTO DEALERS AUTO PROGRAM

• • • •

We will locate the vehicle at the best price, right down to the color and equipment.

We will put you in touch with exactly the right person at the dealership to handle your transaction.

We will arrange for a test drive at your home or office. We make the buying process easy!

When you go to the dealership, speak only with the representative indicated by BCMS.

Ancira Chevrolet 6111 Bandera Road San Antonio, TX

Ancira Volkswagen 6125 Bandera Road San Antonio, TX 78238

Jude Fowler 210-681-4900

Carl Carper 210-681-2300

GUNN AUTO GROUP

GUNN AUTO GROUP

GUNN AUTO GROUP

GUNN Honda 14610 IH 10 W San Antonio, TX

GUNN Infiniti 12150 IH 10 W San Antonio, TX

GUNN Acura 11911 IH 10 W San Antonio, TX

GUNN Nissan 750 NE Loop 410 San Antonio, TX 78209

Bill Boyd 210-859-2719

Bill Boyd 210-859-2719

Hugo Rodriguez and Rick Tejada 210-824-1272

Coby Allen 210-625-4988

Bill Boyd 210-859-2719

Alamo City Chevrolet 9400 San Pedro Ave. San Antonio, TX 78216

Cavender Audi 15447 IH 10 W San Antonio, TX 78249

Cavender Toyota 5730 NW Loop 410 San Antonio, TX

Toyota of Boerne 31205 I-10 W Boerne, TX 78006

Northside Ford 12300 San Pedro San Antonio, TX

David Espinoza 210-912-5087

Julie Herrera 210-681-3399

Gary Holdgraf 210-862-9769

George Ramirez 210-748-4412

Wayne Alderman 210-525-9800

Ingram Park Nissan 7000 NW Loop 410 San Antonio, TX

Ingram Park Auto Center Dodge 7000 NW Loop 410 San Antonio, TX

Ingram Park Auto Center Mazda 7000 NW Loop 410 San Antonio, TX

Mercedes Benz of San Antonio 9600 San Pedro San Antonio, TX

Mercedes Benz of Boerne 31445 IH 10 W Boerne, TX

Alan Henderson 210-681-6300

Daniel Jex 210-684-6610

Frank Lira 210-381-7532

Richard Wood 210-366-9600

John Wang 830-981-6000

KAHLIG AUTO GROUP

KAHLIG AUTO GROUP

KAHLIG AUTO GROUP

KAHLIG AUTO GROUP

North Park Subaru 9807 San Pedro San Antonio, TX 78216

North Park Subaru at Dominion 21415 IH 10 W San Antonio, TX 78257

North Park Toyota 10703 SW Loop 410 San Antonio, TX 78211

North Park Mazda 9333 San Pedro San Antonio, TX 78216

Mark Castello 210-308-0200

Stephen Markham 877-356-0476

Justin Boone 210-635-5000

Scott Brothers 210-253-3300

KAHLIG AUTO GROUP

KAHLIG AUTO GROUP

KAHLIG AUTO GROUP

KAHLIG AUTO GROUP

North Park Lexus 611 Lockhill Selma San Antonio, TX

North Park Lexus at Dominion 21531 IH 10 W San Antonio, TX

North Park Lincoln 9207 San Pedro San Antonio, TX

Jose Contreras 210-308-8900

Justin Blake 888-341-2182

Sandy Small 210-341-8841

North Park VW at Dominion 21315 IH 10 W San Antonio, TX 78257

Ancira Chrysler 10807 IH 10 West San Antonio, TX 78230

Ancira Nissan 10835 IH 10 West San Antonio, TX 78230

Jarrod Ashley 210-558-1500

Jason Thompson 210-558-5000

GUNN AUTO GROUP

GUNN AUTO GROUP

GUNN Chevrolet GMC Buick 16550 IH 35 N Selma, TX 78154

Ancira Buick, GMC San Antonio, TX Jude Fowler 210-681-4900

Batchelor Cadillac 11001 IH 10 W at Huebner San Antonio, TX Esther Luna 210-690-0700

James Cole 800-611-0176

Call Phil Hornbeak 210-301-4367 or email phil.hornbeak@bcms.org

AUTO REVIEW

2017 Audi Q7

By Steve Schutz, MD

The new 2017 Audi Q7 has been completely redone, and in this case, that description is not hyperbole. The Q7 uses a clean-sheet-of-paper platform that will soon underpin the next-gen Porsche Cayenne and Bentley Bentayga, uses high-tech materials to cut hundreds of pounds of weight, and introduces many high tech features that will soon trickle down to lesser Audis.

Pretty cool, right? So why do I keep thinking, “If you’re so new, how come you look so old?” Umm, good question. The last Q7 had a ground breaking design that was so avant garde it looked contemporary even in 2015, a full 9 years after its debut.

And not only did it look new, it sold like it was new. In 2006, its first full year on sale in the U.S, 10,003 Q7’s sold. In 2015 that number had increased to 18,995, a 90 percent increase. I follow the market closely, 44 San Antonio Medicine • December 2016

and I’m unaware of any vehicle that sold that much better after so many years on the market (typically sales decline slowly until a new model debuts).

The new Q7 is as high tech and contemporary as any vehicle on the market. In fact, the tech is so cutting edge it’s almost like living in the future — with some glitches I’ll mention below that I hope are solved soon — and it serves as a reminder that German luxury brands own cool automotive tech these days.

What tech are we talking about? Bluetooth phone/audio, Google earth satnav, in-car wifi, and smart cruise control — that’s all nice and kind of expected. But as our smartphones get smarter, it makes sense that our cars would get smarter too. And they have.

The smart tech available on the new Q7 includes brake-based torque vectoring, Traf-

fic Jam Assist, which drives the Q7 mostly autonomously at low speeds, an F-150-ish trailering assistant that will back up and steer a trailer, lane-departure warning and assist, blind-spot monitoring, and automatic braking. And if that’s not enough for you, Audi promises even more advanced autonomous driving before too long.

Wow. In case you’re totally excited and can’t wait for self-driving cars that take you to work while you nap or update your Instagram, let me provide a little bit of a cold shower. While using the 15-seconds-only self driving feature of the Q7 on the highway, it missed two construction cones and a jog to the right requiring me to quickly grab the wheel and turn us back into our (altered) lane. Based on that experience as well as 53 years of life, I’m going to predict that fully autonomous commuting is many

AUTO REVIEW

years away. I’m going to say 20. How’s that for a cold shower?

Audi’s new virtual cockpit, on the other hand, is real tech that I love right now. Basically, the dashboard right in front of you is one big screen, and you can scroll between a generic (but busy) home screen, audio menu, and a huge map view of the navigation system. It’s a big advance over any other system, and it should replace the second central screen that most vehicles — including the new Q7, ironically — still use.

The auto dimming bright is more tech that I love. I like to think that I can always dim the bright headlights at exactly the right time, and Audi does it as well as I can. I’ve sampled auto dimming headlights before and have been disappointed (invariably the low beams stay on too long). Not so with the Audi system. It raises and lowers the head-

lights exactly when I would.

As did the old one, the new Q7 drives very well in all conditions. In town it’s zippy and easy, and on the highway it’s a paragon of long leggedness. If you need space for up to 7 passengers, there’s not a better driving SUV. The Mercedes GLS, BMW X5, and Lexus LX are all fine vehicles, as most customers looking at this market niche know.

But none drives better than the Q7.

Ok then, why is the Q7 so anonymous looking? I don’t know. The aforementioned luxury SUV competitors all have designs that are more extroverted than the Q7’s. My sense is that the understated Q5 has been such a hit that Audi decided to head in the same direction with the bigger Q7. Presumably they’re betting that lots of tech, cool lights, a big grille, and a (very) low key exterior is a recipe for success. I have no doubt

that they are right in the short term, but I have doubts about five years from now.

The all new Audi Q7 is an impressive full size SUV that has tech galore and offers a wonderful driving experience. What it doesn’t provide is a cool exterior design that will sweep you off your feet. If that matters, get the Mercedes GLS. Otherwise I bet you’ll be happy with the Q7.

If you’re in the market for this kind of vehicle, call Phil Hornbeak at 210-301-4367.

Steve Schutz, MD, is a board-certified gastroenterologist who lived in San Antonio in the 1990s when he was stationed here in the U.S. Air Force. He has been writing auto reviews for San Antonio Medicine since 1995. visit us at www.bcms.org

45

THANK YOU

to the large group practices with 100% MEMBERSHIP in BCMS and TMA ABCD Pediatrics, PA Clinical Pathology Associates Dermatology Associates of San Antonio, PA Diabetes & Glandular Disease Clinic, PA ENT Clinics of San Antonio, PA Gastroenterology Consultants of San Antonio General Surgical Associates Greater San Antonio Emergency Physicians, PA Institute for Women's Health Lone Star OB-GYN Associates, PA M & S Radiology Associates, PA MacGregor Medical Center San Antonio MEDNAX Peripheral Vascular Associates, PA Renal Associates of San Antonio, PA San Antonio Gastroenterology Associates, PA San Antonio Kidney Disease Center San Antonio Pediatric Surgery Associates, PA Sound Physicians South Alamo Medical Group South Texas Radiology Group, PA Tejas Anesthesia, PA Texas Partners in Acute Care The San Antonio Orthopaedic Group Urology San Antonio, PA WellMed Medical Management Inc.

Contact BCMS today to join the 100% Membership Program! *100% member practice participation as of November 15, 2016.

46 San Antonio Medicine â&#x20AC;˘ December 2016