IN 2022 SAN ANTONIO
PUBLISHED By: traveling Blender, llC. 10036 Saxet Boerne, tX 78006
AdvErtiSinG CorrESpondEnCE: louis doucette, president traveling Blender, llC. A publication Management Firm 10036 Saxet, Boerne, tX 78006
SAN ANTONIO MEDICINE is published by SmithPrint, Inc. (Publisher) on behalf of the Bexar County Medical Society (BCMS). Reproduction in any manner in whole or part is pro hibited without the express written consent of Bexar County Medical Society. Material contained herein does not necessarily reflect the opinion of BCMS, its members, or its staff. SAN AN TONIO MEDICINE the Publisher and BCMS reserves the right to edit all material for clarity and space and assumes no re sponsibility for accuracy, errors or omissions. San Antonio Med icine does not knowingly accept false or misleading advertisements or editorial nor does the Publisher or BCMS as sume responsibility should such advertising or editorial appear. Articles and photos are welcome and may be submitted to our office to be used subject to the discretion and review of the Publisher and BCMS. All real estate advertising is subject to the Federal Fair Housing Act of 1968, which makes it illegal to ad vertise “any preference limitation or discrimination based on race, color, religion, sex, handicap, familial status or national orgin, or an intention to make such preference limitation or dis crimination. COUNTY WWW.BCMS.ORG $4.00 2022 75
MEDICAL SOCIETY •
• SEPTEMBER
THE OFFICIAL PUBLICATION OF THE BEXAR
• VOLUME
NO.9 HEALTHCARE COVERAGE
Repairing a Broken System: A New Vision for American Health Care from the American College of Physicians By John J. Seidenfeld, MD 12 Bridging the Diaper Gap: How our Diaper Rash Intervention Saved Families Money By Maryann England and Ashley Chakales 14
Copyright © 2022 Smithprint, inc. prin tE d in tHE u SA San Antonio Medicine is the official publication of Bexar County Medical Society (BCMS). All ex pressions of opinions and statements of sup posed facts are published on the authority of the writer, and cannot be regarded as expressing the views of BCMS. Advertisements do not imply sponsorship of or endorsement by BCMS
PUBLISHER louis doucette louis@travelingblender.com
BUSINESS MANAGER: vicki vicki@Schroder travelingblender.com
SAN ANTONIO: Madeleine Justice madeleine@travelingblender.com Gerry l gerrylair@yahoo.comair
EditoriAl CorrESpondEnCE: Bexar County Medical Society 4334 n loop 1604 W, Ste. 200 San Antonio, tX 78249 Email: editor@bcms.org MAGAZinE AddrESS CHAnGES: Call (210) 301-4391 or Email: membership@bcms.org SuBSCription rAtES: $30 per year or $4 per individual issue
SAN ANTONIO 4 SAN ANTONIO MEDICINE • September 2022 TABLE OF CONTENTS
PROjECT COORDINATOR: Amanda Canty amanda@smithprint.net For more information on advertising in San Antonio Medicine, Call Traveling Blender at 210.410.0014 in San Antonio and 512.385.4663 in Austin.
ADVERTISING SALES: AUSTIN: Sandy Weatherford sandy@travelingblender.com
SmithPrint, Inc. is a family owned and operated San Antonio based printing and pub lishing company that has been in business since 1995. We are specialists in turn-key operations and offer our clients a wide variety of capabilities to ensure their projects are printed and delivered on schedule while consistently exceeding their quality expectations. We bring this work ethic and commitment to customers along with our personal service and attention to our clients’ printing and marketing needs to San Antonio Medicine mag azine with each issue.
•
The Rise of Medical Student Debt: What are the Options and Opportunities for Students? By Sean Rumney, Maryann England, Ashley Chakales 16 CareLink Public Health Coverage By Elizabeth Allen 18 State Allots Millions for School Safety, Mental Health after Uvalde Shooting By Emma Freer
19 Proving Identity Ancient Problem Needs New Solution By David Schulz, MD 20 Public Service Loan Forgiveness (PSLF) for Physicians By Oakwell Private Wealth Management, Platinum Circle of Friends Sponsor of BCMS 22 ADA Requirements for Physician Offices By Sara Bergmanson, Tanya Babitch and Robin Desrocher 24 Health Insurance in Texas By TMA 26 BCMS President’s Message 8 BCMS Alliance President’s Message 10 Another BCMS Milestone Approaching... 170 Years of Advocating for Physicians and Patients By Mary E. Nava, MBA, BCMS Chief Government Affairs Officer 28 2022 AAMSE Award: BCMS Physicians Health and Rehabilitation Program By Monica Jones 29 BCMS 2022 Summer Membership Mixer 30 UT Health SA Student Dinner Orientation 31 Monkeypox: What Bexar County Doctors Need to Know By Junda Woo, MD, MPH, and Anita K. Kurain, MBBS, MPH, DrPH 32 Medical Group Management Association Programs and Professional Benefits By MGMA 34 The American Health Care System By Chloe A. Jensen and The Missing Piece By Calvin Madsen 35 Rockstar Ripped-Off By Anjali Prasad and Cross-Sections of Care By Joshua Sanchez 36 COVID-19 Testing if you are Vaccinated and 10 Things You Can Do to Manage Symptoms at Home By the CDC 37 Physicians Purchasing Directory 40 Auto Review: 2022 Subaru Ascent By Stephen Schutz, MD 44 Recommended Auto Dealers 46
www.travelingblender.comForadvertisingratesand information Call (210) 410-0014 Email: louis@travelingblender.com
Al
Officer PUBLICATIONS COMMITTEE John
Monica
iz,
Representative BCMS
r
ELECTED OFFICERS rajeev Suri, Md, President Brent W. Sanderlin, do, Vice President Ezequiel “Zeke” Silva iii, Md, Treasurer Alice Gong, Md, Secretary John J. nava, Md, President-elect rodolfo “rudy’ Molina, Md, Immediate Past President DIRECTORS vincent Fonseca, Md, MpH, Member Woodson "Scott" Jones, Md, Member lubna naeem, Md, Member lyssa n ochoa, Md, Member Jennifer r rushton, Md, Member raul Santoscoy, do, Member John Shepherd, Md, Member Amar Sunkari, Md, Member lauren tarbox, Member Col. tim Switaj, Md, Military Representative Manuel M. Quinones Jr., Md, Board of Ethics Chair George F. “rick” Evans, General Counsel Jayesh B. Shah, Md, TMA Board of Trustees Melody newsom, CEO/Executive Director taylor Frantz, Alliance Representative ramon S. Cancino, Md, Medical School Representative lori Kels, Md, Medical School Representative ronald rodriguez, Md, phd, Medical School Representative Carlos Alber School SENIOR STAFF Melody newsom, CEO/Executive Director Jones, Chief Operating Officer nino, Controller Mary nava, Chief Government Affairs Officer vela, Membership Director phil Hornbeak, Auto Program Director August trevino, Development Director tty Fernandez, BCVI Director o t Chief Information Joseph Seidenfeld,
Be
Md, Chair Kristy Yvonne Kosub, Md, Member louis doucette, Consultant Alan preston, phd, Member rajam S. ramamurthy, Md, Member Adam v ratner, Md, Member david Schulz, Community Member Faraz Yousefian, do, Member neal Meritz, Md, Member Jaime pankowsky, Md, Member Moses Alfaro, Student Member Winona Gbedey, Student Member tue Felix nguyen, Student Member Cara J. Schachter, Student Member niva Shrestha, Student Member nancy Salas, Editor BCMS BOARD OF DIRECTORS
to rosende, Md, Medical
Brissa
Yvonne
6 SAN ANTONIO MEDICINE • September 2022
Greatness and LeadershipIn Healthcare
The word ‘leader’ often conjures up an image of someone who needs to be followed, who directs others, who controls the ship and provides decisive decisions. Instead of just being the captain of a ship, a leader should also have greatness and be a greatness facilitator who helps create greatness in everyone and the organization around them.
By Rajeev Suri, MD, MBA, FACR, 2022 BCMS President
Paraphrasing Shakespeare from the Twelfth Night, “Some leaders are born great, some achieve greatness, and some have greatness thrust upon them.” Apart from the first category where a select few are born great, leadership and greatness are learned qualities – they require diligence and perseverance to a goal, a sacrifice of wants for musts, a need to give it the very best. So, when you strive hard day and night to be the very best and achieve greatness, or you have great ness thrust upon you through opportunities – you are and must be ready to meet it. The path to leadership and greatness is forever a point of discus sion – in fact whole books, blogs and sessions are devoted to it. Three key dictums still always hold true: find your path, believe in your path and live your path. In addition to following and living your path, understanding and developing key leadership skills is essential, strong communication (listening and learning), emotional intelli gence (understanding and managing one’ own emotions in a positive way and being empathetic), problem solving (thinking critically) and timeMostmanagement.theoriesfor leadership were developed for business settings and have been morphed to healthcare settings as the healthcare busi ness has evolved. Leadership approaches have been identified that are more often situational (modifiable to the situation) rather than being siloed, collaborative leadership (cooperative and encourage in formed decision making), transformational leadership (empowers others, motivational), ethical leadership (treat all with fairness and respect), servant leadership (less hierarchal) and authoritative lead ership. Leaders may only have one of these leadership traits, but great leaders may use different leadership traits in different situations. As the healthcare industry grows, so does the demand for more leaders. In addition to leaders at the local and institutional level, op portunities will also grow at the local, state and national level for or ganized medicine. As physicians we have the opportunity to be at the table and if not, we will definitely be on the menu. We can’t have our heads in the sand, hope that this too shall pass and let someone else take the mantle. To achieve the skills needed to succeed as great leaders, we need to be ready. You can identify mentors and learn on the job, go through leadership training programs (in our practices, institutions and local, state or national chapters) or do a formal grad uate degree (MHA, MBA, certificate courses). Bexar County Med ical Society (BCMS) has a dedicated physician leadership training course that has trained several healthcare leaders in San Antonio, Texas and beyond. After a 2-year hiatus due to COVID-19, this course is coming back this fall with interactive lectures from faculty of Trinity University, Master of Healthcare Administration (MHA) Program and BCMS Physician leaders. Additional options within San Antonio include healthcare administration certificate programs at The University of Texas at San Antonio (UTSA) College of Busi ness, graduate degrees (MHA) at Trinity University and Master of Business Administration (MBA) with a Healthcare focus at UTSA College of Business. TMA also organizes a Texas Medical Associa tion Leadership College for young physicians. These are just few of the several options available in San Antonio for us to be ready to be at the table and achieve our true potential.
Rajeev Suri, MD, MBA, FACR is the 2022 President of the Bexar County Medical Society, Tenured Professor and Interim Chair of the Department Radiology at UT Health San Antonio, and Chief of Staff at University Hospital San Antonio.
PRESIDENT’SMESSAGE 8 SAN ANTONIO MEDICINE • September 2022
President Roosevelt aptly said “We must dare to be great.” So, dare, believe in yourself, be prepared and ready to accept the challenge and rise to it. All of us our capable of greatness, you just have to take step forward!
Greatness is a quality that changes an organization from mediocrity to excellence. Greatness is a culture in an organization that creates fertile ground for exceptional performance to thrive in.
TIPS
Taylor Frantz, RDN, LD is a registered dietitian and the 2022 President of the BCMS Alliance.
As a dietitian myself, my friends often assume that my children eat picture perfect diets and our meals look straight out of a mag azine. If only it were true. Even I find myself subject to the everchanging tastes of a toddler. I deal with the same picky eaters, food jags and mealtime chaos as everyone else. My five-year-old would gladly eat sweets until he felt ill, and my three-year-old will eat an entire head of broccoli one meal and the next time it’s served, he refuses to even look at it. Not to mention that my toddler ends up throwing his plate on the floor most meals. I get it feeding kids is hard Herework!aresome tips for feeding kids that I have learned in my practice and also in my personal life.
Childhood Nutrition
• Food is neither good nor bad. All food has a purpose and place. Teach children why we eat a variety of foods-vita mins, minerals, energy, building muscles, enjoyment, etc.
• Always offer a variety. I know, food prices are sky rocketing and it feels bad to waste, but it’s so important kids see a va riety of foods on their plates. Exposure is key. Research has shown that children need to be exposed to a food up to 30 times before they truly decide if they like the food or not.
10 SAN ANTONIO MEDICINE • September 2022 BCMS ALLIANCE
September is National Childhood Obesity Awareness Month. According to the CDC’s most recent data, obesity affects one in five children with prevalence increasing as children age. It affects children from all racial and ethnic groups and every socioeco nomicChildhoodstatus. obesity has come to the forefront in national media, and we all understand the impact obesity can have a child’s lifetime health. What are some practical ways we can combat this multi faceted issue?
• Serve what the family is eating. Stop being a short order cook and preparing special meals for your children. Serve them what you are having and then add one safe food that you know they will eat. For my family, our safe food is fruit. I know if they refuse the meal, at least they have had some fruit.
• Division of Responsibility. Feeding expert Ellyn Satter, states that the parents are responsible for what, when and where the child eats and the child has the autonomy to de cide how much and if they will eat.
By Taylor Frantz, RD, LD
Remember that getting in nutrition shouldn’t be the only goal when feeding your kids. Meal time should be a time to be together, talk and create memories. Fostering a healthy relationship with all kinds of foods will have a lifelong impact on your child, so serve up those veggies but also find joy in indulging in desserts.
Major reasons to familiarize yourself with this discussion include the vulnerable Americans who lack health maintaining nutrition, childcare, education, potable drinking water and health insurance coverage.
The ACP also includes “public choice” as an alternative which would continue to allow competition among insurers but have significantly less administrative savings compared to a single payer system. Currently in Medicare Advantage and Affordable Care Act (ACA) private insurer run plans “cherry pick” or choose those with lowest predicted expenses. They also pursue a strategy of “lemon dropping” or letting those poli
Repairing a Broken System:
By John J. Seidenfeld, MD C
A New Vision for American Health Care from the American College of Physicians
OVID-19 infections have been more prevalent and more deadly among people living in the southern parts of the city of San Antonio, where the population is 81 percent His panic, according to Laura Garcia of the San Antonio Express News.1 The data indicate more people dying from COVID in the Southside zip codes when compared to Northside code areas. Flaws in the US Health care system were more obvious because of the pandemic, and showed a system that fails marginalized people. These failures result in shorter life span, higher infant and maternal death rates, higher rates of chronic ill ness such as diabetes and heart disease, and poor or no health coverage in vulnerable communities compared to others. In 2020, the American College of Physicians (ACP), the largest or ganization of American Internal Medicine specialists, with over 160,000 members described their new vision for American Healthcare and called for systemic reform. Currently they endorse single payer re form. Why would they embark on this path when many U.S. Medical organizations have opposed this change?2
12 SAN ANTONIO MEDICINE • September 2022 HEALTHCARECOVERAGE
Other problems are expenses of the current system that result in a high rate of personal bankruptcy, and a healthcare system that costs as a per centage of gross domestic product (GDP) more than 1.5 times the cost of healthcare systems in other developed countries. There are serious concerns about access to services, and disparities evident during the pandemic, and equity among citizens. Many of us are troubled by the administrative costs of a multi-payer private health insurance system. Specific issues are excessive payer profit margins and executive salaries, high administrative costs in each prac tice devoted to filing claims with over 100 insurers per practitioner and a malpractice system more concerned with punishing a few offenders than improving the overall quality of care. Fraud, waste and abuse con tribute to these high costs. Macroeconomic concerns include a period of increased inflation and economic instability, reduced competitive ness of American manufacturing products because of additional health care costs for each good produced, a widening gap between the rich and the poor, and the fact that many Americans are either not covered with health insurance or under-covered and susceptible to medical bankruptcy. Canadahas found that converting to a single payer system has re duced administrative costs in health care to from 15-20% down to 2% of premiums.3 The estimated savings from this switch would be more than $200 billion per year in the US. With their current single payer system, Canadians consistently outpace us in quality outcomes in end stage renal disease, type 1 and 2 diabetes, maternal and infant mortality and cystic fibrosis to name a few. Though many initially claimed that delays in the system would make it impractical, at this time complaints about access and quality are no different than those in the US.3
6. A comprehensive policy framework to understand and address dis parities and discrimination health and health care: a policy paper from the ACP. Serchen, J, Doherty R, Atiq, O, and Hilden H. AIM vol.174 no.4. 4/2021. Pp. S29-31 doi:10.7326/M20-7219
John J. Seidenfeld, MD is the Chair of the BCMS Publications Committee and a Fellow of the American College of Physicians. Visit us at www.bcms.org 13
3. The ACP endorsement of single-payer reform: a sea change for the medical profession. Woolhandler, S and Himmelstein, DU. AIM vol 172 no.2 (supplement). 1/21/2020. Pp. s60-62. Doi: 10.7326/M193375
As a result, deaths in these groups were higher than in protected groups particularly before vaccines were available and widely distributed. Has the time come for us to switch to a single payer system? Will such a system fix all the problems in our current healthcare dilemma?
The ACP champions caring for vulnerable people so that no person is left behind.6 Over the past two years, significant health disparities have been evident in our nation. Those with lower incomes were unable to stay home, get large government payments, afford childcare and use the internet to “zoom” to work. They went into their jobs at their own peril as cleaners, cooks, grocery workers, firefighters, construction workers, nurses and aides, doctors, teachers, police and other critical personnel.
4. https://www.cbo.gov/system/files/2019-05/55150-singlepayer.pdf KeyDesignComponentsandConsiderationsforEstablishingaSingle-PayerHealthCareSystemCBO5/2019
cies with the highest medical expenses lapse, dropping plans offered previously, or confusing members through their telephonic customer service and confusing websites. In a similar fashion, the ACA private insurer run plans implement these strategies to remove a de facto “highrisk pool” of patients with greater severity of illness, pre-existing con ditions and higher costs for medical care per year. Despite government attempts to thwart the insurers strategies, costs continue to rise as does administrative overhead charged by insurers. An advantage of “public choice” would be avoidance of confrontation with powerful health plans and their lobbies, and the option to allow individuals to retain their current insurance coverage.
How do the options, single payer versus public choice compare? In a single payer system, if all providers, doctors and hospitals were in one network, it would end self-selecting out of networks which now results in small networks of willing providers and longer wait times or unavail ability in some areas for poor or high-risk patients. The overhead of each office would be reduced as fewer staff would be needed for col lections and insurance follow-up. It would not exclude the inevitable “Blue Stockings” trade which is always available to those able and will ing to pay for care outside of the system. Public choice would require a much more robust regulatory arm to assure fair application of Federal and State resources and would not assure great cost savings as single payerAccordingwould. to a Congressional Budget Office report in December of 2020, single payer would raise worker wages since employers would no longer provide health coverage. It would eliminate a household’s health insurance premiums and most out of pocket expenses thus boosting disposable income, reduce administrative waste and free up resources for other sectors of the economy. Workers’ health outcomes and longevity would be improved, and single payer would create a longterm care program which would compensate unpaid caregivers and in crease wages among care workers.4,5 Other necessary changes suggested by the ACP would include changing the way doctors are paid. Much of the work of primary care is therapeutic, preventative and cognitive. Rewards would require re distribution to recognize the cost savings to the system of the work done in a primary care medical home. For example, by assuring primary prevention measures are recommended and discussed, significant sav ings would accrue from earlier diagnosis, preventive care measures, and therapeutic recommendations tailored to the individual and their cur rentTheregimens. ACPrecommends
Clearly these changes will not fix all our problems and will contribute to a massive bureaucracy larger than that many of us have seen in the Veteran’s Administration, the Military and in Medicare. Although the ACP recommended these changes two years ago, we are in for a pro longed period of debate and discussion. We present this now for our members to begin to formulate their own best solutions and practices to the problems that confront us in delivering the best care to our pa tients and all members of our community.
1. San Antonio Express News. Special Feature. A broken system got worse: How COVID ravaged San Antonio’s South Side by Laura Garcia 4/20/22
5. https://www.peoplespolicyproject.org/2020/12/11/cbo-medicare-for-all-reduces-health-spending/ CBO:MedicareforAllReducesHealthSpending12/11/2020byMattBreunig
References
2. Envisioning a better US healthcare system for all: a call to action by the American College of Physicians. Doherty, R, Cooney, TG, Miro, RD et al. AIM vol 172 no.2 (supplement). 1/21/2020. Pp. s3-s6. Doi:10.7326/M19-2411
HEALTHCARECOVERAGE
universal coverage to avoid safety-net gaps, join other economic partners who assume that such care is the respon sibility of industrialized and technologically advanced nations, and avoid the current cost sharing seen when under- and un-insured patients enter the health care system often through the emergency room door.
By Maryann England and Ashley Chakales T
14 SAN ANTONIO MEDICINE • September 2022 HEALTHCARECOVERAGE
exas has about 4 million people who lack health in surance, nearly 600,000 of which are children, and 3.7 million people who live below the poverty line.1,2 San Antonio and surrounding areas are not immune to this. Nowa days, raising a child in America poses many challenges. In addition to the breast milk shortage and adequate healthcare coverage, diapers and other baby changing supplies are expensive. We want to share with San Antonio Medicine magazine readers how our intervention in Lytle, Texas saved families money each month, by pro viding information on preventing di aper rash and free diapers and supplies.Wechose to work in Lytle, because of its location and population. Lytle, Texas is a small town outside of San Antonio, located 25 miles away from the nearest diaper bank. Based on our research, the majority population in Lytle does not have health insurance and their income is $25,000 per year or lower.3 The clients we served were re ceiving benefits from other govern ment-funded programs such as the Special Supplemental Nutrition Pro gram for Women, Infants and Chil dren (WIC), Supplemental Nutrition Assistance Program (SNAP) and Med icaid. We spread the word about our services by distributing flyers at local daycare centers and clinics. Recently, we started working with the Mayor of Lytle, Ruben Gonzalez and the Superintendent, Michelle Smith to target a wider audience. People who were interested contacted A Brighter Day, a non-profit organization we partnered with for this project. They helped us by providing contact information and baby diaper sizes. A Brighter Day called participants the week of the distribution of diapers and other supplies to remind the community about our event.
Bridging the Diaper Gap: How our Diaper Rash Intervention Saved Families Money
3. Lytle Texas Healthcare Data. Towncharts Healthcare data. (n.d.). Retrieved July 19, 2022, from Texas/Healthcare/Lytle-city-TX-Healthcare-data.htmlhttps://www.towncharts.com/
We held a monthly event every Saturday for three months during Fall 2020, Summer 2021 and Fall 2021. We distributed supplies at St. Andrew’s Catholic Church, where we stationed ourselves next to the church rummage sale to make our station and diaper supplies visible to people who were walking by. At these events, the team volunteers put together baby kits that included diapers, diaper creams, baby wipes and extra goods donated by A Brighter Day. Before distributing sup plies, a research team member asked the parents of the children to fill out a pre-survey to obtain baseline knowledge on diaper dermatitis. After, the research team members designed and handed out pamphlets to provide information and general knowledge about diaper dermatitis: 1) how to properly change a diaper; 2) when to seek medical care for a child's diaper rash; 3) what diapers doctors recommend; 4) what are the best options.
On the third distribution day, the research team conducted post-sur veys to assess knowledge gained by participants in our study research. Providing information to families was a very eye-opening experience for our team. We were able to build and establish a relationship with the participants during our research and volunteer work. One of the most memorable families we helped, was a woman with two children who saw us from the church rummage sale, she was looking for a stroller for her two young toddlers. We had a conversation with her and we re alized that she has multiple jobs and financial struggles every month to make ends meet. She mentioned that our project provided her with all the information and benefits of using the supra-absorbent diapers that we provided during our event. She expressed her children have been using cloth diapers and they have been experiencing skin irritation lately. She received our diapers and supplies, and she was interested in continuing to be a part of our program. Another memorable memory from our time in Lytle, Texas was our interaction with an older mother. She stated that she and her husband were not financially stable to have another child in their family, but our project Bridging the Diaper Gap relieved a financial burden from her family. It was rewarding to see our effort make a difference in the lives of Lytle community members. Since the start the Bridging the Diaper Gap program has helped over 104 people. Our impact was not only noted through the rewarding in teractions with Lytle community members, but it was also reflected in our survey analysis. Pre-surveys determined that 80% of our clients’ ba bies experienced diaper rash at least once in the last year. After regis tering for our project, families reported their babies not experiencing a single episode of diaper rash. Post-survey responses showed that every participant found the Bridging the Diaper Gap program educational and helpful. Families saved about $23.03 monthly, totaling $69.09 over the three months of each cycle. Saving money on diapers, wipes and di aper cream allowed families to spend money on other necessities and basic living expenses. Our goal is to work with A Brighter Day and Lytle City Council in an effort to expand to Natalia, Texas, and other areas near San Antonio.
15
Maryann England and Ashley Chakales are medical students at the UT Health San Antonio Long School of Medicine and leaders of Bridging the Diaper Gap.
2. Knop-Narbutis, A. (2021, September 14). New Census Data Show Federal Investments kept millions out of poverty, but Texas needs bold action. Every Texan. Retrieved July 19, 2022, ges,for%20the%20same%20time%20period.bold-action/#:~:text=Looking%20at%20multi%2Dyear%20averaeral-investments-kept-millions-out-of-poverty-but-texas-needs-https://everytexan.org/2021/09/14/new-census-data-show-fedfrom
References: 1. The uninsured in Texas. Texmed. (n.d.). Retrieved July 19, 2022, from https://www.texmed.org/uninsured_in_texas/
Visit us at www.bcms.org
HEALTHCARECOVERAGE
16 SAN ANTONIO MEDICINE • September 2022 HEALTHCARECOVERAGE
Many Medical students would be surprised to learn that countless scholarships are available to them as they continue their education.
The Rise of Medical Student Debt: What are the Options and Opportunities for Students?
he burden of student debt in the United States is an issue that has far-reaching impli cations. Outstanding student loan debt in the nation is over $1.7 trillion, with 92.6% of this provided by federal student loans. The COVID-19 pandemic and its corresponding relief efforts have offered a brief respite for many students. Since 2020, the rate of in crease of the total national student loan debt has declined significantly. This slowing of the rate of student debt acceleration is attributable to the Coronavirus Aid, Relief and Economic Security (CARES) Act signed into law on March 27th of that year.1 Addition ally, Texans have the advantage of a comparatively low average debt at graduation of $26,273 as of the 2020 graduation year, it ranked the 11th lowest in the na tion. In this environment, students are entering postgraduate programs and should be looking to safeguard themselves against future financial hardship using the resources at their disposal.2 Medical students can build up a staggering amount of educational debt which dwarfs the average debt of undergraduates, with the median of indebted graduates at $200,000 as of 2020. A small but significant minority of physicians will never pay off what they borrow during their four-year postgraduate education. Few students have the resources to pay their way without the help of federal loans, and therefore the goal shifts to minimizing the amount a student needs to borrow. This might be achieved with grants or scholarships. Alternatively, students might choose to pursue loan forgiveness programs or military service. Early efforts to curb the snowballing of student debt have a significant down stream effect on the lifestyle and wellness of students post-graduation, especially when repayment for many will be years in the future.
Grants: Grants are a way medical students can cover costs in medical school. Grants can cover travel, housing, conference registrations and other items applicable to your work. There are various avenues to find grants to apply for. A good place to start is with your specialty of interest. At tending interest group meetings allows you to hear from other students and mentors about what opportunities and projects exist and how to go about establishing your own or applying for one. For example, the Family Medicine Interest Group (FMIG) discussed the Texas Family Medicine Preceptorship Program (TAFP), a program that provides the opportunity to gain experience with a skilled family medicine physician in a community setting. Stipends are available to students ranging from $2,000 -$5,000 depending on the length of the preceptorship and the type of community you serve. Other specialties, such as pediatric and internal medicine, offer similar programs for medical students. This provided a great resource to explore a particular field without the stress of living costs. Additionally, many state and national medical societies offer grants for research electives. One can find these by looking up an organization in their field of interest and searching their website for mentorships or research fellowships. Scholarships: Applying to scholarships does not end at the undergraduate level.
By Sean Rumney, Maryann England, Ashley Chakales T
One of the first steps in applying to scholarships is completing the free application for Federal Student Aid (FAFSA). This is a require ment for many scholarships within your institution. Secondly, apply for scholarships within your school. The school you attend likely
Military and Loan Forgiveness Programs: Beyond minimizing loans through grants and scholarships, students should explore loan forgiveness programs to see if these align with their career goals. A frequently chosen path for loan forgiveness is through the Health Professions Scholarship Program (HPSP), offered by the US Army, Navy and Air Force. This is available for students in medical and dental programs and offers full coverage of tuition along with a monthly stipend. This program is contingent on one year of military service for each year the scholarship is used. As an alternative to military service, there are loan-forgiveness pro grams post-graduation offered by philanthropic organizations in ex change for a commitment to practice in underserved areas, for example, The National Health Service Corps (NHSC) Rural Community Loan Repayment Program (LRP). This Loan repayment program is offered to licensed providers who agree to work in specific rural communities to combat the opioid epidemic. Many medical students enter this train ing with the only goal to service vulnerable and at-risk populations. This program offers loan forgiveness to practice in a field in which they are already highly motivated to work. Sean Rumney, Maryann England, and Ash ley Chakales are medical students at the UT Health San Antonio Long School of Medicine.
References 1. Hanson, M., & Checked, F. (2022, May 30). Student Loan Debt Sta tistics [2022]: Average + total debt. Retrieved July 19, 2022, udent%20loan%20paymentsThe%20nationwide%20total%20student%20loan,on%20their%20sthttps://educationdata.org/student-loan-debt-statistics#:~:text=from 2. Acknowledgements - the Institute for College Access and Success. (n.d.). Retrieved July 19, 2022, from https://ticas.org/wpcontent/uploads/2021/11/classof2020.pdf
3. Physician Education Debt and the Cost to Attend Medical School 2020 Update. (n.d.). Retrieved July 19, 2022, d/368/https://store.aamc.org/downloadable/download/sample/sample_ifrom
Visit us at www.bcms.org 17 sends emails about available scholarships that many students over look. Most scholarship application processes are fairly short and straightforward. Applying to outside scholarships requires more ef fort to find them and to check if you meet the requirements. These types of scholarships tend to have more specific criteria, but they are still worth applying to if you are eligible.
So, while CareLink originally began with the straightforward pur pose of providing access to care, it provides more pieces of the public health puzzle, with screenings and affordability programs that address a broad array of health needs. “That has been an important evolution,” Gonzalez said. Elizabeth Allen is the Director of External Communications at University Health. Public Health
CareLink –
Coverage
By Elizabeth Allen O
“We don’t provide every health need, but take a holistic approach to be able to link people to other health care needs like food security and utilities,” Gonzalez said. “Everyone who enrolls is screened for eligibil ity and need for these other programs.”
ver the past 25 years, our understanding of effective, meaningful public health service has evolved, and Care Link has evolved with it. CareLink is one of the founda tional pillars of public health in Bexar County, and since 1997 the financial assistance program has connected qualifying Bexar County residents to care. A core element of public health is equitable access to care, said Chris tine Gonzalez, PharmD, CareLink Director of Medical Management. “CareLink promotes public health by providing affordable access to care, including preventive care, thus improving the health and overall well-being of our community,” Gonzalez said. “Everybody who joins CareLink selects a primary care provider and that gives them a medical home.”Having a medical home means people have access to the kind of preventive care and screenings that can pre vent serious illness or chronic diseases, meaning less cost in medical bills and a better health outcome. Also, they can be referred to specialized care without having to wait until they are sick enough to go to an emergency room. CareLink is not an insurance plan, but once enrolled our staff will work with a member to establish a monthly payment plan for medical expenses. Payment plans are based on total household income and the number of persons in the family. Bexar County residents with incomes at or below 200% of the federal poverty level, and do not have access to affordable health coverage are eligible for this program. In 2021, the average monthly enrollment in CareLink was 27,850 total members. Since Texas has not expanded Medicaid, many adults under 138% of the federal poverty level (FPL) are left without coverage and they are a considerable portion of the uninsured and CareLink population. Without insurance coverage, buying medications can be out of reach for many people. CareLink helps members to get access by linking them to the patient assistance programs maintained by large drug companies. When people are eligible for other programs, like Medicaid or other insurance coverage through the health care exchange created by the Affordable Care Act (ACA), CareLink helps them nav igate their options and complete the needed paperwork for enrollment.
CareLink staff is always looking for opportunities to serve the com munity, like the recently renewed federal Connecting Kids to Coverage (CKC) grant that they’ve been using for five years to provide enroll ment, and renewal assistance to children and their families, signing them up for Medicaid and the Children's Health Insurance Program (CHIP). At the end of the most recent grant period, staff exceeded their goals in both renewing and newly enrolling applicants. New re sults show that 2,594 more children in Bexar County have access to health care. The team has shared their successful practices in national webinars, so others can learn to extend these benefits to more families. Because of their success, the $1.5 million grant was just re newed for another three years, and for the first time can be used to help enroll ex pectant parents to promote improved maternal and in fant health outcomes. The health picture is even bigger than that, though and CareLink also helps address different important health needs through multiple part nerships with other organiza tions, e.g., the San Antonio Food Bank, City Public Service (CPS) and San Antonio Water System (SAWS).
18 SAN ANTONIO MEDICINE • September 2022 HEALTHCARECOVERAGE
• Increase outpatient and inpatient mental health hospital capacity for children and adolescents; and
• Widen Texas’ statewide Safe Gun Storage Campaign.
“We know as physicians that positive experiences in childhood –specifically safe, secure, nurturing relationships with trusted adults, such as teachers, extended family members, parents, [and] counselors – we actually know that those types of relationships can negate the toxic effect of ACEs. And that’s a powerful thing,” Lubbock pediatri cian Celeste Caballero, MD, testified on behalf of TMA and the other organizations during the special committee hearings.
Visit us at www.bcms.org 19
Emma Freer is a reporter for Texas Medicine. She previously worked in local news, covering city politics, economic develop ment, and public health.
• $4.7 million to increase the number of Multisystemic Therapy teams, which have been proven to reduce the risk of violence; and
• $50 million for bulletproof shields for local law enforcement;
• $10 million for rapid response training and associated travel costs for local law enforcement, including school resource officers;
• Set a Medicaid policy framework to better integrate clinical and com munity services designed to address nonmedical drivers of health;
Copyright Texas Medical Association. Reprinted with permission from Texas Medicine Today.
State Allots Millions for School Safety, Mental Health after Uvalde Shooting
By Emma Freer Q
• $7 million for the Texas School Safety Center to provide training, assessments, and support to school districts as they review their emer gency operations plans and address campus security needs;
• $5.8 million to expand the Texas Child Health Access Through Telemedicine (TCHATT) program, which provides telemedicine services to schools to identify, assess, and treat students with behav ioral and mental health needs;
UICKLY FOLLOWING a series of legislative hearings to address the Uvalde shooting, Texas leaders have an nounced the transfer of more than $105.5 million within the state budget to fund a series of school safety and mental health pro grams through August 2023.
The move heeds several recommendations from the Texas Medical Association and several state specialty societies. In a statement from the governor’s office quoting several state leaders, Speaker Dade Phelan (R-Beaumont) said lawmakers will consider these recommendations and other outstanding proposals during the interim period and throughout the upcoming legislative session, which begins in January.
HEALTHCARECOVERAGE
“[T]his commitment will ensure additional telehealth services are quickly available to more school-aged children both within the Uvalde community and across the state,” he said in the governor’s statement.
Drawing mostly on surplus funds in the Texas Education Agency budget, state leaders allocated:
House Appropriations Chair Rep. Greg Bonnen, MD (RFriendswood), commended the funding push, which stems from the school shooting at Robb Elementary School in Uvalde on May 24.
• $5 million to expand fusion centers, which could help facilitate datasharing among local, state, and federal law enforcement agencies to identify threats to school districts;
TMA and seven state specialty societies called for a multipronged approach to strengthen the state’s health and social services, including the statewide expansion of TCHATT, in written testimony submitted to the Senate’s Special Committee to Protect All Texans on June 22.
TMA welcomes the investment in TCHATT. Meanwhile, state leaders continue to evaluate a series of other proposals by TMA and the other organizations, including to:
• Expand crisis intervention and trauma-informed training among health professionals, school and community leaders, and families;
• $5 million to evaluate mental health services in Uvalde and prepare a needs assessment for the legislature;
• $17.1 million for school districts to purchase silent panic alert tech nology;
• $950,000 to expand Coordinated Specialty Care Teams, which treat youth experiencing their first episode of psychosis.
• Establish Medicaid and Children’s Health Insurance Program pay ment for physicians and health care providers who screen patients for adverse childhood experiences (ACEs);
- Lewis Carroll, the Hunting of the Snark
What I tell you three times is true
Ancient Problem Needs New Solution
Because even if one factor (like your pass word) becomes compromised (and almost all are available on the deep web for a pittance), unauthorized users will be unable to meet the sec ond authentication requirement, ultimately stopping them from gain ing access to your accounts. Today, two-factor security generally involves accessing a second device, primarily a phone, to authenticate identity but even Rachel beat 2FA four millennia ago. For PHI in a world of IoT (Internet of Things), three factor will become common in the near future.
The traditional login process with a username and password is insuffi cient in an increasingly hostile healthcare data environment. Two-fac tor authentication (2FA) has become necessary to other healthcare en terprise compliance as well, including the Drug Enforcement Admin istration's Electronic Prescription for Controlled Substances Rules and the Payment Card Industry Data Security Standard (PCI DSS).
dentity Theft is as old as the Bible: in Genesis, Jacob purloins his brother Esau’s identity to steal his birthright. You may recall that Rachel encouraged her son to use two proofs of identity: to bring the nearly blind patriarch Isaac food appropriate from a hunter, and to wear animal hide on this arm to imitate his brother’s hairiness. Today’s cybersecurity experts would suggest that Rachel defeated “two-factor security,” and explains why your phone and password may soon be insufficient to authenticate your identity.
ProvingI
Identity–
20 SAN ANTONIO MEDICINE • September 2022 HEALTHCARECOVERAGE
Isaac Blessing Jacob, Govert Flinck, c.1638. Oil paint on canvas. “ “
Three Factor Security is defined by the National Institute of Stan dards and Technology (NIST), “something you know” (password); “something you have” (phone, pad, dongle); and “something you are” (fingerprint, retina scan, facial recognition).
According to HHS, “It’s more important in the post-pandemic era for covered entities to develop and implement tighter policies and pro cedures for authorizing EPHI access. It is crucial that only those work force members who have been trained and have proper authorization are granted access to EPHI.” It recommends two strategies to for risk
By David Schulz
According to a report released by Microsoft, by implementing HIPAA MFA, organizations reduce their cybersecurity risk by 99.9%. This is because the most common cause of cyberattacks stem from the use of stolen login credentials, with 81% of breaches caused by stolen credentials.What’seven more concerning is that 55% of organizations in the U.S. suffered from at least one successful phishing attack last year. With only 11% of organizations utilizing MFA or 2FA, these attacks have left many organizations vulnerable to data theft.
At the moment, although two-factor authentication is not required for HIPAA, it can help pave the way to HIPAA compliance and is urged by the U.S. Department of Health and Human Services (HHS).
Why implement MFA?
The Healthcare Industry, with ever-growing use of re mote medicine and Internet connectivity for devices ac cessing Protective Health Information (PHI), and facing Health Insurance Portability and Accountability Act (HIPAA) obligations, is woefully behind in implement ing Multi-factor Authentication (MFA). MFA is a lay ered approach to proving identity, already prevalent in banking, shopping and some healthcare applications; but most ‘patient portals’ still rely on only passwords. A frightening concept when the most common passwords in 2022 remain “12345678” and “PASSWORD.”
Image Copyright Cybersecurity & Infrastructure Security Agency and the Department of Homeland Security (DHS)
Now, the Federal Bureau of Investigation (FBI) is warning healthcare organizations about a new ransomware threat, based on Russia giving free license to cybercriminals attacking the United States infrastructure, including hospitals and emergency services.
theandAgencySecurityInfrastructure&CybersecurityCopyrightImage(DHS)SecurityHomelandofDepartment
Visit us at www.bcms.org 21
HEALTHCARECOVERAGE
It’s not only a HIPAA violation to be feared but the hostage-taking of an organization’s entire data and communication network. The FBI, along with HHS and CISA, has issued a warning to healthcare organ izations stating that they have, “credible information of an increased and imminent cybercrime threat to U.S. hospitals and healthcare providers.”Ransomware attacks have become more prevalent as of late with hackers exploiting the coronavirus pandemic in several ways. First it was hackers impersonating the CDC and WHO by sending out fake COVID tracking maps. Then it was hackers targeting remote workers by impersonating popular companies such as Microsoft Corporation.
For patients, MFA will likely mean additional steps to access the healthcare portals on which they’ve come to rely. Communicating an nually with patients about the importance of safeguarding their Pro tected Health Information is a great way to both show proper stewardship and to explain any new privacy procedures they may need to adopt to satisfy MFA.
David Alex Schulz, CHP is a community member of the BCMS Publications Committee.
management: Implement two-factor authentication for granting re mote access to systems that contain EPHI; and implement a technical process for creating unique user names and performing authentication when granting remote access to a workforce member.
Brian Boswell, CFP®, QKA, is a Private Wealth Advisor at Oakwell Private Wealth Management and a Platinum Sponsor of the Bexar County Medical Society He can be reached at: bboswell@oakwellpwm.com or (800) 556-2593.
Under the new temporary rules, past periods of repayment will now count whether or not you made a payment, made that payment on time, for the full amount due, or on a qualifying repayment plan. In addition to this, under the current waiver, even if you are not currently working for an eligible employer, but have worked for one in the past, you have the opportunity to count those years towards forgiveness (e.g., working for a non-profit during a residency program).
By Oakwell Private Wealth Management, Platinum Circle of Friends Sponsor of BCMS
PSLF Benefits for Physicians
22 SAN ANTONIO MEDICINE • September 2022
Article written by Oakwell Private Wealth Management. The team at Oakwell Private Wealth Management offers comprehensive full financial planning and investment management to physicians and medical profes sionals.Fora complete listing and understanding of the requirements, visit the Federal Student Aid website.
ealth management firms are a great resource for physi cians to work with to provide ongoing financial planning and wealth management services. With proper direction, many physicians have begun taking advantage of the Public Service Loan Forgiveness (PSLF) program, which offers loan forgiveness for qualify ing applicants within the medical field. Already, many have had hun dreds-of-thousands of dollars become eligible for forgiveness.
On October 6, 2021, the U.S. Department of Education (E.D.) an nounced a temporary period during which borrowers may receive credit for payments that previously did not qualify for the program which ex pands the possibility of more physicians qualifying. This change of re quirements and qualifications ends October 31, 2022, which makes now a crucial time for physicians to apply for this program.
The two critical components of qualification for this program include:
With current waiver in place, more physicians are approved for the PSLF program. So, even if you didn’t qualify before, there’s a good chance you could qualify today through the October 31, 2022 deadline.
What is Public Service Loan Forgiveness?
Now Is the Time to Apply
PublicW Service Loan Forgiveness (PSLF) For Physicians
For physicians with years of training behind them, school loans can become rather substantial. Using a combination of specific paymentreduction programs and then working for a PSLF-qualifying employer, you can get a significant amount of your loan forgiven under the PSLF program. With this program, whatever remains of your debt is forgiven tax-free based on your past payment history.
• Working for a PSLP qualifying employer
The temporary waiver for regular PSLF payment history qualifica tions ends on October 31, 2022, so now is the time to act if you meet the above essential requirements. First, go to the Federal Student Aid website to see if you qualify. If eligible, you can fill out the PSLF form and mail, fax, or upload it to the U.S. Department of Education.
The Public Service Loan Forgiveness (PSLF) program gives physi cians tax-free forgiveness on the remainder of their federal loans after 120 payments (10 years). The PSLF program is an excellent way to manage loans for physicians working for a qualifying employer (em ployed by a U.S. federal, state, local, or tribal government or not-forprofit organization).
• Having consolidated loans under the Direct Loan Program
HEALTHCARECOVERAGE
PSLF Requirements and Qualifications*
What does the ADA require for mobility-impaired patients?
A public accommodation is required to remove architectural barriers in existing facilities where such removal is "readily achievable," which is defined as "easily accomplished and able to be carried out without much difficulty or expense." Examples of actions to remove barriers in clude installing ramps, widening doors, installing grab bars in bathroom stalls, installing a raised toilet seat, removing deep pile carpeting, and creating designated, accessible parking spaces.
What am I required to do under the ADA to accommodate patients who are hearing impaired?
Appropriate auxiliary aids and services may include qualified inter preters, assistive listening devices, note takers, and written materials.
Employers with 15 or more employees must comply with the ADA in their employment practices. The ADA protects individuals with dis abilities from discrimination related to employment practices. Individ uals with disabilities who meet "the skill, experience, education, and other job-related requirements of a position held or desired, and who, with or without reasonable accommodation, can perform the essential functions of a job" are protected.
For more information, please refer to the ADA website, www.ada.gov/ada_intro.htm, and resource, "Access To Medical Care For Individuals with Mobility Disabilities,” at www.ada.gov/med care_mobility_ta/medcare_ta.htm.
See more in the “ADA Business BRIEF: Communicating with peo ple who are dead or hard of hearing in hospital settings” at https://www.ada.gov/hospcombr.htm.
T 24 SAN ANTONIO MEDICINE • September 2022
Who has responsibility for ADA compliance in leased build ings, the landlord or the tenant?
For many, the breadth of the ADA’s definitions and resulting respon sibilities can be daunting. Sometimes even more unknown are the con ditions that qualify as a disability under the law.
ADA Requirements for Physician Offices
he Americans with Disabilities Act (ADA) was signed into federal law in 1990 with the intention of providing equal pro tection for people with disabilities, specifically regarding em ployment, housing, federal funding, and access to services, such as health care.
Title III of the ADA declares medical offices and hospitals as “public accommodations” that must comply with ADA regulations. But what constitutes “best practices” for providing reasonable accommodations for disabled patients?
The ADA does not require modifications that would fundamentally alter the nature of the services provided or result in an "undue burden" on the provider. What constitutes an "undue burden" is determined on a caseby-case basis. At least one court has found in favor of the plaintiff over the provision of an interpreter for a hearingimpaired patient in a primary care physician's office.
This article answers six common questions about the ADA
What about those patients who do not speak English? Am I required to provide and absorb the cost of an interpreter? These patients are not considered disabled under the ADA. How ever, according to the Office for Civil Rights, an entity receiving federal reimbursement (such as Medicaid or Medicare) is responsible for en suring that effective oral and written communication occurs with pro gram beneficiaries who are limited English proficient (LEP).
The ADA places legal responsibility to remove barriers or provide auxiliary aids on both the landlord and the tenant. Typically, the ten ant is responsible for the space they use and control such as an exam room or reception area. The landlord is typically responsible for com mon space such as a parking lot or building entrance used by more than one tenant.
To be covered by the ADA, an individual must have a mental or physical impairment that (even with corrective or mitigating measures, such as corrective lenses) substantially limits one or more major life ac tivities. In addition, the ADA prohibits discrimination against persons who are perceived to have a disability.
The entity can take several steps to meet its obligations to LEP pa tients. Providing interpreters, at no cost to the client, is one method. Please visit the Federal LEP website for more information at www.lep.gov.
As an employer, it is essential to train staff members on ADA re
HEALTHCARECOVERAGE
What is my responsibility as an employer under the ADA?
By Sara Bergmanson, Tanya Babitch and Robin Desrocher
HEALTHCARECOVERAGE
Yes. ADA requirements apply to all goods, services, privileges, or ac tivities offered by a business, including those offered on the web. Cur rently, there are no detailed standards enforced by the Department of Justice, and businesses are allowed to choose how they will ensure the accessibility of their online services.
quirements and what makes up “reasonable accommodation” for pa tients. It is good practice to create written policies and procedures that include topics such as scheduling appointments (with attention to patients needs such as accessible examination tables); service animals; providing interpreters; and making the office space as accessible as pos sible. Training resources can be found on the ADA National Network website at https://adata.org/ada-training.
Does my website or patient portal need to be ADA accessible?
The Department of Justice operates a toll-free ADA Information Line to provide information and materials to the public about the re quirements of the ADA. ADA Specialists assist callers in understand ing how the ADA applies to their situation, are available on Monday, Tuesday, Wednesday, and Friday. Calls are confidential.
For guidance, please see the following resources, used by the federal government for its own websites: • Web Content Accessibility https://www.w3.org/WAI/standards-guidelines/wcag/Guidelines at
• Section 508 Standards at https://www.access-board.gov/ict/ • See also the ADA guidance on web accessibility at https://beta.ada.gov/resources/web-guidance/.
How can I get more help understanding and interpreting ADA rules?
To get answers to technical questions, obtain general ADA informa tion, order free ADA materials, or ask about filing a complaint, call 800-514-0301 (voice) or 800-514-0383 (TTY).
Sara Bergmanson is a Digital Marketing and Brand Strategist at TMLT. She can be reached at sara-bergmanson@tmlt.org
Tanya Babitch is an Assistant Vice President of Risk Management at TMLT. She can be reached at sara-bergmanson@tmlt.org Robin Desrocher, BSN, RN, Director and Risk Manager at TMLT. He can be reached at robin-desrocher@tmlt.org Reprinted with permission from Texas Medical Liability Trust. Visit us at www.bcms.org 25
HEALTHCARECOVERAGE 26 SAN ANTONIO MEDICINE • September 2022
HEALTHCARECOVERAGE Visit us at www.bcms.org 27
At Left: Dr. George Cupples, Co-Founder of the Bexar County Medical Society.
In September of 2023, Bexar County Medical Society (BCMS) will celebrate yet another milestone – its 170th anniversary! From its in ception in September of 1853 to the present, the BCMS imprint can be found throughout San Antonio and Bexar County. The visionary, founding physicians of the day back in 1853, among them the Society’s first president, Dr. George Cupples, along with Drs. I.H. Lyons, Henry P. Howard, Adolphus Scholmann, Ferdinand Herff, F. M. Giddings, John Hoffman, E.G.A. Schaffter and Dr. Weisselberg paved the way and were granted a charter to establish what was the first and oldest county medical society in Texas – the Bexar County Medical Society. The Texas Medical Association (TMA) had already been organized in January of the same year.
In the coming months, there will be a variety of articles presented in this publication in honor of the Society’s anniversary. For the record, the last full feature, special edition of San Antonio Medicine honoring the Society’s then 150th anniversary ran in November of 2003. Need less to say, a lot has happened since then. It is our hope to share the historical highlights from the Society’s inception to the present, of what makes this organization great for the physician and student members in San Antonio and Bexar County. With this celebratory year, there will also be a special emphasis on the accomplishments of the organi zation over the last 20 years. An added feature will be to include briefs on many of the physician members who are or were pioneers in their fields and who serve or have served the patients of San Antonio and Bexar County in leadership positions within BCMS and the TMA.
By Mary E. Nava, MBA, BCMS Chief Government Affairs Officer
We will also highlight other “firsts”, including briefs on the first three female presidents in the Society’s history, one of whom is the namesake for a newly established annual BCMS award given in honor of a female physician leader in recognition of significant and on-going contribu tions to the practice of medicine and service to the community.
Last, but not least, we want to share the message of why the Bexar County Medical Society is here and why membership in such an hon orable and prestigious organization is so extremely vital to not only the strength of the organization as whole, but also to up and coming stu dent members as they embark on their journey into medicine and also to physicians in private practice, who so strongly continue to serve and advocate on behalf of patients and physicians everywhere.
If you are interested in writing an article for consideration in honor of the Society’s 170th anniversary, please submit your inquiry to San Antonio Medicine editor, Nancy Salas to editor@bcms.org.
28 SAN ANTONIO MEDICINE • September 2022 HISTORYBCMS Another Approaching…MilestoneBCMS 170
Mary Nava is the chief government affairs officer and lobbyist for BCMS. She has been with the Society since February of 2000. Years of Advocating for Physicians and Patients
Above: Presented to the Bexar County Medical Society, By Dr. Frank Paschal, Dec. 21, 1992.
Monica Jones is the Chief Operating Officer and PH&R Staff Liaison at BCMS.
The BCMS PH&R program has set the standards for other pro grams across the state. In the almost 40 years of its existence, the com mittee has helped hundreds of physicians successfully recover while keeping patients safe. Those being helped are able to safely practice medicine and return to their families and practices whole again and renewed. Evenmore unique is that the weekly evening Caduceus meetings continued to meet in person during the peak of COVID-19. PH&R Chair, Dr. Oliver Johnson explained, “Caduceus meetings are critical; Caduceus is a protected forum where physicians with addiction prob lems can share their challenges openly and offer suggestions and en couragement to their fellow physicians. This exclusive forum where issues of practice difficulties and stresses can be aired and help offered is vital. These special considerations simply cannot be discussed in reg ular AA meetings.” Caduceus meets at BCMS every Thursday night at 7 Thepm.award was accepted by Dr. Oliver Johnson, PH&R Chair since 1995, and Dr. Neal Gray, BCMS President 1992 and co-creator of the PH&R Program in 1982 and Melody Newsom, CEO/Executive Director.Formore information about the Physician Health and Rehabilita tion program visit our website at http://www.bcms.org/phr.php or call Monica Jones, COO and staff liaison for PH&R at (210) 3014373.
2022 AAMSE Award: Bexar County Medical Society (BCMS), Physicians Health and Rehabilitation Program (PH&R)
Congratulations to the BCMS Physicians Health and Rehabilita tion Program (PH&R) who received the Profiles of Excellence award in the Advocacy category from the American Association of Medical Society Executives (AAMSE) on Thursday, July 28.
Visit us at www.bcms.org
The BCMS PH&R program is confidential and led by a committee of physician colleagues that identify and facilitate the recovery success for other physicians whose abilities are impaired by alcohol or drugs through support and monitoring. The goal is to help the impaired doctor return to practice and their home life free of alcohol and drugs. The program helps doctors learn how to cope with the stresses of modern medical practice and learn to live in a safe and peaceful envi ronment without the need for their former coping mechanisms.
By Monica Jones, BBA, BCMS Chief Operating Officer
29 AAMSEBCMSAWARD
On Wednesday, August 3, 2022 Bovino’s Steakhouse @ La Cantera, hosted the Bexar County Medical Society for a summer mixer. Attendees enjoyed an evening of great food, drinks, networking and camaraderie. Bovino’s Steakhouse will now offer all BCMS physician members, their staff and family a 15% discount when dining in. Options include Salad Bar, Assorted Beef Experience, Steak and Seafood. Mention code: BCMS to make your reservation. To make a reservation, please contact Claudia Esponda at 210-508-7895. www.bovinos-usa.com 2022 Summer Membership Mixer BCMS MEMBERSHIPSUMMERMIXER 30 SAN ANTONIO MEDICINE • September 2022
UT Health SA Student Dinner Orientation
UT Health SA students hosted a dinner orientation on Wednesday July 27, 2022. Several BCMS physicians and past presidents attended the dinner. Great conversation and discussion about the future of the incoming medical student class took place.
The first-year students had the opportunity to seat one on one with BCMS physicians to discuss their plans and professional career goals.
UT HEALTH SA STUDENT DINNER
Visit us at www.bcms.org 31
The United States now leads the world in monkeypox cases, with more than 6,300 of the 25,391 cases worldwide. Dallas has the most cases in Texas, followed by Houston, Austin, and then San Antonio, which has 13 cases as of this Fromwriting.nowon, monkeypox will belong in our differential diagnosis of herpes and other unexplained rashes, especially when vesicular, pustular or nodular. For the generalist, here is a quick primer by public health.
• Microbiology: Monkeypox is an Orthopox virus from the same family as variola virus (smallpox) and vaccinia, and a different virus family than varicella virus (chicken pox). It was discovered in 1958, and the first human case was identified in 1970. The fa tality rate was 1%-10% in previous out breaks, but is lower with the current outbreak. The animal reservoir is unknown but is likely small mammals. • Transmission most commonly occurs through direct contact with an infectious rash, scabs or bodily fluids. Transmission is also possible through respiratory secretions during prolonged, face-to-face contact of at least 3 hours; contact with fomites such as bed linens; vertical transmission through the placenta; and scratches, bites or other contact with an infected animal. People without symptoms cannot spread the virus to others, but lesions may not always be no ticed if present in the mouth, rectum or vagina. The Centers for Disease Control & Prevention (CDC) recommends abstain ing from sex for 8 weeks after an infection ends, due to possible persistence in semen or vaginal fluids.
• Symptoms occur after an incubation period of 1-3 weeks. There is often but not always a prodrome of fever, headache, lym phadenopathy, and significant fatigue. After 1-4 days, a rash appears. (Lesion photos are available on the CDC website.) Lesions progress over 2-4 weeks from macules to papules, vesicles, pustules, and then scabs. Enanthem are also possible. The patient re mains infectious until all scabs have fallen off and fresh skin is evident. While most people do not need hospitalization, in some people, pain from genital, anal and oropha ryngeal lesions can be severe enough to in terfere with bodily functions.
• Management of infection: Supportive care includes maintenance of adequate fluid bal ance, pain management, and treatment of any bacterial superinfection. Give anticipa tory guidance and address symptoms early to prevent hospitalizations, for instance through antihistamines and calamine lotion for itching, over-the-counter and prescrip tion mouthwashes for mucositis, sitz baths and topical anesthetics for pain, and stool softeners for proctitis. For people with se vere disease or at high risk for severe disease, tecovirimat (TPOXX) treatment is avail able under a CDC Investigational New Drug protocol. Doctors can call Metro Health’s Epidemiology unit at 210-2078876 or email MpoxConsult@ sananto nio.gov to obtain tecovirimat. A provider prescription will be needed, and ordering providers must complete all CDC proto cols and requirements.
• Screening: While 98% of cases to date are among men who have sex with men, risk is based on behaviors and exposures, not sex ual orientation. A heterosexual, cisgender woman with recent syphilis and gonorrhea is at greater risk than a gay couple in a mu tually exclusive relationship. Thus a good sexual history is a key element of your screening, and will be more fruitful with the use of nonjudgmental, neutral language, without assumptions about sexual orienta tion or behaviors. The CDC recommends the 5 P’s as a mnemonic: Partners, Practices, Protection from STIs, Past history of STIs and Pregnancy intention.
• Diagnosis: Testing is available through commercial labs including LabCorp and Quest with CPT code 87593. A swab of the lesion from any part of the body is ac ceptable. PPE for specimen collection con sists of eye protection, a disposable gown, gloves and a mask (currently the CDC specifies an N95, out of an abundance of caution). Note that two swabs from each le sion should be collected, using synthetic (non-cotton) swabs, preferably from differ ent locations on the body or from lesions that differ in appearance. It is not necessary to unroof the lesion. Co-infections are pos sible, so also test for other potential infec tions as appropriate. Clinical care can begin based on a positive orthopoxvirus result and should not wait on additional viral characterization testing.
PREPAREDNESSEMERGENCY
• Education: Let patients know that the pub lic health department will be reaching out to them. Advise patients to isolate from people and pets until all lesions have re solved, the scabs have fallen off, and a fresh layer of intact skin has formed. In a shared household, they can reduce transmission to others by using separate linens, clothing, drinking glasses and eating utensils, wearing
By Junda Woo, MD, MPH, and Anita K. Kurian, MBBS, MPH, DrPH
NOTE: THIS IS A RAPIDLY EVOLVING RESPONSE. THE INFORMATION BELOW WAS UP-TO-DATE ON AUG. 2, 2022.
32 SAN ANTONIO MEDICINE • September 2022
Monkeypox: What Bexar County Doctors Need to Know
• Vaccination: An attenuated live virus vac cine, Jynneos, is approved by the Food & Drug Administration as a 2-dose series over 28 days for prevention of smallpox and monkeypox in adults. It is currently avail able to a limited number of established pa tients at six San Antonio clinics with large LGBT populations. As the nation’s vaccine supply increases, distribution will be ex panded. Additionally, Metro Health will vaccinate close contacts of people identified during public health case investigations. Pa tients who recently attended a festival, rave or other event where monkeypox exposure is known to have occurred may be referred to Metro Health at 210-207-8876 for as sessment for possible vaccination. For the LGBT community, this monkeypox outbreak has triggered trauma from homo phobia and discrimination experienced early in the AIDS pandemic. People with monkey pox are expressing that they experience pain, shame—especially with facial lesions—guilt, fear, loneliness, and depression. We have even heard anecdotal reports of suicidal ideation.
The HIV epidemic taught us that LGBT stigma and HIV stigma create significant bar riers for at-risk populations who need treat ment, by deterring testing, treatment, and disclosure of contacts. You can make it more likely that people will remain engaged in care by fostering an environment of acceptance and inclusivity. To learn more, check out guide lines for stigma-free care by the End Stigma
Junda Woo, MD, MPH, is Medical Director and Local Health Authority at the San Antonio Metropolitan Health District.Anita K Kurian, MBBS, MPH, DrPH; Assistant Director, San Anto nio Metropolitan Health District. Visit us at www.bcms.org 33
PREPAREDNESSEMERGENCY a well-fitting mask and frequently cleaning household surfaces. If possible, a separate bathroom is ideal. Coversheets or water proof covers can be placed on upholstered furniture and other porous materials that cannot be laundered. To prevent inadver tent infection of the eye, counsel patients to use eyeglasses rather than contact lenses during this time.
End HIV Alliance of San Antonio (EndStig maEndHIV.com), or contact Metro Health’s Clinician Ambassador program at lucinda.zeinelabdin2@sanantonio.gov for an in-service on sexual history-taking and LGBTfriendly care.
By MGMA 34 SAN ANTONIO MEDICINE • September 2022
Medical Group
The board is excited to announce many new opportunities during the upcoming calendar year, which runs from June 2022 to June 2023. We are already planning the first evening meeting in September 2022 with a legislative update on everything going on in Austin TX and Washington DC. The first big event back after the summer hopes to bring forward the latest in healthcare legislation, including prior authorization regulations, the current status of Roe v. Wade and other items heading to the Texas legislative session just around the corner. After this first kickoff event, the board is plan ning on breakfast meetings to provide more educational seminars, evening mixers (to en typically slated in February and the Texas MGMA Annual Conference which will take in April at San Antonio, Texas. This event is one of the premier events for the Texas organ ization and we are excited to be the host chap ter for this conference year. We are encouraging physicians to have their practice managers, administrators and execu tives to come to our events or reach out for more information. Our community is strong in San Antonio and South Texas and we would love the opportunity to take care of your own as well.
AssociationManagement(MGMA):ProgramsandProfessionalBenefits
PREPAREDNESSEMERGENCY cation programs, networking and conference opportunities. While the national chapter of MGMA is well recognized, many don’t know about local chapters that can be even more re warding. These chapters require a separate reg istration and are often overlooked by national members and administrators, who are busy with the day-to-day operations. Texas MGMA is one of the largest states MGMA chapters and San Antonio boasts the largest and most engaged membership of Texas MGMA. Cur rently, San Antonio MGMA has approxi mately one hundred members in San Antonio and South Texas region, representing clinics of all sizes and specialties. One of the greatest benefits of this society is the networking with professionals with sim ilar positions and/or challenges. Oftentimes, these other members are the only people who truly understand the challenges that practice administrators face every day. Our members are able to trade tips and contacts to improve their practice operations and personal careers. year. The group has already celebrated the hol iday season by throwing axes together at Stumpy‘s Hatchet House SA, attending edu cational seminars and finishing off the MGMA calendar year with an education con ference in May, boasting attendees from all over the State of Texas and speakers from North Carolina.
Lindsey Herman Nolan, MHA, CMPE is the SAMGMA President and CEO at Nolan Practice Management. For more information about all of our events please keep an eye on our website www.samgma.org
Chloe A. Jensen is a student at the UT Health San Anto nio Long School of Medicine in the Class of 2023.
Have you ever been working on a puzzle, only to find that one piece is missing at the very end? What about 2, or even 3 pieces? It’s incredibly frustrating to say the least. You can lose your mind searching for it for hours and hours, nowhere to be found. What if there was someone that could help, someone that could always have those puzzle pieces on hand for when you need them? That would sure be nice. It would take a lot of stress off, wouldn’t it? Sure there would still be some stress, likely at the beginning when you don’t know where they are, but having someone in your corner to help fill in the gaps, and to heal what has been broken brings piece, someone that can connect you to your final goal, to be whole. This person is a gift, an angel in disguise. They come in all forms, shapes, sizes and backgrounds. These people are promotor(a)s. They help to build, unite, bridge and complete what we as doctors sometimes struggle to do.
The HealthAmericanCareSystem
This piece is a tribute to the wonderful promotors and promotoras that serve the underprivileged population in San Antonio. These remarkable people help bridge the gap between healthcare providers and their disadvantaged patients, providing them with the resources the y need to find transportation, insurance and healthcare services. They often visit patients’ homes to go over medication regimens and to evaluate living condi tions. They also assist with any healthcare barrier that their providers could have. These promotor(a)s are the keystone to the patient's healthcare and the missing piece they need to live a longer and healthier life. Just as a bridge crumble without its keystone, so too would the quality of life of these patients deteriorate without the service of their selfless promotor(a).
Calvin Madsen is a student at the UT Health San Antonio Long School of Medicine in the Class of 2023. Visit us at www.bcms.org 35
By Chloe A. Jensen
SANMEDICINEANTONIO
It’s different from the picture. The picture shows a vibrant yellow. Quaint, with a little yard and a fence. The paint is muddy mustard greyed by smoke or smog. The yard is dirt, and cans, and trash the window, broken. It had to be witnessed –felt –in Becauseperson.in the picture, This Place is perfect.
PieceMissingThe
By Calvin Madsen, Photography and Digital Art Overlay by Calvin Madsen
By Joshua Sanchez ARTIST NOTE: The shadow in this photograph represents what we as healthcare providers are often limited to seeing during our encounters - a cross-section of the struggles our patients en dure throughout their daily lives; the difficulties and severe costs they bear with fighting for care; and the goals, relationships and experiences that make up the life we’re trying to improve. The barrage of mail, a stolen car, threatened loss of benefits, a collection of artistic clocks, a nostalgia for one's childhood, a love for nature - make up just a fraction beyond the cross-sec tions of those whom we meet for a moment.
Joshua Sanchez is a student at the UT Health San Antonio Long School of Medicine in the Class of 2023.
36 SAN ANTONIO MEDICINE • September 2022
ARTIST NOTE: I met a star patient, she was so organized with her medications and appointments, that management was a breeze for me. The frayed red strings represent the contrasting lack of control she has over her social struggles – legal issues and financial scams. Even as her pills are neatly organized into cases and her blood glucose meticulously recorded, she shows me equally organized documents full of suspicious schemes and promises that she has been convinced to trust. Her "healthcare" teeters on an unsteady precipice as she is being drained of her time, money and energy.
SANMEDICINEANTONIO
Anjali Prasad is a student at the UT Health San An tonio Long School of Medicine in the Class of 2023.
By Anjali Prasad
Ripped-OffRockstar
ofCross-sectionsCare
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 insur ance for the medical community. Brandi Vitier www.thebankofsa.combrandi.vitier@thebankofsa.com210-807-5581
Synergy Federal Credit Union (HH Silver Sponsor)
Dwight Chapman (Account STAT“Trustedwww.livingstonmedlab.com/homeDwight@livingstonmedlab.com210-591-2649Manager)Innovative,Accurate,andMedicalDiagnostics”
“Proudly serving the medical com munity since 1998”
Brian T. Boswell, CFP®, QKA Senior Private Wealth Advisor SERVICE512-649-8113 @ www.oakwellpwm.comOAKWELLPWM.COM
Joey Martinez (Director of Joey@livingstonmedlab.com210-204-7072Operations)
Jim Rice, CPA 210-384-8000, ext. 112 www.ssacpa.comjprice@ssacpa.com
Michael L. Kreager mkreager@kreagermitchell.com210-283-6227
Livingston Med Lab (HHHH 10K Platinum Sponsor) High Complexity Clia/Cola accred ited Laboratory providing White Glove Customer Service. We offer a Full Diagnostic Test Menu in the fields of Hematology, Chemistry, Endocrinology, Toxicology, Infec tious Disease, & Genetics. Robert Castaneda (CEO)
FINANCIAL (ManagementBertuzzi-TorresSERVICESWealthGroup
ASSETT
Thomas M. Duran SVP, Private Banking Team Lead www.broadwaybank.comTDuran@Broadway.Bank210-283-6640
“Dedicated to working with physicians and physician groups.”
BexarORGANIZATIONVERIFICATIONCREDENTIALSCredentialsVerification, Inc. (HHHH 10K Platinum Sponsor) Bexar Credentials Verification Inc. provides primary source verification of credentials data that meets The Joint Commission (TJC) and the Na tional Committee for Quality Assur ance (NCQA) standards for health care entities. Betty Fernandez Director of www.BexarCV.comBetty.Fernandez@bexarcv.com210-582-6355Operations
“More Than Just Your Advisor, We're Your Wealth Management Partner” Elizabeth Olney with Edward Jones (HH Silver Sponsor) We learn your individual needs so we can develop a strategy to help you achieve your financial goals. Join the nearly 7 million investors who know. Contact me to develop an investment strategy that makes sense for you. Elizabeth Olney, Financial www.edwardjones.com/elizabeth-olneyElizabeth.olney@edwardjones.com210-858-5880Advisor
“Client-centered legal counsel with integrity and inspired solutions”
DIAGNOSTICS
"Making Sense of Investing"
“We’re here for good.”
ACCOUNTING FIRMS
PHYSICIANS PURCHASING DIREC-
(ManagementBertuzzi-TorresMANAGEMENTWEALTHWealthGroup HHH Gold Sponsor) We specialize in simplifying your personal and professional life. We are dedicated wealth managers who offer diverse financial solutions for discerning healthcare professionals, including asset protection, lending and estate planning.
Sean Villasana (Chief Scientific Officer, CSO) Sean@livingstonmedlab.com210-237-8557
Sol Schwartz & Associates P.C. (HHH Gold Sponsor) Sol Schwartz & Associates is the premier accounting firm for San Antonio-area medical practices and specializes in helping physi cians and their management teams maximize their financial ef fectiveness.
HHH Gold Sponsor) Healthcare banking experts with a private banking team committed to supporting the medical community.
40 SAN ANTONIO MEDICINE • September 2022
Mike Bertuzzi First Vice President Senior Financial Michael_bertuzzi@ml.com210-278-3828Advisor Ruth Torres Financial http://fa.ml.com/bertuzzi-torresRuth.torres@ml.com210-278-3828Advisor
Gold Sponsor) We specialize in simplifying your personal and professional life. We are dedicated wealth managers who offer diverse financial solu tions for discerning healthcare professionals, including asset pro tection, lending & estate planning.
CLINICAL
“Leaders in Healthcare Software & Consulting” (KreagerATTORNEYSMitchell HHH Gold Sponsor) At Kreager Mitchell, our healthcare practice works with physicians to offer the best representation pos sible in providing industry specific solutions. From business transac tions to physician contracts, our team can help you in making the right decision for your practice.
(BroadwayBANKINGBank
Robert@livingstonmedlab.comEmail:210-316-1792
“Once a member, always a member. Join today!”
ACCOUNTING SOFTWARE Express Information Systems (HHH Gold Sponsor)
Bruce M. Mitchell www.kreagermitchell.combmitchell@kreagermitchell.com210-283-6228
With over 29 years’ experience, we understand that real-time visi bility into your financial data is critical. Our browser-based healthcare accounting solutions provide accurate, multi-dimen sional reporting that helps you accommodate further growth and drive your practice forward. Rana Camargo Senior Account Manager www.expressinfo.comranac@expressinfo.com210-771-7903
FINANCIAL ADVISORS Oakwell Private Wealth (Management HHHH 10K Platinum Sponsor) Oakwell Private Wealth Manage ment is an independent financial advisory firm with a proven track record of providing tailored finan cial planning and wealth manage ment services to those within the medical community.
Looking for low loan rates for mort gages and vehicles? We've got them for you. We provide a full suite of digital and traditional fi nancial products, designed to help Physicians get the banking serv ices they need.
Synergy FCU Member Services www.synergyfcu.orginfo@synergyfcu.org210-750-8333
Support BCMS by supporting the following sponsors. Please ask your practice manager to use the Physicians Purchasing Directory as a reference when services or products are needed.
Mike Bertuzzi First Vice President Senior Financial Michael_bertuzzi@ml.com210-278-3828Advisor Ruth Torres Financial http://fa.ml.com/bertuzzi-torresRuth.torres@ml.com210-278-3828Advisor
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.
INVESTMENT ADVISORY REAL ESTATE Alamo Capital Advisors LLC (★★★★ 10K Platinum Sponsor) Focused on sourcing, capitalizing, and executing investment and de velopment opportunities for our in vestment partners and providing thoughtful solutions to our advisory clients. Current projects include new developments, acquisitions & sales, lease representation and fi nancial restructuring (equity, debt, and partnership updates). Jon Wiegand, Principal www.alamocapitaladvisors.comjw@alamocapitaladvisors.com210-241-2036
“Leaders in Healthcare Software & Consulting”
HOSPITALS/ HEALTHCARE
continued on page 42
ProAssurance professional liability insurance defends healthcare providers facing malpractice claims and provides fair treatment for our insureds. ProAssurance Group’s rating is AM Best A (Excellent). Mike Rosenthal Senior Vice President, Business www.ProAssurance.comMikeRosenthal@ProAssurance.com800-282-6242Development
“People Bank with People” “Your Practice, Our Promise” Amegy Bank of Texas (HH Silver 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 EVP | Private Banking Manager Jeanne.bennett@amegybank.com210-343-4556
HEALTHCARE BANKING
HHHH 10K Platinum Sponsor) With more than 20,000 health care professionals in its care, Texas Medical Liability Trust (TMLT) pro vides malpractice insurance and related products to physicians. Our purpose is to make a positive im pact on the quality of health care for patients by educating, protect ing, and defending physicians. Patty Spann www.tmlt.orgpatty-spann@tmlt.org512-425-5932
“Serving the medical community.” MedPro Group (HH Silver Sponsor) Rated A++ by A.M. Best, MedPro Group has been offering customized insurance, claims and risk solutions to the healthcare community since 1899. Visit MedPro to learn more. Kirsten Baze www.medpro.comKirsten.Baze@medpro.com512-658-0262
Lauren Smith, Manager, Marketing & SmithL9@uthscsa.edu210-450-0026Communications San7979dersonUTAppointments:Cancer.uthscsa.edu210-450-1000HealthSanAntonioMDAnCancerCenterWurzbachRoadAntonio,TX78229
INFORMATION (ExpressTECHNOLOGIESANDInformationSystems HHH Gold Sponsor) With over 29 years’ experience, we understand that real-time visi bility into your financial data is critical. Our browser-based healthcare accounting solutions provide accurate, multi-dimen sional reporting that helps you accommodate further growth and drive your practice forward.
UTFACILITIESHealthSan Antonio MD Anderson Cancer Center, (HHH Gold Sponsor)
First Citizens Bank (HHH Gold Sponsor) We’re a family bank — led for three generations by the same family-but first and foremost a re lationship bank. We get to know you. We want to understand you and help you with your banking.
Karen Leckie Senior Vice President | Private karen.leckie@amegybank.com210-343-4558Banking
Visit us at www.bcms.org 41
Robert Lindley Senior Vice President | Private robert.lindley@amegybank.com210-343-4526Banking
“Get what you deserve … maximize your Social Security benefit!”
“We offer BCMS members a free insurance portfolio review.” (Guardian ★★★ Gold Sponsor) Live Confidently. Every financial dream deserves a well-crafted plan. Ned Hodge www.nedhodge.comned@nedhodge.com210-332-3757 | www.Opesone.com “Take care of today then plan for tomorrow” (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: Jbuss1@humana.com512-338-6167 Shamayne Kotfas: www.humana.comskotfas@humana.com512-338-6103
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 insur ance for the medical community. Katy Brooks, CIC www.thebankofsa.comkaty.brooks@bosainsurance.com210-807-5593
“Community banking partnership”
UT Health San Antonio MD Ander son Cancer Center, is the only NCI-designated Cancer Center in South Texas. Our physicians and scientists are dedicated to finding better ways to prevent, diagnose and treat cancer through lifechanging discoveries that lead to more treatment options. Laura Kouba, Manager, Physician NorrisKouba@uthscsa.edu210-265-7662Relations
Rana Camargo Senior Account Manager www.expressinfo.comranac@expressinfo.com210-771-7903
Recommended partner of the Bexar County Medical Society
Denise C. Smith Vice President | Private Banking www.amegybank.comDenise.C.Smith@amegybank.com210-343-4502
Aspect Wealth Management (HHH Gold Sponsor)
TMAINSURANCEInsurance Trust (HHHH 10K Platinum Sponsor) TMA Insurance Trust is a full-service insurance agency offering a full line of products – some with exclusive member discounts and staffed by professional advisors with years of experience. Call today for a compli mentary insurance review. It will be our privilege to serve you. Wendell England Director of Member Benefits www.tmait.org800-880-8181wendell.england@tmait.org512-370-1776
(TexasMALPRACTICEINSURANCE/MEDICALMedicalLiabilityTrust
(ProAssurance HH Silver Sponsor)
Michael Clark, President www.aspectwealth.commclark@aspectwealth.com210-268-1520
Stephanie Dick Commercial m/tx/austin/stephanie-dickhttps://commercial.firstcitizens.costephanie.dick@firstcitizens.com210-744-4396Banker
SanMILITARYAntonio Army Medical Recruiting office (★★Silver Sponsor) Mission: Recruit highly qualified and motivated healthcare profes sionals for service in the Army Reserves or Active Duty Army, in support of Soldiers and their families. 1LT Thomas Alexandria https://recruiting.army.mil/mrb/milAlexandria.n.thomas12.mil@army.210-328-9022
“Service to Country, Army Medi cine, Experientia et Progressus” MOLECULAR (iGenomeDxLABORATORYDIAGNOSTICS
Mission: Recruit highly qualified and motivated healthcare professionals for service in the Army Reserves or Active Duty Army, in support of Sol diers and their families. 1LT Thomas Alexandria https://recruiting.army.mil/mrb/Alexandria.n.thomas12.mil@army.mil210-328-9022
(AlamoCOMMERCIALSERVICESCapitalAdvisorsLLC
REAL ESTATE
STAFFING SERVICES Favorite Healthcare Staffing (HHHH 10K Platinum Sponsor)
“BCMS members receive GPO discounts of 15 to 50 percent.”
“Where San Antonio’s Healthcare Leaders Meet” San Antonio Medical Group Man agement Association (SAMGMA) (HH Silver Sponsor) SAMGMA is a professional nonprofit association with a mission to provide educational programs and networking opportunities to medical practice managers and support charitable fundraising. Alan Winkler, www.samgma.orginfo4@samgma.orgPresident
Valerie Rogler, Program Coordinator www.thehealthcell.orgValerie@thehealthcell.org210-904-5404
★★★★ 10K Platinum Sponsor) Focused on sourcing, capitalizing, and executing investment and de velopment opportunities for our in vestment partners and providing thoughtful solutions to our advisory clients. Current projects include new developments, acquisitions & sales, lease representation and fi nancial restructuring (equity, debt, and partnership updates). Jon Wiegand, Principal www.alamocapitaladvisors.comjw@alamocapitaladvisors.com210-241-2036
“Favorite Healthcare Staffing offers preferred pricing for BCMS members.”
“Service to Country, Army Medicine, Experientia et Progressus”
www.iGenomeDx.compmishra@iGenomeDx.com210-381-3829
Gold Sponsor) Most trusted molecular testing laboratory in San Antonio provid ing FAST, ACCURATE and COM precisionPREHENSIVEdiagnostics for Genetics and Infectious Diseases.
CARR Realty (HH Silver Sponsor) CARR is a leading provider of commercial real estate for tenants and buyers. Our team of health care real estate experts assist with start-ups, renewals, reloca tions, additional offices, pur chases and practice transitions. Brad Wilson Agent 210-573-6146 www.carr.usBrad.Wilson@carr.us
continued from page 41 42 SAN ANTONIO MEDICINE • September 2022
Commercial & Medical Credit (Services HH Silver Sponsor) A bonded and fully insured San Antonio-based collection agency. Henry Miranda www.cmcs-sa.comhcmiranda@sbcglobal.net210-340-9515
Dr. Niti Vanee Co-founder & CEO nvanee@iGenomeDx.com210-257-6973
MEDICAL BILLING AND COLLECTIONS SERVICES
Tom Rosol www.henryschein.comtom.rosol@henryschein.com210-413-8079
PHYSICIANS PURCHASING DIRECTORY
“Make us the solution for your account receivables.”
RETIREMENT PLANNING Oakwell Private Wealth (Management HHHH 10K Platinum Sponsor) Oakwell Private Wealth Manage ment is an independent financial advisory firm with a proven track record of providing tailored finan cial planning and wealth manage ment services to those within the medical community.
San Antonio Army Medical Recruiting office (HH Silver Sponsor)
“My DNA My Medicine, Pharma cogenomics” (TheORGANIZATIONSPROFESSIONALHealthCell HH Silver Sponsor) “Our Focus is People” Our mis sion is to support the people who propel the healthcare and bio science industry in San Antonio. Industry, academia, military, nonprofit, R&D, healthcare delivery, professional services and more! Kevin Barber, President 210-308-7907 kbarber@bdo.com(Direct)
Dr. Pramod Mishra Co-founder, COO & CSO
MEDICAL SUPPLIES AND (HenryEQUIPMENTScheinMedical HH Silver 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.
“Maximize Your Profitability Through Real Estate”
Brian T. Boswell, CFP®, QKA Senior Private Wealth Advisor SERVICE512-649-8113 @ www.oakwellpwm.comOAKWELLPWM.COM “More Than Just Your Advisor, We're Your Wealth Management Partner”
Serving the Texas healthcare commu nity 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. Cindy M. Vidrine Director of Operations- Texas cvidrine@210-918-8737favoritestaffing.com
Visit us at www.bcms.org 43
REVIEWAUTO 44 SAN ANTONIO MEDICINE • September 2022
Actually, I think Subaru has taken over the space that Volvo occu pied in the 1980s and 1990s: the reasonably priced, reliable and nonmainstream automotive brand for smart people who are comfortable but not rich. Look around. What do college professors, school teach ers, and Nurse Practitioners drive these days? A disproportionate number of them own Subarus, just as their predecessors used to drive
As always, call Phil Hornbeak, the Auto Program Manager at BCMS (210-301-4367), for your best deal on any new car or truck brand. Phil can also connect you to preferred financing and lease rates.
REVIEWAUTO 2022 Subaru
Anyway, the Subaru Ascent lo oks good, and the wagon-esque ex terior design probably makes it look smaller than it is, because it is not small. With a length of 196.8in, width of 76in, and height of 71.6in the Ascent is 7in longer, 2in wider, and 5in taller than the Tribeca. That’s a big difference.
On the road the Ascent is, again, a lot like the Outback. It handles in-town duties without complaint, but it is in no way fun to drive as it does that. Neither are the Explorer, Toyota Highlander or Honda Pilot though. That’s life with kids, isn’t it?
Maybe that’s the secret to Subaru’s success with their newest crossover: charge a reasonable price for a nice, but not lux, vehicle with all of the appeal of an Outback but additional space. And then watch buyers flood your showrooms.
As you’d expect, the Ascent is spacious inside, even in the second row (although the third row is a little tight, as it is in competitors such as the Ford Explorer). While Subaru’s largest vehicle ever can be mistaken for an Outback from the outside, on the inside it’s much roomier, and getting to the third row of seats is easy thanks to a clever second row that moves out of the way quickly and easily.
Subaru finally has a successful mid-size crossover with three rows of seats, the Ascent. Subaru would probably like us to forget the 20052014 B9 Tribeca, which had three rows of seats but never sold well, ostensibly because of its looks.
Volvos.Ascents can be had in Base, Premium, Onyx and Limited versions. I would guess that BCMS members interested in the Ascent would probably order loaded models rather than “strippers”. That means that out-the-door prices will be in the $40,000-$45,000 range, which seems low given everything you get with a well-equipped Ascent.
Road trips are better because the Ascent’s engineers favored stabil ity and comfort over athleticism and performance, so quiet and drama-free describe what the Ascent is like on the highway.
45
I don’t think its design was the problem, although obviously Sub aru corporate did because they rushed a facelift to market just two years after the Tribeca’s debut. No, I think the problem was that it was just too small—the Tribeca, which was based on the Legacy sedan/wagon platform, ended up being not much bigger inside than the Legacy wagon, and that’s what led to its demise. For the record sales dropped from a mediocre 14,797 in 2005 to an embarrassing 1,598 in 2013. Compare that with just under 60,000 Ascents sold in 2021, a number that would have been even higher had there not been computer chip shortages.
Not surprisingly, the Ascent’s interior looks a lot like that of an Outback wagon. It’s not as posh as the aforementioned Audi Q5, but it is quite modern and nice. Given the Ascent’s pricing, which starts at around $33,000 and rises to just over $40,000—in the current mar ket expect to pay close to MSRP, even with Phil Hornbeak’s best ef forts—it should be no surprise that owners will be faced with a lot of plastic and uninspiring buttons and knobs when they sit behind the wheel. The tech is up to date, however, and ergonomics are excellent.
Stephen Schutz, MD, is a board-certified gastroenterologist who lived in San Antonio in the 1990s when he was stationed here in the US Air Force. He has been writing auto reviews for San Antonio Medicine since 1995. Ascent
So, with the new Ascent, the third largest Japanese automobile manufacturer has finally achieved mid-size crossover success. How did they do it? In addition to making the Ascent much larger inside than the Tribeca, they also made it look like an Outback station wagon, only bigger, rather than, “a Subaru crossover that doesn’t look like a Subaru,” which is what the Tribeca was. Too bad, I like different things to look different.
By Stephen Schutz, MD Visit us at www.bcms.org
For perspective, I parked my press car Ascent next to a new Audi Q5 and was astounded at how much bigger the Ascent was. It kinda dwarfed the Audi. I guess the Ascent’s design really is “slimming.”
Land Rover
Raymond
TX 78216 John 210-253-3300Kahlig Mercedes Benz of San Antonio 9600 San Pedro San Antonio, TX Al Cavazos 210-366-9600Jr. 9455 IH 10 West San Antonio, TX 78230 Douglas 210-764-6945Cox Bluebonnet Chrysler Dodge Ram 547 S. Seguin Ave. New Braunfels, TX 78130 Matthew C. 830-606-3463Fraser Northside Ford 12300 San Pedro San Antonio, TX Marty210-477-3472Martinez Northside Honda 9100 San Pedro Ave. San Antonio, TX 78216 Paul 210-988-9644Hopkins 14610 IH 10 West San Marcos, TX 78249 Mark KahligKahlig832-428-9507HenniganAutoGroupAutoGroupKahlig Auto GroupKahlig Auto Group Kahlig Auto GroupKahlig Auto Group Kahlig Auto Group Kahlig Auto Group
Northside Chevrolet 9400 San Pedro Ave. San Antonio, TX 78216 210-912-5087Williams Nash Chevrolet Buick 3209 North Interstate 35 San Marcos, TX 210-859-2719Boyd Park Lexus 611 Lockhill Selma San Antonio, TX 210-308-8900Bridges San Antonio 13660 IH 10 West San Antonio, TX 210-561-4900Tang Park Lexus at Dominion 25131 IH 10 W Dominion San Antonio, TX James 210-816-6000Cole Park Lincoln 9207 San Pedro San Antonio, TX Sandy 210-341-8841Small Park Subaru at Dominion 21415 IH 10 West San Antonio, TX 78257 Phil 877-356-0476Larson Park Subaru 9807 San Pedro San Antonio, TX 78216 210-308-0200Rangel
GMC
Tripp
North
North
11911 IH 10 West San Antonio, TX 78230 210-696-2232Allen Dominion 21105 West IH 10 San Antonio, TX 78257 210-681-3399Cavender
North
William
Rick
North
North
Audi
North
Charles
Cameron
Coby
Cavender Toyota 5730 NW Loop 410 San Antonio, TX Gary 210-862-9769Holdgraf Park Toyota 10703 Southwest Loop 410 San Antonio, TX 78211 Justin 210-635-5000Boone Benz of Boerne 31445 IH 10 West Boerne, TX James 830-981-6000Godkin Park 9333 San Pedro San Antonio,
Chuck
North
Mazda
Mercedes
