Health Insurance in Texas By TMA

Another BCMS Milestone Approaching…

170 Years of Advocating for Physicians and Patients

By Mary E. Nava, MBA, BCMS Chief Government Affairs Officer

In September of 2023, Bexar County Medical Society (BCMS) will celebrate yet another milestone – its 170th anniversary! From its inception 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. Needless 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 organization 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. 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 contributions 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 honorable and prestigious organization is so extremely vital to not only the strength of the organization as whole, but also to up and coming student 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.

Above: Presented to the Bexar County Medical Society, By Dr. Frank Paschal, Dec. 21, 1992.

At Left: Dr. George Cupples, Co-Founder of the Bexar County Medical Society.

Mary Nava is the chief government affairs officer and lobbyist for BCMS. She has been with the Society since February of 2000.

2022 AAMSE Award:

Bexar County Medical Society (BCMS), Physicians Health and Rehabilitation Program (PH&R)

By Monica Jones, BBA, BCMS Chief Operating Officer

Congratulations to the BCMS Physicians Health and Rehabilitation 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.

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 environment without the need for their former coping mechanisms.

The BCMS PH&R program has set the standards for other programs across the state. In the almost 40 years of its existence, the committee 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.

Even more 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 problems can share their challenges openly and offer suggestions and encouragement 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 regular AA meetings.” Caduceus meets at BCMS every Thursday night at 7 pm.

The 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.

For more information about the Physician Health and Rehabilitation 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.

Monica Jones is the Chief Operating Officer and PH&R Staff Liaison at BCMS.

2022 Summer Membership Mixer

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

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.

Monkeypox:

What Bexar County Doctors Need to Know

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.

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 writing.

From now on, 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 (chickenpox). It was discovered in 1958, and the first human case was identified in 1970. The fatality rate was 1%-10% in previous outbreaks, 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 noticed if present in the mouth, rectum or vagina. The Centers for Disease Control &

Prevention (CDC) recommends abstaining from sex for 8 weeks after an infection ends, due to possible persistence in semen or vaginal fluids. • Screening: While 98% of cases to date are among men who have sex with men, risk is based on behaviors and exposures, not sexual orientation. A heterosexual, cisgender woman with recent syphilis and gonorrhea is at greater risk than a gay couple in a mutually 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 orientation or behaviors. The CDC recommends the 5 P’s as a mnemonic: Partners, Practices,

Protection from STIs, Past history of STIs and Pregnancy intention.

• Symptoms occur after an incubation period of 1-3 weeks. There is often but not always a prodrome of fever, headache, lymphadenopathy, 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 remains 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 oropharyngeal lesions can be severe enough to interfere with bodily functions.

• 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 acceptable. PPE for specimen collection consists 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 lesion should be collected, using synthetic (non-cotton) swabs, preferably from different locations on the body or from lesions that differ in appearance. It is not necessary to unroof the lesion. Co-infections are possible, so also test for other potential infections as appropriate. Clinical care can begin based on a positive orthopoxvirus result and should not wait on additional viral characterization testing.

• Management of infection: Supportive care includes maintenance of adequate fluid balance, pain management, and treatment of any bacterial superinfection. Give anticipatory guidance and address symptoms early to prevent hospitalizations, for instance through antihistamines and calamine lotion for itching, over-the-counter and prescription mouthwashes for mucositis, sitz baths and topical anesthetics for pain, and stool softeners for proctitis. For people with severe disease or at high risk for severe disease, tecovirimat (TPOXX) treatment is available under a CDC Investigational New

Drug protocol. Doctors can call Metro

Health’s Epidemiology unit at 210-2078876 or email MpoxConsult@ sanantonio.gov to obtain tecovirimat. A provider prescription will be needed, and ordering providers must complete all CDC protocols and requirements. • Education: Let patients know that the public health department will be reaching out to them. Advise patients to isolate from people and pets until all lesions have resolved, 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

a well-fitting mask and frequently cleaning household surfaces. If possible, a separate bathroom is ideal. Coversheets or waterproof covers can be placed on upholstered furniture and other porous materials that cannot be laundered. To prevent inadvertent infection of the eye, counsel patients to use eyeglasses rather than contact lenses during this time.

• Vaccination: An attenuated live virus vaccine, 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 available to a limited number of established patients at six San Antonio clinics with large LGBT populations. As the nation’s vaccine supply increases, distribution will be expanded. Additionally, Metro Health will vaccinate close contacts of people identified during public health case investigations. Patients 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 assessment for possible vaccination.

For the LGBT community, this monkeypox outbreak has triggered trauma from homophobia and discrimination experienced early in the AIDS pandemic. People with monkeypox 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 barriers for at-risk populations who need treatment, 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 guidelines for stigma-free care by the End Stigma End HIV Alliance of San Antonio (EndStigmaEndHIV.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.

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 Antonio Metropolitan Health District.

Medical Group Management Association (MGMA):

Programs and Professional Benefits

By MGMA

Medical Group Management Association (MGMA), is the largest professional society for practice administrators and medical group managers throughout the U.S. Benefits include certification programs, continuing education 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 rewarding. These chapters require a separate registration 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. Currently, San Antonio MGMA has approximately 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 similar 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.

The San Antonio chapter of MGMA is back and better than ever, after largely surviving on virtual education conferences due to COVID-19 for the last few years, our chapter is excited to host more in-person events this year. The group has already celebrated the holiday season by throwing axes together at Stumpy‘s Hatchet House SA, attending educational seminars and finishing off the MGMA calendar year with an education conference in May, boasting attendees from all over the State of Texas and speakers from North Carolina.

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 planning on breakfast meetings to provide more educational seminars, evening mixers (to encourage support among our members) and events with professional organizations (to network with like-minded individuals in healthcare). The board is also excited to announce our annual education conference, which is 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 organization and we are excited to be the host chapter for this conference year.

We are encouraging physicians to have their practice managers, administrators and executives 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.

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

The American Health Care System

By Chloe A. Jensen

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 person. Because in the picture, This Place is perfect.

Chloe A. Jensen is a student at the UT Health San Antonio Long School of Medicine in the Class of 2023.

The Missing Piece

By Calvin Madsen, Photography and Digital Art Overlay by Calvin Madsen

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.

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 they need to find transportation, insurance and healthcare services. They often visit patients’ homes to go over medication regimens and to evaluate living conditions. 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.

Rockstar Ripped-Off

By Anjali Prasad

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.

Anjali Prasad is a student at the UT Health San Antonio Long School of Medicine in the Class of 2023.

Cross-sections of Care

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 endure 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-sections 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.

Please ask your practice manager to use the Physicians Purchasing Directory as a reference when services or products are needed.

ACCOUNTING FIRMS

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

ACCOUNTING SOFTWARE

Express Information Systems (HHH Gold Sponsor) With over 29 years’ experience, we understand that real-time visibility into your financial data is critical. Our browser-based healthcare accounting solutions provide accurate, multi-dimensional reporting that helps you accommodate further growth and drive your practice forward. Rana Camargo Senior Account Manager 210-771-7903 ranac@expressinfo.com www.expressinfo.com “Leaders in Healthcare Software & Consulting”

ATTORNEYS

Kreager Mitchell (HHH Gold Sponsor) At Kreager Mitchell, our healthcare practice works with physicians to offer the best representation possible in providing industry specific solutions. From business transactions to physician contracts, our team can help you in making the right decision for your practice. Michael L. Kreager 210-283-6227 mkreager@kreagermitchell.com Bruce M. Mitchell 210-283-6228 bmitchell@kreagermitchell.com www.kreagermitchell.com “Client-centered legal counsel with integrity and inspired solutions” ASSETT WEALTH MANAGEMENT

Bertuzzi-Torres Wealth Management Group (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. Mike Bertuzzi First Vice President Senior Financial Advisor 210-278-3828 Michael_bertuzzi@ml.com Ruth Torres Financial Advisor 210-278-3828 Ruth.torres@ml.com http://fa.ml.com/bertuzzi-torres

BANKING

Broadway Bank (HHH Gold Sponsor) Healthcare banking experts with a private banking team committed to supporting the medical community. Thomas M. Duran SVP, Private Banking Team Lead 210-283-6640 TDuran@Broadway.Bank www.broadwaybank.com “We’re here for good.”

The Bank of San Antonio (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians. Our local insurance professionals are some of the few agents in the state who specialize in medical malpractice and all lines of insurance for the medical community. Brandi Vitier 210-807-5581 brandi.vitier@thebankofsa.com www.thebankofsa.com

Synergy Federal Credit Union (HH Silver Sponsor) Looking for low loan rates for mortgages and vehicles? We've got them for you. We provide a full suite of digital and traditional financial products, designed to help Physicians get the banking services they need.

Synergy FCU Member Services 210-750-8333 info@synergyfcu.org www.synergyfcu.org “Once a member, always a member. Join today!”

CLINICAL DIAGNOSTICS

Livingston Med Lab (HHHH 10K Platinum Sponsor) High Complexity Clia/Cola accredited Laboratory providing White Glove Customer Service. We offer a Full Diagnostic Test Menu in the fields of Hematology, Chemistry, Endocrinology, Toxicology, Infectious Disease, & Genetics. Robert Castaneda (CEO) 210-316-1792 Email: Robert@livingstonmedlab.com Sean Villasana (Chief Scientific Officer, CSO) 210-237-8557 Sean@livingstonmedlab.com Joey Martinez (Director of Operations) 210-204-7072 Joey@livingstonmedlab.com Dwight Chapman (Account Manager) 210-591-2649 Dwight@livingstonmedlab.com www.livingstonmedlab.com/home “Trusted Innovative, Accurate, and STAT Medical Diagnostics”

CREDENTIALS VERIFICATION ORGANIZATION

Bexar Credentials Verification, Inc. (HHHH 10K Platinum Sponsor) Bexar Credentials Verification Inc. provides primary source verification of credentials data that meets The Joint Commission (TJC) and the National Committee for Quality Assurance (NCQA) standards for health care entities. Betty Fernandez Director of Operations 210-582-6355 Betty.Fernandez@bexarcv.com www.BexarCV.com “Proudly serving the medical community since 1998” FINANCIAL ADVISORS

Oakwell Private Wealth Management (HHHH 10K Platinum Sponsor) Oakwell Private Wealth Management is an independent financial advisory firm with a proven track record of providing tailored financial planning and wealth management services to those within the medical community. Brian T. Boswell, CFP®, QKA Senior Private Wealth Advisor 512-649-8113 SERVICE@OAKWELLPWM.COM www.oakwellpwm.com “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 Advisor 210-858-5880 Elizabeth.olney@edwardjones.com www.edwardjones.com/elizabeth-olney "Making Sense of Investing"

FINANCIAL SERVICES

Bertuzzi-Torres Wealth Management Group ( 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 & estate planning. Mike Bertuzzi First Vice President Senior Financial Advisor 210-278-3828 Michael_bertuzzi@ml.com Ruth Torres Financial Advisor 210-278-3828 Ruth.torres@ml.com http://fa.ml.com/bertuzzi-torres

Aspect Wealth Management (HHH Gold Sponsor) We believe wealth is more than money, which is why we improve and simplify the lives of our clients, granting them greater satisfaction, confidence and freedom to achieve more in life. Michael Clark, President 210-268-1520 mclark@aspectwealth.com www.aspectwealth.com “Get what you deserve … maximize your Social Security benefit!”

HEALTHCARE BANKING

First Citizens Bank (HHH Gold Sponsor) We’re a family bank — led for three generations by the same family-but first and foremost a relationship bank. We get to know you. We want to understand you and help you with your banking. Stephanie Dick Commercial Banker 210-744-4396 stephanie.dick@firstcitizens.com https://commercial.firstcitizens.co m/tx/austin/stephanie-dick “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 210-343-4556 Jeanne.bennett@amegybank.com Karen Leckie Senior Vice President | Private Banking 210-343-4558 karen.leckie@amegybank.com Robert Lindley Senior Vice President | Private Banking 210-343-4526 robert.lindley@amegybank.com Denise C. Smith Vice President | Private Banking 210-343-4502 Denise.C.Smith@amegybank.com www.amegybank.com “Community banking partnership” UT Health San Antonio MD Anderson Cancer Center, (HHH Gold Sponsor) UT Health San Antonio MD Anderson 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 Relations 210-265-7662 NorrisKouba@uthscsa.edu Lauren Smith, Manager, Marketing & Communications 210-450-0026 SmithL9@uthscsa.edu Cancer.uthscsa.edu Appointments: 210-450-1000 UT Health San Antonio MD Anderson Cancer Center 7979 Wurzbach Road San Antonio, TX 78229

INFORMATION AND TECHNOLOGIES

Express Information Systems (HHH Gold Sponsor) With over 29 years’ experience, we understand that real-time visibility into your financial data is critical. Our browser-based healthcare accounting solutions provide accurate, multi-dimensional reporting that helps you accommodate further growth and drive your practice forward. Rana Camargo Senior Account Manager 210-771-7903 ranac@expressinfo.com www.expressinfo.com “Leaders in Healthcare Software & Consulting”

INSURANCE

TMA Insurance 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 complimentary insurance review. It will be our privilege to serve you. Wendell England Director of Member Benefits 512-370-1776 wendell.england@tmait.org 800-880-8181 www.tmait.org “We offer BCMS members a free insurance portfolio review.”

Guardian (★★★ Gold Sponsor) Live Confidently. Every financial dream deserves a well-crafted plan. Ned Hodge 210-332-3757 ned@nedhodge.com www.nedhodge.com | 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: 512-338-6167 Jbuss1@humana.com Shamayne Kotfas: 512-338-6103 skotfas@humana.com www.humana.com

INSURANCE/MEDICAL MALPRACTICE

Texas Medical Liability Trust (HHHH 10K Platinum Sponsor) With more than 20,000 health care professionals in its care, Texas Medical Liability Trust (TMLT) provides malpractice insurance and related products to physicians. Our purpose is to make a positive impact on the quality of health care for patients by educating, protecting, and defending physicians. Patty Spann 512-425-5932 patty-spann@tmlt.org www.tmlt.org Recommended partner of the Bexar County Medical Society The Bank of San Antonio Insurance Group, Inc. (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians. Our local insurance professionals are some of the few agents in the state who specialize in medical malpractice and all lines of insurance for the medical community. Katy Brooks, CIC 210-807-5593 katy.brooks@bosainsurance.com www.thebankofsa.com “Serving the medical community.”

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 512-658-0262 Kirsten.Baze@medpro.com www.medpro.com

ProAssurance (HH Silver Sponsor) 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 Development 800-282-6242 MikeRosenthal@ProAssurance.com www.ProAssurance.com

INVESTMENT ADVISORY REAL ESTATE

Alamo Capital Advisors LLC (★★★★ 10K Platinum Sponsor) Focused on sourcing, capitalizing, and executing investment and development opportunities for our investment partners and providing thoughtful solutions to our advisory clients. Current projects include new developments, acquisitions & sales, lease representation and financial restructuring (equity, debt, and partnership updates). Jon Wiegand, Principal 210-241-2036 jw@alamocapitaladvisors.com www.alamocapitaladvisors.com

MEDICAL BILLING AND COLLECTIONS SERVICES

Commercial & Medical Credit Services (HH Silver Sponsor) A bonded and fully insured San Antonio-based collection agency. Henry Miranda 210-340-9515 hcmiranda@sbcglobal.net www.cmcs-sa.com “Make us the solution for your account receivables.”

MEDICAL SUPPLIES AND EQUIPMENT

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

MILITARY

San Antonio Army Medical Recruiting office (★★Silver Sponsor) Mission: Recruit highly qualified and motivated healthcare professionals for service in the Army Reserves or Active Duty Army, in support of Soldiers and their families. 1LT Thomas Alexandria 210-328-9022 Alexandria.n.thomas12.mil@army. mil https://recruiting.army.mil/mrb/ “Service to Country, Army Medicine, Experientia et Progressus”

MOLECULAR DIAGNOSTICS LABORATORY

iGenomeDx ( Gold Sponsor) Most trusted molecular testing laboratory in San Antonio providing FAST, ACCURATE and COMPREHENSIVE precision diagnostics for Genetics and Infectious Diseases. Dr. Niti Vanee Co-founder & CEO 210-257-6973 nvanee@iGenomeDx.com Dr. Pramod Mishra Co-founder, COO & CSO 210-381-3829 pmishra@iGenomeDx.com www.iGenomeDx.com “My DNA My Medicine, Pharmacogenomics”

PROFESSIONAL ORGANIZATIONS

The Health Cell (HH Silver Sponsor) “Our Focus is People” Our mission is to support the people who propel the healthcare and bioscience industry in San Antonio. Industry, academia, military, nonprofit, R&D, healthcare delivery, professional services and more! Kevin Barber, President 210-308-7907 (Direct) kbarber@bdo.com Valerie Rogler, Program Coordinator 210-904-5404 Valerie@thehealthcell.org www.thehealthcell.org “Where San Antonio’s Healthcare Leaders Meet”

San Antonio Medical Group Management 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, President info4@samgma.org www.samgma.org

REAL ESTATE SERVICES COMMERCIAL

Alamo Capital Advisors LLC (★★★★ 10K Platinum Sponsor) Focused on sourcing, capitalizing, and executing investment and development opportunities for our investment partners and providing thoughtful solutions to our advisory clients. Current projects include new developments, acquisitions & sales, lease representation and financial restructuring (equity, debt, and partnership updates). Jon Wiegand, Principal 210-241-2036 jw@alamocapitaladvisors.com www.alamocapitaladvisors.com

CARR Realty (HH Silver Sponsor) CARR is a leading provider of commercial real estate for tenants and buyers. Our team of healthcare real estate experts assist with start-ups, renewals, relocations, additional offices, purchases and practice transitions. Brad Wilson – Agent 210-573-6146 Brad.Wilson@carr.us www.carr.us “Maximize Your Profitability Through Real Estate”

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Oakwell Private Wealth Management (HHHH 10K Platinum Sponsor) Oakwell Private Wealth Management is an independent financial advisory firm with a proven track record of providing tailored financial planning and wealth management services to those within the medical community. Brian T. Boswell, CFP®, QKA Senior Private Wealth Advisor 512-649-8113 SERVICE@OAKWELLPWM.COM www.oakwellpwm.com “More Than Just Your Advisor, We're Your Wealth Management Partner”

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Favorite Healthcare Staffing (HHHH 10K Platinum Sponsor) Serving the Texas healthcare community since 1981, Favorite Healthcare Staffing is proud to be the exclusive provider of staffing services for the BCMS. In addition to traditional staffing solutions, Favorite offers a comprehensive range of staffing services to help members improve cost control, increase efficiency and protect their revenue cycle. Cindy M. Vidrine Director of Operations- Texas 210-918-8737 cvidrine@favoritestaffing.com “Favorite Healthcare Staffing offers preferred pricing for BCMS members.”

San Antonio Army Medical Recruiting office (HH Silver Sponsor) Mission: Recruit highly qualified and motivated healthcare professionals for service in the Army Reserves or Active Duty Army, in support of Soldiers and their families. 1LT Thomas Alexandria 210-328-9022 Alexandria.n.thomas12.mil@army.mil https://recruiting.army.mil/mrb/ “Service to Country, Army Medicine, Experientia et Progressus”

2022 Subaru Ascent

By Stephen Schutz, MD

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.

I don’t think its design was the problem, although obviously Subaru 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.

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.

Anyway, the Subaru Ascent looks good, and the wagon-esque exterior 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.

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.”

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 market expect to pay close to MSRP, even with Phil Hornbeak’s best efforts—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.

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.

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?

Road trips are better because the Ascent’s engineers favored stability and comfort over athleticism and performance, so quiet and drama-free describe what the Ascent is like on the highway.

Actually, I think Subaru has taken over the space that Volvo occupied 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 teachers, and Nurse Practitioners drive these days? A disproportionate number of them own Subarus, just as their predecessors used to drive 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.

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 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.

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.

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