San Antonio Medicine, January 2025 by Traveling Blender

S A N A N TO N I O

John Shepherd, MD

2025 BCMS PRESIDENT IN THIS ISSUE

SAN ANTONIO, TX PERMIT 1001

PAID

NON PROFIT ORG US POSTAGE

FINANCIAL WELLNESS

CME content from Texas experts. Topics that impact your practice.

Join 250,000+ professionals who get free Continuing Medical Education (CME) with Texas Health Steps Online Provider Education. Choose from over 50 CME courses developed by trusted Texas experts, for experts like you. Quick courses and case studies on topics such as Medicaid guidelines, ethics and mental health, and more are all available 24/7.

Learn more at TXHealthSteps.com Content on the Texas Health Steps Online Provider Education website has been accredited by the Texas Medical Association, American Nurses Credentialing Center, National Commission for Health Education Credentialing, Texas State Board of Social Worker Examiners, Accreditation Council for Pharmacy Education, and UTHSCSA Dental School Office of Continuing Dental Education. Continuing Education for multiple disciplines will be provided for some online content.

SAN ANTONIO

TABLE OF CONTENTS

THE OFFICIAL PUBLICATION OF THE BEXAR COUNTY MEDICAL SOCIETY

•

WWW.BCMS.ORG

•

$4.00

•

FINANCIAL WELLNESS S A N A N TO N I O

Financial Literacy and Physician Wellness: Recommendations for Debt Resolution

By Rishi Goswamy, Alison Bartak and Ramaswamy Sharma, MS, PhD...............................................12 How Primary Care Physicians Can Thrive in Value-Based Care By Sherri Onyiego, MD, PhD....................................................14

Boosting the Bottom Line: Leveraging Telemedicine and “Teletexting” for Practice Profitability

By Hamed Mizani, MD, FASN..................................................16

Insurance Versus Concierge/Direct Primary Care Medicine By Jennifer Seger, MD........................................................................18

Medical Nomad

By John J. Seidenfeld, MD, MSHA, FACP.................................20

Due Diligence in Hiring Healthcare Employees

Courtesy of MedPro Group......................................................22

John Shepherd, MD

2025 BCMS PRESIDENT IN THIS ISSUE

FINANCIAL WELLNESS

Economic Wellbeing and Overall Health

By Ramaswamy Sharma, MS, PhD, with Ian Dorsa.................24

Health Outcomes Due to Inequity

By Ramaswamy Sharma, MS, PhD, with Elizabeth Ou, Emily Rowe and Camille Irene Hulipas...............................................26

Keeping the Practice Healthy: Staying Compliant with HIPAA to Avoid Costly Data Breaches

By David Alex Schulz, CHP......................................................28

To Use Debt or Not?

By Maria Breen and Bruce McMillan..........................................................................................................................30

Financial Focus: How Can You Plan for Incapacity?

Courtesy of Edward Jones Financial Advisor..............................................................................................................32 BCMS President’s Message........................................................................................................................................8 BCMS Alliance A Year in Pictures..............................................................................................................................10 2025 BCMS Board of Directors.................................................................................................................................34 BCMS Staff...............................................................................................................................................................36 Celebrating Melody Newsom’s 25th Anniversary........................................................................................................37 Art in Medicine...........................................................................................................................................................38 BCMS Vendor Directory.............................................................................................................................................40 The 2025 Lamborghini Urus SE Courtesy of Lamborghini San Antonio.....................................................................44 Recommended Auto Dealers.....................................................................................................................................46

PUBLISHED BY: Traveling Blender, LLC. 10036 Saxet Boerne, TX 78006

ADVERTISING SALES: AUSTIN: Sandy Weatherford sandy@travelingblender.com

PUBLISHER: Louis Doucette louis@travelingblender.com

SAN ANTONIO: Gerry Lair gerrylair@yahoo.com

BUSINESS MANAGER: Vicki Schroder vicki@travelingblender.com GRAPHIC DESIGNER: Jennifer Nelson jennifer@travelingblender.com

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.

SAN ANTONIO MEDICINE • January 2025

JANUARY 2025

•

VOLUME 78 NO.1

San Antonio Medicine is the official publication of Bexar County Medical Society (BCMS). All expressions of opinions and statements of supposed 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. 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 ADVERTISING CORRESPONDENCE: Louis Doucette, President Traveling Blender, LLC. A Publication Management Firm 10036 Saxet, Boerne, TX 78006 www.travelingblender.com

For advertising rates and information Call (210) 410-0014 Email: louis@travelingblender.com 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 prohibited 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 ANTONIO MEDICINE the Publisher and BCMS reserves the right to edit all material for clarity and space and assumes no responsibility for accuracy, errors or omissions. San Antonio Medicine does not knowingly accept false or misleading advertisements or editorial nor does the Publisher or BCMS assume 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 advertise “any preference limitation or discrimination based on race, color, religion, sex, handicap, familial status or national origin, or an intention to make such preference limitation or discrimination.

SmithPrint, Inc. is a family-owned and operated San Antonio-based printing and publishing 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 magazine with each issue.

BCMS BOARD OF DIRECTORS ELECTED OFFICERS

John Shepherd, MD, President Lyssa Ochoa, MD, Vice President Jennifer R. Rushton, MD, President-Elect Lubna Naeem, MD, Treasurer Lauren Tarbox, MD, Secretary Ezequiel “Zeke” Silva, III, MD, Immediate Past President

DIRECTORS

Woodson “Scott” Jones, Member John Lim, MD, Member Sumeru “Sam” G. Mehta, MD, Member M. “Hamed” Reza Mizani, MD, Member Priti Mody-Bailey, MD, Member Dan Powell, MD, Member Saqib Z. Syed, MD, Member Nancy Vacca, MD, Member Col Joseph J. Hudak, MD, MMAS, Military Representative Jayesh Shah, MD, TMA Board of Trustees Representative John Pham, DO, UIW Medical School Representative Robert Leverence, MD, UT Health Medical School Representative Cynthia Cantu, DO, UT Health Medical School Representative Lori Kels, MD, UIW Medical School Representative Ronald Rodriguez, MD, UT Health Medical School Representative Alice Gong, MD, Board of Ethics Representative Melody Newsom, BCMS CEO/Executive Director George F. “Rick” Evans, Jr., General Counsel

BCMS SENIOR STAFF

Melody Newsom, CEO/Executive Director Yvonne Nino, Controller Al Ortiz, Chief Information Officer Brissa Vela, Chief Membership and Development Officer Jacob Hernandez, Advocacy and Public Health Phil Hornbeak, Auto Program Director Betty Fernandez, BCVI Director

PUBLICATIONS COMMITTEE Jennifer C. Seger MD, Chair Timothy C. Hlavinka, MD, Member John Robert Holcomb, MD, Member Soma S. S. Jyothula, MD, Member George-Thomas Martin Pugh, MD, Member Adam Ratner, MD, Member John Joseph Seidenfeld, MD, Member Amith Skandhan, MD, Member Francis Vu Tran, MD, Member Louis Doucette, Consultant Brissa Vela, Staff Liaison Gabriella Bradberry, Staff Liaison Trisha Doucette, Editor Ayomide Akinsooto, Student Elizabeth Allen, Volunteer Rita Espinoza, DrPH, Volunteer David Schulz, Volunteer Ramaswamy Sharma, MS, PhD, Volunteer

SAN ANTONIO MEDICINE • January 2025

Visit us at www.bcms.org

PRESIDENT’S MESSAGE

New Year, New President, New Goals By John Shepherd, MD, President, Bexar County Medical Society

Many people take the beginning of the new year as an opportunity to set personal goals, and I am no exception. However, this year holds a special significance for me. As I step into the role of President of the Bexar County Medical Society, I find myself not only reflecting on my personal aspirations but considering the collective goals that we can achieve together as an organization. Together, we have a chance to amplify and deepen the impact of our existing mission while strengthening our community ties and enhancing the support we provide to our members and the patients we serve. To achieve this, we must prioritize our focus on membership. For existing members, that means continuing to explore innovative ways to enhance the value we provide. For those who are not yet members, it’s essential that we all extend an inviting hand, clearly communicating the benefits of being involved in organized medicine. Each one member added by fostering a positive and welcoming environment makes us stronger. No matter how cliché it sounds, there really is power in numbers. We must remain committed to the community-wide initiative established by Dr. Zeke Silva, our Immediate Past President. Actively engaging with local stakeholders and healthcare partners is essential to our success. By collaborating with these key players, we can leverage our collective insights and resources to enhance our reach and effectiveness. These partnerships will not only strengthen our presence in the community but also allow us to better address the needs of those we serve. Together we can drive meaningful change and create a more robust healthcare ecosystem that benefits everyone involved. Development of a leadership pipeline is crucial for fostering a culture of growth and sustainability with our organization. We need to create a supportive environment where emerging leaders can thrive, but the process really begins by identifying potential leaders at various levels and providing them with development opportunities, mentorship and training. I invite you all to step forward yourself or let us know about someone in your practice; your insights are invaluable in recognizing those who demonstrate leadership qualities and a commitment to our mission. New leaders allow us not only to have fresh ideas but ensure a foundation for our organization’s continued success. Supporting and partnering with the Bexar County Medical Alliance, which is known for its impactful social service projects and advocacy work, presents a unique opportunity for us to expand our

SAN ANTONIO MEDICINE • January 2025

reach and enhance our community engagement. This collaboration often allows us to leverage their established networks and resources to address pressing public health and social issues more effectively. By coming together as a unified Family of Medicine, we significantly amplify our influence and our ability to build a healthier Bexar County. Legislative relationships will be at the forefront this year. To ensure that we as physicians can practice medicine in the way we believe is best for our patients, it’s essential that we engage actively in the political arena. This involvement includes serving on the council of the legislation, attending advocacy events, contributing to campaigns, and sharing your personal stories. If you’re unsure how to get involved or where to start, please reach out to us — we’re here to support you and help you navigate the process. Together we can make a significant difference in shaping the policies that impact our profession and the care we provide. Individually each of you brings a diverse perspective and a unique set of skills and knowledge but it is only together that we can create a stronger, unified organization. It is only through our combined efforts that we can transform our goals into meaningful accomplishments. Abraham Lincoln once said, “The best way to predict the future is to create it.” I’m asking you to join me in creating ours.

John Shepherd, MD, 2025 President of the Bexar County Medical Society, has been an active lobbyist for the Family of Medicine at the Texas State Capital and has held several “Party of Medicine” events, introducing physicians on how to get involved with legislation that affects medical issues. He has been Chief of Surgery at Christus Santa Rosa Children’s Hospital, a past member of the Board of Directors of Tejas Anesthesia, and currently serves on the BCMS Legislative Committee. Dr. Shepherd served as Secretary on the BCMS Board of Directors for 2023.

Visit us at www.bcms.org

Bexar County Medical Society Alliance

A Year in Pictures

FINANCIAL WELLNESS

Financial Literacy and Physician Wellness: Recommendations for Debt Resolution By Rishi Goswamy, Alison Bartak and Ramaswamy Sharma, MS, PhD

hile physicians focus on combatting the various pathologies affecting the health of their patients, physician wellness is critical for avoiding burnout. Poor physician well-being is associated with patient dissatisfaction and poor patient outcomes. A plethora of reasons may contribute to job-related stress such as increased workload, dealing with insurance for reimbursement, need for continuous learning to keep up to date with current developments, malpractice lawsuits, increased regulations and working with electronic health record systems, work-life balance and others. However, financial debt incurred during medical school is also an important contributing factor. The median cost of attendance (COA) for the four years of medical school has increased by 4 percent over the previous year, which translates to approximately $286,000 or $391,000 for students expecting to graduate in 2025 from a public or private medical school respectively. Importantly, about 71 percent of medical students who graduated in 2024 have a median education debt of $205,000. This figure will likely increase every year due to the cost-of-living adjustments, continuously shifting federal interest rates, inflation and/or other macroeconomic factors. A recent report in 2024 indicated that more than 50 percent of specialists under the age of 40 practicing internal medicine, orthopedics, Ob/Gyn or especially family medicine continued to carry student debt. This is not surprising since the median stipend during the first year post-MD degree is $65,100; most physicians begin hitting their “income stride” 10 years behind their age-matched peers. The delay in earning a significant income can lead to further accrued interest on their debts if not properly managed. Undoubtedly, this can lead to stress, anxiety, low quality of life and burnout, especially when staring at further costs of setting up their own practice down the road. Therefore, the importance of financial literacy and wellness as a physician cannot be overstated and is arguably the most critical of non-clinical 12

SAN ANTONIO MEDICINE • January 2025

variables that contributes significantly to the overall satisfaction and well-being of physicians in the United States. Several articles over the years have pointed to a need for integration of unbiased financial literacy training into undergraduate and graduate medical education (UME and GME, respectively) curricula, given that most medical students and residents recognize that they do not possess the skillsets to cultivate, manage, and grow their personal wealth. A systematic review published in 2022 indicated that all of its 49 included articles pertaining to financial literacy in the context of UME or GME participants concluded that their audiences were unprepared for making sound financial decisions and, therefore, desired financial education. Towards this goal, many medical schools now offer individual and group financial training that includes preparation of budgets, sessions on debt management, information on loan repayment options and other topics, taught by financial counselors, physicians who are certified financial planners, and physicians with coding and reimbursement knowledge, among others. A few recommendations to help manage debt are listed below: Understand and consolidate your debt burden. The first of many variables that need to be addressed towards attaining robust financial health is to understand the principles and terminologies of personal debt obligations such as principal, fixed and variable interest rates, capitalization, interest accrued and others. Next, consolidate the many loan bundles to simplify record-keeping, save time on filling out multiple forms, and reduce the number of payments to different entities every month. Refinancing at a lower interest rate, qualifying for a Public Service Loan Forgiveness program, and income-driven repayment plans may be viable options if an academic career or working for a non-profit organization is pursued. Finally, create a regiment-

FINANCIAL WELLNESS ed monthly payment plan, perhaps with a monthly autopay feature, beginning as early during residency as possible. Live like a resident until you are debt-free. It is critical to understand this concept, not only throughout the course of the training experience, but also through the first five to seven years of practice, until the debt burden has been alleviated. The underlying concept is to live within one’s means by designing a budget and then adhering closely to it. Any one of several free personal budget apps can be used to keep track of expenses that can help towards this goal. Plan carefully before acquiring large assets during training. Large assets include purchasing a house, a new car and other big budget items. Most residents may not have the capital for a down payment on a starter home that costs $200,000 or above. In addition, the accessory costs associated with purchasing a home (i.e. closing costs, property taxes, monthly mortgage payments and homeowner’s association payments, maintenance-related issues, etc.) significantly inflate expenses. Residents may also choose to move to a different city after training; the relatively short duration of time owning a house (less than five years) may not be sufficient to fully realize the financial benefits of ownership. The opportunity costs in terms of money and time devoted to upkeep of the house could, perhaps, be better utilized by paying off student debts as soon as possible, smart investing in securities (see below), and investing time towards either furthering career interests or learning the fundamentals of investing. However, if a resident is resourceful and can utilize a purchased house to generate a positive return on investment (ROI) by simultaneously living and renting a portion of the house, then it may make sense to buy rather than rent. Thus, long-term planning is key towards making a sound decision. Save money and invest carefully as early as possible. Understanding the money market and securities such as stocks, bonds, exchange traded funds, mutual funds, certificate of deposits, real estate investment trusts and investing as early as possible can help towards maximizing wealth in a strategic manner and hasten debt resolution. The effect of compound interest is well-known; so is the rule of 72. Various resources are available for students and residents. An excellent review by Poppler and colleagues (see References) is recommended as is the White Coat Investor blog (https://www.whitecoatinvestor. com/). It is important to realize that becoming financially literate would not only provide stability and relief from stress but also allow physicians to become more generous with their time in providing compassionate care to those in need.

References: 1. Association of American Medical Colleges (2024, October). Medical Student Education: Debt, Costs, and Loan Repayment Fact Card for the Class of 2024 | AAMC. https://store.aamc. org/medical-student-education-debt-costs-and-loan-repaymentfact-card-for-the-class-of-2024.html 2. Blake, A. (2024, June 26). What is the 5-Year rule for selling a house? There are actually two. HomeLight Blog. https://www. homelight.com/blog/5-year-rule-for-selling-a-house/?msockid=038fddcf033c63cb0bb9c88702976238

3. Budd, K. (2022, August 9). 7 ways to reduce medical school debt. AAMC. https://www.aamc.org/news/7-ways-reduce-medicalschool-debt 4. Calonia, J. (2024, April 18). What’s the average medical school debt in 2024? Forbes Advisor. https://www.forbes.com/advisor/ student-loans/average-medical-school-debt/ 5. Cawyer, C.R., Blanchard, C., & Kim, K.H. (2022). Financial literacy and physician wellness: Can a financial curriculum improve an Obstetrician/Gynecologist resident and fellow’s Well-Being? American Journal of Perinatology Reports, 12(01), e64–e68. https://doi.org/10.1055/s-0041-1742268 6. Chen, J. (2024, August 1). Compounding Interest: Formulas and examples. Investopedia. https://www.investopedia.com/terms/c/ compounding.asp 7. Igu, J.A., Zakaria, S., & Bar-Or, Y.D. (2022). Systematic review of personal finance training for physicians and a proposed curriculum. BMJ Open, 12(12), e064733. https://doi.org/10.1136/ bmjopen-2022-064733 8. Lusco, V.C., Martinez, S.A., & Polk, H.C. (2005). Program directors in surgery agree that residents should be formally trained in business and practice management. The American Journal of Surgery, 189(1), 11–13. https://doi.org/10.1016/j. amjsurg.2004.05.002 9. Mizell, J.S., Berry, K.S., Kimbrough, M.K., Bentley, F.R., Clardy, J.A., & Turnage, R.H. (2014). Money matters: a resident curriculum for financial management. Journal of Surgical Research, 192(2), 348–355. https://doi.org/10.1016/j.jss.2014.06.004 10. Medscape Millennial Physician Compensation Report 2024. (2024, September 27). How much green comes with the white coat? Medscape. https://www.medscape.com/slideshow/2024young-phys-comp-rpt-6017632?icd=login_success_email_ match_norm#13 11. Poppler, L.H., Sharma, K., Buck, D.W., & Myckatyn, T.M. (2019). Five financial pearls for medical students, residents, and young surgeons. Plastic & Reconstructive Surgery Global Open, 7(2), e1992. https://doi.org/10.1097/gox.0000000000001992 12. Rivera, H. (2024, November 24). What is the average medical school debt? Yahoo Finance. https://finance.yahoo.com/news/ average-medical-school-debt-215819483.html 13. Shanafelt, T.D., Sloan, J.A., & Habermann, T.M. (2003). The well-being of physicians. The American Journal of Medicine, 114(6), 513–519. https://doi.org/10.1016/s00029343(03)00117-7 14. Wright, A.A., & Katz, I.T. (2018). Beyond Burnout — redesigning care to restore meaning and sanity for physicians. New England Journal of Medicine, 378(4), 309–311. https://doi. org/10.1056/nejmp1716845 Rishi Goswamy is a medical student at the University of the Incarnate Word School of Osteopathic Medicine, Class of 2027. In addition to medicine, he has an interest in healthcare strategy and economics. Alison Bartak is a medical student at the University of the Incarnate Word School of Osteopathic Medicine, Class of 2027. Her current interests include Preventative Medicine and Surgery. Ramaswamy Sharma, MS, PhD, is a Professor of Histology and Pathology at the University of the Incarnate Word School of Osteopathic Medicine. He is interested in delineating the multiple molecular and cellular roles of melatonin in maintaining our quality of life. Dr. Sharma is a member of the BCMS Publications Committee. Visit us at www.bcms.org

FINANCIAL MEDICAL YEAR WELLNESS IN REVIEW

How Primary Care Physicians Can Thrive in Value-Based Care By Sherri Onyiego, MD, PhD

alue-Based Care (VBC) has been positioned as the future of healthcare — a system that promises better outcomes, improved patient experiences and lower costs. Yet, like the pursuit of renewable energy or universal prosperity, VBC remains a goal easier to envision than to achieve. 14

SAN ANTONIO MEDICINE • January 2025

For more than a decade, VBC has been a movement focused on healthcare reform, but its implementation in primary care, a cornerstone of any successful VBC model, remains slow. The Commonwealth Fund, a private U.S. foundation dedicated to improving healthcare, recently issued a report1 exploring why primary care has been sluggish

FINANCIAL WELLNESS

in adopting VBC. The main reasons are financial, with primary care providers (PCPs) criticizing the model for looking good on paper but lacking in practice. According to a 2022 Commonwealth Fund survey,2 just 46 percent of primary care physicians (PCPs) reported receiving any value-based payments. Commonwealth Fund researchers found that PCPs weren’t opposed to VBC in principle. In fact, they longed to move away from the current fee-for-service model and spend more time with patients, providing comprehensive, proactive care. The problem, they say, is that VBC and its payment models are not designed or implemented in such a way that makes it possible for them to participate. VBC can work for PCPs — delivering measurable benefits to clinicians, patients and entire communities. However, to make VBC a practical reality for PCPs, its financial, administrative and patient engagement challenges must be addressed. Let’s explore how enablement-based VBC models can overcome these barriers. Financial Stability: Aligning Risk and Reward One of the biggest barriers to VBC adoption is financial risk. Many PCPs, especially those caring for high-acuity patients, find the outcome-based reimbursement model unpredictable. Payments are often tied to year-end results and delayed even further by claims processing, creating revenue gaps that strain practices. VBC enablers3 — organizations that bridge the gap between PCPs and VBC health plans — are changing the game. These partners help practices navigate unfamiliar payment models, reduce financial risk, and ensure more predictable cash flow. For example, enablers focused on Medicaid populations often assume downside financial risk or offer activity-based payments for addressing care gaps and providing proactive wellness visits. This approach delivers timely, stable revenue streams for practices while enabling them to focus on high-quality care. Technology Reduces Administrative Burden One of clinicians’ most common complaints about VBC is the additional administrative work required to document care and to show progress against performance metrics, which can vary by managed care organizations overseeing the contracts. The need to document care and track performance against varying quality metrics can overwhelm practices, particularly smaller, independent ones with limited staff and technology. A single PCP could have a different value-based contract with a dozen-plus health plans and MCOs. VBC enablers aggregate the contractual obligations for PCPs and offer advanced technology that automates and eliminates much of the administrative strain. These tools integrate seamlessly with existing electronic health records (EHRs), healthcare information exchanges (HIEs) and other data sources, helping PCPs identify and prioritize patients for chronic care management, wellness visits or care transitions. Many enablers provide this technology at no cost to practices within their networks, ensuring smaller practices can participate in VBC without investing in expensive tech tools and infrastructure. Addressing Patients Holistic Needs, Enhancing Engagement Addressing patients’ medical needs often requires tackling Non-Medical Drivers of Health (NMDoH), such as food insecurity

or housing instability. Many PCPs feel ill-equipped to manage these challenges, which can significantly impact patient outcomes. Recognizing the major barriers of NMDoH to health outcomes, some VBC enablers also specialize in connecting patients with community resources to address NMDoH and improve care accessibility. The very innovative enablers offer multidisciplinary field teams — including community health workers, nurse practitioners, care coordinators and chaplains — to supplement PCP efforts. These teams serve as extensions to the PCP to assist complex care patients and re-engage them with their PCPs, ensuring personalized, holistic support that addresses both medical and social needs. Proven Success in Medicaid Populations VBC models supported by enablement partners have demonstrated success across thousands of PCPs in multiple states, particularly in underserved communities. By removing financial, administrative and operational hurdles, enablers empower PCPs to focus on delivering high-quality care. PCPs across Bexar County and all of Texas can partner for VBC success. Look for enablers that can align, engage and empower providers and health plans to focus their work on the individuals and communities that need it the most. For PCPs, the right enablement partner can transform VBC from an idealized concept into a practical and rewarding reality. These partnerships are essential to making VBC work — for PCPs, patients and the broader American health system. References: 1. www.commonwealthfund.org/publications/issue-briefs/2024/ jul/why-primary-care-practitioners-arent-joining-value-based-payment 2. www.commonwealthfund.org/blog/2023/engaging-primarycare-value-based-payment-new-findings-2022-commonwealthfund-survey 3. www.healthcareitnews.com/news/value-based-care-enabler-explains-its-successful-model

Dr. Sherri Onyiego is Texas, Tennessee and Louisiana Senior Medical Director for Equality Health, a value-based care enabler with a Medicaid-first model uniquely equipped to address the needs of diverse and historically underserved populations. Equality Health partners with independent PCPs delivering technology, coaching, clinical expertise, financial support and a deep understanding of valuebased payment models to engage plans, providers, patients and communities in improving whole-person care. Equality Health is Gold Member of the BCMS Circle of Friends Program. EqualityHealth.com

Visit us at www.bcms.org

FINANCIAL FINANCIAL WELLNESS WELLNESS

Boosting the Bottom Line: Leveraging Telemedicine and “Teletexting” for Practice Profitability By Hamed Mizani, MD, FASN

he healthcare landscape has undergone a seismic shift, with telemedicine emerging as a transformative force. Once a tool of convenience, telemedicine is now recognized as a cornerstone of modern medical practice, essential for improving patient access and optimizing practice operations. Telemedicine has evolved rapidly since 2000, propelled by technological advancements and increasing demand for accessible healthcare. The widespread adoption of smartphones and mobile apps in the 2000s made virtual healthcare more convenient, allowing patients to consult with providers from anywhere. Integrating electronic health records (EHRs) further streamlined telemedicine, enabling seamless communication and coordination of care. The COVID-19 pandemic in 2020 was a transformative moment for telemedicine, driving its mainstream adoption. Lockdowns and social distancing measures forced healthcare systems to embrace virtual care on a large scale. At the same time, governments and insurers implemented policy changes to relax regulations and improve reimbursement for telehealth services. How Telemedicine Enhances Profitability For medical practices, telemedicine represents a clinical tool and a powerful driver of financial health. Here are seven ways telemedicine enhances practice profitability. Increased Patient Volume: Telemedicine’s improved accessibility allows providers to see more patients daily by eliminating commute and waiting room times. Practices can also extend the geographic reach of their services to patients in rural or underserved areas without needing a physical office. Employees in customer-facing industries can also easily access healthcare via their cell phones when convenient. Cost Savings: Practices often see reduced overhead costs from fewer in-office visits, which means lower expenses for utilities, cleaning, staffing and supplies. The more efficient use of resources means providers can utilize telemedicine for follow-ups and routine consultations, reserving in-office resources for more complex cases. Better Appointment Utilization: Virtual visits are more convenient, leading to fewer cancellations and missed appointments, thanks 16

SAN ANTONIO MEDICINE • January 2025

to fewer no-shows. Providers can offer more flexible scheduling for patients with extended hours or short consultations during downtime, maximizing schedules. Revenue Opportunities: Many insurance plans now reimburse telehealth visits similarly to in-person visits, ensuring providers can monetize their services thanks to reimbursement. Offering virtual services via telemedicine can be a competitive differentiator, attracting tech-savvy or busy patients seeking convenient care. Improved Patient Retention: Telemedicine enhances patient engagement by simplifying regular check-ins, improving patient satisfaction, and ensuring better care follow-up. Additionally, virtual monitoring and follow-ups enable more proactive care, helping to prevent costly escalations in treatment while enhancing outcomes and strengthening the provider’s reputation. Boost in Operational Efficiency: Telemedicine offers a scalable model, enabling practices to expand their services without costly investments in physical infrastructure. It streamlines workflows by integrating digital tools with EHRs, making documentation more efficient and reducing the administrative burden on providers. Adapting to Market Demands: As patients increasingly expect telehealth options, offering these services allows providers to meet consumer demand and maintain a competitive edge. Telemedicine gives practices added resiliency during crises, ensuring continuity of care and revenue when in-person visits are disrupted, such as during pandemics. By thoughtfully integrating telemedicine into a medical practice’s operations, healthcare providers can enhance profitability, optimize operations, and deliver convenient, patient-centered care. Born from a Crisis, Built for the Future The COVID-19 pandemic upended healthcare systems, forcing practices to adapt to sudden operational and financial challenges. Many clinics faced declining patient visits and significant revenue losses while patients struggled to access timely care. As a practicing physician, I realized these challenges illuminated a critical gap in the healthcare delivery model. Existing telehealth solutions often needed more integration and efficiency to thrive.

FINANCIAL WELLNESS

When I founded LASO Health right before the pandemic, I aimed to address the critical pain points in healthcare delivery that many practices faced. Today, LASO Health is at the forefront of the telemedicine revolution, providing innovative solutions that help providers improve patient care and boost their practice profitability. By streamlining access to care and optimizing operational efficiency, we’ve become a trusted ally for practices navigating the challenges of modern healthcare. LASO Health’s Tailored Solutions LASO Health takes telemedicine further with programs designed to meet diverse practice needs. Each offering addresses critical aspects of profitability and care delivery. Connect: Streamlined Telehealth Services Connect is the backbone of LASO Health’s telemedicine and “teletexting” platform, providing seamless virtual care for practices. By connecting patients to physicians via secure texting followed by video conferencing, LASO Connect helps providers expand patient access while minimizing operational burdens. Using a teletexting solution such as Connect can impact a practice’s profitability by: • Enabling concierge practices to offer patients paid membership access to physicians outside regular visits without per-visit fees • Increasing patient volume to expand the practice’s geographic reach • Lowering overhead costs from transitioning routine visits to virtual care • Optimizing reimbursement processes to ensure practices get paid for their services Therapy: Transforming Behavioral Health Access LASO Therapy addresses a growing demand for mental health services by connecting patients with licensed therapists. This telemedicine program allows practices to incorporate behavioral health into their offerings without overextending resources. Practices can become more profitable thanks to: • New revenue streams from mental health services • Enhanced patient satisfaction by offering private, affordable and easy access to mental healthcare needs and • Minimizing operational costs while maintaining high-quality service WorkWell: Supporting Workforce Health WorkWell is LASO Health’s corporate telehealth solution for employers offering healthcare services to their employees. For healthcare providers, this translates to: • Lower the cost of healthcare from payors and self-funded companies while attracting competitive contracts to medical practices • Reliable income from contracted employer partnerships • Expanded practice visibility as a trusted provider for local businesses • Diversified revenue sources that stabilize income during seasonal fluctuations.

Case Study: Real-World Success Stories The benefits of telemedicine aren’t theoretical — LASO Health has already helped practices achieve tangible results: • A Texas primary care practice increased its patient volume by 20 percent within six months of implementing LASO Connect, thanks to its ability to attract patients from surrounding rural areas. • An independent clinic added a new revenue stream by offering LASO Therapy’s mental health services, quickly becoming a popular option for existing patients. • A multi-specialty practice partnered with local employers through WorkWell, generating consistent revenue and building strong community ties. Overcoming Barriers to Adoption Despite its benefits, some practices still need to be more open to adopting telemedicine due to concerns about technology, reimbursement and patient acceptance. Telemedicine platforms like LASO Health address these barriers head-on with their simplified technology, which integrates seamlessly with existing systems, minimizing disruptions. LASO Health provides practices with reimbursement guidance through training and tools to help them navigate telehealth billing and ensure compliance. LASO also equips providers with strategies to educate patients on the convenience and reliability of virtual care. LASO Health is committed to staying ahead of these trends and innovating solutions that keep practices competitive and profitable in a digital-first world. Looking Ahead: Telemedicine as a Profitability Tool Telemedicine is no longer a temporary fix. It’s a strategic asset for practices seeking sustainable growth. As demand for virtual care persists and policies supporting reimbursement expand, telemedicine remains integral to hybrid care models that blend in-person and virtual visits. Its ability to improve access, streamline operations, and create new revenue streams makes telehealth solutions indispensable to modern healthcare. Advances in artificial intelligence, wearable devices and remote monitoring can further enhance capabilities, ensuring telemedicine’s continued relevance. Practices that embrace this evolving technology will be well-positioned to thrive in an increasingly digital healthcare environment. As telehealth platforms continue to evolve with advancements in technology and policy, practices that integrate telemedicine into their care models will be well-equipped to adapt and thrive in a rapidly changing healthcare landscape.

Hamed Mizani, MD, FASN, is the founder and CEO of South Texas Renal Care Group and LASO Health, an innovative telemedicine platform available to patients nationwide. LASO Health is a Silver Member of the BCMS Circle of Friends Program. LASOHealth.com Visit us at www.bcms.org

FINANCIAL WELLNESS

Insurance Versus Concierge/ Direct Primary Care Medicine By Jennifer Seger, MD

ver the past 40 years, healthcare delivery has undergone a significant transformation, with models emerging in an effort to meet patient needs and adapt to shifting economic landscapes. This article focuses on the differences between traditional fee-for-service (FFS) insurance-based medical practices and the rapidly growing practice concierge or direct primary care membership models, of which there are now estimated to be 5,000 to 7,000 of these in the U.S.1 While both aim to provide excellent medical care, their business structure, philosophy and patient experience are markedly different. Traditional Fee-for-Service Models: Commercial or Government-Funded Insurance: In traditional insurance-based practices, the emphasis is on patient volume and relative value units (RVUs). The vast majority of patients in FFS practices rely on private insurance or government programs to cover their medical costs. Billing and coding are critical components, as each service must be properly documented to receive payment. A major problem in FFS is actually getting paid for the services provided, which seems like it should be straightforward, but ask any provider working in this setting and they will tell you the struggle is real. High Patient Volume: Due to low reimbursement rates for some services, FFS practices often operate with high patient volumes in order to sustain profitability. This is particularly true nowadays due to rising overhead costs and declining reimbursement (which makes absolutely no sense), as reported by one local physician who has been practicing in a FFS insurance-based private practice for more than 20 years in San Antonio. Her office has been closed to new patients for several years, which is the case for many primary care practices in San Antonio. Patients frequently report frustration with these traditional high-volume practices as they are often unable to be seen in a timely manner, leaving them no choice but to utilize urgent care clinics that are more costly. 18

SAN ANTONIO MEDICINE • January 2025

Administrative Burden: Tremendous time and resources are spent navigating complex insurance requirements. This includes pre-authorizations, claim denials and extensive documentation. That same physician believes insurance companies are using “obstructionist tactics, which ultimately create delays in patient care and a huge increase in administrative costs for practices.” Limited Continuity of Care: The time constraints in this model can make it challenging for doctors to build deep, ongoing relationships with their patients; however, this is very provider dependent and many in FFS practices go above and beyond to do just that. But that dedication comes at a price. Physicians in FFS practices are experiencing higher-than-ever levels of burnout compared to their counterparts in concierge-type practices. With shorter appointments, the focus ends up being on addressing immediate concerns rather than preventive care or holistic wellness so many genuinely want to provide. Concierge/Direct Primary Care Medicine: Membership-Based Structure: Patients pay a flat fee, either monthly or annually, which will range from as low as $50-75/month to as high as several hundred dollars per month, depending on the region and level of care being provided. Some practices require patients to pay for the entire year up front. These fees are often set up as auto payments to ensure the provider is paid whether the patient uses his/her services or not. Some concierge practices still contract with insurers, putting them at risk for “double dipping” since contracted physicians cannot legally charge patients for anything the plan already covers. In this case, the concierge physician must very clearly delineate services he/she is offering that would justify these additional fees. In contrast, Direct Primary Care practices almost never contract with insurance companies. It is always recommended that patients have commercial/government-based insurance as the membership fees often do not apply to services outside of provider visits, such as labs, imaging, procedures and hospitalizations.

Lower Patient Volume: Concierge physicians typically limit their patient panel from a few hundred to as many as 600 to 700 on the high end. This is dramatically less than the patient panel a FFS clinician maintains, which is several thousand. This limited panel allows providers to see patients more promptly (often the same day), and spend more time with each patient, often allowing for more comprehensive care.2 Enhanced Accessibility: Patients in concierge practices often have more avenues for direct communication with their doctor via phone, email or text, as well as same-day or next-day appointments. This level of access can be invaluable, especially for individuals with chronic conditions and/or busy schedules. (NOTE: many providers in FFS practices also do this; however, getting properly reimbursed for their time is virtually non-existent — hence, the burnout.) Focus on Preventive Care: With more time and resources, concierge doctors report being able to prioritize preventive care, wellness planning and patient education, and feel they are better able to coordinate care with specialists, further improving continuity of care.2 In conclusion, both traditional fee-for-service and concierge practices have their place in the healthcare ecosystem, catering to different patient needs and priorities. The FFS model emphasizes accessibility and cost-sharing through insurance, while concierge medicine offers a personalized, patient-centered experience for those who can afford it, which herein, lies a problem. Many opponents feel the concierge model further highlights the health inequity that exists in our country. While patient satisfaction survey results point to a higher level of satisfaction in concierge practices, there is a scarcity of data related to improved patient outcomes. There is some data suggesting improvements in chronic care disease management, and fewer ER visits and hospitalizations in the concierge model.3 When surveyed, physicians who have chosen to transition to concierge medicine have done so not for more money, but because of their frustration with our current healthcare system and their deep desire to genuinely provide better patient care. References: 1. Knope, S.D. Concierge Medicine: A new system to get the best healthcare. Rowan and Littlefield 2010 2. 2024 AAFP Direct Primary Care Brief: https://www.aafp.org/ dam/AAFP/documents/practice_management/direct-primarycare-2024-data-brief.pdf 3. http://www.marketwatch.com/story/whyconcierge-medicine-will-get-bigger-2013-01-17

Jennifer Seger, MD, is the Medical Director of the Seger MD, a fully Comprehensive Medical-Surgical Weight Management and Wellness Program in San Antonio. Dr. Seger graduated from the University of Texas Medical School at San Antonio in 1999 and completed her residency in Family Medicine at Texas Tech Medical School in 2002. She joined OMA ( formerly ASBP) and became involved with committee work, was a primary author of the first OMA Obesity Algorithm published in 2012, served as a Trustee to the OMA Board and has completed two terms on the Board as a Director for the American Board of Obesity Medicine. Dr. Seger was recognized as the Bariatric Physician of the Year by OMA in 2014. She is a member of the Bexar County Medical Society and chairs the Publications Committee.

FINANCIAL FINANCIAL WELLNESS WELLNESS

Medical Nomad By John J. Seidenfeld, MD, MSHA, FACP

ver the past 50-plus years, it has been my great pleasure and passion to serve patients as a Pulmonary Internist. I have taken my patients’ trust and vulnerability seriously, and their wellbeing as a primary goal. After five years of training at the University of Iowa in Iowa City and certification in Internal Medicine and Pulmonary Disease, the Army drafted me during the Vietnam conflict, and I served at Fort Ord caring for active-duty military members and their dependents, and military retirees. After serving in active status for two years, I remained in reserve status for another 10 years. My first civilian job was at the University of Arizona in Tucson (U of A) as an Assistant Professor doing lab research, teaching and clinical care in Pulmonary and Critical Care Medicine at the University Hospital and Veterans Administration Hospital. Because of research interests and the Southwest Foundation, I moved to the University of Texas Health Science Center in San Antonio on the faculty with duties like those at U of A. Despite a love of teaching and research, and to pay for my children’s college education, I went into solo pulmonary practice in San Antonio. The practice thrived with the help of Frost Bank and Santa Rosa Health Care, and coverage “partners,” Dr. Carlos Orozco and Dr. James Andry. Highlights of this time were working with many pulmonary patients in and out of all the San Antonio hospitals, chairing the Bioethics committee and Respiratory Therapy department at Methodist Hospital, being President of the Medical Staff at Santa Rosa Northwest Hospital, and chairing and serving on committees of the Bexar County Medical Society and other non-profit organizations. Eventually I was invited to be Medical Director of the Soloman Anthony Clinic, a group familiar with my pulmonary practice. When the CEO of the group left, I was asked to fill that position. Unfamiliar with medical business at that level, I went to Trinity University and earned a master’s degree in healthcare management three years later. The group was brought under the management of Health Texas, then a Santa Rosa group and I left for the next pursuit. After 14 years of practicing Pulmonary Medicine and administration, I looked for work with Health insurers to improve the quality of care and was a Medical Director with Humana and Cigna in Texas before taking a job as Medical Director and Senior Vice President 20

SAN ANTONIO MEDICINE • January 2025

with Blue Cross of Missouri. In St. Louis, I served on the medical society board of directors and was President of the St. Louis Heart Association. When the company was sold to Wellpoint and eventually Anthem, the coverage expanded to 13 mid-western and southern states. Areas of responsibility included quality management, provider relations, credentialing, and review and authorization of care. I retired from this work in 2006 and returned to San Antonio and family here, and practiced Internal Medicine and Pulmonary with a group downtown at the Nix. I left this work in 2013 and focused on family matters. When an opportunity arose to resume teaching, I joined the faculty at the University of the Incarnate Word School of Osteopathic Medicine in San Antonio. Over the past six years, it has been my great pleasure to work and share a wide range of experiences with the faculty and medical learners from year one to graduate medical education physicians. It was also a great honor to chair the Publication Committee of BCMS during this time. As one of my longtime friends has noted, “John, you can’t keep a job!” The way I see this nomadic medical career is that I am grateful and privileged to have worked with patients and doctors during all these years in a variety of settings, with an aim to focus on patient care and assure quality work in practice. Family has always been central to life, and my wife and I devote much of our time and energy to four children and eight grandchildren. Medicine is practiced “under a big tent” and there are many ways to express your passion as a doctor. My regards to all my colleagues and best wishes as they care for their patients.

John J. Seidenfeld, MD, MSHA, FACP, is an Associate Professor, CASE, at the University of the Incarnate Word School of Osteopathic Medicine. He is a member of the Bexar County Medical Society and serves on the Publications Committee.

FINANCIAL WELLNESS

2025 MDX

Premium Performance SUV 355-HP | 3.0L TURBO V-6 (Type S)

GunnAcura.com Visit us at www.bcms.org

FINANCIAL FINANCIAL WELLNESS WELLNESS

Due Diligence in Hiring Healthcare Employees Courtesy of MedPro Group

aving qualified, competent and reliable employees in healthcare settings is pivotal to providing exceptional care, preventing patient harm, and reducing liability exposure. Due diligence of the workforce begins during the hiring process and should include thorough screening of candidates and verification of their skills and expertise. A paper in the University of Cincinnati Law Review explains that “Predicting the likelihood of future malfeasance by any single employee is impossible, [but] effective backgrounding enhances quality of care, decreases risks, and lowers costs.”1 Healthcare organizations should have formal recruiting and hiring processes in place that comply with state and federal laws, and individ22

SAN ANTONIO MEDICINE • January 2025

uals involved in hiring should consistently apply these processes to all applicants. Lax or inconsistent employment processes can pose risks to patients, other employees and the corporate entity. The following tool offers a high-level list of areas to review and validate for applicants during the hiring process. (Healthcare organizations should get appropriate consent, authorization and release forms from applicants to do background checks, contact references and employers, verify academic performance, etc.) This list is not exhaustive, and the process will vary depending on the type of position and qualifications required. However, healthcare organizations can use this checklist as a starting point to assess their processes and identify potential gaps.

FINANCIAL WELLNESS

Education and Training

Personal Character, Conduct and Health Status

Have you verified the applicant’s education and training, including: Educational transcripts and diplomas from degree programs? Accreditation of educational institutions? Residency/internship certificates of completion? References from residency/internship program directors to verify performance and competency? Specialty board status? Continuing education certificates showing completion of adequate hours?

Have you reviewed the applicant’s personal character, conduct and health status, including: A general internet search and social media screening (used unofficially to identify potential red flags)? State and federal criminal background checks, including sex offender registries? History or red flags related to substance abuse, including drug testing (according to organizational policy)? Any remediation efforts that the applicant has taken in relation to substance abuse issues? Attestation of physical abilities from a licensed healthcare provider (according to organizational policy)? Necessary health screenings and vaccinations?

Licensure and Certification Have you verified the applicant’s licensure and certification, including: Active state license and letters of good standing in any states in which licenses were obtained? National Provider Identifier? Drug Enforcement Administration number? Medicare number that is current and unencumbered? Proof of board certification or eligibility? Basic, advanced and/or pediatric advanced life support certification? Experience and Work History Have you verified the applicant’s experience and work history, including: Current and prior employment (accounting for and clarifying any gaps in employment/residencies)? Scope of practice or professional duties (including experience in clinical practice for clinicians)? Staff privileges at current and prior places of employment? At least three professional recommendations/references that are validated with follow-up communication? (Healthcare organizations should require applicants to provide a copy of a government-issued photo identification as part of the hiring process. A picture of the applicant should be included with requests for recommendations/references to ensure that the applicant has not misappropriated the identity of another individual.)

Insurance Coverage Have you verified the applicant’s insurance coverage, including: Proof of malpractice insurance, including current certificate of coverage with policy number and copy of declarations? Adequate dollar amount of limits (per occurrence and aggregate)? Lack of gaps in coverage, including proof of prior acts or tail coverage? Other Considerations Have you reviewed or validated other information that might be pertinent in the hiring process, including: Collaborative practice or supervisory agreements? U.S. citizenship or compliance with federal immigration laws? Government-issued photo identification? Motor vehicle driving records? Credit history/financial background check? (Healthcare organizations should be aware of, and comply with, state laws that may restrict using credit histories/reports for applicants and employees.)

Malpractice Claims and Adverse Outcomes Have you reviewed the applicant’s history of malpractice claims and negative clinical outcomes, including: The National Practitioner Data Bank? Negative sanctions from the U.S. Department of Health and Human Services’ Office of Inspector General? Insurance loss runs (for the last 10 years if available, or 5 years at minimum)? Board of Medical Examiners’ investigations? Prior professional disciplinary actions?

References: 1. Winn, J. I., & Govern, K. H. (2018). Due diligence and legal obligations of employment screening in healthcare organizations. University of Cincinnati Law Review, 87(1), 1–27. Retrieved from https://scholarship.law.uc.edu/uclr/vol87/iss1/1 MedPro Group is a Silver Member of the BCMS Circle of Friends Program. MedPro.com Visit us at www.bcms.org

FINANCIAL FINANCIAL WELLNESS WELLNESS

Economic Wellbeing and Overall Health By Ramaswamy Sharma, MS, PhD, with Ian Dorsa

conomic well-being and health are tightly intertwined. Having greater financial resources opens the doors to safer living environments and helps reduce the risk to health hazards; these include indoor exposures to mold, lead and other environmental toxins as well as outdoor exposures to uncomfortable temperatures, injuries related to violence and crime, and others. Options for more expensive but nutrient-rich, organic dietary choices, such as fresh fruits and vegetables, as compared to the less expensive “junk” foods are on the table. Healthy behaviors, such as regular physical activity through gym memberships with the help of personal trainers or the purchase of exercise equipment, can be adopted and maintained; living in well-developed communities with parks, recreational facilities and other open spaces also provides opportunities for physical activities. Stress and anxiety related to financial concerns for supporting oneself or their family decreases. Financial stability plays an important role in receiving access to healthcare as health insurance, medications and preventive care services, such as screenings, immunizations and treatments, become affordable. The importance of early diagnosis of most pathologies and their management cannot be overstated; similarly, chronic diseases can be better managed. Economic well-being correlates with higher levels of education and fosters health literacy, critical for assimilating and understanding health-related information, and making informed decisions. Several studies have shown that a direct correlation exists between income and health. For example, a Swedish study reported that an increase in income by 10 percent after betting or winning lotteries resulted in an increased life expectancy by five to eight weeks and elevated their health index status. Another study in South Africa showed that the entire family of individuals who received large pensions experienced significant improvement in health and a decrease in depression symp24

SAN ANTONIO MEDICINE • January 2025

toms when the pension was shared with them; individuals who did not share their pensions with their families reported their health status a step higher (from “average” to “good”) than their families. Children in these households grew taller and their nutritional status improved. Similarly, children from poor families who moved out of the poverty bracket as a result of income supplementation in western North Carolina exhibited a significant decrease in their psychiatric symptoms. Another recent study, wherein 1,746 participants randomly selected out of a total population of 2,880 participants in Chelsea, Massachusetts, received $400 monthly for nine months, showed that income support resulted in fewer visits to the emergency department, decreased hospitalization, and increased outpatient use of subspecialty care; importantly, visits related to behavioral health and substance use decreased significantly. Not surprisingly, there is a significant difference in life expectancy by 15 years between the rich and poor. It must be noted, however, that some studies show that retirees in a higher income bracket experienced higher mortality rates as compared to retirees in the low-income bracket; it is hypothesized that the low-income retirees had to work post-retirement, and the increased physical activity contributed to lower mortality rates. Therefore, translating economic wealth to healthy behavior is key for sustaining good health. Federal government programs such as the Earned Income Tax Credit (EITC) and Temporary Assistance for Needy Families (TANF) aim to directly supplement and increase family income and can improve health by addressing basic needs. The EITC increases tax refund for low-income workers to reduce poverty; the refund amount varies based on disability, the number of children, dependents and other criteria. TANF provides financial assistance via debit card or direct deposit for those families with little to no income and have children aged 18 or young-

FINANCIAL WELLNESS er; the transferred money can be used for food, housing, paying utility bills, childcare, medical supplies and various other basic needs. Positive health outcomes have been associated with EITC. Smoking is a significant risk factor for cancer; an increase in EITC benefits significantly decreased among unmarried mothers. Mental health of low-educated mothers having two or more children improved and stress-related biomarkers decreased. The number of children born pre-term or those born with low birthweight also decreased among beneficiaries of EITC. Programs that help with providing food such as the Supplemental Nutrition Assistance Program (SNAP), Women, Infants, Children (WIC), National School Breakfast and National School Lunch Program, Child and Adult Care Food Programs, Congregate Meals and Home Delivered Meals Program, Emergency Food Assistance Program and Commodity Supplemental Food Program can offer in-kind assistance to low-income families. National Health Interview Survey (NHIS) data from 2017 based on 4,447 low-income adult participants showed that SNAP decreased healthcare expenditure by $1,400 per year, per person. The correlation between income and health is of special importance to San Antonio. The Status of Poverty report of 2024 indicates that San Antonio is ranked second in poverty among large cities in Texas, behind Houston. San Antonio’s median income of $59,593 is also lower than the national average income of $75,149. Importantly, 75 percent of households living in poverty consisted of families with dependents. Poverty also correlated with lack of education; 32 percent of the population did not graduate high school and 65 percent were not college educated. Therefore, combating poverty in San Antonio is a critical step towards addressing the multifactorial issues that determine health. A multi-faceted strategy recommended in 2019 is ongoing and includes programs focusing on populations with highest need, integrating asset building with social safety-net services, expanding programs that offer financial support for safety-net low-income families, developing services that support asset building and maintenance, and providing long-term funding for sustained increase in financial health outcomes. References: 1. Agrawal, S., Sharma, N., Dhayal, K.S., & Esposito, L. (2024). From economic wealth to well-being: exploring the importance of happiness economy for sustainable development through systematic literature review. Quality & Quantity. https://doi.org/10.1007/ s11135-024-01892-z 2. Agarwal, S.D., Cook, B.L., & Liebman, J.B. (2024). Effect of cash benefits on health care utilization and health. JAMA. https://doi. org/10.1001/jama.2024.13004 3. Berkowitz, S.A., Seligman, H.K., Rigdon, J., Meigs, J.B., & Basu, S. (2017). Supplemental Nutrition Assistance Program (SNAP) participation and health care expenditures among Low-Income adults. JAMA Internal Medicine, 177(11), 1642. https://doi. org/10.1001/jamainternmed.2017.4841 4. Case, A. (2001). Does money protect health status? Evidence from South African pensions. NBER Working Paper No. 8495; https:// www.nber.org/papers/w8495 5. Chetty, R., Stepner, M., Abraham, S., Lin, S., Scuderi, B., Turner, N., Bergeron, A., & Cutler, D. (2016). The Association between Income and Life Expectancy in the United States, 2001-2014. JAMA, 315(16), 1750. https://doi.org/10.1001/jama.2016.4226

6. Costello, E.J., Compton, S.N., Keeler, G., & Angold, A. (2003). Relationships between poverty and psychopathology. JAMA, 290(15), 2023. https://doi.org/10.1001/jama.290.15.2023 7. Cowan, B., & Tefft, N. (2012). Education, maternal smoking, and the earned income tax credit. The B E Journal of Economic Analysis & Policy, 12(1). https://doi.org/10.1515/1935-1682.3305 8. Evans, N.W., & Garthwaite, C.L. (2010). Giving Mom a Break: The Impact of Higher EITC Payments on Maternal Health. NBER Working Paper No. 16296; JEL No. I1,I12; https://www.nber.org/ system/files/working_papers/w16296/w16296.pdf 9. Finkelstein, D.M., Harding, J.F., Paulsell, D., English, B., Hijjawi, G.R., & Ng’andu, J. (2022). Economic Well-Being and Health: The role of income support programs in promoting health and advancing health equity. Health Affairs, 41(12), 1700–1706. https://doi. org/10.1377/hlthaff.2022.00846 10. Gennetian, L.A., & Miller, C. (2002). Children and Welfare Reform: A View from an Experimental Welfare Program in Minnesota. Child Development, 73(2), 601–620. https://doi. org/10.1111/1467-8624.00426 11. Kawachi, I., Adler, N.E., & Dow, W.H. (2010). Money, schooling, and health: Mechanisms and causal evidence. Annals of the New York Academy of Sciences, 1186(1), 56–68. https://doi. org/10.1111/j.1749-6632.2009.05340.x 12. Khullar, D., & Chokshi, D.A. (2018, October 4). Health, Income, & poverty: Where we are & what could help | Health Affairs Brief. https://www.healthaffairs.org/content/briefs/health-income-poverty-we-could-help 13. Lindahl, M. (2005). Estimating the effect of income on health and mortality using lottery prizes as an exogenous source of variation in income. The Journal of Human Resources, XL(1), 144–168. https://doi.org/10.3368/jhr.xl.1.144 14. Reuell, P. (2016, April 11). For life expectancy, money matters. Harvard Gazette. https://news.harvard.edu/gazette/ story/2016/04/for-life-expectancy-money-matters/ 15. Sharma, V., & Sharma, R. (2024). Food is Medicine initiative for mitigating food insecurity in the United States. Journal of Preventive Medicine and Public Health, 57(2), 96–107. https://doi. org/10.3961/jpmph.23.505 16. Snyder, S., & Evans, W. (2002). The Impact of Income on Mortality: Evidence from the Social Security Notch. National Bureau of Economic Research. https://doi.org/10.3386/w9197 17. TANF Cash Help | Texas Health and Human Services. (n.d.). https://www.hhs.texas.gov/services/financial/cash/tanf-cash-help

FINANCIAL FINANCIAL WELLNESS WELLNESS

Health Outcomes Due to Inequity By Ramaswamy Sharma, MS, PhD, with Elizabeth Ou, Emily Rowe and Camille Irene Hulipas

ealth disparities or inequities can be referred to as unfair and avoidable systematic differences in health that are due to unequal distribution of health-related resources and/or health-related opportunities across different levels of groups within a given population. These inequities are often driven by social determinants of health such as income, wealth, education, occupation, gender, ethnicity, disability, immigration status and other factors, and lead to decreased access to healthcare and significant economic impact. For example, income and employment play a major role in covering costs related to health insurance. The National Center for Health Statistics reports that individuals who received delayed medical care due to cost slightly increased from 2022 to 2023. Lack of access to mental healthcare due to cost has been consistently increasing over the past five years. Several papers document the nexus between low income and poor education, and correlation of these socioeconomic parameters to poor health outcome measures such as mortality of adults and infants, incidence of diseases, healthy habits and life expectancy. The rise in income and wealth disparity during the past few decades will only serve to further exacerbate health inequities. Health inequities in Bexar County are a significant concern, with disparities affecting racial and ethnic groups. An update on the status of diabetes in Bexar County in 2020 indicated that diabetes-related mortality in Non-Hispanic (NH) Black males and Hispanic/Latino males were twice the rate as compared to non-Hispanic White males. Diabetes mortality was three times the rate in NH Black and Hispanic/Latino females as compared to non-Hispanic White females. Similarly, the rate of asthma-related hospitalization is highest among NH Black individuals (particularly females; 16.9 percent) while COVID-19-related mortality was highest among Hispanics. Lack of education appears to be associated with diabetes. There is a strong correlation (95 percent confidence interval between 0.80 and 0.92) between diabetes and lower level of education as zip codes with a higher proportion of diabetes also had a higher number of adults with no high school diploma; the converse — lower proportion of diabetes in zip codes with lower numbers of adults with no high school diploma — is also true. A higher percentage of Hispanic/Latino (71 percent) and Black/African American (68 percent) students in Bexar County are economically disadvantaged as compared to other races/ ethnicities; Black/African Americans are under-represented in career 26

SAN ANTONIO MEDICINE • January 2025

and technical education and over-represented in special education, which could result in reduced quality of education. Data from 2019 also indicated that median income of Hispanic/Latino ($48,474) and Black/African American ($48,509) households were lower as compared to White ($73,108) households. Approximately 19 percent of Hispanic/Latinos and 13 percent of Black/African Americans did not have health insurance as compared to 9 percent of Whites. Language barriers, cultural mismatch, medical mistrust, and fear of deportation have been cited as possible reasons that prevent Latinos from seeking medical care. How can physicians help mitigate health inequity to improve health outcomes? While physicians can collaborate with policy makers, medical education systems, social service providers, local community leaders and others to address system-level factors such as socioeconomic conditions that contribute to health inequity, they can take small steps to directly address this issue when they interact with their patients. Examining their own explicit and implicit biases related to patient sociodemographic characteristics including race and ethnicity is an important step towards this goal. While providers are generally expected to be objective and impartial when treating their patients, time pressure due to excessive workload and the need to diagnose and treat their patients within a short period of time may lead to stereotyping and judgmental errors. Several studies document that provider behavior, diagnosis and treatment recommendations can be influenced by sociodemographic categorization, thereby adding to race/ethnicity inequities. African American patients or patients from lower or middle socioeconomic status groups are perceived more negatively as compared to Whites or patients from upper socioeconomic status groups. Race influences perception of education and intelligence as well as beliefs about adherence or non-compliance to medical treatment and risk behavior while socioeconomic status is associated with perception of personality and behavioral demands. Communication with patients, both verbal and non-verbal, also plays a significant role. Communication is essential not only for understanding patient complaints but also for promoting health literacy during medical encounters. Barriers in communication can disproportionately affect patients with low health literacy who may then be unable to participate effectively in their own health-related decisions

FINANCIAL WELLNESS and thereby receive a lower quality of care. Roter and Hall classified physician-patient interaction as paternalism when physicians were in control and patients were passive participants; consumerism, when patients were in control and physicians were passive; mutuality, when both shared control; and default, when both lacked control during the medical encounter. Clearly, providers should strive for mutuality. Providers can also optimize instructional materials for better readability and understanding; these materials can serve as an adjunct to direct communication and promote informed decision-making. A recent report, which evaluated 20 years of education materials, found that printed materials at eighth grade level were most readable; thus, designing materials at optimal reading levels would be more useful. Encouraging and empowering patients to ask questions either directly or by using interpreters, focusing and summarizing their health information, and approaching minority patients with cultural humility allows for better communication. Implementing these small steps that show clinical empathy and intent will lead to decreased medical mistrust and thereby increased patient engagement in the treatment process, more equitable care, and improved health outcomes. References: 1. Baciu, A., Negussie, Y., Geller, A., & Weinstein, J. N. (2017, January 11). The root causes of health inequity. Communities in Action - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/ NBK425845/ 2. Braveman, P. (2005). Health disparities and health equity: Concepts and Measurement. Annual Review of Public Health, 27(1), 167–194. https://doi.org/10.1146/annurev. publhealth.27.021405.102103 3. Braveman, P. (2003). Defining equity in health. Journal of Epidemiology & Community Health, 57(4), 254–258. https://doi. org/10.1136/jech.57.4.254 4. Conteh, N., Gagliardi, J., McGahee, S., Molina, R., Clark, C.T., & Clare, C.A. (2022). Medical mistrust in perinatal mental health. Harvard Review of Psychiatry, 30(4), 238–247. https://doi. org/10.1097/hrp.0000000000000345 5. De Snyder, V.N.S., McDaniel, M., Padilla, A.M., & Parra-Medina, D. (2021). Impact of COVID-19 on Latinos: A Social Determinants of Health model and Scoping Review of the literature. Hispanic Journal of Behavioral Sciences, 43(3), 174–203. https://doi. org/10.1177/07399863211041214 6. Health Status | City of San Antonio Strategic Health Plan Dashboard. (n.d.). https://dashboards.mysidewalk.com/city-ofsan-antonio-strategic-health-plan-dashboard-5bbc32e941c7/ health-status#c-18054488 7. Lai, S., Lu, L., Zhou, Z., Shen, C., Yang, X., Zhao, Y., & Zhang, X. (2021). The effects of family physician-contracted service on health-related quality of life and equity in health in China. International Journal for Equity in Health, 20(1). https://doi. org/10.1186/s12939-020-01348-4 8. National Center for Health Statistics. Percentage of adults aged 18 and over who did not get needed medical care due to cost in the past 12 months, United States, 2019—2023. National Health Interview Survey. Generated interactively: Dec 02 2024 from https://wwwn. cdc.gov/NHISDataQueryTool/SHS_adult/index.html

9. Rooney, M.K., Santiago, G., Perni, S., Horowitz, D.P., McCall, A.R., Einstein, A.J., Jagsi, R., & Golden, D.W. (2021). Readability of Patient Education Materials from High-Impact Medical Journals: A 20-Year Analysis. Journal of Patient Experience, 8. https:// doi.org/10.1177/2374373521998847 10. Roter, D., & Hall, J.A. (2006). Doctors Talking with Patients/ Patients Talking with Doctors. Bloomsbury Publishing. https:// www.torrossa.com/en/resources/an/5526590 11. How can physicians promote health equity? (2023, February 7). Wolters Kluwer. https://www.wolterskluwer.com/en/expert-insights/how-can-physicians-promote-health-equity 12. Sorkin, D.H., Ngo-Metzger, Q., & De Alba, I. (2010). Racial/ Ethnic discrimination in health care: Impact on perceived quality of care. Journal of General Internal Medicine, 25(5), 390–396. https://doi.org/10.1007/s11606-010-1257-5 13. Mejia, P., & Blunt Jr., R. (2019). State of the African American Community in San Antonio and Bexar County. https://www. bexar.org/DocumentCenter/View/32463/State-of-African-American-Community-Report 14. van Ryn, M. and Burke, J. (2002). Research on the provider contribution to race/ethnicity disparities in medical care. Medical Care 40(1):p I-140-I-151 15. Viagran, R.J., Banos, E., & Clay-Flores, R. (2024, September 24). How a 20-year lifespan disparity impacts communities in San Antonio and South Texas. San Antonio Report. https://sanantonioreport.org/20-year-lifespan-disparity-south-side-san-antoniohealth-care/ 16. World Health Organization (2018, February 22). Health inequities and their causes. https://www.who.int/news-room/facts-inpictures/detail/health-inequities-and-their-causes 17. World Health Organization: WHO. (2021, July 7). Health equity. https://www.who.int/health-topics/health-equity#tab=tab_1

Ramaswamy Sharma, MS, PhD, is a Professor of Histology and Pathology at the University of the Incarnate Word School of Osteopathic Medicine. He is interested in delineating the multiple molecular and cellular roles of melatonin in maintaining our quality of life. Dr. Sharma serves on the BCMS Publications Committee. Elizabeth Ou is a medical student at the University of the Incarnate Word School of Osteopathic Medicine, Class of 2027. She is a Registered Nurse and a cancer survivor. Her interests include reproductive endocrinology, women’s health and dermatology. Emily Rowe is a medical student at the University of the Incarnate Word School of Osteopathic Medicine, Class of 2027. Camille Irene Hulipas is a medical student at the University of the Incarnate Word School of Osteopathic Medicine, Class of 2027. Visit us at www.bcms.org

FINANCIAL WELLNESS

Keeping the Practice Healthy:

Staying Compliant with HIPAA to Avoid Costly Data Breaches By David Alex Schulz, CHP

hen discussing financial wellness in a healthcare practice, we must consider diagnostic codes for maladies like “Ransomware Paralysis Syndrome” and “Death by Unencrypted Laptop.” Each year seems to set a new record for breaches of Personal Health Information (PHI) from providers, payers, processors and pharmacies. In the U.S., 2023 saw a record-breaking 725 breaches affecting the privacy of over 133 million health records, and 2024 is on track to be far worse, with more than 180 million records compromised. Texas alone has experienced 55 healthcare breaches in the first 11 months of 2024, resulting in the loss of 12 million records. From North Texas’ Concentra Health Services losing control of four million records to Coastal Plains Community Mental Health’s breach of 500, healthcare providers were the most frequent targets in the state. However, it was only two business associates — ESO Solutions of Austin and WebTPA Employment Services — that lost control of five million records. The costs of mishandling data continue to grow. Federal penalties can easily run into millions of dollars for egregious breaches, but the financial fallout can go far beyond HIPAA penalties. Breaches can also fall under state-specific laws like the Texas Medical Records Privacy Act (HB 300), which imposes substantial state penalties even for prac28

SAN ANTONIO MEDICINE • January 2025

tices that are HIPAA compliant. Federal Trade Commission (FTC) regulations also come into play, and healthcare practices that fail to safeguard data may face FTC investigations for inadequate security measures, as seen in high-profile breach cases. Internationally, the General Data Protection Regulation (GDPR) — though primarily a European regulation — can apply to U.S. practices handling patient data of EU residents. Additionally, civil litigation, including class-action lawsuits from affected patients, can result in significant financial consequences. Liability does not stop at state borders. Consider the case of Global Care Delivery (GCD), a Dallas-based payment processing service. GCD lost five unencrypted laptops containing protected health information (PHI) for 18,000 patients of a Long Island, NY hospital. Although the theft occurred in Texas, GCD was subject to New York State’s SHIELD law, which added millions of dollars to the cost of the HIPAA violation. GCD waited nine months to alert patients, ensuring that the HIPAA audit would be thorough. Nine months later, GCD ceased operations and essentially disappeared, leaving its clients’ reputations scarred. As cyber-attacks evolve (“ransomware” may have been novel in 2016, but it spread like wildfire after Hollywood Hospital publicly acquiesced to data blackmail), the tools for attackers have become more accessible. Today, ransomware can be purchased as a pre-packaged, shrink-wrapped

FINANCIAL WELLNESS crime and put into operation for less than a hundred dollars. With attackers proliferating, how can a healthcare practice build immunity and resistance to minimize vulnerability and liability? The answer, though unexciting, is simple: HIPAA. Enacted in 1996, just as the World Wide Web and desktop PCs were becoming widespread, the HIPAA framework for data security and privacy has grown more relevant with each passing year. Unfortunately, many practitioners still view HIPAA’s prescriptive approach to data safety as unworthy of attention. Often, responsibility is delegated to a subordinate who is already overwhelmed and may lack the technological know-how to manage vast amounts of data. Let’s break it down: • The Privacy Rule is more general, governing all personal health information — whether spoken, written or digital. It covers a broad range of scenarios, from prohibiting loud conversations about PHI in the office to determining who may access PHI (e.g., law enforcement, family members). If your practice has posted a Notice of Privacy Practices in the office, this likely reflects some of the necessary policies. • The Security Rule is more specific, outlining safeguards for electronic PHI (ePHI) storage and transmission. For example, had Global Care Delivery encrypted their laptops’ hard drives, the loss would have been a non-event: data encrypted to HIPAA standards turns a stolen computer into a useless object. The Security Rule defines administrative safeguards (who can access what data), physical safeguards (e.g., door security, intrusion detection), technical safeguards (e.g., passwords, automat-

ic log-offs to prevent unauthorized access), and organizational safeguards (e.g., record maintenance and updates). To best safeguard the financial health of a practice from the threat of data breaches, assume that a security incident is always around the corner. Upon investigating a breach, a HIPAA auditor will first seek evidence of policies, staff training on privacy issues, and documentation that the practice’s Security Officer regularly assesses breach risks and conducts annual vulnerability analyses. If the practice is negligent in fundamental areas like policies and training, the auditor will scrutinize processes in detail. On the other hand, if the practice demonstrates diligence and a commitment to safeguarding confidential data, it can gain favor in an audit process that allows some flexibility. It’s important to note that no violation is necessary to trigger a HIPAA compliance audit. Not only does the U.S. Department of Health and Human Services (HHS) conduct random audits, but any patient can file a complaint with HHS about perceived privacy violations. Given the complexities of privacy laws, this is a powerful tool for a patient who may harbor resentment or hostility. In an era marked by widespread patient non-compliance with medical advice, it’s prudent for practitioners to overcompensate with thorough compliance efforts. After all, it’s not just good sense — it’s the law! David Alex Schulz is certified in HIPAA privacy and security compliance, serves on the BCMS Publications Committee and is a contributing writer to San Antonio Medicine magazine.

Save the Dates for First Tuesdays at the Capitol

The Texas Legislature meets every odd-numbered year for 140 consecutive days and will convene again January 14, 2025. Legislators need to hear from you — their physician, medical student and alliance constituents — during the session to understand how proposed legislation can potentially impact the practice of medicine in Texas. Mark your calendar for 2025 First Tuesdays at the Capitol. • February 4 • March 4 (TMA Alliance and Young Physician Month) • April 1 (TMA Medical Student and Resident Month) • May 6

Visit us at www.bcms.org

FINANCIAL FINANCIAL WELLNESS WELLNESS

To Use Debt or Not? By Maria Breen and Bruce McMillan

o kick off 2025, let’s deep dive into financial wellness, focusing on making strategic decisions around using debt for asset acquisition and growth. Understanding potential financial strategies can help guide your next steps in 2025.

expenses and any upcoming financial commitments. This will help determine if you can comfortably manage additional loan repayments. If you are making a decision based on future revenue growth, be sure to be realistic to avoid over extending your cash flow.

Understanding the Landscape The financial landscape for healthcare professionals remains in a constant state of change. With ongoing updates in medical technology and infrastructure, having quick access to capital can be essential. However, it’s crucial to balance this agility with sound financial planning.

Consider Future Growth If you’re planning to expand your practice or invest in new technologies, project the potential return on investment (ROI). Will the new equipment or facility lead to increased patient numbers or reduced operational costs? Weigh these potential gains against the cost of taking on debt.

The Pros and Cons of Debt Using debt as a tool for asset acquisition or business growth can be advantageous, but it’s not a one-size-fits-all solution. Here are some key considerations: Advantages 1. Tax Benefits: Interest paid on business-related loans is generally tax-deductible, which can reduce your taxable income. 2. Retain Ownership: Financing through debt means you won’t have to give away a portion of your business, unlike equity financing. 3. Predictable Payments: Fixed loan payments help with budgeting and planning, providing a clear picture of your financial obligations. 4. Build Wealth: Acquiring appreciating assets, such as real estate, can help build wealth and expand the business. Disadvantages 1. Financial Risk: Defaulting can lead to significant financial strain, impacting both personal and professional assets. 2. Interest Costs: Over time, interest payments can add up, sometimes outweighing the initial benefits of the asset purchase. 3. Impact on Credit: Taking on too much debt can affect your credit score, limiting future borrowing capabilities. 2025 Financial Strategies for Medical Professionals Assess Your Cash Flow Before deciding to take on debt, evaluate your current cash flow. Ensure that you have a solid understanding of your monthly income, 30

SAN ANTONIO MEDICINE • January 2025

Diversify Your Financing Don’t rely solely on loans. Explore other financing options such as leasing or vendor financing, which can sometimes offer more flexible terms and lower initial costs. Seek Professional Advice Engage with financial advisors who specialize in healthcare. They can provide advice and help you explore various financing options, ensuring that your financial decisions align with both your personal and professional goals. In 2025, achieving financial wellness requires decision-making based on your unique situation, particularly when it comes to using debt for growth. By carefully considering the pros and cons, consulting with experts, and maintaining a strategic approach, you can ensure that your financial practices support your personal goals and the growth of your medical practice. Maria Breen, Executive Vice President, Private Banking Manager, and Bruce McMillan, Senior Vice President, Private Banking Relationship Manager, are experienced private bankers, providing customized solutions for healthcare professionals and medical practices. Connect with us to explore and customize the right features and benefits for you. Contact primera@ texaspartners.bank today. Texas Partners Bank is a Gold Member of the BCMS Circle of Friends program. TexasPartners.Bank

FINANCIAL WELLNESS

Financial Focus: How Can You Plan for Incapacity? Courtesy of Edward Jones Financial Advisor

e all hope to enjoy long, healthy lives, retaining the ability to think clearly and make our own decisions. But life doesn’t always work out that way — which is why you need to prepare for a potential incapacity that could affect your independence and possibly create financial problems for your family. So, in thinking about incapacity planning, you may want to consider the following arrangements: Health Care Power of Attorney. When you establish a health care power of attorney, you name someone, such as a spouse or adult child, to make medical decisions on your behalf, should you become incapable of making them on your own due to disability or illness. These decisions include choosing doctors, treatments and care facilities. Financial Power of Attorney. With a financial power of attorney, you designate someone to assume a variety of duties for you in case you become incapacitated. These tasks include investing, selling property, paying bills and debts, collecting Social Security benefits and adding or changing insurance policies. When establishing a health care or financial power of attorney, you may need to decide whether it’s “durable” or “springing.” A durable power of attorney typically takes effect immediately after you sign it, have it notarized and witnessed. So, the person you’ve chosen to have power of attorney — sometimes called an “agent” — can act on your behalf whenever you choose. On the other hand, you could select a power of attorney that “springs” into effect only when you become incapacitated — hence, the “springing” designation. One issue affecting a springing power of attorney involves the speed with which it can be enacted. Generally, it won’t go into effect until 32

SAN ANTONIO MEDICINE • January 2025

a licensed physician declares in writing that the person granting the power of attorney is indeed incapacitated. This could cause a problem if your chosen agent needs to act quickly on your behalf. It’s because of this potential delay that a durable power of attorney is often favored over a springing power of attorney. However, everyone’s circumstances are different, so if you have a choice between a durable or springing power of attorney, you may want to consult with an estate-planning professional for guidance. Apart from the health care and financial powers of attorney, you may also want to consider one other incapacity-related legal document — a living will. When you establish a living will, you describe the steps you would or wouldn’t want taken to keep you alive, along with other medical decisions, including pain management and organ donation. Obviously, the decision to create a living will is highly personal, involving your feelings about self-sufficiency and the circumstances that define the quality of life you wish to have. But the mere fact of having a living will can relieve your loved ones of having to make potentially agonizing decisions. Planning for an incapacity may not be the most pleasant task — but it’s an important one. Of course, you may never become incapacitated at all, but by making the proper arrangements, you can make things easier for yourself and your family — just in case. Elizabeth Olney with Edward Jones is a Silver Member of the BCMS Circle of Friends Program. Contact her at 210-858-5880. This article was written by EdwardJones.com/Elizabeth-Olney for use by your local Edward Jones Financial Advisor.

BCMS EVENTS

The 1853 Club The 1853 Club is a retired physicians’ group formed by retired physician leaders to promote the well-being of retired/senior physicians (65 or older) through education, socialization and peer support. Bexar County Medical Society first founded the 1853 Club in mid-2023 and, as a pilot to identify the interest of our senior/retired physicians, have held quarterly luncheons. The feedback from those who have attended the luncheons has been very positive. Attendance at the quarterly luncheons has steadily grown throughout this past year, and it’s easy to see why. The 1853 Club luncheons provide the perfect opportunity to catch up with friends and colleagues while listening to guest speakers and enjoying a great meal. Bexar County Medical Society understands the importance of creating ample opportunity for our members to connect in person and to continue hosting the 1853 Club luncheons to ensure everyone can enjoy its benefits and endeavors. As such, we are requesting that all participants make a small donation of $50 each year to help

offset the costs of the luncheons. This annual donation covers all four scheduled luncheons and is lower than the rate set by other neighboring medical societies with similar programs. If you wish to attend only one luncheon, we will have an option to pay $20 for the individual event. Spouses will be allowed to attend the luncheons free of charge. We thank you for your support and are looking forward to our future luncheons. 2025 Luncheon Dates and Topics: • January 14: Smart Home; Smartphone to Enhance Senior Living • April 8: Healthy Diet, Healthy Living • July 8: Keeping Your Mind Sharp • October 7: Dr. Aureliano Urrutia Story – Anna Elise Urrutia For additional information about the 1853 Club, please contact membership@bcms.org or (210) 301-4391.

Visit us at www.bcms.org

2025 BCMS Board of Directors

John Shepherd, MD 2025 BCMS President

Lyssa Ochoa, MD Vice President

Jennifer R. Rushton, MD President-Elect

Lubna Naeem, MD Treasurer

Lauren Tarbox, MD Secretary

Ezequiel “Zeke” Silva, III, MD Immediate Past President

Alexander Arena, MD First Term 2025-2027

Woodson “Scott” Jones, MD First Term 2024-2026

John Lim, MD First Term 2025-2027

Sumeru “Sam” G. Mehta, MD First Term 2023-2025

M. “Hamed” Reza Mizani, MD First Term 2024-2026

Priti Mody-Bailey, MD First Term 2023-2025

Dan Powell, MD Appointed to fill Term 2024-2025

Saqib Z. Syed, MD First Term 2025-2027

Nancy Vacca, MD First Term 2024-2026

Col Joseph J. Hudak, MD, MMAS Military Representative

SAN ANTONIO MEDICINE • January 2025

Thank you for your service and leadership as you represent the Bexar County Medical Society in 2025.

Jayesh Shah, MD TMA Board of Trustees Representative

John Pham, DO UIW Medical School Representative

Robert Leverence, MD UT Health Medical School Representative

Cynthia Cantu, DO UT Health Medical School Representative

Lori Kels, MD UIW Medical School Representative

Ronald Rodriguez, MD UT Health Medical School Representative

Alice Gong, MD Board of Ethics Representative

Melody Newsom BCMS CEO/Executive Director

Welcome 2025 Boards and Committees Chairs and Co-Chairs Board of Ethics Dr. Alice Gong, Chair Dr. Manuel Quinones, Vice Chair

George F. "Rick" Evans, Jr. General Counsel

Medical-Legal Liaison Dr. David Siegel

Delegation to TMA Dr. Jesse Moss, Chair

Nominating/Constitution & Bylaws Dr. John Nava, Chair Dr. Ezequiel “Zeke” Silva, III, Vice Chair

Emergency Preparedness Dr. Bob Johnson, Chair Dr. Kirby Turner, Vice Chair

Physician Health & Rehabilitation Dr. Alejandro Gonzalez, Co-Chair Dr. Matthias H. Kapturczak, Co-Chair

International Committee Dr. Jim Humphreys, Chair

Physician Wellness Dr. John Nava, Co-Chair Dr. Nora Vasquez, Co-Chair

Leadership Development Dr. David N. Henkes Legislative & Socioeconomics Dr. Jennifer Rushton, Chair

Public Health & Patient Advocacy Dr. Diane Simpson, Chair Dr. Leah Jacobson, Vice Chair

Joint Academic Collaboration Dr. Woodson “Scott” Jones

Publications Dr. Jennifer Seger, Co-Chair

Medical Student Collaboration Dr. Adam Ratner Visit us at www.bcms.org

BCMS STAFF ADMINISTRATION Melody Newsom CEO/Executive Director (210) 301-4363 (210) 219-5229 cell Melody.Newsom@bcms.org

MEMBERSHIP Brissa Vela Chief Membership and Development Officer (210) 301-4371 Brissa.Vela@bcms.org

Gabriella Bradberry Admin/Communications Specialist (210) 301-4391 Gabriella.Bradberry@bcms.org

Ann Marie Ortiz Administrative Assistant Membership & Corporate Partners (210) 301-4398 AnnMarie.Ortiz@bcms.org

FINANCE Yvonne Nino Controller (210) 582-6343 Yvonne.Nino@bcms.org

ADVOCACY AND PUBLIC HEALTH Jacob Hernandez Advocacy and Public Health Specialist (210) 582-6371 Jacob.Hernandez@bcms.org

COMPUTER SYSTEMS Al Ortiz Chief Information Officer (210) 301-4385 (210) 382-6044 cell Al.Ortiz@bcms.org

AUTO PROGRAM Phil Hornbeak Auto Program Director (210) 301-4367 (210) 347-0391 cell (210) 301-2155 fax Phil.Hornbeak@bcms.org

Bexar County Medical Society Main Number: (210) 301-4391 Fax: (210) 301-2150 BCMS.org

BEXAR CREDENTIALS VERIFICATION, INC. Betty Fernandez Director of Operations (210) 582-6355 Betty.Fernandez@bexarcv.com

Kris King Director of Software Services (210) 301-4394 KKing@bexarcv.com

Cindy Barron Credentialing Specialist (210) 301-4370 Cindy.Barron@bexarcv.com

Jennifer Oliphant Credentialing Specialist (210) 301-4370 Jennifer.Oliphant@bexarcv.com

Victoria Perez Nerio Credentialing Specialist (210) 301-4370 Vicky.Nerio@bexarcv.com

SAN ANTONIO MEDICINE • January 2025

Sandra Cadena Credentialing Specialist (210) 301-4370 Sandra.Cadena@bexarcv.com

Lori Marie Rose Administrative Assistant (210) 301-4370 Lori.Rose@bexarcv.com

BEXAR COUNTY MEDICAL SOCIETY

Celebrating Melody Newsom’s 25th Anniversary During her 25-year tenure with the Bexar County Medical Society, Melody Newsom has contributed to the growth and success of the organization, holding nearly every position within BCMS. Starting as the Executive Secretary, she has been a Publications Specialist, Managing Editor for San Antonio Medicine, Web Master, Executive Assistant, Office Manager, Chief Operating Officer and now, CEO/Executive Director. In recognition of her dedication to serving and representing the physicians of Bexar County through BCMS, we would like to share her insight into the organization and why its mission has been, and continues to be, her passion. Congratulations, Melody! Tell us how you first joined the BCMS team. In 1999, my husband and I had the opportunity to purchase a ranch, and we ended up with a ranch south of Pawelekville, Texas, about 55 miles southeast of San Antonio. Bexar County Medical Society was one of several businesses I interviewed with in San Antonio. Luckily, the Executive Director at the time hired me on the spot for the open Executive Secretary position. Who knew that day would change my life? Did you have a mentor in the organization? I was blessed to have worked with and been mentored by twice CEO/Executive Director Stephen C. Fitzer. What has been one of your most rewarding professional experiences with BCMS? One of the most rewarding experiences I’ve had at BCMS was working diligently to successfully get more than 1,000 physicians and other medical professionals vaccinated (both the initial vaccination and booster) when the COVID-19 vaccine was very hard to come by. To this day, physicians and others thank me for getting them vaccinated! While there have been many, tell us about one of BCMS’s greatest successes in your 25 years with the organization? One of our greatest successes was providing personal protective equipment (PPE) to the medical and San Antonio community. It was extremely hard to get what our physicians, their staff and others needed during the COVID-19 pandemic, but BCMS, in conjunction with the Texas Division of Emergency Management (TDEM), donated over 7 million surgical and N95 face masks to local non-profit organizations, including the San Antonio Area Food Bank, Haven for Hope, Catholic Charities, several area churches, etc. This was in addition to providing over 250,000 PPE items to independent physician practices since the coronavirus pandemic in March of 2020. Why have you stayed for 25 years? I love working with the physicians and our excellent staff. As mentioned above, I had the blessing of working with Steve Fitzer for 13 of my years here. I also take great pride in serving our community through Emergency Preparedness, Public Health and Patient Advoca-

cy. I became involved with our Emergency Preparedness Committee after 9/11, and became entrenched in the emergency response during the Hurricane Katrina evacuee sheltering. The physician members are always ready to serve their patients, our community and those in need, and I love working alongside them during the good times and the challenging times! Where do you see BCMS in the future? Our goal is to continue to grow our membership and provide physicians with valuable services so they can focus on the health and safety of their patients and our community. The practice of medicine is ever-evolving, and my goal is for BCMS to always be there to support physicians whether they are in private practice, small or large group practices, or choose to work for an employer/hospital. What do you like to do in your free time? I don’t have much free time, but when I do, I take my two little dogs for walks in the park or to the Pearl Farmer’s Market on the weekends. I enjoy attending an occasional musical concert or night at the theater, and watching football. What’s on your bucket list? Cruise the world, starting with the Mediterranean and Greek Islands. Visit us at www.bcms.org

ART IN MEDICINE

Joy

I chose to make this portrait of an old woman who is joyful despite her many burdens of life. As a person with Indian heritage, I wanted to depict a joyful Indian woman who is relaxed despite her many challenges. With close relationships within the family and staying connected to our cultures, we can overcome health challenges and barriers to care.

Anu Singh

Class of 2025 Long School of Medicine UT Health San Antonio

SAN ANTONIO MEDICINE • January 2025

ART IN MEDICINE

Contours of Existence

Zainah Siddiqi

Class of 2027 Long School of Medicine UT Health San Antonio A fusion of charcoal and chalk on paper unveils a visual tapestry that transcends the boundaries of traditional art. This poignant drawing is a meticulously crafted collage. It serves as a profound exploration of emotion, skillfully intended to resonate with the viewer’s innermost sentiments. Inspired by the profound concept of “One World, One Health,” the I reflect upon the stark realities of inequality faced by individuals in their daily lives. Through nuanced details, the composition highlights interconnectedness, inviting contemplation on the human experience.

Visit us at www.bcms.org

Shop Businesses Who Support BCMS BCMS Business Directory

We encourage you to use our friends of medicine businesses whenever you or your practice need supplies or services. ACCOUNTING SERVICES

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. Christopher Davis, CPA 210-384-8000, ext. 118 CDavis@ssacpa.com www.ssacpa.com “Dedicated to working with physicians and physician groups.”

ASSET WEALTH MANAGEMENT

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 “Your wealth. . .All aspects”

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.”

Texas Partners Banks (HHH Gold Sponsor) Our private banking team specializes in healthcare banking and will work with you to craft and seamlessly integrate financial solutions for you and your practice, including practice loans, lines

of credit and custom local lockbox solutions headquartered in San Antonio. Maria Breen 210-807-5562 Maria.Breen@texaspartners.bank www.texaspartners.bank

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

CLINICAL DIAGNOSTICS

Lone Star National Bank (HHH Gold Sponsor) Established in 1983, Lone Star National Bank has provided banking services to communities in South Texas for the past 41 years. LSNB is an independent and locally owned bank subsidiary of Lone Star National Bancshares-Texas, Inc with consolidated assets of $3 billion (12/31/23) and 36 full-service banking centers throughout Starr, Hidalgo, Cameron and Bexar counties. Aside from personal and business banking, LSNB offers investments, wealth management & trust along with property and casualty insurance, health insurance and supplemental coverage. Ivan Corona Molina Assistant VP 210-479-4713 MolinaI@lonestarnationalbank.com www.lonestarnationalbank.com “We do what the Little Banks can’t, and the Big Banks won’t!” 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. Robert Lindley SVP | Private Banking Team Lead 210-343-4526 Robert.Lindley@amegybank.com Denise Smith Vice President | Private Banking 210-343-4502 Denise.C.Smith@amegybank.com Scott Gonzales Assistant Vice President | Private Banking 210-343-4494 Scott.Gonzales@amegybank.com www.amegybank.com “Community banking partnership” 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.

SAN ANTONIO MEDICINE • January 2025

Genics Laboratories (HHH Gold Sponsor) Genics Laboratories offers accurate, comprehensive and reliable results to our partners and patients. Genics Laboratories is committed to continuous research, ensuring our protocols are always at the peak of current technology. Yulia Leontieva Managing Partner, Physician Liaison 210-503-0003 Yulia@genicslabs.com Kevin Setanyan Managing Partner 210-503-0003 Kevin@genicslabs.com Artyom Vardapetyan Managing Partner 210-503-0003 www.genicslabs.com “Accurate results in record time.” Livingston Med Lab (HH Silver 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 and Genetics. Robert Castaneda CEO 210-316-1792 Robert@livingstonmedlab.com www.livingstonmedlab.com/home “Trusted Innovative, Accurate and STAT Medical Diagnostics”

American Health Imaging (HHH Gold Sponsor) American Health Imaging (AHI) has 5 state-of-the-art imaging centers in San Antonio, TX with industry- boardcertified subspecialized radiologists delivering precise, reliable results. Easy scheduling and prompt report turnaround times, serving both physicians and their patients. Imaging at AHI is priced up to 60% less than hospitals and in-network with 99% of health plans with competitive rates to save patients money. AHI has an additional 37 best-in-class diagnostic imaging facilities in Alabama, Florida, Georgia, Texas and South Carolina.

US Radiology Physician Number 210-572-1211 Casey Allen Regional Sales Director | San Antonio US Radiology Specialists 210-846-0606 Casey.Allen@usradiology.com Jasmine Mendoza Jasmine.Mendoza@usradiology.com Jaime Zamora Jaime.Zamora@usradiology.com Sydnie Caradec Sydnie.Caradec@usradiology.com Sarah McMindes Sarah.Mcmindes@usradiology.com Scott Roberson Scott.Roberson@usradiology.com Ryan Denman Ryan.Denman@usradiology.com www.americanhealthimaging.com (main site) www.americanhealthimaging.com/ physician-resources/ (Physician Resources to refer to American Health Imaging)

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 healthcare 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 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

HOSPITALS/PRACTICE SERVICES

Hancock Whitney (HHH Gold Sponsor) Since the late 1800s, Hancock Whitney has embodied core values of Honor & Integrity, Strength & Stability, Commitment to Service, Teamwork and Personal Responsibility. Hancock Whitney offices and financial centers in Mississippi, Alabama, Florida, Louisiana and Texas offer comprehensive financial products and services, including traditional and online banking; commercial, treasury management, and small business banking; private banking; trust; healthcare banking; and mortgage services. John Riquelme San Antonio Market President 210-273-0989 John.Riquelme@hancockwhitney.com Larry Anthis Corporate Banking, Relationship Manager 210-507-9646 Larry.Anthis@hancockwhitney.com Serina Perez San Antonio Business Banking 210-507-9636 Serina.Perez@hancockwhitney.com Erik Carrington Texas Regional Wealth Management Manager 713-543-4517 Erik.Carrington@hancockwhitney.com www.hancockwhitney.com

Equality Health (HHH Gold Sponsor) Equality Health deploys a wholeperson care model that helps independent practices adopt and deliver value-based care for diverse communities. Our model offers technology, care coordination and hands-on support to optimize practice performance for Medicaid patients in Texas. Cristian Leos Network Development Manager 210-608-4205 CLeos@equalityhealth.com www.equalityhealth.com “Reimagining the New Frontier of Value-Based Care.”

GERIATRICS/PRIMARY CARE

DialOPS (H Bronze Sponsor) We were founded to meet a need: helping business owners succeed by giving them simple, quality, affordable U.S.-based contact solutions. In only a few years, our focus on nurturing client relations and building trust not only helped our customers grow their businesses, but helped us stake our claim in the highly competitive TAS industry as one of the most well-regarded and referred. Our 50 years of collective experience are the driving force behind our clients’ satisfaction. Rachel Caero Managing Partner 844-554-3473 Rachel@dialops.net

HUMAN RESOURCES UT Health San Antonio MD Anderson Cancer Center (HHH Gold Sponsor) UT Health provides our region with the most comprehensive care through expert, compassionate providers treating patients in more than 140 medical specialties at locations throughout San Antonio and the Hill Country. UT Health San Antonio Physicians Regina Delgado Business Development Manager 210-450-3713 DelgadoR4@uthscsa.edu UT Health San Antonio MD Anderson Mays Cancer Center Laura Kouba Business Development Manager 210-265-7662 NorrisKouba@uthscsa.edu Appointments: 210-450-1000 UT Health San Antonio 7979 Wurzbach Road San Antonio, TX 78229

Insperity (HH Silver Sponsor) Insperity’s HR solutions offer premium service and technology to facilitate growth by streamlining processes related to payroll, benefits, talent management and HR compliance. We provide the tools to help you lighten your administrative load, maximize productivity and manage risks – so you can focus on growth. Fran Yacovone Business Performance Advisor 210-558-2507 Fran.Yacovone@insperity.com Dayton Parker Business Performance Advisor 210-558-2517 Dayton.Parker@insperity.com www.insperity.com “Insperity’s mission is to help businesses succeed so communities prosper”

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 512-370-1746 Wendell.England@tmait.org 800-880-8181 www.tmait.org “We offer BCMS members a free insurance portfolio review.”

INSURANCE/MEDICAL MALPRACTICE

Texas Medical Liability Trust (HHHH 10K Platinum Sponsor) With more than 20,000 healthcare 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 healthcare for patients by educating, protecting and defending physicians. Patty Spann Director of Sales and Business Development 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, RPLU, ARM AVP Market Manager, SW Division 512-658-0262 Fax: 844-293-6355 Kirsten.Baze@medpro.com www.medpro.com

IT-TELEMEDICINE SERVICES

LASO Health Telemedicine and Rx App (HHH Silver Sponsor) LASO Health is the industry’s only solution that makes healthcare services accessible, cost-transparent and convenient. Its mission is to reinvent “healthcare” in the United States by empowering every individual and employer, insured or uninsured to have easy, timely, predictable, cost-effective care. LASO combines an intuitive, mobile superapp with a marketplace of virtual and in-person health services to give customers a one-touch, onestop-shop, comprehensive health solution. Ruby Garza, MBA 210-212-2622 RGarza@texaskidneycare.com www.lasohealth.com

MICROPRACTICE SERVICES

Parvis Medical Suites (HHHH 10K Platinum Sponsor) Parvus Medical Suites offers a new way to start your own private clinical practice, either full-time or part-time, at a much lower cost than a traditional clinic. We take care of providing well-qualified employees, so that you can focus solely on delivering high-quality patient care. Our turn-key practice spaces in San Antonio and New Braunfels are available for short- and long-term lease options, and come complete with all amenities. Micropractice medicine is revolutionizing independent clinical care. John Rodriguez, MD Chief Medical Officer 210-632-3411 DrJohn@parvussuites.com www.parvussuites.com

Visit us at www.bcms.org

BCMS Business Directory 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 Field Sales Consultant 210-413-8079 Tom.Rosol@henryschein.com www.henryschein.com “BCMS members receive GPO discounts of 15 to 50 percent.”

PRACTICE MANAGEMENT Eleos Virtual Healthcare Solutions (HH Silver Sponsor) Empowering physicians for a Balanced Future. Our virtual health associates alleviate administrative burdens in the evolving healthcare landscape, combatting burnout. Join us in transforming healthcare delivery, prioritizing your wellbeing and patient care. Darby Rodriguez Regional Client Executive 281-753-3565 D.Rodriguez@eleosvhs.com www.equalityhealth.com “Reimagining the New Frontier of Value-Based Care”

PROFESSIONAL ORGANIZATIONS Healthcare Leaders of San Antonio (HH Silver Sponsor) We are dedicated to nurturing business connections and professional relationships, exchanging knowledge to enhance leadership, and creating career opportunities for healthcare and other industry leaders in a supportive community. David Neathery President 210-797-8412 HealthcareLeadersSA@gmail.com Gary Meyn, LFACHE Vice President 210-912-0120 GMeyn@vestedbb.com https://healthcareleaderssa.com/ “Come, Learn, Connect!”

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. Jeannine Ruffner President info4@samgma.org www.samgma.org

Oakwell Private Wealth Management (HHH Gold 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. Touchstone McDonald, CFP® Lead Private Wealth Advisor | Partner 210-625-4692 Service@oakwellpwm.com www.oakwellpwm.com “More Than Just Your Advisor, We’re Your Wealth Management Partner”

SAN ANTONIO MEDICINE • January 2025

STAFFING SERVICES

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. San Antonio Office 210-301-4362 www.favoritestaffing.com “Favorite Healthcare Staffing offers preferred pricing for BCMS members.”

Visit us at www.bcms.org

AUTO REVIEW

The 2025 Lamborghini Urus SE:

Power, Luxury and Sustainability Redefined Courtesy of Lamborghini San Antonio

The automotive world is a fast-moving landscape, and Lamborghini continues to set the standard for performance and innovation. The 2025 Lamborghini Urus SE, the latest iteration of Lamborghini’s Super SUV, is a bold statement that combines breathtaking power, cutting-edge hybrid technology and luxurious practicality. With every purchase, including a three-year maintenance package, Lamborghini ensures that owning this masterpiece is as seamless as it is thrilling. Engineering Excellence At the core of the Urus SE lies a twin-turbo V8 engine paired with a plug-in hybrid system, delivering a staggering 790 horsepower and 700 lb-ft of torque. This powertrain propels the SUV from 0 to 60 mph in seconds, making it one of the fastest in its class. What sets the Urus SE apart is its 25.9 kWh battery pack, offering up to 38 miles of pure electric driving. The hybrid system enhances performance while reducing emissions, enabling guilt-free commutes and silent urban journeys without sacrificing the signature Lamborghini roar when you need it. Unmatched Driving Dynamics The Urus SE adapts to any road or terrain, thanks to its advanced all-wheel-drive system and adaptive air suspension. Its nine driving modes include: • Strada, Sport and Corsa for road conditions • Neve, Sabbia and Terra for off-road adventures • Hybrid, Performance and Recharge to optimize the hybrid system Whether you’re craving the excitement of Sport mode or the eco-conscious serenity of Recharge, the Urus SE delivers a driving experience tailored to your mood. 44

SAN ANTONIO MEDICINE • January 2025

Iconic Lamborghini Design Exterior Elegance The Urus SE demands attention with its aggressive lines, aerodynamic contours and updated design elements. Highlights include: • New front light banks inspired by the Lamborghini bull logo • A restyled rear hatch featuring Y-style lighting and mesh accents • An enhanced rear spoiler and diffuser, which reduce lift by 35 percent for improved aerodynamics These updates optimize both performance and style, ensuring the Urus SE remains unmistakably Lamborghini. Endless Customization Through Lamborghini’s Ad Personam program, you can personalize your Urus SE with over 150 exterior colors and dozens of interior combinations. Whether you opt for bold hues or understated elegance, the possibilities are limitless. A Luxurious Sanctuary Inside Step into the Urus SE, and you’ll find a refined cabin that blends cutting-edge technology with premium materials. From supple leather to carbon fiber accents, every detail exudes sophistication. The spacious interior seats four comfortably (five in a pinch) and offers ample cargo space, making it as practical as it is luxurious. An intuitive infotainment system, advanced driver-assistance features and an immersive sound system ensure every drive feels like a first-class experience. Luxury Meets Sustainability The Urus SE redefines what it means to drive responsibly. Its plugin hybrid system reduces your carbon footprint while delivering supercar-level performance. With 38 miles of electric range, you can handle daily commutes without burning a drop of fuel — an achievement that aligns with Lamborghini’s commitment to innovation.

Three-Year Maintenance Package Every 2025 Urus SE comes with a three-year maintenance package, giving owners peace of mind. This comprehensive plan covers routine service and unexpected needs, ensuring that your Lamborghini remains in peak condition without worry. Practical Yet Extraordinary The Urus SE strikes a perfect balance between thrilling performance and everyday practicality. Its spacious design, versatile driving modes, and advanced hybrid system make it ideal for any lifestyle — whether you’re navigating city streets, exploring rugged terrain, or embarking on family road trips. A Masterpiece of Versatility The 2025 Lamborghini Urus SE is more than a car; it’s an experience. With its perfect blend of power, luxury and sustainability, the Urus SE is the ultimate choice for discerning drivers who demand more from their vehicles. It’s proof that practicality and performance can coexist without compromise.

Experience the 2025 Lamborghini Urus SE Ready to redefine your driving experience? Visit Lamborghini San Antonio to explore the Urus SE. Our team is here to help you customize your dream car and discover why this Super SUV stands in a league of its own. The future is here! Please contact Alex or Alivia at Lamborghini San Antonio to reserve your Urus SE! Lamborghini San Antonio is a Member of the BCMS Auto Program. LamborghiniSanAntonio.com • 210-600-5770

Visit us at www.bcms.org

Kahlig Auto Group

11911 IH 10 West San Antonio, TX 78230

Audi Dominion 21105 West IH 10 San Antonio, TX 78257

Northside Chevrolet 9400 San Pedro Ave. San Antonio, TX 78216

Coby Allen 210-696-2232

Anthony Garcia 210-681-3399

Domingo Saenz 210-341-3311

Bluebonnet Chrysler Dodge Ram 547 S. Seguin Ave. New Braunfels, TX 78130 Matthew C. Fraser 830-606-3463

Northside Ford 12300 San Pedro San Antonio, TX Marty Martinez 210-477-3472 Kahlig Auto Group

Northside Honda 9100 San Pedro Ave. San Antonio, TX 78216 Jaime Anteola 210-744-6198

14610 IH 10 West San Antonio, TX 78249

Lamborghini San Antonio 27605 IH 10 West Boerne, TX

Tim Rivers 832-428-9507

Douglas Cox 210-600-5770

Land Rover San Antonio 13660 IH 10 West San Antonio, TX Cameron Tang 210-561-4900

Kahlig Auto Group

North Park Lexus at Dominion 25131 IH 10 W Dominion San Antonio, TX

North Park Lincoln 9207 San Pedro San Antonio, TX

James Cole 210-816-6000

Sandy Small 210-341-8841

Kahlig Auto Group

North Park Subaru 9807 San Pedro San Antonio, TX 78216

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

Cavender Toyota 5730 NW Loop 410 San Antonio, TX

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

Raymond Rangel 210-308-0200

Phil Larson 877-356-0476

Spencer Herrera 210-581-0474

Justin Boone 210-635-5000

Mercedes Benz of Boerne 31445 IH 10 West Boerne, TX

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

James Godkin 830-981-6000

Chris Martinez 210-366-9600 Kahlig Auto Group

As of September 26, 2024, our loan rate will be

5.0% for 60 months with approved credit.

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

SAN ANTONIO MEDICINE • January 2025

North Park Lexus 611 Lockhill Selma San Antonio, TX Jose Contreras 320-308-8900

9455 IH 10 West San Antonio, TX 78230 Jordan Trevino 210-764-6945

Enhance Your Health and Relaxation with Every Swim Get a FREE Quote Today!

Call Today 210-504-4141 Pools by Blue Haven.com

Stunning custom designs for your private oasis. Expert cleaning services for crystal-clear water. Trusted by over 200,000 homeowners.

PLUNGE POOLS military and first responder

discounts

STARTI

NG AT

$49,75

• Space-Saving Design • Easy to maintain • Energy-efficient • Uses less water • Financing Available Visit us at www.bcms.org