Florida
MEDICAL
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Summer 2008
Shaping the Future of Practicing Medicine Page 10
The Evolution of Medical Technology Page 12
Doing Your Final Rounds Page 20
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Florida
MEDICAL FEATURES
Magazine
SUMMER 2008
24 FMA Past Presidents — Leading the Way
The Usual 04
Editor’s Letter
08
President’s Letter
16
Florida Medical Association Alliance
Since 1874,some of Florida’s finest physician leaders have served as president of the FMA. Learn more about a select few who led our organization through some of its greatest challenges and where they are today.
36 One Student at a Time
Shaping the Future of Health Care...
For more than fifty years, Florida has been home to some of our nation’s best medical schools. Soon, two new programs, at the University of Central Florida and Florida International University, will join our academic medical community. Join us as we take a look at Florida’s medical schools, and their unique approaches to preparing tomorrow’s physicians.
54 An Interview with Gerold L. Schiebler, MD Across generations,no physician has had a greater impact on his colleagues than Gerold L. Schiebler, M.D. Learn more about his life in medicine, and his continued efforts to shape its future.
Sobel is Always Looking for Ways 71 Eleanor to Give Back Few of Florida’s politicians have done more to serve the interests of physicians than Representative Eleanor Sobel. This year, she is running for a seat in the State Senate. As she looks ahead to the November election, we take a look back at how she became such a great friend of medicine.
The Future of Medicine 10 Shaping the Future of Practicing Medicine
As the business of medicine becomes increasingly complex, we ask some of Florida’s top practice management consultants how physicians can improve their practices.
Marc J. Yacht, MD, MPH Medicine’s Future Brings Many Challenges
Steven R. West, MD, FMA President Staying the Course
Diane R. Andrews, PhD, RN FMAA President Focused on the Future
Special Sections Reimbur sement
32
Are You Ready for RAC?
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Point-Counter Point The Future of Reimbursements
Professional Liability
62
12 The Evolution of Medical Technology
Take a look at how Electronic Medical Records will impact the practice of medicine today and in the future.
20 Doing Your Final Rounds
Retiring from practice is a challenging experience for most physicians. Find out how to become prepared, and make a smooth transition.
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Professional Liability Five Years Later
Medical Student Section
69
Getting to Know Jeremy Tharp
Summer 08 Florida Medical Magazine 1
MEDICAL Florida
Editorial Staff Editor-In- Chief
Magazine
Marc J. Yacht, MD, MPH
SUMMER 08
2008-2009 Board of Governors
Associate Editor Karl M. Altenburger, MD Associate Editor
Steven R. West, M.D.
Harold L. Greenberg, M.D.
James H. Rubenstein, M.D.
President
District D
FMA PAC
Thomas L. Hicks, MD Director of Communications and
James B. Dolan, M.D.
Ralph J. Nobo, Jr., M.D.
M. Kamel H. Elzawahry, M.D.
Public Relations
President-Elect
District E
Specialty Society Section
Lynne Takacs
Madelyn E. Butler, M.D.
Nabil A. El Sanadi, M.D.
Ashley E. Booth, M.D.
Publication Specialist
Vice President
District F
Young Physician Section
W. Trent Batchelor
Vincent A. DeGennaro, M.D.
Stephan Baker, M.D.
Joel R. Judah, M.D.
Staff Writer
Secretary
District G
Resident and Fellow Section
John Tyler
W. Alan Harmon, M.D.
Silvio A. Garcia, M.D.
Jeremy L. Tharp
Staff Writer
Treasurer
At Large
Medical Student Section
Christina Katopodis
Alan B. Pillersdorf, M.D.
Neal P. Dunn, M.D.
Diane R. Andrews, Ph.D., R.N.
Communications Intern
Speaker
At Large
FMA Alliance
Dominique Lightsey
David J. Becker, M.D.
Lisa A. Cosgrove, M.D.
Donald F. Foy, Sr.
Vice Speaker
Primary Care Specialties
Public Member
Karl M. Altenburger, M.D.
Linda S. Cox, M.D.
Karen Wendland
Immediate Past President
Medical Specialties
Council of Medical Society Execs
John N. Katopodis, M.D.
Alan S. Routman, M.D.
Ana Viamonte Ros, M.D., M.P.H.
District A
Surgical Specialties
State Surgeon General
Eli N. Lerner, M.D.
Miguel A. Machado, M.D.
Robert E. Cline, M.D.
District B
Council on Legislation
State Board of Medicine
David M. McKalip, M.D.
E. Coy Irvin, M.D.
District C
AMA Delegation
Upcoming Events Oct. 3-5, 2008 FMA Fall Board of Governors & Council Days Hyatt Regency Coconut Point Bonita Springs, FL Nov. 8-11, 2008 AMA Interim Meeting Marriott World Center Orlando, FL
Copyright Š 2008 Florida Medical Magazine is published quarterly by the Florida Medical Association, Inc., located at 123 South Adams Street, Tallahassee, Florida, 32301. This publication is copyrighted by the Florida Medical Association, Inc. Views expressed in this issue represent those of the individual authors and may not represent
Jul. 23-26, 2008 FMA Annual Meeting Boca Raton Resort Boca Raton, FL
the views of the Florida Medical Association, Inc. The Florida Medical Association, Inc., does not represent the accuracy or reliability of any of the advertisements displayed in this publication or endorse any of the
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Visit www.fmaonline.org for more information and updates or call Helping Physicians Practice Medicine 800.762.0233.
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Improve the health of your practice. The AMA can show you how. Helping doctors help patients begins with helping you build a stronger practice. That’s why the American Medical Association (AMA) offers proven resources to help you better manage the business side of medicine. Practice management resources that improve reimbursement
Access AMA resources on topics ranging from claims management and fee scheduling to model managed care contracts, performing internal billing audits and protecting your practice from unfair payment practices. Discounts of up to 25 percent on AMA books and products
Enjoy members-only discounts on AMA books and products, as well as programs and services from partners such as Henry Schein medical supplies and equipment, First National credit card processing, Chase and Hertz. Award-winning publications
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Stand united with AMA members nationwide on professional and public health issues, from ensuring access to medical care to pursuing fair Medicare payment.
The AMA helps its members save time, save money and build a better practice. ATTENTION: AMA dues will not appear on your Florida Medical Association invoice this year. Join or renew the AMA by visiting www.ama-assn.org or calling (800) 262-3211.
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Helping doctors help patients
Summer 08 Florida Medical Magazine 3
Editor’s Letter
Marc J. Yacht, MD, MPH
COMMUNITY H
Medicine’s Future Brings Many Challenges B Y M a r c J . Ya c h t , M D , M P H Editor-In-Chief When a doctor thinks about the future of medicine, those thoughts may travel in many directions. Each day brings new technology, new procedures, and new remedies for prevention and ways to better treat the infirm. People are living longer and healthier lives. Efforts at greater efficiency, which include the electronic medical record, telemedicine, and distance learning are allowing better use of our time, are cost-efficient, and offer unique benefits to patient and provider alike.
4 Florida Medical Magazine Summer 08
Yet, as we progress and open new doors in the House of Medicine, not all is well. As our treatment modalities improve and our skills reach new heights, one cannot deny that gnawing at this progress are some fundamental ethical and moral issues that deny too many Americans equitable health care. While each specialty has its own vision for its progressive evolution, together, all physicians
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E A LT H WAT C H must consider whether our unique achievements are undermined by access and cost issues. For without health care equity among our population, can the House of Medicine fully celebrate progress? The increasing punitive oversight casts another shadow on the profession. Cookbooks have tried to atomize medical services into pegholes and boxes. This may be described as trying to define the shape of smoke. Such characterizations may work well in mathematical models, but have questionable application when caring for patients. Perhaps slicing and dicing medical management has some value in billing codes, but should hospital admissions and stays be at their mercy? Recently, I reviewed McKesson’s InterQual® Level of Care 2007 (2008 is now available). I can appreciate the comprehensive nature, relating to severity of illness (SI), intensity of care (IC), and determining the appropriateness or level of patient hospital stays, but has adherence to these criteria gone beyond the pale? Is the “tail wagging the dog,” so to speak? This exhaustive workbook drives potential hospital denials and ultimately may affect physician billings. Does adherence to such complex criteria drive a further wedge between the doctor and the hospital? What are we really saving here? The Medicare Modernization Act of 2003 established the Medicare Recovery Audit Contractor (RAC) program as a demonstration program to identify improper Medicare payments. Florida was a pilot state for RAC. Hospitals were requested to copy and mail large numbers of Medicare records to a contracted team of reviewers who had the power to deny payment for hospital admissions going back four years. The review team, as I understand it, profited financially from denials. These were admissions previously paid. The hospital must meet a timeframe for submitting charts for review and immediately reimburse for determined rejections. Although decisions can be appealed, the hospital is immediately put on the defensive in a drawn -out expensive appeal process involving large numbers of professional and ancillary staff. Costs for appeal are not considered if the hospital prevails on singular chart appeals. Rigid timeframes have to be respected.
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Draconian oversight has its own costs, and one has to wonder if there is a savings at all in casting a large shadow over every Medicare hospital admission. I would suggest that there is no overall savings, but rather an undermining impact on the provider. I would suspect that some community hospitals may not be able to survive this oversight. Currently, I volunteer in two local free clinics. One accepts uninsured patients over 55 and the other accepts uninsured families. In each case, financial criteria must be met. Both are very busy and waiting lists for care are long. Further complicating free clinic efforts are a dearth of volunteers and needed specialty referrals. Although the clinics are helpful, I would not suggest that they equal a standard of care available to the insured. (Note: the insured and underinsured also have issues, but will not be addressed in this article.) As we look to the future, medical professionals can anticipate breathtaking advancement in the medical arts. One can expect significant progress in treating spinal cord injuries and infectious and degenerative diseases. Polio, T.B., and Malaria may be conquered worldwide. There will be major advances in prosthetic devices and exciting successes in molecular and human genetics. One can anticipate the development of more exotic diagnostic tools along with the more efficient pooling of international research. Yet, advancement in treatment and prevention should not fall under the penumbra of poor access. When Americans must choose between rent and medicine or treatment is delayed because of costs, if tens of thousands of children lack basic coverage for their health needs, and equity of care escapes the reach of 50 million people, our medical triumphs will take a back seat to an ongoing American tragedy and continued moral and ethical misfortune. We can do better as a nation. The resolution of health care equity must stand equally with scientific achievements, if the House of Medicine can fully bask in the sunshine of progress. Comments? Email us at communications@medone.org
Summer 08 Florida Medical Magazine 5
Build Your Future, and the Future of Florida Medicine With the FMA Foundation Gift Annuity Program...You can Plan for retirement Save for your children’s education Protect your assets Contact Kimberly Scott kscott@medone.org 850.224.6496
6
Florida Medical Magazine Summer 08
The Program is designed to suit your individual needs and goals. Investing in the FMA Foundation will help create scholarships for medical students, and provide funding for public health awareness.
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FMA_WAGAR
9/18/07
1:30 PM
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BEFORE EVEN CLAIMING DISABILITY, MAKE SURE YOUR BASES ARE COVERED
By Kirk Wagar
Kirk Wagar is managing partner at the disability and life insurance firm Wagar & Feit in Coconut Grove
Q: : I am a cardio-thoracic surgeon who has developed herniated discs in my cervical spine region at C4-C5 and C5-C6, and am experiencing numbness in my fingers as well as difficulty in holding my head down for the time required to do open procedures. I would like to maintain my office practice and perhaps do some endovascular procedures — should I file for partial/ residual or total disability benefits? A: The biggest mistake clients make when filing a disability claim either on their own or with the assistance of a disability attorney is minimizing job duties on the first interaction with the insurance company. Many simply put “medical doctor” and maybe add the specialty they practice. If this happens, you will be playing from behind the rest of the game. It is crucial when filing initial claims and in any discussions with the representative of the insurance company that you highlight the different things you do on a daily, weekly or monthly basis. Furthermore, you need to identify those job duties that are primary, and those which are more secondary in nature. For example, if the bulk of your office practice currently stems from either pre-op or post-op consultations and the make-up of your patient base will change, you may have been rendered [or may be considered or may meet the definition of] totally disabled from your occupation. If, however, you have always had a mixed practice and you will be cutting out a portion of that practice, then you are more likely to fall in the residual or partial disability definition. It is important to file a claim for total disability benefits if it is applicable for numerous reasons. Often insurance companies attempt to persuade you from filing a total disability claim because the economic calculations allow you to receive the exact same monthly amount in
benefits. What they may not tell you is that most residual claims end at age 65, even if you have a policy that pays life-time benefits for total disability — cutting a huge financial obligation from their books and leaving you without benefits when you need them the most. There may be other ramifications for residual claim versus a total claim, such as cost of living increases occurring at different rates, and requirements to provide the insurance company with numerous financial documents that they would not otherwise be entitled to, such as tax returns. Another common mistake is not fully documenting the early stages of your medical problems. Prior to any mention of disability claims, it is important that doctors you have consulted with, even in corridor consults, have some record to give an adequate timeline, if possible. Disability insurance policies all require that in addition to suffering a disability, you must be treated by a doctor other than yourself. Also, watch out for the many policies that pay lifetime benefits for medical conditions that are caused by accidents, but limit those caused by illness to age 65. Finally, remember that filing an insurance claim is at its essence a commercial matter. The paperwork must be treated with extreme care and the insurance company’s requests for information must be placed in the context of what they are entitled to receive — and how that may benefit them should your claim be forced into litigation. Too often claimants rush through the initial paperwork and interviews, believing their medical condition is clear regardless of its documentation. There are many land mines in a claim for disability, from an insurance company wanting all of your accountant’s records for fishing expeditions to payment of claims under a reservation of rights. It’s important to get proper consultation before embarking on this road.
Phone: 305-443-7772 | Fax: 305-443-1969 3250 Mary Street, Suite 302 | Coconut Grove, FL 33133 1-888-812-0393 | www.wagarlaw.com
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Summer 08 Florida Medical Magazine 7
President’s Letter
S t e v e n R . We s t , M D
Staying the Course
B Y S t e v e n R . We s t , M D FMA President Speaking with physicians and friends, I often am asked what my theme is going to be for my year as FMA President. What they really want to know is, what are my goals? I usually smile and say I am going to stay the course. My goal is to build on the foundation laid by the FMA Board over the past year and abide by our renewed mission — Helping Physicians Practice Medicine. Last year, Dr. Karl Altenburger and members of the FMA Board of Governors made great strides toward reorganizing and rejuvenating our organization. My job is simply to hold our bearings and stay the course. Of course, doing so is easier said than done. In order to succeed, we will all need dedication, a clear vision, and above all a plan. I invite you now to review the highlights on the adjacent page. I’m excited and I look forward to serving you in the year ahead. With the talents and efforts of the FMA Board, FMA staff, and our members, I can’t wait to see what we can accomplish together. Sincerely,
Steven R. West, MD 8
Florida Medical Magazine Summer 08
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the goals Support an EVP who embraces our mission; one with the talent, vision, and expertise to elevate the FMA to greatness. Develop a call center that meets the needs of our members, answering questions in a timely manner. This will provide correct and meaningful information regarding practice management, coding and billing issues, regulatory and licensure issues, and legislative issues. Build a Center for Practice Management, providing members with the tools they need to implement more effective business strategies and improve their practices. Initiate a Health Care Policy Institute, with the resources to collect data regarding the practice of medicine and make our case before the public, the legislature, and regulatory agencies. Improve our Membership Department, and provide it with the tools necessary to discover what our members desire most from the FMA. This includes an accurate database of who our members are, and where they live and work.* This data is crucial to making the FMA great. Continue to expand and develop the health insurance and workers compensation programs. This will enable our members to save money and focus on their practices. Further develop our Governmental Affairs Department. The Government Affairs Department is one of our greatest assets, one of which I am continually proud. Finally, we must develop strategies and tactics to see that physicians are compensated adequately and fairly for the care they provide, whether the care is provided in a private practice setting, a hospital, a public health clinic, the VA system, or a university setting.
*Thanks to Dr. Miguel A. Machado for his relentless support on this issue.
www.fmaonline.org
Summer 08 Florida Medical Magazine 9
Practice Management
John Tyler
Shaping the Future of Practicing Medicine With each passing year, the nature of medicine grows more complex. To thrive in practice, physicians must be proficient in numerous areas, reaching far beyond patient care. “Physicians know medicine is a business,” said Jerry Hermanson, M.B.A., a practice management consultant in Ft. Lauderdale. “But this becomes more true all the time. In the future, the business side of practice will be a foremost concern.” For physicians, the success of a practice will require more than simply managing the business end. Even today’s best-managed medical practices still suffer from poor reimbursement. And, when it comes to the consistent decline, know this: there are formulas at work. Although these formulas were created by managed care organizations in an effort to fairly compensate physicians, since their inception, physicians have seen earnings dwindle year after year. “No one understands how it all works,” says Miriam Martinez, M.B.A., a Florida practice management consultant. “But where does a 500 pound elephant sit? Wherever it wants, for as long as it wants. Physicians understand that the cost of business is going up, while income goes down. This formula won’t hold up for long.”
Tapping New Markets
To succeed in the future, physicians must become more creative. Practice management must evolve, to become far more strategic. The necessary strategies, in many ways, are entrepreneurial in nature; that is, finding ways to create new forms of income and working around or breaking free from the constraints of managed care reimbursement.
not covered by insurance, patient demand for non-needbased care is high, and continues to grow.
Breaking Tradition
Futhermore, as a result of new Stark II Legislation, physicians now are able to open medical facilities in addition to their practice, which can provide new streams of income. These include medical imaging centers and laboratories. According to Hermanson, many physicians already are taking advantage.
“But where does a 500 pound elephant sit? Wherever it wants, for as long as it wants.” “It’s all a matter of thinking differently,” said Martinez. “Thinking differently, and being proactive. Many physicians are stuck in traditional modes of practice. The Monday through Friday, 8 a.m. to 4 p.m. practice is missing considerable opportunities. Remaining open during off-hours or on weekends, allows practices to utilize equipment and other assets which are otherwise sitting idle.”
Becoming More Marketable
Even other, simpler factors are becoming vital to the success of a practice. “How marketable is your practice?” asks Martinez. “When a patient walks into your office, what is their first impression?” With many
Many physicians are already beginning to tap new markets. Ophthamalogists are performing corrective LASIK™ procedures. Otolaryngologists are treating snoring issues and sleep apnea. Weight-loss programs are becoming popular among a number of specialties. Need assistance with Practice Management? Let the Although these and FMA help. Visit www.fmaonline.org for updates on this similar procedures are new and exciting member benefit or call 800.762.0233.
Coming In 2009!
10 Florida Medical Magazine Summer 08
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practices venturing beyond need-based care, office visits must become more enjoyable in order to compete. “If I have a choice between a plain, cold office, and one which goes further to provide a warm and positive experience, I’ll take the latter. Both will take my insurance card.”
Calling in the Troops
Of course, for physicians, time has always been an issue. Finding time to improve a practice, in addition to serving patients, is nearly impossible. The easiest way around this is to hire outside consultants. Unfortunately, there is a bit of a paradox. Practices that need the most help are often small, with one or two physicians. These practices typically cannot afford the service necessary to make lasting improvements. Until now. “We can be bought by the pound,” said Martinez. “Fortunately, the smaller the practice, the smaller the existing problems. A little help can go a long way.” Consultants can be engaged on an as-needed basis, to suit the financial needs of any given practice. According to Hermanson, independent practice associations (IPAs), also offer a cost-effective solution to smaller practices. Originally, IPAs were created in the mid-90s to help practices negotiate with managed care. Today, they are doing far more. “IPAs now provide general advocacy,” said Hermanson. “They focus on improving the www.fmaonline.org
quality of practices, all for the low cost of membership.” Ultimately, to succeed in the future, physicians must build practices that can adapt to new challenges with new ideas, becoming less reliant on managed care reimbursements.
“We can be bought by the pound.” “Patients will always come first,” said Hermanson. “But a physician’s ability to provide the best care is increasingly dependent upon the growth and success of their practice.” Striking an effective balance is key, and will allow physicians and their patients to move forward with renewed direction and confidence in their future. Jerry Hermanson, M.B.A., CHE is a practice management consultant with more than twenty-eight years of experience. He is Chief Executive Officer of HealthCare Integration Consultants, Inc, and is based in Ft. Lauderdale. To learn more, go to: www.healthcareintegration.com. Miriam Martinez, M.B.A., is a practice management consultant with more than twenty years of experience. She serves as the Chief Executive Officer of the Management Consulting Network, Inc., in Melbourne. Comments? Email us at communications@medone.org
Summer 08 Florida Medical Magazine 11
M e d i c a l Te c h n o l o g y
John Tyler
evolution the
of medical technology
The evolution of technology has brought positive changes in every profession and industry. Medicine is no exception. Of all the recent advancements, perhaps none is greater than the advent of the Electronic Medical Record (EMR). President Bush has issued an executive order that by 2014, every medical practice in the United States will have made the shift to using an EMR. “It’s coming,” said Glen Fielder, Director of the Florida Medical Foundation’s EMR Grant Project. “There are still roadblocks that have kept practices from making the change, but new approaches are being explored to overcome these obstacles.” 12 Florida Medical Magazine Summer 08
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For Your Consideration
For medical practices, efficiency is more important than ever. Given the time-intensive nature of medicine, EMRs can provide significant advantages. “The paper trail can become a bit of a maze,” said Fielder. “Chasing charts takes time. Transcription takes time and money. The list goes on.” Implementing an EMR system eliminates the hassle, and often the cost associated with paper records. Patient information is literally at your fingertips. With today’s EMR, physicians can pull any patient’s records with the click of a mouse or the push of a button. Webbased software even allows physicians to do this from home. Although this increased efficiency will certainly save time, EMRs have the potential to directly increase a practice’s revenue. “EMRs streamline and maximize the coding process,” said Fielder. “These systems are designed to account for every conceivable possibility during diagnosis and treatment, with proper implementation.” This allows physicians to focus more on caring for their patients, and reduces the likelihood of overlooking necessary diagnostic testing. Of all its advantages, none is greater than EMR’s advancements in patient safety. Software templates, which are designed to meet the needs of both physicians and patients, eliminate potential errors. For example, a diabetic patient will have a unique template designed to meet their specific needs. This template will walk the physician through preferred protocols customized to his or her standards for this diagnosis. In addition, the system holds previously stored medications and tests that have been performed on this patient. All of this information otherwise would require considerable time to retrieve via phone calls and documentation.
The benefits of this model are two-fold. It eliminates duplicate entry into multiple systems and factors a patient’s entire medical history into a prescription. This also will use one of an EMR’s most valuable safety features — instant drug interaction warnings.
“Though this increased efficiency will certainly save time, EMRs have the potential to directly increase
a
practice’s
revenue.” Universal Connectivity
With all of the advancements in health information technology, the question remains: why is EMR adoption in an outpatient setting still so low? Right now, only about 24% of physicians in Florida take advantage of EMRs. Unfortunately, in many cases, physicians who use EMRs stand alone. While they enjoy streamlined digital information within their own medical practice, a large percentage of the data received from outside sources, such as referral physician offices, insurance companies, hospitals, or pharmacies, often means revisiting the paper trail. As a result, initiatives are in motion to unite health care
Given the unique nature of each individual practice, it is important for physicians to choose EMR software that allows for customizable templates. “No two physicians practice medicine exactly the same way,” said Fielder. “The best EMR software allows for and encourages this, aligning with a physician’s individual needs and preferences.” With increased connectivity, EMRs are also able to receive lab results in a more expeditious manner. Physicians also can use e-prescribing through their EMR, connecting directly to pharmacies online, handling the entire process electronically. While stand-alone e-prescribing software exists, according to Fielder, it is best used as an extension of a complete EMR system. www.fmaonline.org
Summer 08 Florida Medical Magazine 13
project offering grant funding to offset the financial burden physicians face in making the EMR transition. “This should offer a much needed boost to the universal adoption of EMRs,” said Fielder.
EMR Confidential
Once an EMR system is in place, a physician must choose hardware that best fits his or her practice style. Available options are tablet PC’s (pen tablets), desktop computers, and laptops. Almost any type of computer will work, though certain models provide more advantages than others. Some physicians choose to keep their exam rooms free of any hardware and maintain a computer in their office. Physicians who choose the option of a desktop, or even a laptop in the exam room, must take special precautions to close out one patient’s record, with password protection, before another patient enters the same room or run the risk of a HIPAA security violation.
“A system with universal benefits requires universal contribution.” entities under fewer, regional data exchanges. This would allow the sharing of medical data between multiple entities, on multiple platforms. Equally important to physicians is the concept that these other parties finance a portion of the physician’s investment. “It’s the only reasonable solution,” said Fielder. “A system with universal benefits requires universal contribution.”
The most widespread solution is the pen tablet computer. These devices are about the size of a clipboard, with full software capability and wireless connectivity. “Pen tablets are a bit more costly than a desktop or notebook computer,” said Fielder. “But their convenience showcases their value. They offer increased patient security and efficiency, and allow physicians to maximize the use of their EMR system.” Ultimately, each physician must determine which hardware solution best suits the needs of his or her practice. Whether President Bush’s deadline will be met is yet to be seen, but one thing is certain: EMRs are the future of medical information. Glen Fielder is the Director of the Florida EMR Grant Project and can be contacted at gfielder@medone.org.
The Center for Medicare and Medicaid Services (CMS) recently initiated a program that allows medical societies and RHIOs to apply for participation in a demonstration
Comments? Email us at communications@medone.org
We Need You
CONNECTING THE DOCS
Share your knowledge with students and young physicians through the FMA Mentorship Program. Play an active role in shaping the future of your profession. SSOCIAT
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THIS COURSE WILL HELP YOU S AV E L I V E S ! ! !
Don’t miss important information from your Florida Medical Association. Submit or update your email address today at membership@medone.org www.fmaonline.org
Summer 08 Florida Medical Magazine 15
Florida Medical Association Alliance
focused
Diane R. Andrews, PhD, RN
future on the
Diane Randall Andrews, PhD, RN FMA Alliance President
The FMA Alliance and its Alliance partners at the county and national level have a long history of meeting that commitment. Alliance members have led the way in addressing substance abuse, domestic violence, bullying, early childhood education, and internet safety. Hundreds of thousands of dollars have been raised to provide scholarships for promising students. It was through the efforts of the Alliance and its members that the Florida Legislature enacted comprehensive health education requirements for middle school children.
On Saturday, August 2, I raised my hand and promised to lead the Florida Medical Association Alliance as 80 presidents had done before. I was reminded that in this role, I would require strength, clear vision and conviction. I was told that success would be determined not by my ability to lead, but by the ability of our members to have a positive impact on the health and well-being of those living in their communities. This is the essence of the Alliance—its members. Without their strength, vision, and conviction, our desire to unite is little more than recognition of a common bond forged through commitment to the medical family. That common bond provides the catalyst for our coming together, but it is the commitment of the members to their communities and each other that gives the Alliance its purpose. The Alliance leadership is dedicated to this. 16 Florida Medical Magazine Summer 08
Alliance members were a part of successful campaigns to encourage organ donation, promote the reconciliation of medication for older adults, prevent teen suicide, ensure the use of car seats, and require the wearing of bicycle helmets. They have been leading advocates in the fight against cancer, the spread of communicable diseases, providing shelter for the homeless, securing health care for those without resources, and in campaigns to reduce the use of tobacco and promote smoke-free environments. The positive impact that Alliance members have had on their communities occurred through the hard work and dedication of members who came together for a common purpose. From that has grown multiple grant programs to assist members with associated expenses. Health Promotion Grants of $500 are available to support current programs or develop new ones. The Ariel Goldman Memorial Fund will provide financial assistance to activities that provide for the health and welfare of children, and there are additional funds to assist with the implementation of programs that address sexually transmitted disease. In recognition of the long-standing commitment of the Alliance to issues concerning children and public www.fmaonline.org
health, the FMA Alliance has joined the AMA Alliance in promotion of “Screen Out!”. This national public awareness campaign is dedicated to removing tobacco products from youth-related movies. It was undertaken when research revealed that nearly 60% of youth exposure to smoking was the result of viewing G, PG, or PG-13 rated movies. The FMA Alliance asks its members to educate and advocate, persuading others in their communities to petition, write letters, and endorse the “Screen Out!” campaign. The FMA has endorsed this effort and medical societies and Alliances throughout the state are encouraged to become involved in efforts to ensure that films most likely to be seen by our children are free of on-screen tobacco products or imagery. The FMA Alliance also wishes to support the active engagement of its members in the legislative arena. Grants are available to help cover the expenses of members traveling to Tallahassee, either in preparation for or during the legislative session. Participants will work directly with the FMA legislative team, developing their skills as grassroots lobbyists. In addition, and in cooperation with the FMA, members are encouraged to participate in informative sessions related to legislative initiatives held throughout the state. Members also are eligible for partial reimbursement of their expenses when
they travel to specified state and national meetings. These meetings address the individual development of members as future leaders and provide information on legislative priorities. Information about each of these opportunities is available at the FMA Alliance website at www.fmaalliance.org. In addition, Allison Finley, FMA Alliance Executive Director, will answer any questions, provide additional information, and assist members with grant applications. She may be reached at afinley@medone.org or 800.762.0233. As your new president, working together with members, the counties, the FMA, and the AMA, I am committed to and excited about the year to come and the future of our organization. Comments? Email us at afinley@medone.org
Build Your Future, and the Future of Florida Medicine With the FMA Foundation Gift Annuity Program...You can Plan for retirement Save for your children’s education Protect your assets The Program is designed to suit your individual needs and goals. Investing in the FMA Foundation will help create scholarships for medical students, and provide funding for public health awareness. Contact Kimberly Scott kscott@medone.org 850.224.6496 www.fmaonline.org
Summer 08 Florida Medical Magazine 17
18 Florida Medical Magazine Summer 08
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Summer 08 Florida Medical Magazine 19
Retirement
Christina Katopodis
doing your
FINAL rounds Florida maintains one of the worst legal environments for practicing
physicians in the country. In 2006,the American Medical Association (AMA) declared Florida as one of twenty-one states in a medical liability crisis. This, among other issues, has driven many physicians into early retirement. Coupled with an average age of 52 among practicing physicians, it is easy to understand why our state faces a looming physician shortage. No matter your age, the time to begin thinking about retirement is now. Retiring from medicine is far different than retiring from almost any other industry. Not only are there countless rules and regulations to fulfill, there is also a uniquely human component. Retirement can be a difficult transition for physicians and their patients alike.
with a large practice, cannot be done overnight. Even if retirement is years away, an exit plan should be ready in case unexpected circumstances expedite the process. Planning ahead, and notifying people of your plans, increases understanding and decreases disagreements. “Contracts you have with partners should be worked out years ahead of time,” said Dr. James Stockwell, retired gastroenterologist and founder of the Digestive Disease Clinic in Tallahassee. Working together with a strong management team will ease the transition.
How can you make the transition easier? The answer is simple: plan ahead. “Plan for the worst and hope for the best,” said Dr. Terence McCoy, retired Tallahassee family physician and past president of the FMA.
Financial stability is essential. Saving retirement funds should begin as early as residency. If you don’t have a retirement plan, talk to a trusted financial advisor to devise a personal investment plan. Be cautious when you’re shopping because financial mistakes can put stress on your family, practice, and patient care. “Like a squirrel,” said Dr. Stockwell, “if you’ve got a bunch of nuts, you’re making some money. Put them away wisely and you’ll be just fine.”
If you currently do not have plans, the time to develop them—both professional and personal—is now, no matter how far off retirement may seem.
The Ins and Outs of Retiring Planning for retirement requires more than just money and preparation—it requires time. For instance, developing the stages for closing your panel, especially 20 Florida Medical Magazine Summer 08
Your transition out of practice can be made smoother when you plan in stages and increase your controlled variables. Ask yourself questions to prepare your plan. www.fmaonline.org
For example, when will you stop accepting new patients? When will you stop seeing patients to finish remaining paperwork? Will you go full steam until your last day or gradually wind down?
charts are part of a community-wide Electronic Health Record (EHR). Look for vendor recommendations on our website at www.fmaonline.org and follow the link to EMR Florida.
In a larger practice, physicians have the ability to transfer patients to the care of trusted partners. Distribution of equity in the practice can be arranged ahead of time. Physicians who are in solo practices have the option of selling their practice or transferring the care of their patients to trusted colleagues. In both situations, the transferred patients will be familiar with the location of the practice, which can help smooth their transition.
Be Prepared Most importantly, you will need to notify your patients, staff, and any partners in a timely manner. Everyone needs to be prepared for your departure. Although your professional services might be replaceable, patients may say that you, personally, are not. One of the best things you can do for them is to recommend and refer them to a physician, perhaps a partner, who will fit their needs. Your reassurance as their trusted caretaker is invaluable.
Cross the T’s, Dot the I’s When you are ready to set your plan in motion, you will need to publish a notice in your local newspaper, notify insurance companies with which you have contracts, and alert the Board of Medicine. The Board of Medicine will give you advice on your license status. You can keep your license active, renew your license and continue your education after retirement, or relinquish your license altogether. For information, call the Board of Medicine at (850) 245-4131 or go to their website at: http://www.doh.state.fl.us/mqa/medical/index.html.
“Not only are there countless rules and regulations to fulfill, there is also a uniquely human component—transitioning your patients and yourself.” You also will need to make patient records available, or transfer them. Electronic Medical Records (EMR) are less expensive, easier, and safer to store compared to physical records. “There are tremendous benefits and efficiencies gained through EMR functionalities,” says Glen Fielder, Director of the Florida EMR Grant Project. “Compared to physical records, EMRs are like the invention of the wheel. Charts can be electronically transferred either by facsimile or e-mail versus patients driving to the office to pick up physical records.” To take this one step further, Fielder notes, if your EMR is connected to a Health Information Exchange (HIE), there is no transfer required. Your patients’ electronic www.fmaonline.org
Dr. Stockwell wrote short biographies on some of his patients. Providing personal information—as simple as a person’s occupation or life circumstances—facilitates the transition into new hands. This “snapshot” helps the new physician to understand the patient as a person and, as a result, the patient feels more comfortable. This enhances trust and the effectiveness of the visit and treatment. “Knowing the person was very important to me,” said Dr. Stockwell. Knowing your patients and staff are in good hands may ease your mind. Your staff, especially your office manager, is critical to making this transition work. Public relations, patient care, and dealing with business issues are all important components to leaving a practice with which your staff can assist you.
Post-Parting Depression The first year of retirement is the most stressful and the transition may feel unnatural. “Abandoning old habits is difficult,” said Dr. J. Darrell Shea, retired orthopaedic surgeon in Orlando. “It is potentially fatal to be a busy surgeon one day and an inactive, regular citizen the next. For at least the first nine months, I cocked my head at every ringing phone and woke at 6:00 a.m. sharp. More than one retired surgeon has confessed that he operates on a complex patient regularly in his dreams.” Physicians who have emotionally prepared for retirement often see an improvement in their health, relationships, and quality of life. Developing other areas of interest before retirement will help you fill the void that comes from leaving your practice. Solitude and reflection help identify what is most important in your work life. Once you have identified those factors, you can find ways to incorporate them into your retirement. Retiring from practice does not mean you are exiled from the medical community. Remaining active in the medical community may help ease your transition. “The amazing thing,” said Dr. McCoy, “is that when you retire Summer 08 Florida Medical Magazine 21
from medicine, you think you’ve retired from one job, but you’ve really retired from about five. You’re involved in many things. You think you will have all this time on your hands, but you use all the available time. Your personality doesn’t change. I spend most of my free time with family.”
may be finally time to take that trip to paradise, whether it’s China or your back porch. You can go fly fishing in North Carolina. You can read the books you haven’t had time for, or you can volunteer at a local health clinic. See side bar about Dr. Stockwell to read about his experience. Time is yours to use and to give freely.
“When you retire from medicine, you think you’ve retired from one job, but you’ve really retired from about five.”
What do you want to do? No matter your age, you should ask yourself what you want to do with your time. Retirement necessitates both financial and emotional planning, which should begin early. You work hard to take care of your patients, sometimes extending their futures. It is important that you take the time necessary to look into yours. Comments? Email us at communications@medone.org
Saving time for yourself to do what you want is equally as important as saving money. As you decrease your workload, fill your extra time with other interests. It
Retirement is James Stockwell,MD
In 2007, Dr. James Stockwell was the first physician in his gastroenterology practice to retire. Choosing to stay active, Dr. Stockwell does not consider himself “officially retired.” Instead he practices a fervent involvement in the medical community, preserving what he calls, “the precious heritage of medicine, compassion and generous charity.”
Combining forces in his volunteer efforts has bred success. “We are a ‘can do’ society and a rich nation that can provide better access to care,” said Dr. Stockwell. “I think doctors know more about health care and patients than anybody. We have patients’ best interests at heart. We have the knowledge and should take on a leadership role to ensure that all can receive quality care. Our mission is to treat people in order to halt disease progression, alleviate suffering, and prevent needless deaths. If they can’t get in your door, how can you treat them?”
Dr. Stockwell’s continued active involvement in the medical community reveals how much a “retired” physician can contribute. He is not only the Chair of the Leon County Health Advisory Board, but he is also the Co-Chair of the Access to Care Committee of the Capital Medical Society. “You always get back more than you give,” said Dr. Stockwell. “We Care has been wonderful for doctors because it affords us the ability to exercise our compassion and charity. The doctors in this town are very willing to volunteer their skills and time. It also gives doctors credibility, and a seat at the table whenever health care issues are discussed.”
“Retirement is going as expected so far,” said Dr. Stockwell. “The greatest loss is that I miss my patients tremendously. I miss the interactions with our staff and administration. They were a pleasure to work with.”
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Dr. Stockwell also has experienced a great deal of satisfaction in retirement. Aside from his active involvement in organized medicine, he also spends more time with friends and family. Through it all, he remains busy, sewing compassion and generosity into his daily life.
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American College of Phlebology
22nd Annual Congress November 6-9, 2008 Marco Island Marriott Resort & Spa Marco Island, Florida
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Other member benefits include complimentary subscriptions, discounts on books and brochures, affiliations with the ACP Foundation and American Board of Phlebology, networking opportunities, and more!
Visit www.phlebology.org/join for details. www.fmaonline.org
Summer 08 Florida Medical Magazine 23
Feature Article
John Tyler
Leading the Way FMA Past Presidents
Since beginning in 1874, the Florida Medical Association (FMA) has been guided by some of the finest minds in medicine. Even with a long and distinguished history of great leadership, the individual efforts of our past presidents are easy to recognize. Each of our leaders came from a unique background, and left an equally unique mark on the FMA. They are combat veterans, leaders of national organized medicine and public health, parents and grandparents. Above all, they are passionate and committed physicians, who rose to the unique challenges of their time with remarkable strength and success. As medicine in Florida faces new challenges, we take a look back at how some of our finest leaders helped shape the FMA, and their hopes for its continued growth into the future. Looking closer at the past, we are able to better understand our purpose and direction in the years to come. The FMA is proud to honor these individuals and all they have done and continue to do for the patients and physicians of Florida.
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T H E C O M M U N I C AT O R
Karl M.Altenburger, MD 2007-2008 When Dr. Karl Altenburger took over as the 131st President of the FMA, he had one goal in mind—evolution. Retired from practice, Dr. Altenburger focused all of his efforts on redefining the organization. “I felt it was important to take a closer look at our direction,” said Altenburger. “To be honest about our strengths and weaknesses, and know exactly where we want to go in the future.” Under his leadership, the FMA Board of Governors made strategic planning a renewed priority. Before long, and after tremendous effort from staff and leadership, a new mission statement was born. “Helping Physicians Practice Medicine,” said Dr. Altenburger. “This is our primary focus. Everything we do must take us further in achieving this mission.” To accomplish this, Dr. Altenburger felt it was necessary to increase the FMA’s visibility statewide. More than any other president
before, he traveled the state of Florida, visiting representatives in nearly every county medical society. “These partnerships are a big part of our Association’s future,” said Altenburger. “We must continue to reach out and build relationships around the state, with county and specialty societies, or really anywhere physicians are practicing. Cooperation is essential.” Dr. Altenburger is no stranger to breaking ground. A native of Coral Gables, he graduated with the inaugural class of the University of South Florida College of Medicine in 1974. After completing his graduate training at the University of Colorado in pediatrics and allergy and clinical immunology, Dr. Altenburger returned to Florida to practice. Before long he became active in organized medicine, serving as President of the Marion County Medical Society and the Florida Allergy, Asthma
and Immunology Society. He also rose to numerous leadership roles within the FMA, and is one of a handful of physicians who served as president of both the FMA and FMA PAC. “He’s a tremendous problemsolver,” said current FMA President Steven R. West, M.D. “He has a remarkable talent for studying problems and seeing their solutions. He’s a clear thinker, a risk taker, and it’s an honor to follow his legacy and vision for this organization.” In the future, Dr. Altenburger hopes physicians will become even stronger advocates for their patients and their profession. “We must respect the past, the accomplishments of all who’ve come before,” he said. “But we must also look at where we are now, our renewed mission as an organization, as a new beginning.”
“He has a remarkable talent for studying problems and seeing their s o l u t i o n s . H e ’ s a c l e a r t h i n k e r, a r i s k t a k e r, a n d i t ’ s a n h o n o r t o follow his legacy and vision for this organization.” www.fmaonline.org
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THE COLONEL
H. Frank Farmer, Jr., MD, PhD 2001- 2002 Dr. Frank Farmer still can pass an Air Force flight physical. Of course, he has only been retired from service for three years. A former flight surgeon, professor of history, and decorated Green Beret, Dr. Farmer also led the Florida Medical Association through one of our nation’s most difficult times—the attacks of September 11, 2001. “That changed everything,” said Dr. Farmer. “The economy was devastated, which forced me to change many of our goals. But there was also the looming threat of biological or other terrorist attacks.” Farmer became active in preparedness efforts, meeting with then Florida Secretary of Health John Agwunobi to discuss what the medical community might do in the event of such a catastrophe. The FMA drafted articles and developed plans to ensure that Florida’s physicians would never be caught off guard, but would be ready to act in any situation. Meanwhile, Dr. Farmer and the FMA still had other issues to tackle.
Namely, Farmer hoped to increase membership and engage the FMA more with the Legislature. However, his top priority was tort reform. “Professional Liability was a serious problem back then,” said Farmer. “For some throughout Florida, it was absolutely devastating. We had to act.” The FMA began pursuing a constitutional amendment that would limit the amount of damages a plaintiff could receive from a favorable verdict. “I understood the frustration,” said Farmer. “But I also understood we’d pushed a similar amendment ten years earlier, and been defeated soundly.” Believing the amendment faced a similar fate, which would cost the FMA considerable time and resources, Farmer chose a different path. “I believed the amendment would come eventually,” said Farmer. “My plan was to lay the necessary groundwork.” Dr. Farmer began organizing efforts within the FMA. He established committees, such as the Expert Witness Committee, chaired by then future
FMA President Dennis Agliano, M.D., and continued gaining political headway at the Capitol. Two years later, a constitutional amendment limiting contingency fees passed. “It is easy to believe that forces are aligned against you,” said Farmer, “if you fail to look far enough ahead.” He encourages future presidents of the FMA to remain hopeful no matter the odds, and to face challenges head-on. “Your efforts may not be appreciated until years later,” he said. “But that makes them of no lesser merit.” A professor of history, Dr. Farmer certainly knows this to be true. Today he continues practicing medicine and remains an active member of the FMA. Dr. Farmer also enjoys knowing that, given the chance, he could once more suit up and take to the skies.
“ Yo u r e f f o r t s m a y n o t b e a p p r e c i a t e d u n t i l y e a r s l a t e r, ” h e s a i d . “ B u t t h a t makes them of no lesser merit.”
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THE VISIONARY
Glenn Bryan, MD 1998 - 1999 Once Steve Spurrier won the Heisman Trophy and was drafted into the NFL, the University of Florida needed a new quarterback. Among his potential replacements, was a young Glenn Bryan. Although he never rose to the first string, Bryan remained a steady backup for one of America’s finest college football programs. His leadership, developed on and off the field, prepared Bryan for a career as a physician. After receiving his bachelor’s degree in 1972, Bryan enrolled in the University of Florida College of Medicine, receiving his medical degree four years later. He then moved to Charlotte, North Carolina, where he would complete his residency in Orthopedic Surgery. Dr. Bryan moved back to Florida, and began practicing in Melbourne at Holmes Regional Medical Center. He also became active in organized medicine, joining the Florida Medical Association in 1981. He soon joined the American Medical Association, the Brevard County
Medical Society, and a number of other organizations. This experience showed Dr. Bryan the essential need for physicians to work cooperatively toward common goals. As a member of the FMA, Dr. Bryan became active in the FMA PAC, ultimately serving as President. During this period, the FMA was based in Jacksonville. Realizing the need for greater involvement at the state Capitol, Dr. Bryan initiated efforts to move the FMA Headquarters to Tallahassee.
Today, Dr. Bryan is retired from practice and FMA leadership, and enjoys spending his time between Florida and the mountains of West Virginia. However, his legacy within the FMA will remain as vibrant and active as his efforts to realize its true potential.
Though the move was controversial, it has proven invaluable to the FMA’s legislative efforts, providing immediate access to the political process and those involved. “Glenn Bryan refocused our entire organization,” said Dr. Steve West, FMA President. “He really showed us the importance of targeting legislative issues. We had been active in legislation before we moved to the Capitol. But we weren’t nearly this powerful, or as effective.”
“He really showed us the importance of targeting legislative issues.”
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T H E P A R L I M E N TA R I A N
Cecil B. Wilson, MD 1997-1998 This past June, Dr. Cecil Wilson announced his candidacy for President-Elect of the American Medical Association. If elected, he’ll be one of a select few past FMA presidents to achieve this position within the AMA. For Dr. Wilson, it will be one more step in a long, distinguished career of leadership in organized medicine and throughout the community. After graduating in 1961 from the Emory University School of Medicine, Dr. Wilson’s commitment to serving others led him into the military. For ten years he served as a flight surgeon with the United States Navy. “It was at a time when so many young physicians were being drafted,” said Wilson. “So I decided not to wait, and volunteered for service.” After training for three years in Pensacola, Dr. Wilson was stationed for three years at the Marine Corps Air Facility in Okinawa. Living in the Far East, Dr. Wilson was able to travel throughout Japan,
and visit exotic locations such as Hong Kong, Taiwan, and the Philippines. Today, he still speaks a bit of Japanese. “I’m hardly fluent,” he said. “But it comes back to you.” Returning to Florida in 1971, Dr. Wilson began his solo medical practice in Winter Park. That same year, he joined the Florida Medical Association, a decision that would shape both Dr. Wilson’s career, and the future of the organization for decades to come. In the years prior to his FMA presidency, he served as vicespeaker and speaker of the House of Delegates. Dr. Wilson led the House of Delegates through one of the most contentious periods in FMA history, presiding over the debate to move the organization’s headquarters from Jacksonville to Tallahassee. Throughout the proceedings, Dr. Wilson showed remarkable evenhandedness, and maintained a sense of order and clarity. In the end, he won the respect and admiration of
delegates from both sides of the issue, solidifying his ability to bring people together toward a common purpose. The move from Jacksonville was not easy. The FMA staff had to be strengthened and reconstructed to face new challenges in the state capital. Dr. Wilson oversaw this difficult transition, guiding the FMA to renewed levels of ambition and success. Today, Dr. Wilson continues to practice in Winter Park, and is an active participant in the efforts of organized medicine. “We have an obligation as members of the medical profession, to ourselves and the patients we serve, to maintain the integrity of our health care system.” A decade after his presidency, Dr. Wilson continues to lead by example in pursuit of this honorable goal.
“ We h a v e a n o b l i g a t i o n a s m e m b e r s o f the medical profession, to ourselves and the patients we serve, to maintain the integrity of our health care system.”
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T H E D I P L O M AT
Yank D. Coble, MD 1988 - 1989 To say that Dr. Yank Coble has been around the world is a bit of an understatement. Soon after graduating in 1962 from the Duke University School of Medicine, Dr. Coble traveled to far-off destinations, including Egypt, to further his medical education. Coble, specializing in endocrinology, was sent to Egypt by the National Institutes of Health to treat children who were not growing properly. After brief stints in England and Nigeria, Dr. Coble joined the faculty at Vanderbilt University. “But before long I made a decision,” he said, “that what I’d really wanted to do all along was practice medicine.” Dr. Coble then moved to Florida and opened a solo practice. It didn’t take long for him to gain positive exposure to the world of organized medicine. “The Duval County Medical Society was very active in recruiting young physicians,” said Coble. After joining, Coble began meeting other influential members, who introduced him to the Florida Medical Association. Organized medicine played a tremendous role throughout Dr.
Coble’s career. In addition to his tenure as FMA president, he served as president of the American Medical Association from 2002 to 2003, and also the World Medical Association. Throughout his experience as a leader in organized medicine, one of the most valuable lessons Dr. Coble learned is the importance of effective communication. “As physicians, we’re not naturally comfortable with advocacy,” he said. “We’re not trained for it. Organizations like the FMA give physicians an opportunity to learn and apply this other, important side of medicine.” As FMA president, Dr. Coble actively fought what he still considers one of the worst tort systems in the nation. “When I was presidentelect, Amendment 10 failed.” The previous year, the FMA drafted this constitutional amendment that would have capped economic damages in medical professional liability cases. “To take over following that was a little disheartening, but it also strengthened my resolve to tackle the issue.” Even today, Dr. Coble remains a passionate advocate of tort reform in Florida. Dr. Coble also currently serves as
Director of the Center for Global Health and Medical Diplomacy at the University of North Florida. There he is able to continue his efforts to increase dialogue and cooperation throughout the world to see that all people can find access to health and medical care. O n e o f D r. Co b l e ’s g re a t es t challenges as FMA president was finding a balance between his presidency and other professional obligations. “I kept practicing during my tenure,” he said. “And it was difficult to manage everything.” Dr. Coble found it essential to rely on the efforts of his colleagues and abide by three traditions he believes will always be fundamental to the success of the medical profession. “Caring is number one,” said Coble. “It’s, in essence, what we do — care for patients. We create trust and hope through great hardship. Ethics is second. We must do all in our power to put our patients’ needs ahead of everything else. Last is science. We’ll never know everything, but we should make constant progress. It should be our goal.”
“Caring is number one,” said Coble. “It’s, in essence, what we do—care for patients.” www.fmaonline.org
Summer 08 Florida Medical Magazine 29
THE CORNERSTONE
T. Byron Thames, MD 1980 - 1981 Dr. T. Byron Thames has met Walt Disney. “Walt and Roy,” he said. “On several occasions.” During the building phase of the Walt Disney World Resort, Walt Disney personally began a search for the park’s Medical Director. “At the time,” said Thames, “my partner and I were handling most of the occupational medicine in the Orlando area. Our names must’ve crossed their desks.” Walt and Roy Disney personally hired Dr. Thames, and were present at his contract signing. They were just two of the influential people Dr. Thames would meet during his tenure at Disney World. “I also met former President Nixon,” he said. “His granddaughter became sick during a visit to the park, and I treated her.” Dr. Thames was later hired as a medical consultant to Coca-Cola, Sea World, Wet-N-Wild, and others across Central Florida. Before moving to Orlando to start his family practice, Dr. Thames served in the United States Air Force. After graduating in 1955 with his medical
degree from Duke University School of Medicine, Dr. Thames enlisted and shipped off to Lake Charles, Louisiana. Before long, he moved on to San Antonio, Texas, for flight surgeon school, and soon took to the skies in B-47s and C-130s. Eventually, Dr. Thames retired from service and moved to Florida. He joined a practice with Dr. Duncan McEwan, a former president of the FMA. Dr. Thames credits Dr. McEwan with encouraging him to becoming involved in organized medicine. “He showed me how important it is for physicians to spend time outside of private practice,” said Thames. “You can’t shape the future of medicine in an examination room.” It didn’t take long for Dr. Thames to join the Florida Medical Association. In 1980, he served as president. During his tenure, Dr. Thames led the FMA through a familiar struggle —medical professional liability issues. “In 1975,” said Thames, “we lost every professional liability insurance carrier in the state. Every
single one.” In response, the FMA began its own professional liability insurance company, which would ultimately become First Professionals Insurance Company (FPIC). Now, Dr. Thames serves as a member of the National Board of Directors for the AARP. He recently testified in Washington D.C., on behalf of physician reimbursement in Florida. He met with AMA leaders, including former FMA President Dr. Cecil B. Wilson. Although retired, when it comes to medicine, Dr. Thames remains issue-oriented. He believes the FMA, and future presidents, should be like-minded. “There’s simply no better way to reach your goals,” he said, “than to focus, not on partisan differences, but on common issues. By and large, all physicians want the same things.” In the future, Dr. Thames hopes physicians in Florida will continue working together, and always remember the heart of practice. “Healing patients is a privilege,” said Thames. “We cannot forget that.”
“ Yo u c a n ’ t s h a p e t h e f u t u r e o f m e d i c i n e i n an examination room.”
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Summer 08 Florida Medical Magazine 31
Reimbursement
Leslie Barber
Are You
READY for RAC?
32 Florida Medical Magazine Summer 08
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RACS On December 8, 2003, President Bush signed the Medicare Modernization Act, profoundly changing the Medicare program. This act led to the use of Recovery Audit Contractors, or RACs. Since their inception, RACs have conducted exhaustive audits of medical practices to determine the overpayment or underpayment of Medicare reimbursements. Initially, Congress opened a three year demonstration program using RACs, hoping to determine whether they were a cost-effective method of ensuring correct payment to providers and suppliers. The Act also specified that payments may be made to audit contractors on a contingent basis. Essentially, audit contractors are paid according to the amount of Medicare payments they recover through audits of charges submitted. The Act further specified that the contractors need to have the appropriate clinical knowledge of and experience with the payment rules. In March of 2005, the RACs were announced as a three state demonstration program including California (PRGSchultz), New York (Connolly Consulting), and Florida (Health Data Insights). Appropriately, these three states maintain the largest utilization of Medicare claims. Two months later, the Centers for Medicare and Medicaid Services (CMS) began providing each RAC claims data that had been processed from October 1, 2001, through September 30, 2004, by Carriers/Fiscal Intermediaries. Every three months during the pilot, CMS gave each RAC another quarter’s worth of claims with the oldest quarter becoming off-limits. The RAC reviews were all post-claims pay with no pre-pay review. In November of 2006, CMS released a RAC status report that found that the RAC process had recovered $54.1 million for the Medicare Trust Fund and that another $232 million had not yet been collected, but had been identified as overpayments. The report also showed that $2.5 million were identified for payment to providers who had been underpaid. In December 2006, Congress passed the Tax Relief and Health Care Act, Section 302 which makes the RAC program permanent, expanding to all 50 states by no later than January 1, 2010. Last year, the program expanded into Massachusetts, South Carolina, and Arizona. Currently, CMS is in the process of procuring four RAC contractors through a full and open competition. Each of these four contractors will handle one quarter of the country. Existing RACs will have to re-bid for these contracts along with other interested audit companies.
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You Still Have
RIGHTS
Despite the invasive nature of these audits, physicians are not without their rights. Physicians can request an extension on due dates for medical records, and discuss issues with the RAC contractor. They also have the right to know when the records review is complete. Physicians are provided with the same appeal process as regular Medicare claims adjudicated by a third party: First level – Second level – Third level –
FI/Carrier/DMERC QIC (Qualified Independent Contractor) ALJ (Administrative Law Judge)
If a physician is successful at the first appeal level, the RAC does not receive payment for the overpayment identified. The RAC is required to defend its decisions through the appeal process. CMS hopes to implement actions that will prevent future improper payments, so physicians can avoid submitting incorrect claims, CMS can lower its error rate, and taxpayers are protected. CMS has reported that $371.5 million in improper Medicare payments has been collected or repaid to health care providers and suppliers as part of a demonstration program using RACs in California, Florida and New York. Nearly $400 million has been collected since the program began in 2005. In 2007, the RACs in the three-state pilot returned a total of $247 million to the Medicare Trust Fund after taking into account the dollars repaid to health care providers ($14.3 million), the money overturned on appeal ($17.8 million), and the costs of operating the RAC demonstration program ($77.7 million). RACs will not be allowed to review: claims made before October 1, 2007; claims more than three years past the date the claims were originally paid; claims under review or adjudicated by another Medicare contractor (including carriers like First Coast Service Options);
Summer 08 Florida Medical Magazine 33
Most Common Problems That Draw Attention from RAC Auditors
1
Incorrect codes Example: The provider submits a claim for a certain procedure but the medical record indicates that a different procedure was actually performed.
2 3
No documentation or insufficient documentation Example: Providers fail to submit documentation when requested, or fail to submit enough documentation to support the claim. Duplicate claims Example: The provider is paid twice.
claims being reviewed for fraud (OIG, Justice); programs other than Medicare fee-for-service programs, medical education programs, randomly selected claims, etc. CMS will maintain a master list for RACs to check. Although authorized, review of E&M codes currently is not allowed by CMS (although HDI is considering some and probably will propose a few by this fall). Unlike the pilot program, the permanent RACs must have a physician medical director and certified coders. With few exceptions, physician offices must pay for the copies requested.
How RACs Operated The original RACs used all existing National Coding Determinations and Local Coverage Determinations and payment and coding policies. They used automated proprietary software programs to identify potential payment errors, such as: medically unnecessary, insufficient documentation, duplicate payments/services, coding errors, and services that were not covered. In addition to a fully automated review, the RACs may follow up with a more complex review having a clinician (usually an RN) review medical records. RAC demand letters or requests for records were sent out on RAC letterhead. There could be “full denials” (service incorrectly coded) or “partial denials” (correct CPT code but wrong level). RACs notified the Carrier FCSO (First Coast Services Options), who recouped the overpayment or paid the provider for an underpayment. The average Florida physician overpayment demand letter in 2006 was $135.00. RACs would not accept unsolicited requests from providers for underpayment. 34 Florida Medical Magazine Summer 08
RAC reviews are in addition to other Medicare audit processes such as CERT (Comprehensive Error Rate Testing), which only audit less than 10% of claims filed. Since the RAC program began, the error rate dropped from 14.2 percent in 1996 to 3.9 percent in 2007. This decline in improper payments reflects CMS efforts to target erroneous claims processing, inaccurate billing, and errors by health care providers. CMS did not specify which claims the RACS had to review or even how the RACs were to identify claims for review. Instead, CMS left the claims selection methodology completely up to each RAC. Although each RAC used the knowledge they had gained from prior experience auditing health care provider payments in the private sector, the RACs also used the findings of the OIG and GAO reports to help target their review efforts. The OIG and GAO issue many reports each year, some of which highlight specific Medicare services that are vulnerable to improper payments. The RAC utilized these reports in their efforts to identify claims most likely to contain improper payments. Learn more about RAC at www.fmaonline.org
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King & Spalding is pleased to announce the following additions to our healthcare industry practice:
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WASHINGTON, D.C. Dennis M. Barry Christopher L. Keough Joseph E. Lynch Stephanie A. Webster J. Harold Richards Robert E. Waters Lori K. Mihalich Daniel J. Hettich
HOUSTON Gary W. Eiland Dennis C. Dunn Nancy C. LeGros Adam Robison Christina A. Gonzalez
According to the membership rankings of the American Health Lawyers Association, King & Spalding has the largest healthcare law practice in the United States.
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Summer 08 Florida Medical Magazine 35
Education
John Tyler & Dominique Lightsey
Sha pi n g t h e F ut u re o f H e a l t h Ca re ...O n e St ud e n t a t a T i me The M e d ic a l S c hools of F lor ida
36 Florida Medical Magazine Summer 08
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The number of physicians practicing in Florida is in decline, and promises to grow smaller each year. In response, lawmakers and medical schools in Florida are working hard to curb this shortage. By 2009, Florida will introduce two new medical schools. Although Florida has been home to elite, traditional programs for more than fifty years, our medical education community continues growing and improving all the time. With academic strength in common, Florida’s medical schools are also highly unique and provide the Sunshine State with an exciting and diverse community of medical education. We invite you to take a closer look at Florida’s medical schools and what they are doing to shape future generations of physicians to practice in Florida, across our nation, and throughout the world.
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Summer 08 Florida Medical Magazine 37
“We don’t believe business and medicine are mutually exclusive,” said Klasko.“The concepts that drive innovation in business can be just as effective in medicine.” Stephen Klasko, MD, MBA, Dean University of South Florida College of Medicine
PROMOTING IDEAS A N D I N N O VAT I O N 38 Florida Medical Magazine Summer 08
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University of South Florida TA M P A
The University of South Florida has established a different kind of medical school. Under the guidance of Dean Stephen Klasko, M.D., M.B.A., the University of South Florida College of Medicine is preparing students for practice in an uncertain, fast-changing world. “Medicine isn’t what it used to be,” said Klasko. “The landscape is very different, which is why we’ve incorporated so many different elements into our curriculum.” USF combines medicine, nursing, and public health clinically, and in terms of research, under one unifying body—USF Health. When it comes to combining disciplines, USF doesn’t stop there. Diverse skill-sets are a fundamental part of medical education at USF. They offer numerous joint degrees, joining a degree in medicine with one in business, law, public health, or health systems engineering. Every student also must take a minor, which can be in a research topic, business, law, or medical writing. All of this is centered on USF’s entrepreneurial academic model. “We don’t believe business and medicine are mutually exclusive,” said Klasko. “The concepts that drive innovation in business can be just as effective in medicine. We teach this creativity, and reward it on a daily basis.” USF hopes to provide students with the knowledge and creativity necessary to avoid the normal pitfalls of postgraduate practice. “Most students grow bitter soon after residency,” continued Klasko, “because they’ve only learned half of what they need to know to survive. They haven’t learned how to market a practice or negotiate contracts. They don’t know how to run an effective meeting.”
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“One of our best programs is the Longitudinal Clinical Experience, or LCE,” said Justin Sempsrott, a third-year medical student. “It gives us an opportunity to shadow practicing physicians, not for clinical experience, but to see how a practice functions from the inside.” Although USF is focused on a diverse curriculum, its primary focus is medicine. But even in teaching the fundamentals, USF takes a creative approach. “They brought in a full-time education professional,” said Sempsrott, “to observe our classes and figure out what was working and what wasn’t. Our learning process evolves every day.” With this innovative approach to medical education, the University of South Florida is preparing not just tomorrow’s physicians, but tomorrow’s medical school. “In 1915,” said Klasko, “a report was taken, called the Flexner Report, which documented how medical schools should be run. Nothing much has changed since then.” Until now. A new report known as “Flexner 2” currently is being researched, involving six medical schools in the United States. The University of South Florida is among them. It’s just one of the many exciting new developments at USF, one which shows that the best is yet to come.
Summer 08 Florida Medical Magazine 39
University of Central Florida ORLANDO The University of Central Florida College of Medicine aims to be this century’s leading medical school. “We’re building on a tremendous legacy,” said Dr. Deborah German, UCF’s founding Dean. “Learning from the successes of Florida’s established programs, and two hundred years of medical education in this country, our goal is to create a curriculum and research program that takes a step forward.” Understanding that students choose to attend medical school in the hopes of following a lifelong dream in medicine, UCF has added a four-year course to its curriculum titled “Individualized Research and Study.” “I call it the ‘Keep the dream alive’ course,” says German. “It allows each student to take the dream, which brought them to medical school, and make it a reality.” With dreams in mind, UCF’s College of Medicine has done what no other medical school in the nation’s history has—UCF is providing full funding for each one of its forty inaugural students. “I know the difference freedom from debt can make to a student’s education,” said German, who also received a full scholarship to medical school. “In a way, I’ve always wanted to pay back those who provided my scholarship. In building this program, I’m instead working to pay their generosity forward to the next generation of physicians.” UCF’s College of Medicine also is determined to create opportunities to advance cancer research in the state of Florida. The M.D. Anderson Cancer Center (Orlando’s Cancer Research Center) and the College of Medicine will join together in an effort to immerse students in the process of research, obtain CRI researchers as faculty, and aid the state of Florida with new and innovative developments in therapy for the most prevalent forms of cancer. The CRI intends on moving into the building that will house UCF’s College of Medicine until their building, also located on UCF’s campus, is complete in 2012. This union represents the first step in UCF’s plan to make the area surrounding the College of Medicine a ‘medical city’ of sorts. “But we haven’t forgotten the city of Orlando,” said German. “One thing that I believe truly distinguishes us is that we belong to our community. With all the contributions and support they’ve given us, in many ways we belong to them, and they belong to us.” 40 Florida Medical Magazine Summer 08
Ultimately, UCF strives to graduate a variety of physicians who will impact medicine in new and exciting ways. “Medical students often fit three distinct types,” said German. “First, we have the Mother Theresas, who wish to take care of patients one at a time. Then, we have the future policy makers, those striving to fix the health care system. These are our future Surgeon Generals. Finally, there are the hopeful researchers, who want to cure cancer or irradicate the AIDS virus. These are our future Nobel Prize winners.” In an environment so focused on cultivating and realizing the dreams of students, UCF is both confident and excited about taking part in shaping the next generation of physicians.
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C R E AT I N G OPPORTUNITY
“I know the difference freedom from debt can make to a student’s education.” Debra German, M.D., Dean, University of Central Florida College of Medicine
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Summer 08 Florida Medical Magazine 41
C R E AT I N G TRADITION
42 Florida Medical Magazine Summer 08
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University of Florida GAINESVILLE Home to one of the most renowned collegiate athletic programs in recent history, the University of Florida also boasts one of Florida’s oldest and proudest medical schools. Established in 1956, the UF College of Medicine has long served as the training ground for some of the Sunshine State’s greatest physicians. According to UF medical student Nitesh Paryani, this tradition remains strong. “I can’t imagine a better place to study medicine,” he said. “The faculty and administrators are very supportive of the students and encourage us to pursue our passions and our interests. Being a medical student at UF is an amazing opportunity.”
revolutionary cancer treatment with fewer side effects. Despite these outstanding research accolades, UF’s primary focus is medical education, for both medical students and practicing physicians. For students, UF offers a diverse curriculum, which accounts for and embraces the rapidly changing medical landscape. “We do our best to prepare students for the realities of medicine today and tomorrow,” said Dr. Michael Good, Interim Dean of the UF College of Medicine. “The next generation of physicians needs exceptional technical knowledge with an exceptional human touch. Our goal is to equip our future physicians with both.”
One of UF’s greatest strengths is its legacy of advancement in medical research. Less than a decade after welcoming the inaugural class, UF medical researchers developed what soon would become one of the most recognizable products on the planet — Gatorade®. Today, UF remains firmly in the top ten American universities in licensing income, averaging more than fifty issued patents each year.
There are also plenty of opportunities for residents and practicing physicians to continue their education. The partnership between UF and Shands Hospitals has created residencies in fifty-six specialties, as well as numerous clinical and research fellowships. UF also offers a wide variety of continuing education opportunities for physicians, through their Continuing Medical Education Office. “Patients travel from across the state and the country to receive care at our medical facilities,” said Good. “The student experience here is as exciting and diverse as they come.”
UF faculty break new ground every day at the Evelyn F. and William L. McKnight Brain Institute, the UF Institute on Aging, and the UF Genetics Institute. The UF Shands Cancer Center is also among the top cancer research facilities in the country. Additionally, UF’s campus in Jacksonville is home to the Florida Proton Therapy Institute (FPTI). Using one of just five medical proton beams in the United States, physicians at FPTI are able to provide
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Even as rapid innovation continues to change the practice of medicine, UF’s commitment to preparing tomorrow’s physicians remains a constant tradition.
Summer 08 Florida Medical Magazine 43
Florida State University TA L L A H A S S E E
In 2001, the Florida State University College of Medicine welcomed its inaugural class, becoming the first new medical school in Florida in more than three decades. Their mission: to develop quality, compassionate physicians to care for Florida’s many underserved populations. “I believe we’re unique in the state, and somewhat nationwide,” said former Dean J. Ocie Harris. “We had an opportunity to develop a completely new program, one which would focus not just on medical education, but a medical education that would suit the specific needs of Florida.” The FSU College of Medicine focuses on general practice, with a large percentage of students specializing in primary care and family medicine. From their first year, students are encouraged to use this general knowledge to serve the areas of Florida that need it most. First and second year students work closely with practicing physicians in Tallahassee. They also take advantage of the Clinical Learning Center, a state-of-the-art medical simulation facility.
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The Clinical Learning Center brings the community to the students. Community members are brought in to act as “standardized patients.” Trained to portray symptoms of specific illnesses, standardized patients provide students with genuine human interaction in a controlled setting, providing a realistic training environment. FSU also uses regional campuses that span the state of Florida. Third and fourth year students spend considerable time traveling between campuses in Orlando, Pensacola, Tallahassee, Sarasota, Daytona Beach and Fort Pierce. Their clinical experiences in these cities extend into private practices, hospitals, and other health care settings, giving students invaluable hands-on training. “We want our students to be well-versed in practice as it exists today,” said Harris. “We want our students to see the best that medicine has to offer, as well as its challenges, with a firsthand perspective.”
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FOCUSING ON RURAL COMMUNITIES Participating in organized medicine is also a priority for FSU medical students. “There is more to being a physician than patient care. The best doctors take an active role in patient advocacy,� said Richard Rodriguez, a fourth year student. Rodriguez is currently a member of the Florida Medical Association, and is Chair of the FMA Medical Student Section. He credits FSU with providing him the encouragement and opportunities to engage in organized medicine. Combining patient care and advocacy, while focusing on rural, minority, elderly, and underserved populations, the Florida State University College of Medicine is shaping both future generations of physicians and the landscape of health care in Florida.
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Summer 08 Florida Medical Magazine 45
University of Miami MIAMI Since 1952, the University of Miami Miller School of Medicine has cultivated some of the brightest minds in medicine. But Dean Pascal Goldschmidt has a greater vision for the future of UM. “Florida should be a medical destination,” said Goldschmidt. “My goal is to provide Floridians with access to the finest medical care, right here in their backyard.” Ultimately, he hopes to extend this access to patients across the country. “Right now, people are leaving Florida for treatment. In the future, the opposite should be true.” In bringing Dean Goldschmidt’s vision to life, UM is off to a great start. They recently opened the first allopathic medical campus in Palm Beach county, with programs in obstetrics, surgery, and pediatrics. UM also opened the Miami Institute for Human Genomics. Dean Goldschmidt considers this facility the “future of medicine.” “Our goal is really to personalize medicine,” he said. “The idea is to discover our susceptibility for illnesses and find ways to prevent them before they occur.” While UM researchers continue to blaze exciting new trails, medical students are able to take advantage of a cutting-edge medical education. “Having Jackson [Memorial Hospital] right on campus is huge,” said Angela Mendoza, a third year student. Miami students gain rapid clinical exposure, with rotations beginning in their second year. “We have an amazing opportunity every day to experience the real world of practice, with an incredibly diverse population of patients.” According to Goldschmidt, Miami’s diverse population provides the University of Miami with a unique advantage. “Florida, and really the United States as a whole, is experiencing a significant shift in demographics,” he said. “The Latin American population in our country continues to grow, and our students and faculty are fortunate to have an opportunity to adapt to a changing cultural landscape.” Most of the Miami faculty is bilingual.
William J. Harrington Medical Training Programs have facilitated these opportunities for international physicians, leaving UM’s mark across the globe. “But the people of Florida come first,” said Goldschmidt. Every day, the University of Miami Miller School of Medicine makes major strides in cutting edge research, while providing students with diverse clinical experiences. For the future of Florida’s southernmost medical school, it appears that the sky is the limit.
“My goal is to provide Floridians with access to the finest medical care, right here in their backyard.” Pascal J. Goldschmidt, M.D. Dean, University of Miami Miller School of Medicine
Although UM is focused on developing Florida’s medical community, they also are committed to global health. “Many students come here from places like Haiti or a variety of Latin American nations, and have every intention of returning home to practice. We encourage this.” For more than forty years, the
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MAKING A G L O B A L I M PA C T www.fmaonline.org
Summer 08 Florida Medical Magazine 47
Nova Southeastern University F T. L A U D E R D A L E
Built in 1979 from the vision of Morton Terry, D.O., Nova Southeastern University College of Osteopathic Medicine is the only school of its kind in Florida. Keeping with the methods of the founder of osteopathy, Andrew Taylor Still, M.D., Nova challenges its students to examine the cause of diseases and other problems associated with health from a holistic approach. “We analyze treatment from every possible angle,” said Dean Anthony J. Silvagni, D.O., PharmD. “Everything from how it will impact different organ systems,to the impact on a patient’s career or their family life.” Nova prides itself on the continued emphasis on general practice, preparing students for the diverse nature of today’s practice. “Almost half of our graduates are primary care physicians,” said Silvagni. Community-based health care is also a priority at Nova. “We graduate more students with combined DO/MPH degrees than any other osteopathic program in the nation,” said Silvagni. Anywhere from 20-35 Nova students have graduated with this joint degree over the past few years. “The future of practice in many ways will involve potential pandemics, international issues, population-based medicine and
48 Florida Medical Magazine Summer 08
others that will require public health knowledge. We’re working to prepare our students for this reality.” Nova also makes global exposure a priority for its students each year, offering four international trips to students. Although students travel to remote locations, such as rural Argentina, Nova works to ensure that they are well-connected. “We’re in the process of integrating an online electronic library, which will house thousands of resources, medical journals, text books, and medical sites,” said Silvagni. Anywhere in the world, students with internet access will be able connect. Back home in south Florida, Nova is reaching out to the underserved. “There is a huge migrant worker population in the Okeechobee area,” said Silvagni. “Every year our students are involved with our health fair. We bring in state and national agencies, offer health screenings, and make treatment referrals.” In these ways, Nova is preparing medical students for the constant evolution of medicine. At home or abroad, Nova medical graduates will be ready to face today’s health care challenges, and develop tomorrow’s solutions.
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TA K I N G A H O L I S T I C APPROACH www.fmaonline.org
Summer 08 Florida Medical Magazine 49
URBAN COMMUNITY
“We measure success beyond exam scores or the future accomplishments of our students. For us, in many ways, our focus is improving the community and shaping physicians who will do this throughout their careers.� John Rock, M.D., Dean, Florida International University College of Medicine 50 Florida Medical Magazine Summer 08
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Florida International University MIAMI When the Association of American Medical Colleges (AAMC) recommended that the number of U.S. medical school graduates increase by thirty percent in 1995, Florida International University began its ten year strategic plan to meet the challenge. Eleven years later, in the fall of 2009, Florida International University will introduce its first class of medical students. Florida International University has various goals set for these students. They hope to cultivate physicians with a renewed sense of social responsibility. “It’s vital that we take the learning experience out of the classroom and into our communities,” said Dean John Rock, M.D. “It provides us with an opportunity to train our students to be compassionate and culturally-sensitive, celebrating the unique diversity of south Florida.”
individual needs.” For example, according to Rock, nearly 80 percent of area residents use Jackson Memorial Hospital for every health concern. HELP attempts to direct patients to community health centers and other more accessible primary care locations. Florida International University hopes to prepare students for all of the challenges involved in practice. In addition to medicine, students are encouraged to take courses in business, law, and other fields that impact a physician’s daily practice. Business classes are offered during the first year. “We feel our curriculum is unique in its relevance,” said Rock. “We’re going into our neighborhoods and we’re staying. We measure success beyond exam scores or the future accomplishments of our students. For us, in many ways, our focus is improving the community and shaping physicians who will do this throughout their careers.”
To accomplish this, FIU initiated a new and innovative four-year program entitled Neighborhood HELP (Health Education Learning Program). HELP sends teams of FIU students into need-based communities to track and monitor the health of families throughout the students’ four years of study. Each team consists of a medical student, as well as students of social work, nursing public health, and the social sciences. “We’re going door to door,” said Rock, “and learning about our community person by person, addressing
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52 Florida Medical Magazine Summer 08
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INSURANCE ASSURANCE INC. Full Lines Licensed Public Adjusting Firm We work for you, not the insurance company
Photo by Palm Beach Post
We are pleased to offer our services to members of the FMA as we previously had the opportunity to provide our services to individuals in your field.
Our purpose is to prepare a detailed Insurance Loss assessment of all the damages sustained resulting from a covered loss. We scrutinize, interpret and make claim for your loss in accordance with all policy provisions; thoroughly supporting your claim with documentation. Insurance Assurance Inc. then provides the claim package to our client for their review. Only after the client and we agree as to the loss and restorations needed do we then make claim to the insurance carrier. The vast majority of claims in which we become involved the client involves our services as result of a specific dispute that arose. i.e.; the client and/or their experts feel the roof requires replacing and the carrier wants to pay for a small repair. Many times in a fire the carrier sends their “PREFERRED” contractors and a dispute arises out of minor discrepancies although as denoted below our collections are typically hundreds of percent higher in the cases in which we become involved. This is a direct result of not only the issue for which we were initially called being paid, but our investigation of the claim discovering the damage to be greater than the Insured realized. Many times our clients relied on a contractor to estimate their damages although there are very few contractors that can investigate a loss and determine all damages. Contractors generally are licensed to construct projects and not to conduct forensic investigations.
To date, we are still being contacted by clients that have fallen victim to the ’04 - ’05 hurricane seasons. Has your insurance company properly indemnified you? Does your insurance company owe you a better settlement? If you do not believe you were paid appropriately and would like us to review your claim, just give us a call. You owe it to yourself to find out. Florida usually allows up to five years from the date of loss to file a supplemental claim. If we don’t document and collect more than you have been paid or offered, our services are Free. We have had a 100% success rate on claims we have accepted. If you do not have a Public Adjuster representing you, who is documenting your damages, the insurance carriers adjuster? In cases in which we have become involved, our collections are typically hundreds of percent higher and in numerous cases thousands of percent higher settlements than the insurance companies’ original offer prior to us As reported by help columnist Doug Lang December 9, 2004 in the Florida Today and written about being retained. Our Insurance Assurance Inc. services have been “Public adjusters can help with insurance woes” utilized by all types In this same article a spokesman for the Florida Department of Financial Services described their work as of professions and “Helping policy holders prepare and file claims and negotiating the best possible settlement.” businesses including doctors and lawyers. Insurance Assurance Inc. has the ability to appraise and achieve an equitable insurance settlement for losses that affect: Single Family Dwellings - Multi-Family Dwellings –Condominium Associations - Commercial & Industrial Properties - Residential Personal Property - Business Personal Property - Business Inventories - Machinery & Equipment Business Interruption & Extra Expense Claims - Loss of Rental Income - Additional Living Expenses derived from such losses as: Hurricane damage, tornado and windstorm damage, flood, wind driven water and other water-related damages, fire and much more. A couple of the Recoveries gained for our clients
in the past 30 Days.
To many carriers surprise an Adjustment is not negotiation; adjustment is the quantification and defense of the amount claimed, based upon clearly quantifiable damages, Adjustment is where we can identify and quantify the value down to the smallest degree, and based upon the facts, the loss is argued and settled—not based upon what you want vs. what I want. Even if you have not suffered a loss, you may want to establish a relationship with a public adjuster before you need one. This is especially true if you’re in a high risk area or industry. If the unthinkable happens, you’ll know exactly whom to call first.
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FL. License # D032331 Summer 08 Florida Medical Magazine 53
Member Profile
John Tyler
AN INTERVIEW WITH
GEROLD L. 54 Florida Medical Magazine Summer 08
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Sunday Sitting in the back of the crowded ballroom at the Grand Hyatt Regency in Coral Gables, I’m looking for one man. I’ve heard a great deal about Dr. Gerold Schiebler, and met him twice, briefly. He promised me an interview on both occasions. It’s Sunday morning and the Spring Board of Governors Meeting is drawing to a close. Time is short. I fidget anxiously, toe-tapping soft and quick on the carpet, eyes scanning the physicians and medical professionals who line the meeting tables. From a corner across the room, Dr. Schiebler stands. He pushes in his chair and walks toward the back of the room, his dark glasses fixed straight ahead. I refuse to bring attention to myself as he draws closer. Not with the meeting in full swing. He passes, nearly brushing my shoulder, and says nothing. I’ve missed my chance. Looking back, the exit door is unmoved. Then a warm hand lands on my shoulder. I turn back just as Dr. Schiebler leans down and says, “After all this is over, let’s have lunch and talk.” I nod and can’t hold back a smile of relief.
SCHIEBLER,MD www.fmaonline.org
Summer 08 Florida Medical Magazine 55
FRIDAY
think about politics. We just want to practice medicine. Dr. Schiebler, however, understood the value and the necessity of engaging in the process. Children can’t vote, so Dr. Schiebler became more than just their pediatrician. He became their advocate.” Dr. West and Dr. Altenburger both agreed that Dr. Schiebler was instrumental in focusing the FMA’s political efforts. “He’s the consummate scientist,” said Dr. West. “He understands that you live and die by the facts.” Dr. Schiebler brought in strong outside political consultants, and made sure the PAC based its decisions on real data, strengthening their voice in Tallahassee.
This was my first morning in Coral Gables at a FMA Board of Governors meeting. Dr. Karl Altenburger, the current FMA President, invited me for breakfast. When I walked in, I found him seated at a table with Dr. West. Dr. Altenburger asked, “You’re hoping to interview Dr. Schiebler while you’re here?” “Yes sir,” I said. “I understand he was your mentor.” Dr. Altenburger laughed and met the eyes of his colleague. “Mine,” he said, “and just about everyone else’s.” Dr. West looked back knowingly. Dr. Altenburger stood, and so did I. The three of us sat down on sofas before a picture window overlooking the morning
Dr. Altenburger then told me how the two of them
From the beginning, the more I learned about Dr. Schiebler, the more untouchable he seemed. Everyone had a story to tell, and they were all great stories. Stories of pioneering efforts, great accomplishments, and countless lives changed. When I met earlier in the weekend with Dr. Steven West, a practicing cardiologist and then President-Elect of the FMA, I asked him what to expect when I interviewed Dr. Schiebler. He said, simply, “It’s an experience.”
met. Dr. Schiebler recruited Dr. Altenburger to join the faculty at the University of Florida College of Medicine soon after Altenburger completed his residency. However, Dr. Altenburger turned him down. “I wanted to practice,” he said, smiling. “So I moved to Ocala, and did just that.” They stayed in touch, and before long, Dr. Schiebler appointed him to the FMA PAC Board, and introduced him to physicians who would play a major role in his career and in the future of the FMA. “That’s how we met,” Altenburger said, pointing at Dr. West. It’s how Dr. Altenburger met many
“ D r. S c h i e b l e r i s a m e n t o r t o a l l of his ‘ c h i l d ren ’ ,” s a i d D r. A l t e n bu r g e r. “Tha t i s , ever yo ne c o m i ng up t he l a d der. An d t h e l a d d e r re a l l y n eve r e nd s .” K a r l M . A l t e n b u r g e r, M D , F M A I m m e d i a t e P a s t P r e s i d e n t
Miami skyline. “Dr. Schiebler is a mentor to all of his ‘children’,” said Dr. Altenburger. “That is, everyone coming up the ladder. And the ladder really never ends.” “My relationship to Dr. Schiebler came later,” said Dr. West. “I knew his name very well in cardiology circles, but never knew him personally until I joined the FMA PAC.” Dr. Schiebler is one of a handful of physicians who served as both president of the FMA and FMA PAC. Dr. Altenburger is another. “Most physicians,” said Altenburger, “don’t want to even
56 Florida Medical Magazine Summer 08
of the physicians I’d meet later that weekend. Individuals like Dr. Miguel Machado, Dr. Madelyn Butler, and Dr. James Dolan. In a way, it seemed Dr. Schiebler helped shape the future of the FMA without even trying. “I’ll tell you one thing,” said Dr. West. “In this profession you’ll find people who are special. They are special because they make you better. Dr. Schiebler is certainly one of these people.”
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“He’s treasured,” said Dr. Altenburger. “It’s a testament to the greatness of our profession, that it attracts people of such quality and stature.” The three of us stood and said our goodbyes. Dr. Altenburger and Dr. West left to attend meetings, and I went back to my room to review my notes on Dr. Schiebler and prepare to speak with him in person.
Theater. He was killed in Okinawa in May of 1945. The following summer, Gerold Schiebler graduated from high school as class valedictorian. He attended Franklin and Marshall College, graduating Magna Cum Laude, and in 1950 became their first graduate ever to attend Harvard Medical School. His tuition would be covered by Klaus’s military death benefits. I put away my notes and went down to attend meetings through the afternoon. Later that evening, I met Dr. Schiebler for the first time. It was during the Medical Student Section meeting, a collective of the best and brightest students from all of Florida’s medical schools. Dr. Schiebler serves as its Board Liaison. This will be his last year. He walked into the room, and I introduced myself immediately. “Ah, yes,” said Dr. Schiebler, looking me square in the eye. “You’re the fellow who wants three hours of my time to talk?” We’d spoken by phone a week before the Board of Governors meeting. I’d asked him for twenty or thirty minutes, a brief interview. “Sir,” I said, caught off guard. “I…I don’t remember asking for that much time.” “Relax,” he said, patting me on the arm. “We’ll talk soon.”
Here’s what I knew: I knew that Gerold Schiebler was born in 1928 to first-generation German immigrants in Hamburg, Pennsylvania. I knew he went with his family to visit relatives in Germany in the mid-1930s, and saw the oppression of the Third Reich up close. Because of the Schiebler family’s close ties to Germany, they fell under FBI surveillance during World War II. Klaus Schiebler, Gerold’s other brother, decided to join the service. Because his parents did not want him fighting in Europe, where many blood relatives fought for Nazi Germany, Klaus instead shipped off to the Pacific
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It took me until I sat down, with the meeting underway, to realize that one of the greatest physicians in the country had just joked with me. Watching him with the students, it made sense. His rapport with each of them was remarkable, as was his willingness to treat them as equals. Unfortunately the meeting ran long, and my chance to speak with Dr. Schiebler that night dissolved.
SATURDAY
The following day was no different. My chance
Summer 08 Florida Medical Magazine 57
came that evening during the poolside reception and dinner. He arrived and I went to him immediately. “We’ll talk soon,” he said once again. “I promise.” By the end of the night however, I was still without my interview. Again I went back to my room to review notes. After graduating from Harvard, Dr. Schiebler became a pediatrics resident at Massachusetts General Hospital in Boston. It was there in the delivery room that he met nurse Audrey Lincourt. The two soon married, and remain so today. Dr. Schiebler took the position of senior resident at the University of Minnesota Hospital,renowned for its advances in pediatrics and open-heart surgery.With specialized knowledge of both pediatrics and cardiology, Dr. Schiebler became the first board-certified pediatric cardiologist in Florida. He was pursued by the University of Florida, and ultimately was hired as a full professor of pediatrics, and head of the burgeoning Pediatric Cardiology Department. Dr. Schiebler
in Amelia Island. Yet, here he stands, offering to have lunch with me on the last day of meetings. The meeting adjourns and the crowd disperses. I find Dr. Schiebler and we walk together to the lunch room next door, making small talk. We go inside and sit down at a quiet table in the corner. We talk about the Boy Scouts. “Obviously,” I say, “you’re considered a mentor to a great number of physicians and medical students. Someone must have influenced you over the years to take such a role in so many lives.” “Well, I was very lucky,” says Dr. Schiebler. “I had that advantage in my life. There were great men who influenced me. Every summer until I graduated from medical school, I’d work with the Boy Scouts in Massachusetts, setting up
“I’ l l t el l yo u o n e t h i n g ,” s a i d D r. Wes t. “ I n t h i s p ro f e s s i o n yo u ’ l l fi n d p e ople w h o a re s p e c i a l . They ’re s p e c i a l bec a u se t hey m a ke yo u b e t t e r. Dr. S c h i e b l e r i s c e r t a i n l y o n e o f t h e se peop l e.” S t e v e n R . W e s t , M D , F M A P r e s i d e n t played a considerable role in establishing the University of Florida and Shands Hospital as the pediatric giants they are today. However, there was so much more. I needed to hear details, the finer points of the stories, and I needed to hear them from Dr. Schiebler.
SUNDAY
This morning, I woke up certain it wouldn’t happen, that we’d catch up later by phone. I watched him walk by, sure he was leaving, heading back to his home
58 Florida Medical Magazine Summer 08
Explorer programs and such.” The pay, even for that time, was meager. “I had support from home,” says Schiebler, smiling, his eyes drifting upward as if to remember. “You know, I called my dad once from up there. I said, ‘Dad, I’m making five dollars a month here, just enough to eat. Maybe I should look for work with some greater rewards.’ He didn’t miss a beat. He said, ‘You stay right there. Enjoy the woods.’” Bill Collins, the Boy Scouts District Executive in Massachusetts, taught Dr. Schiebler a great deal about leadership and making a difference in the lives of young people. They were lessons that would
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influence Schiebler’s entire professional —well worth five dollars a month.
career
“So,” I ask him, “why medicine? Did you know all along it was what you wanted to do?”
“Not long after you graduated medical school,” I say, “you were recruited by the University of Florida to be the head of Pediatric Cardiology. It was 1958, right?”
“Why not medicine?” he says, looking at me in feigned disbelief. “What field other than medicine offers greater rewards, or a greater use of talent? No matter how bad it gets for doctors, the profession will always be worthy. Always.” And then it’s over. “Now you’re done with me,” says Schiebler, smiling.
“The first time they recruited me, yes. ’58,” says Schiebler. “But I didn’t join them until 1960. In ’58, segregation was still very much an issue, plus I simply wasn’t ready.”
“I am?”
“ W h a t fi e l d o t h e r t h a n m e d i c i n e o ff e r s g re a t e r rewa rd s , o r a g re a t e r u s e o f t a l e n t ? N o m a t t e r h ow b a d i t g et s for doc t o r s , t h e p ro f e s s i o n w i l l a lwa y s be wo r t hy. A lwa y s .” G e r o l d L . S c h i e b l e r, M D
It didn’t take long for this to change. Barely a decade after joining the University of Florida faculty, despite its rural location, Dr. Schiebler helped turn the UF medical school and Shands Hospital into respected, sought-after institutions. In 1973, he founded and became director of Children’s Medical Services in Tallahassee. Two years later, he was appointed Legislative Liaison by the University of Florida Health Science Center, a position he would hold for thirty years. For three decades, Dr. Schiebler became a force in the Florida Legislature, lobbying aggressively for children and physicians. “I’m still involved in politics,” says Schiebler. “I was in Washington last week, actually. There’s still so much left to be done.” It isn’t a surprise. What’s surprising to me is how accessible and genuine Dr. Gerold Schiebler is, even to a stranger asking a whole lot of questions. Before long, it seems we were just two people talking.
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“Aren’t you?” He pushes his chair back from the table and stands. “Let’s go get some food.” Not long after we sit down with full plates, people begin to swarm the table, saying hello to Dr. Schiebler. Many of them I’ve met this weekend, but can’t remember. He remembers all of them by name. I eat in relative silence and excuse myself, thanking Schiebler for his time. “A pleasure, John,” he says, giving me a firm handshake. The Board of Governors meeting is officially over. My bags are packed, stacked, and waiting in the corner of the room. I’ll soon board a plane bound for Tallahassee. All things considered, the weekend has been successful. People file out of the room. Soon there is only me, Dr. Altenburger, and Dr. Schiebler. The two men approach one another, shake hands, and say their goodbyes too quietly for me to hear. Then, like family, the two of them embrace warmly as equals.
Summer 08 Florida Medical Magazine 59
FCSO FMA Ad 3.694x9.875.pdf
7/28/08
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Walking out the door, again I feel a hand on my shoulder. “Take this, John,” says Dr. Schiebler. I turn, and he hands me a business card with a phone number written in pen. “You need anything else,” he says, “you call me. Okay?” I can tell he means it. It’s difficult to believe someone like Dr. Schiebler, for whom buildings are named, a man who arguably has done more for children’s health care or medicine in Florida than anyone else, can be so willing. We say goodbye, and I walk out into a warm Miami afternoon, looking to hail a taxi. Waiting, I reach into my pocket and take Dr. Schiebler’s card. The hand-written number is underlined. I won’t call, and I couldn’t ask him for anything more. I’m sure that if I did, however, Dr. Schiebler would remember my name. “What field other than medicine offers greater rewards, or a greater use of talent? No matter how bad it gets for doctors, the profession will always be worthy. Always.”
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Summer 08 Florida Medical Magazine 61
Professional Liability
John Tyler
Professional Liability Five Years Later “We have to work together, and protect the progress we made five years ago.� Bob White - President, First Professionals Insurance Company
62 Florida Medical Magazine Summer 08
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Since the end of 2006, physicians across Florida have enjoyed considerable decreases in their medical professional liability premiums. According to First Professionals Insurance Company (FPIC) President Bob White, this stems from a number of factors. “Tort reform has played a role,” he says. “But it isn’t the whole story.” He attributes these decreases to an overall drop in claims frequency. “Claims frequency is down,” explains White, “because of a number of factors including tort reform, aggressive claims defense, wider use of alternative dispute mechanisms including arbitration, and the patient safety movement.” All things considered, for physicians in one of the worst states to endure professional liability claims, things are looking up. The reduction in claims frequency has had a positive effect on medical professional liability insurance (MPLI) premiums statewide. SNL Financial provides data included in annual statements from all Florida MPLI carriers. Direct written premiums for those Florida MPLI carriers in 2006 and 2007 indicates that Florida doctors paid $184,410,000 less for their MPLI coverage in 2007 than they did in 2006. Mr. White explains, “If we assume that rates decrease an average of another 12% statewide for 2008, then Florida doctors will have paid $263,952,000 less in 2008 than they did in 2006, for a cumulative savings of $448,362,000.” Unfortunately, according to White the future of Florida’s professional liability climate is uncertain. Several indicators suggest that things could get worse. First of all, the United States economy seems to be gearing down for a recession. During a recession, claims frequencies in all lines of insurance begin to rise. “Unfortunately,” says White, “it’s just not something we can control.” In November 2007, the nearly five-year span of relative professional liability calm came to an abrupt end. Juries in four separate trials awarded plaintiffs verdicts of over $30 million. It is the highest concentration of such large verdicts to ever occur in Florida. Historically, large verdicts
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like these tend to attract more lawsuits. Already in 2008, plaintiffs are winning jury trials more often than they have in the recent past. However, the greatest potential threat will be determined in Tallahassee. Several members of the Florida Supreme Court, some of whom are proven friends of medicine, will soon resign or retire. Recently, Justices Raoul G. Cantero III and Kenneth B. Bell announced their resignations effective September and October, respectively. Meanwhile, Justices Charles T. Wells and Harry Lee Anstead face mandatory retirement next year, when they both turn 70 years old. Since the Florida Supreme Court consists of only seven members, the four new appointees will have a major impact on determining the constitutionality of the cap on noneconomic damages passed by the Legislature in 2003. The four new justices will be selected by Governor Charlie Crist, who will choose from a list of recommendations from Florida’s Supreme Court Judicial Nominating Commission. The Commission is responsible for identifying qualified candidates who ultimately will be selected by the governor for Florida’s high court. Fortunately, the Judicial Nominating Commission may include members from a range of professional practice areas and is not limited to the legal profession. Two of Florida’s most dedicated physician advocates, Dr. Andrew Borom, Chair of the FMA PAC 1000 Club, and Dr. Rick Lentz, a former FMA President, have both submitted their names to Governor Crist for consideration. Whether they will be selected, and whether Florida’s physicians ultimately will influence the next judicial appointments, remains to be seen. According to White, physicians can do more than simply wait and see. “We have to work together,” he concludes, “and protect the progress we made five years ago.” Comments? Email us at communications@medone.org
Summer 08 Florida Medical Magazine 63
Point - Counter Point
Ray Bellamy, MD and David M. McKalip, MD
The Future of Reimbursements
On July 1, 2008, Medicare cut reimbursements for physicians by nearly 11 percent. This unprecedented decrease is just one of numerous obstacles threatening the financial well-being of Florida’s physicians. Across the state, and throughout the nation, physicians understand that the future of reimbursement must change. Two primary schools of thought have developed. Some physicians support a universal health care system, created and sustained at the federal level, eliminating or severely regulating any private business interests. Others believe that the principles of a free economic market would regulate on its own, and encourage new, much-needed growth. FMA members Ray Bellamy, MD, and David McKalip, MD, have taken opposite sides on this pressing issue. We invite you to take a look at both views and gain a better understanding of how the future of reimbursements could take shape. 64 Florida Medical Magazine Summer 08
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Ray Bellamy,MD In Favor of a Single-Payer System All signs point to major political pressure for health care reform in 2009. Our present system is unsustainable, costs are rising faster than inflation, the number of uninsured is increasing steadily, and employers are reducing or dropping health insurance coverage for their employees. The question becomes: “What do we want the new way of delivering health care to look like?” My answer is that we want national health insurance — comprehensive coverage for all, unconnected to employment, portable and universal, a package only affordable in single-payer format. A recent survey shows 59 percent of American physicians support a single-payer plan, and recent action by the AMA supports this position (a motion at the December AMA meeting to “reaffirm the AMA’s longstanding opposition to single payer NHI” was defeated). Florida physicians need to inform themselves about proposals for reform and assist in shaping the debate. Will covering the uninsured with comprehensive health care for all be affordable? The short answer is “yes,” but only with a single-payer system eliminating the massive waste and excess profits going to the insurance industry along with the associated administrative costs. Current administrative costs are 31 percent, and with the $350 billion saved through a single-payer system, we can have comprehensive, portable coverage for all with no increase in cost. This would include long term care, dental, and full mental health coverage. These figures have been verified independently by health care consultants with the Lewin Group. The exorbitant salaries and profits of the insurance industry and the bureaucratic headaches of dealing with them would have to go. No, this is not socialized medicine being proposed. Physicians would remain private; hospitals would remain as they are. The health care Vice President Dick Cheney obtained for treatment of his cardiac difficulties was socialized medicine. Bethesda Naval Hospital, where his care was obtained, is government owned and the physicians are government employees. That is socialized health care. www.fmaonline.org
What about waiting lists for elective surgery and all of those stories we have heard about England and Canada? There are some problems with waiting for elective surgery in Canada’s single-payer system, but they are being addressed. The median waiting time for elective surgery in Canada in 2005 was 4 weeks. In Tallahassee, my son’s patients wait 2 or 3 times that long for elective hip or knee replacement. Ask any of the 47 million Americans with no health insurance, or the millions more with inadequate coverage, or the families of the estimated 18 thousand citizens who die annually in the US for lack of insurance, or the 1.8 million veterans who have no health coverage, or the 750,000 Americans each year who are in medical bankruptcy because of underinsurance. Ask any of these about the waiting times for elective surgery in Canada, and the question will have a different connotation. What about the plans proposed by McCain, Clinton, and Obama? In my opinion, none of these plans would cover all of us in comprehensive format without increasing costs. Electronic medical records, disease management, competition and market forces, — none of these has been shown to reduce costs. Mandating coverage at the threat of a fine, as Massachusetts has done, is insufficient to force people to buy coverage that they consider unaffordable. Costs are soaring in Massachusetts as well. Insurance works best when there is a large pool of individuals, some healthy mixed in with those who are sick. When those who wish to take a chance on going uninsured are allowed out of the pool, persons with preexisting conditions and others left in the pool must assume greater expense and risk. All other industrialized countries have national health insurance, most at less than half the per capita costs of what we have in the US. On quality measurements of comparison, the US fares poorly in ratings against most of these countries which spend far less. With single payer, would the government make the medical decisions? No. Medical decisions would be left to the patient and physician with policy set by appointed and elected officials in consultation with Summer 08 Florida Medical Magazine 65
66 Florida Medical Magazine Summer 08
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medical experts. Currently insurance companies, with their profits uppermost on their agenda, make many of these decisions.
reduce professional liability expenses for physicians and hospitals because the medical expenses portion of liability awards would be eliminated.
This is more ambitious than the plans proposed by the presidential candidates, but both Obama and Clinton have indicated their willingness to go along with a single payer plan “if the people want it.” My sense is that the 1993 disaster with the Clinton plan has left politicians chastened and reluctant to make bold proposals.
Everyone agrees the present health care system in this country is unsustainable and in crisis. Fortunately, relief is available now in the form of HR676, a bill pending in the US House of Representatives to establish a single-payer system. As a member of Physicians for a National Health Plan (PNHP), I urge you to inform yourself about a single -payer plan’s benefits, and support the passage of HR676. For more information see Info@PNHP.org
How about tort reform and reducing liability costs? Having comprehensive health coverage for all would
Dr. Ray Bellamy is an Orthopedic Surgeon practicing in Tallahassee, Florida.
David M. McKalip, MD Against a Single-Payer System Over the next two to three years, considerable debate will occur about reforming the methods for financing health care for individual Americans. Proposals will range from a complete government takeover to complete abandonment of third party payment in favor of individual financing. Many special interests will seek to advance their own agendas through health financing reform that addresses topics as far-ranging as social justice, corporate welfare, wellness, health disparities and the appropriate role of government in our lives. The quality and quantity of health care available to individual Americans is a pivotal issue and serves as a model for reform in many areas of society.
financing that care. Americans have grown used to health insurance paying for nearly all of their care, with small co-pays and deductibles. Insurance has transformed from being a hedge against unexpected accidents and sickness to an entitlement program. Most people gain their health insurance benefit from their employers (with limited choices), while this benefit lowers their salaries. The employment-based health insurance model flows mainly from the unfair tax advantage given for this benefit— one not enjoyed by Americans for individual purchase of health insurance which is leftover from WW II price and wage controls.
Our FMA Council on Medical Economics has spent over a year analyzing the issues related to health care financing. FMA members have been advised of our working draft of health financing reform through email and our website, and are encouraged to provide feedback.
It is no wonder that about 16.9 percent of our GDP is going to health care, and that the growth of the health care sector has been rapid. In distinct contrast to the remainder of the American economy, the most powerful engine of cost and quality control is missing — the consumer. When people make complex decisions about purchasing a car, computer, house, or life insurance, they do so individually and thus drive down costs and increase quality. Not so in the American health economy, where nearly everyone has a third party paying health benefits for routine health care and a fourth party (the employer) picking the policy.
Evaluating reform proposals requires a working knowledge of some facts and an understanding of some common misperceptions. The conclusion of this author is that many of the current challenges facing Americans for access to affordable high quality health care are due mainly to the predominance of third party payment as a means of www.fmaonline.org
Summer 08 Florida Medical Magazine 67
Many people will argue that the best way to solve the problems in our health economy is to revert to a singlepayer system in which the government sets the standards for payment, coverage and even medical care. Sadly, the track record of those systems is not good. There is no dispute that people in Canada wait longer for elective surgery. Dr. Brian Day, orthopedic surgeon and President of Canadian Medical Association, tells of young athletes waiting over a year for knee replacement surgery and then ending up severely disabled when they can’t get it in a timely fashion. Cancer survival rates in the U.K. are vastly lower than in the U.S. There are queues that the privileged and well-connected can bypass, and disparities between urban to rural settings. There is lack of innovation and paucity of advanced technologies. The myths of the value of a single-payer system are well-described by John Goodman in his book, “Lives at Risk,” and a summary is available on the website of the Cato Institute. “Forty-seven million uninsured Americans” is a frequently quoted number used by many as a premise for reform. Sadly, proponents of third party payer empowerment and others use this misleading number to create a crisis mentality and push their solutions. The fact is that 9.7 million of these are not American citizens. Over 16 million more make more than $50,000 (the American median income is about $48,000) and have not found enough value in insurance to purchase it. Additionally, 45 percent of this number are miscounted because they are only uninsured for less than 4 months. Only 26 percent are uninsured for more than a year. Finally, the percentage of Americans without insurance has not changed from the 15-16 percent range for many years. Yet, based on this number, there are calls for mandates for all Americans to buy private, but unaffordable, insurance (a solution now failing in Massachusetts).
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The AMA supports an insurance mandate and now supports providing tax relief for health financing only to those with lower incomes who purchase insurance. This will raise taxes on nearly all Americans earning above an annual limit set by politicians (likely in the $50-$100 thousand range) and also lead to a mandate to purchase unaffordable insurance. These government and private sector insurance options still will deny payment to physicians, harass doctors for years, impose unfunded mandates on their practices, and try at every turn to interfere with the patient-physician relationship. Our FMA Council on Medical Economics is focusing on solutions that will empower consumers, transform health insurance back into a risk-management vehicle, and ensure that the public safety net is a strong one reserved for those in need. Making insurance affordable, returning control to health consumers for routine annual health care, and limiting the role of third parties in the practice of medicine and the patient-physician relationship has the greatest potential to vastly improve access to health care, improve quality, and lower costs. As physicians, we all want the best for our patients and our practices. We understandably are frustrated with the problems that we face and are looking for ways to ensure that we can keep our doors open and get paid for our services. However, we must be wary of solutions that will further empower third parties—the same parties that have led us to where we are today. Dr. David M. McKalip is a Neurosurgeon, practicing in St. Petersburg, Florida.
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Medical Student Section
Christina Katopodis
Profile Name
Jeremy Landon Tharp
Age 24
Hometown Ta m p a , F L
Medical School
3 r d Ye a r S t u d e n t a t UF College of Medicine
Future Plans
Stay in Florida and own his own Family Medicine Practice.
Getting to Know:
Jeremy L. Tharp Jeremy Tharp is a true leader. In addition to being a third-year medical student at the University of Florida, Jeremy also serves on the FMA Board of Governors as the Medical Student Representative. With a bachelor’s degree in microbiology, Jeremy has chosen a specialty in family medicine. “When I was going through undergrad, I spent some time with a good friend in family practice in Tampa,” says Jeremy. “I really enjoyed it. I realized the impact that a family physician could have on patients’ lives. I always www.fmaonline.org
came back to that in medical school. It’s the right fit.” Jeremy’s passion for helping others makes him a good fit for the FMA. “Medicine can give you some financial stability and job security, but for me it’s more than that. Through practicing medicine, you can make a difference. You can wake up every day and feel excited to go to work.” But not everything about practicing medicine is exciting. Increasing regulations and decreasing reimbursement rates have made
knowing the ins-and-outs of business increasingly important. “You have to be business savvy,” says Jeremy. “You have to broaden your approach to practice if you want to be successful. A background in business would be great, but we don’t get very much of that in medical school.” In addition to studying outside of his 80-hour work week, Jeremy feels students need to educate themselves in management, marketing, and finance. When Jeremy isn’t studying or working, he makes time for sports, friends, and reading “non-medical” Summer 08 Florida Medical Magazine 69
literature. He also enjoys spending time with his family. “My parents are on call for me 24/7,” he says, smiling. “They have always supported me no matter what. They taught me about building character, investing in people, and the important things in life. They taught me about faith in God.” With his parents and faith at the center of his support system, Jeremy knows the importance of having a strong foundation during medical school and residency. Concerns of medical students today extend beyond passing medical school to choosing a place for residency and tackling medical school debt. However, Jeremy, like others, has no trouble sleeping. “I’m usually exhausted,” he says.
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Despite this, Jeremy is proud to be part of a generation that will shape the future of medicine. “I think medicine is going to change a lot in the next couple of decades,” he says. “We’ll see more technological advances. The knowledge base in medicine will continue to advance. There are a lot of areas that need to be improved. It’s this generation of doctors coming now who have the responsibility to make these improvements. Many of these things are going to come to a critical point with the insurance crisis and the professional liability situation. It’s exciting.”
to physicians, and enabling them to better treat their patients.” Jeremy plans to stay involved. “One of the great benefits of the FMA is having the opportunity to meet people. FMA leadership has devoted much of their time and energy to shaping the future of medicine — they have shaped organized medicine into what it is today.” Following residency, Jeremy plans to stay in Florida. In twenty years he sees himself married and raising a family. “That is very important to me,” he said. “I would like to open my own practice, and I’m sure I’ll still be involved in the FMA.”
Jeremy believes the FMA plays an integral role in the future of medicine in Florida. “The FMA is working to return some of the power
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We Need You CONNECTING THE DOCS Share your knowledge with students and young physicians through the FMA Mentorship Program. Play an active role in shaping the future of your profession. FMA Mentorship Program for Florida students, residents, and fellows
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70 Florida Medical Magazine Summer 08
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Political Profile
John Tyler
Eleanor Sobel is always looking for ways to
Give Back
After nearly two decades of teaching special education, and helping to build her husband’s dermatology practice, Eleanor Sobel successfully ran for office. This year, as she campaigns for a seat in the Florida Senate, Sobel hopes to continue a political career throughout which she has been a consistent friend of medicine.
In 1992, she became a Hollywood City Commissioner. She also joined the Broward County Medical Association
After graduating with master’s degrees from Columbia University and the City University of New York, Sobel, a native New Yorker, began her teaching career at home. “But the winters in Brooklyn are just terrible,” said Sobel. “My parents often vacationed in Florida, and I just loved it. You can’t beat that weather.” Once her husband graduated from medical school, the two of them moved south to Hollywood to open a medical practice. “One of the first things I did was join the Alliance,” said Sobel. “I was always looking for ways to help doctors, because they’re very close to my heart.” In addition to her husband, Sobel has several other physicians in her family. Her brother, brotherin-law, and daughter all practice medicine. During this period, Sobel continued teaching. At Broward Community College, she taught adult special education courses, and also worked as a substitute for the Pine Crest School in Fort Lauderdale. When she wasn’t teaching, Sobel helped develop her husband’s practice. “I did the hiring,” she said, “and helped modernize it. Computers were being used more in medical offices, and I made sure we had one.” Between her time in education and in a modern medical practice, Sobel laid the groundwork for a new career in public service.
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Auxiliary, continuing her involvement in organized medicine. Then, in 1998, Eleanor Sobel was elected as the State Representative of Florida’s 99th District. “As a member of the House, health care was always one of my top priorities,” said Sobel. She served
Summer 08 Florida Medical Magazine 71
as Vice Chair of the Health Care Regulation Committee and as a member of several others. Throughout her years in the State Legislature, Sobel fought for legislation that would improve the practice of medicine for patients and physicians. Of course, the fight is far from over. Sobel hopes to continue her advocacy as a member of the Senate. “I want the new way of medicine to reflect the old,” she
“Right now, Medicaid reimbursement is flat-out inadequate,” she said. “It shouldn’t cost physicians money to
physicians, and protect the integrity of the profession. Finding a solution to decreasing reimbursements is also one of Sobel’s top priorities. “Right now, Medicaid reimbursement is flat-out inadequate,” she said. “It shouldn’t cost physicians money to participate in the system.” Ultimately, Sobel also hopes to return greater control to physicians. “So much stands in their way these days,” she said. “As for me, when I need medical help, I see a doctor, not the bureaucrats.” Working cooperatively with insurance companies and others, Sobel hopes to reduce outside influences and provide physicians with more freedom to focus on the practice of medicine.
par ticipate in the system.” said. “There was a time when doctors alone were doctors. Now, everyone thinks they can do what physicians do. It’s outrageous.” Sobel hopes to pursue legislation that will further limit the scope of practice for non-
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For now, Eleanor Sobel continues her campaign, and remains active in public service as a member of the Broward County School Board. She looks ahead to November with confidence, and a renewed desire to stand by Florida’s physicians.
Reasons to JOIN the
FMA PAC 1 2
The FMA PAC Supports candidates running for the State Legislature that support and protect medicine. The FMA PAC stands as one of the premier PAC’s in the state and is considered one of the best medical PAC’s in the nation. Our candidates WIN. Over 85% of FMA PAC-supported candidates won their legislative races in 2006.
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Medicine’s adversaries raise enormous sums of money to keep promedicine candidates out of office. Medicine’s friends, through the FMA PAC, must dig deeper to raise equivalent or greater amounts of funds.
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The upcoming election cycle will bring new challenges to how you practice medicine. FMA PAC support can make the difference between victory and defeat.
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With grassroots support from thousands of physicians, medical students, and Alliance members, elected officials know they are hearing the voice of medicine when the FMA PAC speaks.
Join Today @ www.fmaonline.org/fmapac 72 Florida Medical Magazine Summer 08
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Florida SHOTS™.
The antidote to record-keeping fatigue. Already entering your shots into some type of medical software? Then Florida SHOTS data upload is just what you’re looking for to boost efficiency. Capture historical information from your existing records for input into Florida SHOTS
To see a list of participating medical software providers, visit www.flshots.com/resources/upload.html.
without having to re-key all of those immunizations.
877-888-SHOT www.flshots.com Florida SHOTS, a statewide, online immunization registry, is a program of the Florida Department of Health. Endorsed by the Florida Pediatric Society, the Florida Medical Association, and the Florida Osteopathic Medical Association.
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Summer 08 Florida Medical Magazine 73
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