The Stethoscope Winter/Spring 2022

the

Stethoscope WINTER / S P RING 2022

MEDICAL BULLETIN OF THE VOLUSIA COUNTY MEDICAL SOCIETY

TH E S TE TH OS C OP E | WI N TE R / S P R I NG 2 0 2 2

1

2

T H E S T E THO SCO PE | WIN TER / SPRIN G 2022

the

Stethoscope TABLE OF CONTENTS President’s Message.................................................................................4 Food for Thought Goes Cruising.............................................................6 Is Conventional Wisdom Costing You Money?........................................8 Medicare Requires 60 Percent of Your Medicare Patients Have Their Annual Wellness Visits This Year! Are you Ready?.............................................12

VCMS is Here for You Overloaded? Stressed? You’re not alone. Does your workday start before dawn and end well after dusk? Do you go to bed tired and wake up the same way? Maybe it’s time you talk to someone who can help you make positive changes for a healthier, happier life and lifestyle. The VCMS has three professional counselors who are available to you - free of charge - free of worry. This program remains one of the few in the state that serves all county physicians without cost, without question. The sessions are completely confidential and autonomous.

Amanda Nixon

386-301-3355 hackmystress.com

Do You Use SPF, DKIM, and DMARC to Authenticate Outgoing Email?..........................................................13

Dawn Parr Chappel

Three Common Places for Jewelry Theft..............................................15

Karen Ste. Claire Spicer, PhD

386-299-3606 dawnparrchappel.com

Pathography: Patient Centered Ethics...................................................16

386-322-4676 drkarenspicer.com

2022 Legislative Recap from Physician’s Society of Central Florida.....................................................................18

Special thanks to AdventHealth Daytona Beach and Halifax Health Medical Staff who are helping the VCMS fund this program.

EXECUTIVE COMMITTEE Nichole Robinson, DO............................................................... President J. Richard Rhodes, MD...................................................... President-Elect Robert Feezor, MD..................................................................... Secretary Amol K. Gupta, MD.................................................................. Treasurer Andria Klioze, MD .......................................... Immediate Past President Elizabeth Eads, DO .................................................... Board of Directors Steven Miles, MD ...................................................... Board of Directors

COMMITTEE CHAIRS Bridget Highet, MD ...................................................... East Volusia Rep Open ............................................................................ West Volusia Rep Betsy Eads, DO ....................................................................... FMA PAC Open.......................................................................... Membership Chair J. Richard Rhodes, MD ................................................... Professional/PR Lauren Girard, DO ................................ Young Physician Representative

NOMINATING COMMITTEE CHAIRS Tamara Clancy, MD | Michael Diamond, MD

RESIDENCY PROGRAM REPRESENTATIVES Nicholas Stagliano, MD | Joseph Jones, DO

FSU STUDENT REPRESENTATIVES Joshua Boyd | Michael Krusick

Medical Bulletin of the Volusia County Medical Society P.O. Box 9595 | Daytona Beach, FL 32120 | Published Quarterly Cover photographs and stories for the Stethoscope are gladly accepted from members of the Volusia County Medical Society. If you are interested in submitting a cover photograph or article, please contact Sami Bay, Executive Director, 386-255-3321. The opinions expressed in the Stethoscope are those of the individual authors and do not necessarily reflect policies of the Volusia County Medical Society, its committees or members. The Stethoscope reserves the right to edit all contributions for clarity and length, as well as reject any submitted material. We greatly appreciate our advertisers, however the inclusion of an advertisement does not imply endorsement.

VCMS Launches Modernized Website The Volusia County Medical Society reactivated its updated and modernized website: www.vcms.org.

Relaunching was the culmination of 90+ days of collaboration between VCMS Executive Director Sami Bay and the Orlando Medical News’ Lead Website Designer, Jennifer Cerna. The process leveraged multiple strategy sessions to understand VCMS leadership’s vision, as well as how the modernized website could best serve membership and the Volusia County community. “www.VCMS.org now functions as an “Information Hub” for membership and the community,” shared Sami Bay. Visitors marvel during their initial visit about the website’s flow and ease of attaining both Clinical & Business of Medicine information. Examples: • Referral-generating membership and directory • Legislation • Board of Medicine • Health department & community resources • Healthcare Career Classifieds • Revenue opportunities to assist sustaining the VCMS • Many other features “The Show It Platform provides VCMS never e njoyed ability to edit, flexibility, and eliminates costly workorder fees inherent to the former “code burdensome” WordPress platform,” shared Jennifer Cerna.

Continuous improvement is the goal. Please visit www.VCMS. org and share your feedback; Docs420@aol.com. Correctable errors can only be addressed with membership’s help. Please visit www.VCMS.org this week.

TH E S TE TH OS C OP E | WI N TE R / S P R I NG 2 0 2 2

3

Connections.

President’s Message

Dr. Nichole E. Robinson Today, everywhere we look, listen, click, surf, and even Zoom, we are connected. 24/7.

A virtual avalanche of information overload: conversations, political propaganda, sales solicitations, opinions, advice, gossip, “news,” and even more endlessly tempting, yet detrimental distractions from our time, our relationships, and the best of what life has to offer. But more and more each day as a society, we actually feel more disconnected, more distanced, empty, and alone. The data, of course, shows this, but it doesn’t take a genius to notice, even the simplest among us have noticed, that this is all around us. We see ever more evidence daily, especially on a local, gut-level. We see and hear of neighbors and colleagues who have never really spoken to each other, so many people living alone, and increased stories of suicide all around us. Although we can literally “connect” to almost anyone instantaneously anywhere in the world, the conversation seems to be one way only.

The entire world is talking but no one is really listening. To have a real, human conversation – and therefore a human connection – requires that we be present in the same room, at least occasionally.

It requires that we breathe the same air, 4

T H E S T E THO SCO PE | WIN TER / SPRIN G 2022

that we present and react spontaneously and unconsciously to the unspoken, almost imperceptible nuance of emotions just lurking beneath the surface of the masks we all wear, the emotions so easily hidden from view when “communicating” electronically. We can do better, and for the sake of all – our patients, our community, our families, and ourselves we must do so, and now.

Of course, the current COVID-19 pandemic has emphasized more than ever that humans need to have connections. Real. Tactile. Not virtual. And so, ironically, it has exposed the more pervasive, more insidious, and more detrimental pandemic of social isolation, which has been here all along, growing steadily, silently, exponentially, like an incurable cancer. To have face to face, human interaction with patients, colleagues and community is not only beneficial, it’s essential. It’s primal.

As we move ahead in a world that continues to become more technologically advanced and, frankly, ever more obsessed with efficiency, we diminish the human connection. It becomes easier and easier to remain at arm’s length, more removed, more disconnected. We have meetings via Zoom, or TEAMs, and we complete our CME virtually, rather than live and in person – all the while remov-

ing the human element. We hide behind the camera, never fully participating or engaging in the moment. We have social media for our practices now and for years advertising budgets continued to grow. In as much, there is an ever-growing group of physicians, both veterans and new, who have lost sight of the value of being a part of the VCMS, of being a part of the broader community, much less the professional community. But sadly, this loss of vision or focus has consequences, for them and for all of us.

This year, my desire is to restore VCMS membership to historic levels and foster the camaraderie, cooperation, and connection of years past. By continuing and expanding our community outreach, I hope that we can connect to those in need, while simultaneously improving the visibility and utility of VCMS, both to its members and the public. VCMS must evolve, so I ask that you actively participate, at least a few times a year, and that you tell us what changes you would like to see to remain invested. What would make VCMS better? What would help you and the community the most, and more importantly, what would draw you back to VCMS? By doing so, we can better serve you and the public.

When I was the VCMS Member-

ship chair, my platform motto was “Get Invested. Let’s Get Connected.” Getting Connected is not a slogan. It’s a reminder for us to not forget that the essence of medicine is not merely data or studies but the essential art of medicine, which is human connection. Actively listening, understanding, and responding to the physical needs and even perhaps more important, psychological, and emotional needs, too. Getting Connected means a return to a somewhat anachronistic but better way of doing medicine, of being a part of the community, and of actively caring for each other. Whether it’s your neighborhood, your town or even your medical society, we all benefit more by having real, active in-person relationships. And we must remember that being efficient, while ever important, must be ultimately subservient to efficacy. Just as we must heal the whole patient and

not just the disease, we must put in the time and effort – no matter how precious – to nurture human connections with our neighbors, our patients, and our colleagues in the community. Being virtually connected to your medical society or community has its place; real is infinitely better.

The history of medical societies dates to the late 18th century, as professional and scientific organizations originated initially by state, then eventually by county. They served to promote the interests of the physician members, and to ensure high quality health care for patients in the community. They served as the local voice of medicine, by providing governmental advocacy and by protecting and strengthening medical practice in the area. Years ago, too, the town doctor was a pillar of society not because he ‘was a doctor.’ It was because

Experience the Ultimate in Luxury

he knew everyone, and everyone knew him. Not just by name, but by person, by circumstance, and through an actual relationship. The physicians all knew each other well, and social interaction was much broader than today. Today that is, of course, more difficult but is ever more necessary. There is an urgent need for connection, for bilateral communication. Long forgotten but hidden within that need is an opportunity and benefits for us as physicians as well. By becoming more actively and intimately involved in our communities, both local and professional, we can make a collective difference to our neighbors and colleagues, and simultaneously help our profession thrive. We can become more visible and strengthen the appreciation of what we bring to the community. So, I ask each of you to “Get Invested. Let’s Get Connected.” 

Your VCMS & the Orlando Medical News is once again bringing you an experience outside of the norm...an encounter that will get your heart racing and your adrenaline flowing. Gary Yeoman’s Lincoln is hosting VCMS members for a one-of-a-kind test drive event with the newest Lincolns - the jewels of the fleet. Catered by Supper Club 31, this evening is destined to become an occasion to remember.

APRIL 20, 2022 | 5:30-7:30PM GARY YEOMAN’S LINCOLN IN DAYTONA BEACH

RSVP BY APRIL 13 Laughter, libations, and luscious hors d’oeuvres with test drives during the first hour.

Prospective members and guests welcome! RSVP required for proper headcount.

TH E S TE TH OS C OP E | WI N TE R / S P R I NG 2 0 2 2

5

Food for Thought Goes Cruising for Quality of Food for Ambiance for Price for Service Cleanliness & Safety

Wow, finally after more than two years of isolating, the cruising industry has finally opened up. After Lisa and I both showed our negative Covid test 2 days prior to boarding as well as proof of our vaccinations and boosters, we were able to board the Celebrity Silhouette.

The cruise company limited the ship to about 2/3 capacity and the 1000 crew members all tested negative prior to this sailing. Once onboard, masks were only required in the casino and theater areas.

All crew members still had to wear N95 masks throughout the voyage. No smoking was allowed inside the ship itself. Those that smoked were only allowed to do so in one tiny area on the upper outer deck away from others. As far as our balcony cabin, we had fresh sea air and were also informed of the following: “The heating, ventilation and air conditioning (HVAC) systems on our ships con6

T H E S T E THO SCO PE | WIN TER / SPRIN G 2022

tinuously supply 100 percent fresh, filtered air indoors. You can breathe easy knowing the robust system’s layers of protection make the transmission of aerosol particles between spaces extremely low to virtually impossible. This has been validated in an independent assessment conducted by the University of Nebraska Medical Center and National Strategic Research Institute.”

We felt extremely safe.

We did have to wear our masks at most of the ports we docked at, both indoors and out!

Now why we are all here...for the food! First off, the buffet that cruise lines are noted for was no longer self-serve.

Before you even entered the buffet, a crew member would squirt your hands with antibiotic hand sanitizer. Then you would go up to the counter and tell or point to the servers your choice of food and the server would dish out the food and hand it

to you on a cloth napkin so there would be no touching. All counters were protected with glass shields. Very safe. And the buffet food was incredible, too. They even had a whole counter area for vegans and vegetarians everyday. Also, there was an area for gluten free diets. As for variety, they served almost everything from American dishes to Indian, Mexican, Italian, seafood, Spanish, Tapas, French, British and Asian.

All wonderful. Deserts galore, too.

As far as sit-down dining, our ship had a multitude of specialty restaurants that you could pay a modest upcharge for. These included a steak and seafood restaurant, Italian fare, Sushi, and French.

Also, there is a very unique restaurant aboard Celebrity not found on any other cruise line. Le Petit Chef in the Qsine dining room.

You enter the room at your assigned continued on page 10

It's Luxury, the Yeomans way.

DAYTONA

(386) 868-4112

GaryYeomansLincoln.com

1410 North Tomoka Farm Rd • Daytona Beach, FL 32124

Custom, Private Wholesale, Fine Jeweler Specializing in all things Jewelry

386-243-4399

YeomansGems.com | @YeomansGems TH E S TE TH OS C OP E | WI N TE R / S P R I NG 2 0 2 2

7

Is Conventional Wisdom Costing You Money?

BY J. MICHAEL BASS

We have been the victims of conventional wisdom since the beginning of time. The earth is not flat. Bloodletting is not a valid medical treatment. A human being can run a mile faster than 4 minutes. Elvis really is dead!

Let’s just say, conventional wisdom is often wrong. A very wise man once asked me, “If what you know to be true, turns out not to be true, when do you want to know it?

This issue can be even more compelling when it comes to our personal financial picture. Stephen Covey, in his book, The 7 Habits of Highly Effective People, pointed out we can get caught up in climbing the ladder of success only to discover it’s leaning against the wrong wall. You’re only going to retire once; you think you might want to get it right?

The following statements represent some of the conventional wisdom of the day concerning financial matters.

But are they true?

Picking the best investments will make you wealthy.

Too many people believe the path to riches is finding the best investments.

This is wrong on so many levels. First, it ignores what you’re doing with the rest of your money. What if you’re making mistakes in how you pay your taxes; making major purchases like cars, college educations, and weddings; saving for retirement; selecting the right insurances; handle

debt; etc.? The truth is making better decisions with your money is the path to riches. When you make poor financial decisions, you put more pressure on your investments to make up the difference.

This can cause you to take too much risk.

Speaking of risk, this is the most overlooked factor of selecting investments or an investment strategy. Looking at return without considering the risk is like driving a car without brakes! The risk/return tradeoff is imperative. If you can’t stand the risk, you will sell out too soon and not be around to enjoy the return.

The fact of the matter is investments are not good or bad. They’re like tools.

You use the one that fits its intended purpose. To do that you need an investment strategy that works. Most people don’t even have an investment strategy, and if they do, they are likely to abandon it when it looks like it’s not working.

The point is, trying to pick the winners is not the answer to growing your wealth!

Pay your house off as soon as possible! Pay cash for everything!

The problem is, most people think if they owe money they are in debt. There is a difference between debt and leverage.

Debt is when you owe money you can’t pay back. Leverage is when you choose to borrow money to pay for something even though you have the money to pay for it.

There are a couple of issues here.

First, paying your house off gets you

nothing. Equity does not grow. Real estate appreciates whether the house is debt free or mortgaged to the hilt.

Therefore, the equity you have in your house earns nothing. It’s dead money!

Second, there is no such thing as paying cash. What you’re really doing is self-financing. When you take money out of an investment to pay for something, you not only lose that money forever, but you also lose the growth on that money. Even if you pay yourself back, you will never make up for the money you lost.

A couple of caveats here. You must have an arbitrage between your borrowing rate and your investment rate. And you can make the payments without interrupting the funding of your investments. If you can’t do that, you can’t afford it.

You’ll pay less taxes in retirement.

Sorry to disappoint you, but the only way this one is true is if you’re living off Social Security. One of the many reasons you will pay more taxes in retirement is you deferred the taxes on most if not all your retirement savings. Remember 401(k)s and IRAs? You did not defer it, you just postponed it. In retirement, when you have little or no ability to control your income, you will be paying 100 percent ordinary income tax on every dollar. Oh, and you get to pay taxes on up to 85 percent of your Social Security.

Not to mention you may get the privilege of paying extra for your Medicare. continued on page 10

The information given herein is taken from sources that IFP Advisors, LLC, dba Independent Financial Partners (IFP), IFP Securities LLC, dba Independent Financial Partners (IFP), and its advisors believe to be reliable, but it is not guaranteed by us as to accuracy or completeness. This is for informational purposes only and in no event should be construed as an offer to sell or solicitation of an offer to buy any securities or products. Please consult your tax and/or legal advisor before implementing any tax and/or legal related strategies mentioned in this publication as IFP does not provide tax and/or legal advice. Opinions expressed are subject to change without notice and do not take into account the particular investment objectives, financial situation, or needs of individual investors. This report may not be reproduced, distributed, or published by any person for any purpose without IFP’s express prior written consent.

8

T H E S T E THO SCO PE | WIN TER / SPRIN G 2022

Your Single Source for Healthcare Real Estate Healthcare Real Estate & Development Services, LLC • Brokerage Services • Consulting Services • Property Management Services

FRANK RICCI

SPECIALIZING IN MEDICAL OFFICE

FrankR@HealthcareRealtyOnline.com

• • • •

407-947-5074

Licensed Real Estate Broker Licensed Building Contractor Medical Facility Project Manager

Medical Office Buildings Surgery & Diagnostic Facilities Senior Living Facilities Mixed Use Developments TH E S TE TH OS C OP E | WI N TE R / S P R I NG 2 0 2 2

9

Food for Thought Goes Cruising

Is Conventional Wisdom Costing You Money?

continued from page 6

continued from page 8

time where you are led to a table with a white surface, white plate, glass, and silverware. You are told not to touch anything on the table until served. Once everyone is seated, the lights are dimmed and a tiny 3D chef appears on your plate. Our first course was Bouillabaisse, a traditional Provencal fish stew which originated from Marseille, France. Our white table was transformed into an aquarium before our amazed eyes in which the little chef fished and threw in the ingredients including mussels, clam, octopus, and fish.

Then he was washed away by a wave and the actual dish placed on our table by our waiter. This was then repeated with our petit chef cooking a steak, lobster (which he lassoed and rode on like a cowboy), and desert which he flambéed.

Disney would be so jealous!

Lisa and I paid a little extra for our assigned dining area called Blu. This area actually was for guests wanting “healthy eating options.” You could order from this menu or from the standard less-healthy eating option menu if you wished.

The one large splurge that Lisa and I chose to do was Celebrity’s Chef Table sponsored by Daniel Boulud. His Michelin starred restaurant in NYC is one of my favorites.

He was asked to become the gourmet chef for Celebrity and of course he accepted. He has worked with each head chef of all the Celebrity ships to assure they follow his menu. And he sends all the ingredients and spices to the ships for the Chef Table. Only once a cruise do they offer it. I booked it 6 months ago to assure we had 2 of the 8 spots offered. It was worth it. Our head chef did not let us down. It was so great that the next day Lisa and I spent an hour interviewing him for this article.

Kuntal hails from Calcutta, India where he became enamored with cooking while watching his Mom prepare large family 10

T H E STE THO SCO PE | WIN TER / SPRIN G 2022

meals. They would spend their free time together watching food shows on TV to get new ideas to try. He went to school for a degree in Hospitality Management in Scotland and received a degree from the Culinary Institute of India. He then became the head chef of the Taj Hotel Chain in Mumbai. Kuntal was so well received that he served as Chef for the Prime Minister of India from 2005-6. He also had some training with Gordon Ramsey.

Kuntal has been with Celebrity Cruise Lines since 2007. He uses 150 different spices in his culinary creations. He believes that 50 percent of the enjoyment of food comes from its presentation, 35 percent from the smell, and only 15 percent from the taste itself.

Our meal consisted of 5 courses. Each was paired with a wine if you wished.

First came a savory hot curried cauliflower soup made with saffron and apples with a few dollops of cream. Second was an outstanding mushroom risotto persillade with aged parmesan. Are you drooling yet? Third was a heavenly Mediterranean Seabass with za’atar and seasoned with fennel, sweet pepper, and a lemon vinaigrette. Fourth a magnificent duo of beef filet and short rib with a root vegetable boulangére, and a mushroom - red wine sauce. Finally, the 5th course - desert. A fantastic creation of a Java Grand Cru Cacao, Sumatra Coffee Crémeux with a chocolate Borneo Spice Ice Cream!

And, of course, there’s more! The chef gave each couple Daniel Boulud’s book of French Cuisine! It must weigh 10 lbs!

Great book for display in your living room.

All in all, it was such a wonderful trip and so nice to get back to a more normal environment. We wound up booking another cruise for 2024 while on board the ship.

This time it will be to India and Asia.

Stay tuned for the review of that trip. 

Net worth is a measurement of wealth.

Who came up with this one? Your net worth statement is nothing more than a point in time estimate of what your assets are worth. It’s really a personal balance sheet. Ask any business owner if they use their balance sheet to run their business?

Of course not! They use their Profit and Loss statement and manage cash flow.

Remember this, assets that cannot be converted to cash or cash flow when you need it are worthless. The dirty little secret in the financial services industry is they do not know how to create sustainable cash flow when you need it. The main reason is they cannot figure out how to get paid to do it. Here’s a novel idea, if what you want in retirement is cash flow, why don’t you plan for that in the beginning?

Revenue – Expenses = Profit This one actually is true! Unfortunately, it leads one to believe profits are what fall out after everything else has been accounted for. What’s worse when you do make a profit have you ever wondered where it went? I’m reminded of the old Wendy’s commercial, “Where’s the beef?”

So, where’s the cash? A simple adjustment to the formula produces a dramatically different outcome. Revenue - Profit = Expenses. Many of us learned this principle when we were children with our piggy bank. Pay yourself first! So, it turns out your mother may have been the best business coach you ever had.

We just wanted you to know there is a better way.  J. Michael Bass, CFP®, CIMA®, is the President and CEO of PrimeQuest Wealth Strategies in Altamonte Springs, FL. He has over 30 years’ experience helping business owners and professionals learn to make better decisions with their money so they can achieve financial independence. Visit https://primequestwealth.com Investment advice offered through IFP Advisors, LLC, dba Independent Financial Partners (IFP), a Registered Investment Adviser. IFP and PrimeQuest Wealth Strategies are not affiliated.

Looking for Financial Homeruns?

Many people believe the way to achieve financial success is to pick the best investments. This ignores the most important component to investment success which is risk. We believe there is more opportunity in helping our clients avoid the losses than there is picking the winners.

Financial success is far more than picking the winners, it’s Process over Products, it’s Strategic Thinking before Tactical Implementation.

Transferring Your Wealth Away Unknowingly and Unnecessarily?

Is Your Ladder of Success Leaning Against the Wrong Wall?

There are three types of money; Lifestyle money, Accumulated money and Transferred money. Lifestyle money is the money you spend on your current standard of living. The goal is to provide Lifestyle money to secure your financial future. Accumulated money is the money you already have or are currently investing. Most people focus their attention on these dollars to find better investments that potentially pay higher rates of return. The overlooked money is Transferred money. It is the money you are transferring away Unknowingly and Unnecessarily. Focusing on eliminating these wealth transfers can help to solidify your financial future without impacting your current Lifestyle and all with lower investment risk.

Many people spend their entire lives climbing the ladder of success only to find out it is leaning against the wrong wall. What if what you believe to be true turns out not to be true?

How do you know if the financial decisions you have made are leading you to the financial future you desire? We use a Personal Economic Model to help our clients stress test their decisions. It allows you to compare one decision against another to give you a better indication of which decision will give you the intended outcome. Facts vs. Feelings!

OFFICE: (407) 767-7800 | FAX : (877) 767-0745 | INFO@PRIMEQUESTWEALTH.COM MON - FRI 9:00 AM - 5:00 PM | 800 MAITLAND AVENUE | ALTAMONTE SPRINGS FL 32701 E S TE TH OP E | WI N TE R / S P R I NG 2 0 2 2 Investment advice offered through IFP Advisors, LLC, dba Independent Financial Partners (IFP), a Registered Investment Adviser. IFP and PrimeQuest WealthTH Strategies areOS notCaffiliated.

11

Medicare Requires 60 Percent of Your Medicare Patients Have Their Annual Wellness Visits This Year! Are you Ready?

BY DEREK ESTY

With the passing of the affordable care act, Medicare established a new benefit for all beneficiaries, the Annual Wellness Visit (AWV). This recent benefit visit is designed for all beneficiaries to have an opportunity to discuss their health with their providers, to build a plan of care, to help manage current medical concerns and prevent new ones from forming.

AWSs are not the most profitable Medicare visit a practice can perform and have no cost to the beneficiary since all costs are covered at one hundred percent with no copay deductible to the patient.

AWVs are designed for the patient to engage with their providers for an individualized long-term treatment plan of care to ensure that healthy patients stay that way, and sick patients do not worsen. Most patients and, sadly, many providers do not understand what AWVs are or how to perform them. The Centers for Disease Control (CDC) and Medicare have calculated that less than twenty percent of all Medicare beneficiaries received them last year. In fact, those same studies have shown that patients who received the visits saved Medicare over five percent in annual costs and have improved patients’ lives not only in quality, but also in longevity.

12

T H E STE THO SCO PE | WIN TER / SPRIN G 2022

Both providers and patients confuse AWVs with a yearly physical, but the AWV is something else altogether. Yearly physicals focus on the current condition of the patient. AWVs identify ways to keep the patient healthier longer and prevent illnesses from starting or worsening. A significant focus of the annual wellness visit is to ensure that patients have access to all the services Medicare suggests, like preventive care, annual screenings (mammogram, colonoscopy, etc.), immunizations, and other missed services by busy practices. AWVs focus on lifestyle changes, understanding family history, and how the patient can have a life free from disease instead of just treating disease. Patients and providers build a plan of care to help keep that patient healthier longer and address areas that both the patient and the provider need to ensure a better health outcome.

The requirements for an AWV set

by Medicare are why the visits are underutilized. The visit requires the practice to collect and store a large quantity of data about the patient, allowing them to develop treatment plans for existing conditions and annual wellness plans to help prevent future illness. Today, many practices do not have a system to gather all the information required to complete the annual wellness visit, let alone the time

needed to review the information with the patient. Most of what makes up an AWV is gathering and studying patient information and building a treatment plan for care. Still, most practices do not have the time or the staff to accomplish this goal, with medicine changing to more outcome-based versus fee-forservice. Medical practices that adapt now will provide the best care possible and ensure profitability in the future.

Don’t forget that Medicare requires that practices complete AWVs on 60 percent of their Medicare patients this year. How are you doing?  Derek Esty is COO for ThoughtSwift, an early-stage medical software provider of Medical Assessments to Primary Care & Internal Medicine Physicians. Esty created ThoughtSwift with a goal of helping doctors generate additional revenue while providing the highest level of care.

RX2Live is a Health and Wellness Services Company positioned to advance healthcare through the BHS platform. We have been able to help our physicians open better paths of communication with their patients, limit hospital readmissions, diagnose and treat conditions that otherwise might have gone unnoticed and create an environment where the practice or facility can thrive and realize additional growth.

Visit RX2Live or email John Fogarty at Jfogarty@RX2Live.com John Fogarty is regional Developer for RX2Live.

He has spent 21 years in nuclear generation, transmission and distribution. He holds a master’s in International Management. He became an RX2Live developer to improve patient care and help providers and practices succeed.

Do You Use SPF, DKIM, and DMARC to Authenticate Outgoing Email?

What do SPF, DKIM, and DMARC mean, and what do they do?

BY JAMES GENTRY

SPF, DKIM, and DMARC are designed to help confirm that emails that come from your domain are not forgeries or sent by an impostor.

You will need to know a few basic things to understand how this works: • bob.smith@sender.com will be our sender’s email address.

• mary.jones@recipient.com will be our recipient’s email address.

• Email domain: everything on the right side of the @ symbol is the email domain. Therefore, Bob’s email domain is sender.com, and Mary’s email domain is recipient.com.

• *Email spoofing: when impostors send forged emails that appear to come from within your organization.

Now what do those acronyms mean?

• SPF (Sender Policy Framework): SPF provides a way to specify which mail servers are allowed to send an email from your email domain.

When Mary receives an email from

Bob, her mail server checks to see if it came from an allowed server. If it matches, the email goes through. If not, it can be blocked, quarantined, or deleted depending on how SPF is set up.

• DKIM (Domain Keys Identified Mail): DKIM is another way to prove that an email comes from your organization. Outgoing emails are given a digital signature and are secured with encryption. The recipient’s mail system can then confirm that the contents of an email have not been tampered with or changed.

• DMARC (Domain-based Message Authentication, Reporting and Conformance): DMARC uses SPF and DKIM to ensure that an email did not come from an impostor.

With DMARC, you can specify how recipients should handle emails that did not pass SPF or DKIM checks— either by blocking altogether or quarantining into a spam folder.

Why are SPF, DKIM, and DMARC important?

Email spoofing* has become common.

Such emails appear to come from within your organization. Impostors may use malicious links in spoofed emails to commit phishing attacks, social engineering scams, or ransomware attacks.

Example: a spoofed email appearing to come from upper management is sent to a lower-level employee (or other managers) with an urgent request. The recipients, believing that the email came from a trusted source, may be fooled into clicking something dangerous or may follow instructions that lead to ransomware, data theft, or even fraudulent wire transfers.

Likewise, a spoofed email could be sent to vendors, customers, or others— also with an urgent request. Remember: These types of emails are designed to get the recipient to panic and act quickly without thinking.

Using SPF or DKIM can greatly reduce spoofing attacks. Using SPF, DKIM, and DMARC all together can possibly even eliminate spoofing attacks.

Does your business already use SPF, DKIM, and/or DMARC? TH E S TE TH OS C OP E | WI N TE R / S P R I NG 2 0 2 2

13

You or your IT provider can fairly easily determine if your email is authenticated by SPF, DKIM, and/ or DMARC. The method depends on your email provider and whether you have your own email domain. Here are the differences:

If you DON’T have your own email domain: • If you use either Office 365 or Google as your mail provider, and your email domain is either outlook.com or gmail.com, then SPF, DKIM, and DMARC are already set up for you, and you need no further action.

• If you DON’T use Office 365 or Google as your mail provider, you may or may not have authentication in place. Instructions on how to determine follow below.

If you DO have your own email domain:

• If you are using Office 365 or Google, then a basic form of authentication may be set up by default, but for full protection, you or your IT provider will need to ensure that SPF, DKIM, and DMARC are all working together.

• NOTE: If you have your own email domain, it is up to you or your IT provider to fully set up authentication.

As for how to determine what (if anything) you have in place, you can click on the following links. Enter your email domain to get your results: • SPF – https://www.mimecast.com/ products/dmarc-analyzer/spf-recordcheck/ • DKIM – https://www.mimecast. com/products/dmarc-analyzer/ dkim-check/ - NOTE: You must enter your DKIM selector(s) to run this test. Ask your IT provider if you don’t know your DKIM selectors.

• DMARC – https://www.mimecast. com/products/dmarc-analyzer/ dmarc-check/

Do you need help understanding or implementing SPF, DKIM, and/or DMARC? If your business is not using authentication, or if you cannot determine its use with certainty, you will need to ask your email provider or your IT staff to help.

If you don’t have anyone to ask, you can reach out to Atlantic Data Team, and we will help you find out at no charge. We are committed to making the web a safer place. Stay vigilant!  James Gentry is the president of Atlantic Data Team, a central-Florida-based business IT company. If you cannot get a straight answer on whether you use filtering or not, we will be happy to help you, at no charge to determine if you are protected. We are committed to making the web a safter place. For more information go to www.atlanticdatateam.com or email office@atlanticdatateam.com.

Medical Grade IT Professionals High Quality Protection For Your Practice and Patient Data Against: • Ransomware – Devastating and epidemic.

• Phishing Emails – So easy to fall for.

• Stolen/Compromised Credentials – High Risk!

• Data Loss Due To Hardware/Software Failure.

ZeroTrust – The Most Effective CyberBreach Protection Don’t Lose Your Practice To A Cyber Breach!

122 Valencia Shores Drive Winter Garden, FL 34787 407.205.1098 OR 386.677.9295 | ATLANTICDATATEAM.COM 14

T H E STE THO SCO PE | WIN TER / SPRIN G 2022

Three Common Places for Jewelry Theft

BY LYLE TRACHTMAN

Jewelry theft can happen to anyone anywhere and anytime. The three most common places where jewelry is stolen are:

3 The Gym While you are working up a sweat, make sure your jewelry stays where you left. Gyms are a common place for thieves to steal jewelry.

PREVENTION TIPS:

• Make sure you lock your gym locker if you store any jewelry there.

• If possible, keep valuables secured at home when going to the gym.

Working out is one of many activities you shouldn’t do with your ring on anyway.

2 Your Car Your vehicle is the second most common place where jewelry is stolen.

Thieves often steal first and think about the value later – smashing car windows just to peer inside a bag to see if it contains anything worth swiping.

PREVENTION TIPS:

• Do not leave anything of value in plain sight, including jewelry in the cup holder or side door compartments.

• Lock your doors and roll up your windows when you leave your vehicle, even if you think you’re in a lowcrime area. Many cars get broken into within the first few seconds

after the driver steps out of sight.

• If you have a garage, use it. If you park outside, do not leave your garage door opener in the vehicle, providing access to your garage at least, and your home as well for attached units. It may seem like common sense, but you’d be surprised how often these basic tips are overlooked as we rush from place to place on our daily routine.

1 Your Jewelry Box While your home is, and should be your safe space, it’s also the most common place from which jewelry is stolen.

PREVENTION TIPS:

• Store your jewelry in a secure location other than your dresser drawers or jewelry box, especially when you have guests in your home. One option is an immobile home safe. If the safe weighs less than 500 pounds, be sure to bolt it to the floor. Also consider storing seldom-worn jewelry in a bank safe-deposit box.

• Install quality locks on your doors and windows. For exterior doors, install UL-Listed locks with one-inch throw bolts. When practical, keep your doors locked at all times, and always when you leave.

• Having your children use a back door or a door that is routinely monitored if they need quick entry.

• Make it look like you are home when you are not. Use automatic

timers on interior and exterior lights, have your mail picked up daily by someone you trust and keep your yard groomed.

Keep anything of value locked up and out of sight anytime you have people in your home you don’t know all that well – like contractors, painters, maids or even babysitters. You can never be too careful when protecting valuable jewelry in your home.

Insurance for Jewelry • Make sure you have a current jewelry appraisal from a qualified gemologist.

• Make sure you have your jewelry insured for loss, theft, damage and mysterious disappearance. For this you will need to have a jewelry rider.

Check with the company that you have your homeowner policy about a jewelry rider.

• There is also a company called Jeweler’s Mutual Insurance Company.

We insure our jewelry store with them, and they also write a personal jewelry rider. You can contact us for more information: Seabreeze Fine Jewelry, 529 Seabreeze Blvd., Daytona Beach, FL 32118. Phone: 386-252-6135  Lyle Trachtman is the owner of Seabreeze Fine Jewelry and is a graduate in Diamonds and Colored Stones of the Gemological Institute of America.

TH E S TE TH OS C OP E | WI N TE R / S P R I NG 2 0 2 2

15

Pathography: Patient Centered Ethics

BY ABIGAIL SCHIRMER

Familiar Fears I thought had my entire career planned out, until my 3rd year general surgery clerkship.

I learned more than I ever imagined I could as a medical student during six weeks in DeLand, FL— lessons of surgery, medicine, patient care, airplanes, life, and even myself. Unexpectantly, my “perfect” plan changed for the better because of two general surgeons and one, life changing, patient.

This one patient, ironically, had nothing particularly abnormal or complex about her case. She presented with fear and abdominal pain. Symptoms started earlier that morning when experiencing a horrible pain in her lower abdomen after lifting a heavy object. This elderly woman, mother, church-goer, and friend appeared much younger than her stated age. She had no history of health issues, making this a terrifying event for her. After episodes of vomiting, she came to the hospital because she was afraid it could be something serious, which would require her biggest fear—surgery.

It was my first week of the clerkship.

I met her on admission, with NG tube vigorously draining and remarkable concern on her face. It was a look of concern and fear which I knew all too well.

16

T H E STE THO SCO PE | WIN TER / SPRIN G 2022

You see, at the beginning of medical school, I got sick. Not just any cold or flu- I fell ill with a rare medical condition. The fear which accompanied those moments of uncertainty, was something I tackled head on, all while trying to learn medicine as a 1st year student. There was a steep learning curve in handling this mode of fear and adversity, but with support and resilience, I overcame facing the unknown and I hope to utilize my experience to help others face theirs. I attribute part of this resilience to my own grit, but the other part to my hematologist who showed me how effective empathy can be in helping patients feel cared for. Learning empathy became a driving, and distracting, factor as I returned to my healthy self. Now on rotations, I could finally practice it.

Like my hematologist did for me, I attempted to ease her fears and comfort her in a time where she did not have any family locally. We discussed how she was feeling and talked about why she was concerned—she needed someone to listen. We conversed over details of her life and family, not pertaining to her prognosis, but significant to her healing—I knew this once helped me.

At the time, I didn’t think my efforts were any help to her care. I thought, what could a medical student possibly do to help? After interview, examination, and imaging, it was determined she had an incarcerated hernia. I watched my

attending ease her fears of surgery effortlessly, noting how he was able to connect with a stranger in a matter of minutes, as we told her of the need for urgent repair later that afternoon.

As we scrubbed for the case, my attending inquired my field of interest. I adamantly relayed my career plan, “I’m going to be an anesthesiologist”. Little did I know how this would change, and how pivotal this moment truly was.

The patient tolerated the procedure well and the hernia was repaired with no signs of bowel ischemia. In the PACU, we told her everything went well. The face once surmounted by fear, was resolved with relief. Over the next days, we removed her NG tube, she tolerated PO intake, and was successfully discharged with immense gratitude.

On my third week of the clerkship, I was excited to see her in outpatient post-op clinic. We talked about how well she was recovering; amongst other things, as we had established a relationship through the time she was in the hospital. I told her I was very happy to see she was feeling better. She took my hand, looked me in the eye, and thanked me for “just…caring.”

At this point, I had a lot going through my mind. I could never develop a relationship and empathize with patients if I followed through with my original career plan. I recognized I could never quickly fix the problem through

operation, if I wasn’t a surgeon. Did I need to revisit the “perfect” plan I once had in mind? I prayed for a sign for which path I should choose.

On the fourth week of my clerkship, I received a text, “You’ve Got Mail!”.

Alongside it, a photo of an envelope addressed to me. It was a letter written to me from the patient I had cared for.

I fought back tears as I read this letter, recognizing I have written similar words to physicians who cared for me.

She wrote how she sensed that I have compassion much like my surgery attending, and it meant a lot to her to be cared for in that way. She wrote she would “pray for success in my medical career so that other patients would experience the same care that my attending and I afforded her.”

This letter was clearly that sign I prayed for. It was in this moment, because of the relationship with this patient, I choose to pursue a career in surgery.

Before starting rotations, I set an intention to care for patients in the way I have been cared for and the way I’d want my family to be cared for. I hope this intention resonates with my future patients the way it resonated with this individual. She taught me the importance of practicing empathy even when it doesn’t feel effective or helpful— even, if I’m “just” a medical student.

In my final week, one of my attendings told me a quote that I carry with me every day: “It ain’t what you don’t know that gets you into trouble, it’s what you know for sure that just ain’t so.” I thought I knew what my calling was for nearly six years, but it just wasn’t so.

Two exceptional general surgeons and teachers, a relationship with one grateful patient, and a heartfelt, handwritten, letter showed me which path I was meant to take. I owe much of my future career to the influence, teaching, and guidance these surgeons provided and to the opportunity this patient gave me to practice and share empathy in the face of a familiar fear. 

17 Hours: Chris Nikic’s Ironman Story | SC Featured Behind the mantra of getting “1% better every day,” 21-year-old Chris Nikic races to become the first person with Down syndrome to complete an Ironman triath ... https://youtu.be/XsqI-BD2GMs

Growing Practice?

Recruiting Board Certified Physicians • Nurses • Marketing • Administration Nurse Practitioners • Physician Assistants

SHARE your opportunity with 16,000 Physicians & Healthcare Professionals in 8-Central Florida Counties Visit Orlando Medical News Medical Employment

1st Ad Complimentary!

Each additional Classified $25/Mo.

JKelly@orlandomedicalnews.com

407-701-7424

TH E S TE TH OS C OP E | WI N TE R / S P R I NG 2 0 2 2

17

2022 Legislative Recap from Physician’s Society of Central Florida Bills Signed into Law by the Governor: SB 7014 - COVID-19-related Claims Against Health Care Providers by Senator Burgess SB 7014 extends the length of time that health care providers receive certain liability protections from COVID-19-related claims. According to legislation passed during the 2021 Legislative Session, liability protections from COVID-19-related claims apply to claims accruing within 1 year after the effective date of the act, which was March 29, 2022. The bill extends the application period of the liability protections, making them applicable to claims accruing before June 1, 2023. The net result of the bill is to extend the liability protections for about 14 months, from March 29, 2022, to June 1, 2023.

Loan Forgiveness for Physicians Practicing in Areas of Critical Need Budgetary Request While the state pursues mechanisms to ensure access to care in underserved areas, the state already had the statutory framework to provide loan forgiveness for physicians to serve in those communities. The Legislature provided $10 million in the budget to provide loan forgiveness for physicians, nurses, and dentists practicing in underserved communities.

Bills Waiting for the Governor’s Signature: 18

T H E STE THO SCO PE | WIN TER / SPRIN G 2022

HB 817 - Emergency Medical Care and Treatment to Minors Without Parental Consent by Rep Massullo The bill authorizes physicians licensed under chapters 458 or 459, F.S., to provide emergency medical care or treatment to a minor without parental consent. This allows physicians to provide such care in prehospital settings, similar to EMTs and paramedics, or in hospital settings. This became more important due to the Parental Rights legislation passed in 2021 that made it a criminal offence for physicians to render care to minors without parental consent. Effective Date – July 1, 2022.

SB 312 - Telehealth by Senator Diaz Allows a telehealth provider to issue a renewal prescription for a controlled substance listed in Schedule III, IV, or V of s. 893.03, F.S., through telehealth, within the scope of his or her practice, and in accordance with other state and federal laws. Currently, telehealth providers are prohibited from prescribing controlled substances through telehealth unless the prescription is for the treatment of a psychiatric disorder, inpatient treatment at a hospital, the treatment of a patient receiving hospice services, or the treatment of a resident in a nursing home facility.1 The bill narrows this prohibition to the prescribing of only Schedule II controlled substances through telehealth, except under those specific circumstances. The final bill did not include a provision to add “Audio Only” services to the statutory

definition of telehealth. Effective Date – July 1, 2022.

HB 459 - Step-therapy Protocols by Rep Willhite The bill defines “step therapy protocol” as a protocol or program that establishes the specific sequence in which prescription drugs, medical procedures, or courses of treatment must be used to treat a health condition. The bill also requires a process to receive a “protocol exemption”, which is a determination by an insurer or HMO to exempt an insured patient from an existing step therapy protocol. The bill requires an insurer or HMO to publish on its website, and provide to an insured in writing, a procedure for an insured patient and health care provider to request a protocol exemption. Effective Date – July 1, 2022.

The procedure must include: • The manner in which an insured patient or health care provider may request a protocol exemption; • The manner and timeframe in which the health insurer or HMO is required to authorize or deny a protocol exemption request; and, • The manner and timeframe in which an insured patient may appeal the denial of a request. The bill requires an insurer or HMO granting a protocol exemption to specify the prescription drug, medical procedure, or course of treatment approved. Alternatively, an insurer or HMO denying a protocol exemption request must provide a written explanation of the denial, including

the clinical rationale supporting the denial. The written explanation must also describe the procedure for appealing the determination by the insurer or HMO. HB 1099 - Living Organ Donors in Insurance Policies by Rep Latvala The bill prohibits insurers of life insurance policies, industrial life insurance policies, group life insurance policies,

credit life and credit disability insurance policies, and long-term care insurance policies from discriminating against living organ donors, or prospective donors, in coverage or eligibility solely on their status as a living organ donor. The bill makes such discrimination a violation of the Unfair Insurance Trade Practices Act, subject to existing penalties within the Act. Effective Date – July 1, 2022.

Bills that Failed to Pass • Scope of Practice Expansions • Wrongful Death Liability Expansions • Restrictive Covenant Reform • Personal Injury Protection/Auto No-Fault Repeal • Freedom of Speech for Physicians (Prohibition on the Board of Medicine from disciplining physicians for expressing their medical opinion) • Recognizing Additional Athletic Associations

LEGAL & REGULATORY UPDATES Federal Register Notice: CDC’s updated Clinical Practice Guideline for Prescribing Opioids is now open for public comment CDC’s National Center for Injury Prevention and Control is in the process of updating the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain.

As of today, the draft updated Clinical Practice Guideline for Prescribing Opioids is available for public comment in the Federal Register. The public comment period will be open for 60 days, through April 11, 2022. We encourage all patients, caregivers, providers, and others who care about safe, effective, and informed pain treatment options to submit their comments via the Federal Register docket.

It is vitally important to CDC that we receive, process, and understand public feedback during the guideline update process. The guideline is intended to be a clinical tool to improve communication between providers and patients and empower them to make informed, patient-centered decisions related to safe and effective pain care. The guideline recommendations are voluntary and are not intended to be applied as inflexible standards of care or replace clinical judgement or individualized, patient-centered care. To add your voice to the conversation please go to: https://

www.federalregister.gov/public-inspection/2022-02802/proposed-2022-clinical-practice-guideline-for-prescribing-opioids Learn more about the Federal Register Notice and how to submit a comment: • Federal Register: Reader Aids: Using FederalRegister.Govexternal icon • Federal Register: Reader Aids: Videos & Tutorials • View the process and timeline of the draft Guideline update: www.cdc.gov/ opioids/guideline-update/index.html.

New Materials Available for Healthcare Professionals Supporting Pregnant and Postpartum Patients CDC released a new webpage and suite of materials for healthcare professionals as part of the Hear Her campaign, which aims to reduce pregnancy-related deaths. Over 700 women die every year due to pregnancy-related complications, and two in three of these deaths are preventable. Healthcare professionals play a critical role in eliminating preventable maternal mortality. The website contains specific information for obstetric providers, pediatric staff, and other healthcare professionals.

• Obstetric professionals such as OBGYNs, obstetric nurses, mid-

wives, and women’s health nurse practitioners have an opportunity to provide important education to pregnant and postpartum patients about recognizing urgent maternal warning signs. It’s important for obstetric providers to build trust with patients when prenatal care begins and encourage them to share any concerns they may have.

• Pediatricians, pediatric nurses, and other pediatric staff can be an important connection to care for postpartum people. Women can suffer from pregnancy complications up to a year after birth. When doing infant check-ups, pediatric staff can ask moms how they are feeling and listen for urgent maternal warning signs that may be mentioned.

• Emergency department staff, EMTs/ paramedics, urgent care staff, primary care providers, mental health professionals, and many others have an important role to play in asking about recent pregnancy status and recognizing the signs and symptoms of pregnancy-related complications. It’s critical for healthcare professionals to always ask if patients are pregnant or were pregnant in the last year.

Campaign materials include posters, palm cards, shareable graphics, and sample social media content in English TH E S TE TH OS C OP E | WI N TE R / S P R I NG 2 0 2 2

19

and Spanish. Clinical resources and tools from a variety of organizations are also featured. Information for healthcare professionals can be found at https://www.

cdc.gov/hearher/healthcare-providers/index.html.

CDC also supports the American College of Obstetricians and Gynecologists efforts to address readiness in a variety of healthcare settings to identify and manage obstetric emergencies during pregnancy and the postpartum period. More: Commitment to Action:

Eliminating Preventable Maternal Mortality

CDC Mask Use on Public Transportation At CDC’s recommendation, TSA will extend the security directive for mask use on public transportation and transportation hubs for one month, through April 18th.

During that time, CDC will work with government agencies to help inform a revised policy framework for when, and under what circumstances, masks should be required in the public transportation corridor. This revised framework will be based on the COVID-19 community levels, risk of new variants, national data, and the latest science. We will communicate any updates publicly if and/or when they change.

CDC Updates COVID-19 Community Levels CDC updates the COVID-19 Community Level. You can see the new data at https://www.cdc.gov/coronavirus/2019-ncov/your-health/covid-bycounty.html.

FDA Roundup March 22 The U.S. Food and Drug Administration is providing an at-a-glance summary of news from around the agency: • On March 21, the FDA issued a Letter to Health Care Personnel to provide recommendations, including

20

T H E STE THO SCO PE | WIN TER / SPRIN G 2022

conservation strategies, for prefilled 0.9% sodium chloride IV lock/ flush syringes. The FDA is aware the United States is experiencing interruptions in the supply of prefilled 0.9% sodium chloride (saline) intravenous (IV) lock/ flush syringes.

Prefilled 0.9% sodium chloride IV lock/ flush syringes are in shortage because of an increase in demand during the COVID-19 public health emergency. Another recent vendor supply chain challenge includes the permanent discontinuance of certain prefilled saline lock/ flush syringes.

• On March 21, the FDA has added prefilled 0.9% sodium chloride IV lock/flush syringes (product code NGT – Saline, Vascular Access Flush) to the device shortage list and the device discontinuance list. The FDA also added certain discontinued surgical apparel (product codes FME, FXP, FYF, LYU and OEA) to the device discontinuance list.

• On March 21, the FDA issued a recall notice about Philips Respironics is recalling certain V60 and V60 Plus ventilators because a subset of these devices had parts that were assembled using an expired adhesive. If the adhesive fails, it could cause the ventilator to stop providing oxygen to the patient. This failure may cause an alarm to notify the health care provider, or it may not sound any alarm at all. The FDA identified this as a Class I recall, the most serious type of recall. Use of these devices may cause serious injuries, serious health consequences or death.

• On March 18, the FDA approved Ztalmy (ganaxolone) to treat seizures associated with cyclin-dependent kinase-like 5 deficiency disorder (CDD) in patients aged 2 and older. This is the first treatment for seizures associated with CDD and the first treatment specifically

for CDD. Ztalmy is associated with certain risks, which are described in the prescribing information.

COVID-19 testing updates: • As of today, 425 tests and sample collection devices are authorized by the FDA under emergency use authorizations (EUAs). These include 293 molecular tests and sample collection devices, 84 antibody and other immune response tests and 48 antigen tests. There are 75 molecular authorizations and 1 antibody authorization that can be used with home-collected samples.

There is 1 EUA for a molecular prescription at-home test, 2 EUAs for antigen prescription at-home tests, 15 EUAs for antigen over-the-counter (OTC) at-home tests, and 3 for molecular OTC at-home tests.

• The FDA has authorized 28 antigen tests and 9 molecular tests for serial screening programs. The FDA has also authorized 892 revisions to EUA authorizations.

CMS Redesigns Accountable Care Organization Model to Provide Better Care for People with Traditional Medicare Innovation models Medicare Parts A & B Building on the Biden-Harris Administration’s priorities for a better health care system, the Centers for Medicare & Medicaid Services (CMS) announced a redesigned Accountable Care Organization (ACO) model that better reflects the agency’s vision of creating a health system that achieves equitable outcomes through high quality, affordable, person-centered care. The ACO Realizing Equity, Access, and Community Health (REACH) Model, a redesign of the Global and Professional Direct Contracting (GPDC)

Model, addresses stakeholder feedback, participant experience, and Administration priorities, including CMS’ commitment to advancing health equity.

In addition to transitioning the GPDC Model to the ACO REACH Model, CMS is canceling the Geographic Direct Contracting Model (also known as the “Geo Model”) effective immediately. The Geographic Direct Contracting Model, which was announced in December 2020, was paused in March 2021 in response to stakeholder concerns.

As CMS works to achieve the vision outlined for the next decade of the Innovation Center, CMS wants to work with partners who share its vision and values for improving patient care, guided by three key principles. First, any model that CMS tests within Traditional Medicare must ensure that beneficiaries retain all rights that are afforded to them, including freedom of choice of all Medicare-enrolled providers and suppliers. Second, CMS must have confidence that any model it tests works to promote greater equity in the delivery of high-quality services. Third, CMS expects models to extend their reach into underserved communities to improve access to services and quality outcomes.

Models that do not meet these core principles will be redesigned or will not move forward.

Consistent with these principles, the ACO REACH Model, tested under the CMS Innovation Center’s authority, will adhere to the following priorities: a greater focus on health equity and closing disparities in care; an emphasis on provider-led organizations and strengthening beneficiary voices to guide the work of model participants; stronger beneficiary protections through ensuring robust compliance with model requirements; increased screening of model applicants, and increased monitoring of model participants; greater transparency and data sharing on care quality and financial

performance of model participants; and stronger protections against inappropriate coding and risk score growth.

The ACO REACH Model builds on CMS’ ten years of experience with accountable care initiatives, such as the Medicare Shared Savings Program, the Pioneer ACO Model, and the Next Generation ACO Model. The ACO REACH Model provides novel tools and resources for health care providers to work together more closely to improve the quality of care for people with Traditional Medicare. To help advance health equity, the ACO REACH Model will require all participating ACOs to have a robust plan describing how they will meet the needs of people with Traditional Medicare in underserved communities and make measurable changes to address health disparities. Additionally, under the ACO REACH Model, CMS will use an innovative payment approach to better support care delivery and coordination for people in underserved communities.

REACH ACOs will be responsible for helping all different types of health care providers — including primary and specialty care physicians — work together, so people get the care they need when they need it. In addition, people with Traditional Medicare who receive care through a REACH ACO may have greater access to enhanced benefits, such as telehealth visits, home care after leaving the hospital, and help with copays. They can expect the support of the REACH ACO to help them navigate an often complex health system.

“CMS is testing a redesigned model because accountable care organizations make it possible for people in Traditional Medicare to receive greater support managing their chronic diseases, facilitate smoother transitions from the hospital to their homes, and ensure beneficiaries receive preventive care that keeps them healthy,” said CMS Deputy Administrator and Director of the CMS

Innovation Center Liz Fowler, PhD, JD. “Under the ACO REACH Model, health care providers can receive more predictable revenue and use those dollars more flexibly to meet their patients’ needs — and to be more resilient in the face of health challenges like the current public health pandemic. The bottom line is that ACOs can improve health care quality and make people healthier, which can also lead to lower total costs of care.”

The GPDC Model will continue until December 31, 2022 and then will transition to the ACO REACH Model.

In the meantime, CMS will operate the GPDC Model with more robust and real-time monitoring of quality and costs for model participants. GPDC Model participants that do not meet model requirements, such as participants that restrict medically necessary care, will face corrective action and potential termination from the model.

The first performance year of the redesigned ACO REACH Model will start on January 1, 2023, and the model performance period will run through 2026.

CMS is releasing a Request for Applications for provider-led organizations interested in joining the ACO REACH Model.

Current participants in the GPDC Model must agree to meet all the ACO REACH Model requirements by January 1, 2023 in order to participate.

For a fact sheet on the ACO REACH Model, visit: https://www. cms.gov/newsroom/fact-sheets/accountable-care-organization-aco-realizing-equity-access-and-community-health-reach-model A comparison table of ACO REACH and GPDC is available at: https://innovation.cms.gov/media/document/ gpdc-aco-reach-comparison More information on the ACO REACH Model is available at: https:// innovation.cms.gov/innovation-models/ aco-reach 

TH E S TE TH OS C OP E | WI N TE R / S P R I NG 2 0 2 2

21

GROW Monthly Revenue WITHOUT Increasing Costs Double or Triple practice revenue without adding any new patients, staff, and little to no upfront money while producing BETTER outcomes for patients.

Chronic Care Management without Chronic Headaches!

(CCM) • CPT Code 99490 • Acting as a seamless extension of your practice, we help you enhance your patient care and help you capture additional reimbursable revenue.

I would encourage any practitioner to really take a close look at RX2Live. The benefits, the value, the potential are fantastic.

— Dr. Whit Roberts, MD

Remote Patient Monitoring (RPM) • Securely collect physiologic health data from your Medicare patients from the safety of their home. Use this regular data feed to inform your patient’s treatment.

Medication Management

Book A Consultation

• Designed to be proactive in identifying non-compliance issues before they become an adverse drug event.

John Fogarty 609-605-6859 or JFogarty@rx2live.com 22

T H E STE THO SCO PE | WIN TER / SPRIN G 2022

rx2livecentralflorida.com