On Call - The Journal of Palm Beach County Medical Society (March-April 2011) by Palm Beach County Medical Society

The Journal of The Palm Beach County Medical Society

March - April 2011

Setting the Course for 2011 Board of Directors Set Priorities

Board Members in Action

Forgive Them Father for They Know Not What WE Do.

n trying to keep up with the rings of the Circus of Medicine, I have been to Washington, D.C and Tallahassee during the past six weeks. I’ve returned with the conclusion:

“They Know Not What WE Do!” Physicians get angry and frustrated when politicians or the people in power at various levels of government either make rules that do not make sense, or fail to take action on issues that seem obvious to us. “WHY did they do that to us?” is not an uncommon remark. What we fail to see is that they really do not understand how medical care is delivered when we get down to the level of the office, of the individual Physician. And that is something we must work to correct. It is noble to develop policies and procedures that will provide care to all. Unfortunately, it is the local Physician and hospital that actually provide the care. I heard a comment in the Florida Senate about how not providing enough money for local clinics would force the uninsured into the Emergency Department, which would cost the patient more. I found this comical, because it would be the Physicians and hospitals that will provide the extra care….and never get paid. It is not the patient who will incur extra expenses, it is the Physician and the hospital. We who provide the care and operate medical offices are very aware of the costs and challenges we face. We know that our employees expect to be paid on time, and that we do provide health insurance to our employees. My own premiums just went up 42 percent! We also know that, even when we don’t get paid, our employees do. Our vendors do. FPL does. The telephone companies do. We need to make our elected and not yet elected representatives/officials more aware of how medicine is delivered. We need to make sure they are aware that the days of Wednesday afternoons on the golf course are long gone. The 8-5 day has become the 7-7 day… or worse! I found a surprising lack of knowledge among the support staffs. However, the good part is that they seemed willing to listen. They seemed teachable, regardless of the Party they work for. It behooves us to speak up to provide this education. We can do that by providing personal experiences/insights about how we work, what challenges we face, and what we see for the future.

It is not going to work to just rail against a bill or law. We must explain how anything they do affects us, and thereby affects the delivery of care in Palm Beach County. How can we recruit new Physicians if the medical atmosphere can’t compete with other areas of the country? How does the current liability climate affect how we order tests or medications, and what do these habits cost? Last year in Washington, we were told that Tort Reform wasn’t worth the effort as it would only save about 2 percent of the budget, about $55 BILLION!!! $55 BILLION is not a large enough sum to try to save! People do not understand that just having health insurance does not mean everybody gets paid. My new office insurance policy starting June 2011 (with the same company) will now have a $3000 deductible and cost me 42 percent MORE than the current policy. If I wanted to keep my employees’ current plan, the rate increase will be about 77 percent!!!! How many deductibles do the hospitals eat? Perhaps the media could write about what happens when you find out that you don’t have what you thought you had, at least until the deductible is paid.

President’s Report

James J. Byrnes, M.D. I President, Palm Beach County Medical Society

The whole concept of “Entitlement” will need to be addressed. American citizens don’t want to admit that, no, we can’t afford everything, and no, we can no longer depend on the Government to provide all at no cost. There is a huge difference between the farmers in Iowa and the retirees of South Florida as regards expectations. Americans believe that we can have everything for everybody. Looking at the current budget issues, we will all need to take a look at what our society can afford, and I believe this will require more reliance on ourselves, our friends, and, especially, our families. No longer can we, or should we, look to the Government to save us from our sins. No longer will we be able to expect to be rescued by Washington or Tallahassee. We at the Medical Society already volunteer our time and talents through Project Access, HERC and MERC. Do we get “credit” for trying? Perhaps the average citizen needs to try, too. Can you imagine the outcry if we asked every policeman, fireman, County and City employee to “donate” one hour per day in unpaid overtime to society…just as we already donate 2-3? “Father, forgive them for they know not what they do” is still true, as it applies to some of our government representatives and leaders, and we need to make sure that we make every attempt to eliminate what we also now have, “they know not what WE do”.

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OnCall I Mar-Apr 2011

8 Features I2I

President’s Page

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The Medical Advocacy Group

Articles I 10 I Radiation Injury: Are we at risk? I 12 I

Clinically Integrating Your Medical Practice

I 13 I Medical Student’s Letter to Politicians Beach County Medical Society I 15 I Palm Services Annual Report

I 18 I A New Member’s Perspective I 19 I Med Memo

Status for Newly Created Entities I 22 I Tax Under Health Reform

I 25 I Membership / Classified Cover photo: 2011 Palm Beach County Medical Society New Board Members L to R: Hatem Abou-Sayed, M.D.; Mark Brody, M.D.; Dyani Loo and Richard Greenwald, M.D.

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Palm Beach County Medical Society Tenna Wiles I CEO, Palm Beach County Medical Society

Providing value added services to our physician members is the highest priority for the PBCMS Board of Directors. PBCMS has engaged in an aggressive advocacy agenda in Washington DC, Tallahassee and locally. Our physician leaders have met with all of our elected officials to discuss our legislative priorities. Meetings have been held with Congressional Delegation, Governor Scott, State Legislative Delegation, County Commissioners and the State Drug Czar.

Director’s Desk

What Have We Done For You Lately?

We are keeping a close eye on the implementation through regulation associated with healthcare reform. Throughout Palm Beach County’s healthcare community, the doctor’s perspective is being represented to make sure that physicians are considered as part of the solution of the county wide health plan as well as the critical issue of pain clinics. Discussions are underway through our Medical Advocacy Council with the Health Care District to ensure the continuation of the physician retro payment and to advocate for the reinstatement of the hospital retro payment program. PBCMS Circle of Friends partners offer members significant savings on the cost of insurance, accounting services, billing solutions, IT support, computer hardware, practice management consulting, banking, legal services and collections. We are delighted to welcome Shutts and Bowen, PA to the PBCMS Circle of Friends. Mark your calendar for April 25, 26, or 27 to learn about two exciting member benefits – the PBCMS Health Insurance Trust and Electronic Health Insurance Assistance Program in partnership with the South Flordia Regional Extension Center. A special invitation with detailed information will be mailed to our members. We continue to engage our members through numerous programs including the Medical/Legal Committee, a collaborative effort with the Palm Beach County Bar, Retired Physician Luncheons, Young Physician events , and support of Medical Society Services charitable programs. Be sure to check out the Services Annual Report. On May 11, we will pay tribute to the outstanding accomplishments of our 2011 Heroes in Medicine at the Kravis Center. Check out our educational opportunities to ensure that you and your staff get the most accurate and up-to-date information available to keep your practice running smoothly. The Practice Management Resource Work Group is planning an exciting Spring/Summer series of programs for physicians.

Our Council on Communications is working diligently to update our website and enhance our member communications. We would love to hear from you. What are you doing that you’d like us to know about? What more do you need us to be doing on your behalf? Finally, we ask for your help in telling your nonmember colleagues what PBCMS is accomplishing. Please encourage nonmember physicians to join at pbcms.org. Please join us. Now is the time. The needs are great, but the possibilities are greater.

Last OnCall Issue

2011 Board of Directors James J. Byrnes, M.D.. . . . . . . . . . . President Jack Zeltzer, M.D.. . . . . . . . . . . . . . President-Elect K. Andrew Larson, M.D.. . . . . . . . . First Vice President Richard Raborn, M.D.. . . . . . . . . . Second Vice President Malcolm Dorman, M.D.. . . . . . . . . Secretary Ronald Zelnick, M.D.. . . . . . . . . . . Treasurer Lawrence Gorfine, M.D.. . . . . . . . . Immediate Past President Brandon Luskin, M.D. . . . . . . . . . . Member at Large Michael Lakow, M.D. . . . . . . . . . . . Member at Large Andrew Shapirio, M.D. . . . . . . . . . Chair, Council on Communications Brent Schillinger, M.D.. . . . . . . . . Chair, Council on Ethical & Judicial Affairs Richard Greenwald,, M.D.. . . . . . . Chair, Graduate Medical Education Daniel R. Higgins, M.D.. . . . . . . . . Chair, Health Information Technology Larry Gorfine, M.D.. . . . . . . . . . . . . Chair, Council on Legislation and Council on Medical/Legal Affairs Daniel Kapp, M.D.. . . . . . . . . . . . . . Co-Chair, Council on Legislation and Council on Medical/Legal Affairs David Soria, M.D. . . . . . . . . . . . . . . Chair, Council on Public Health & Emergency Medicine K. Andrew Larson, M.D.. . . . . . . . . Chair, Council on Membership William Adkins, M.D.. . . . . . . . . . . Chair, Retired Physicians Section Maureen Whelihan, M.D. . . . . . . . Chair, Women Physicians Section Hatem Abou-Sayed, M.D. . . . . . . Chair, Young Physicians Section Richard Shugarman, M.D. . . . . . . Chair, Specialty Section Harish Madhav, M.D.. . . . . . . . . . . Co-Chair, Ethnic/Minority Section Roger Duncan, M.D.. . . . . . . . . . . . Co-Chair, Ethnic/Minority Section Randy Gershwin, M.D.. . . . . . . . . . Chair, Hospital Relations Mark Rubenstein, M.D.. . . . . . . . . Chair, Bylaws Stephen Babic, M.D.. . . . . . . . . . . . Chair, MEDPAC Andrew Shapiro, M.D.. . . . . . . . . . West District Representative Shawn B. Baca, M.D.. . . . . . . . . . . . South District Representative Mark Brody, M.D. . . . . . . . . . . . . . . Central District Representative Alan B. Pillersdorf, M.D. . . . . . . . . AMA/ FMA Liaison Jose F. Arrascue, M.D. . . . . . . . . . . PBCMS Services Liaison Dyani Loo. . . . . . . . . . . . . . . . . . . . . Medical Student Representative

Palm Beach County Medical Society 2011 Board of Trustees Lawrence Gorfine, M.D. Maureen Whelihan, M.D. Daniel R. Higgins, M.D. Jose F. Arrascue, M.D. Alan B. Pillersdorf, M.D. Brent M. Schillinger. M.D.

Mark Rubenstein, M.D. Jack Zeltzer, M.D. K. Andrew Larson, M.D. James J. Byrnes, M.D. Richard Raborn, M.D.

Staff: Tenna Wiles, CEO Yvonne Shapiro, Director of Communications Randy Scheid, Associate Director/Director of Resource Development Ashley Eckes, Director of Disaster Services Deanna Lessard, Director Member Services & Education Nicola Chung, Project Access Program Director Victoria McMath, Project Access Senior Program Coordinator Patsy Westall, Project Director Mindi Tingler, Administrative Assistant Natalie Gonzalez, Receptionist Lauren Tomé, Receptionist

OnCALL Managing Editor: Tenna Wiles Advertising Assistant: Yvonne Shapiro Subscriptions to On CALL are available for an annual rate of $50. For more information, please contact Yvonne Shapiro at (561) 433-3940. The opinions expressed in On CALL are those of the individual authors and do not necessarily reflect official policies of the Palm Beach County Medical Society, unless so stated. Advertising in On CALL does not constitute endorsement by the Palm Beach County Medical Society or its committees. On CALL is owned and published (6) times per year by the Palm Beach County Medical Society, Inc. 3540 Forest Hill Blvd., West Palm Beach, FL 33406 (561) 433-3940 & (561) 276-3636. © Copyright 2011 Palm Beach County Medical Society, Inc.

Available online at pbcms.org I6I

OnCall I Mar-Apr 2011

The Medical Advocacy Group (A Report of the Success of Political Activism by Doctors) By Lawrence Gorfine, M.D. In 2009, we began seeing proposals for massive changes in healthcare delivery, both nationally and locally. In many cases physicians were not involved with the process, or had minimal involvement with the process. Locally, the Palm Beach County Healthcare District announced that doctors and hospitals would no longer receive “RetroPayment” for indigent healthcare.

The first meeting of the Medical Advocacy Group (MAG) was in early February, 2010. All the County hospitals were invited and most attended. A structure was created and an Executive Committee was formed. The hospitals pledged support and the doctors of the County donated the start-up expenses of approximately $45,000. Mr. Don Mathis was chosen as our political consultant and strategist.

Prior to mid-2009, individuals who arrived in the Emergency Departments of Palm Beach County hospitals and who were eligible for Health District coverage could be “retroactively” signed-up for coverage, and doctors and hospitals would be paid for the medical services provided, according to the Healthcare District payment schedule (Retro-Payment). In mid-2009, doctors and hospitals were told that they had to absorb the expense of this type of indigent care, and that the “Retro-Payment” would cease. The Palm Beach County Healthcare District (HCD) paid doctors and hospitals $7 million for this type of care in 2008. The reason for the change was a presumed decrease in tax money due to the recession. No other HCD projects were cut, only payments to doctors and hospitals.

Physicians and hospital CEOs began attending the Healthcare District meetings and addressing the HCD Board members. Eventually, at one of the meetings, a HCD Board member, Representative Joseph Abruzzo, made a motion to reverse the decision to not pay “RetroPayment.” A brief study was then undertaken by the HCD, and at the following HCD meeting, the HCD reversed their prior decision and voted to pay physicians for “Retro-Payment” care for one year. Hospitals, however, would not receive “Retro-Payment.”

The Board Members of the Palm Beach County Medical Society determined that this situation required action by the Medical Society. Much time, study and discussion followed. The Board determined that a political coalition with the county hospitals would be the most effective vehicle to influence the delivery of health care in the county. Thus was born the Medical Advocacy Group.

The result of this HCD decision means that Palm Beach County doctors will be paid up to several million dollars for their services for one year. But, equally important, we have learned that from carefully planned and designed advocacy activities, doctors can be influential in local and regional politics. We no longer need to complain and accept what others are doing to us. Our political activism works. The Medical Advocacy Group will continue into the future. We must continue our work to assure “Retro-Payment” to doctors in future years. We will work with the HCD as medical leaders and partners to assure quality healthcare delivery

Continued on pg 24

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OnCall I Mar-Apr 2011

Radiation Injury: Are we at risk?

RADIATIONEXPLOSURE

RISK?

By David Soria, M.D.

WILL IT EFFECT US?

NUCLEAR MELTDOWN JAPAN DISASTER WHAT ARE THE SYMPTOMS?

DANGEROUS LEVELS

Radiation exposure and possible injury occur from many sources. These include exposure from simple low-dose background radiation to high-dose nuclear weapon catastrophes and dozens of others in between these ranges of exposure. The most common ionizing radiation is emitted by radioactive substances such as uranium, radon, and plutonium. The Sievert(Sv) is the measurement of the dose of radiation after an exposure to humans and takes into consideration the sensitivity of different tissues in the body to radiation. The average American is exposed to 3mSv per year just from background radiations and another 3mSv from man-made sources. Nuclear power plants rarely release radioactive material. For example, the Three Mile Island accident, even though infamous, only exposed people living within one mile of the plant to 0.08 mSv, equivalent to four chest x-rays.

The damaging effects of radiation depend on several factors: the amount of the dose, how rapid the exposure, how much of the body is exposed, and the sensitivity of the particular tissue. For instance, in a situation where a specific rapid dose exposed to the entire body would be lethal, up to 10 times that same dose given to the body over weeks or months may not cause serious harm. Certain body tissues are more sensitive to radiation such as intestines and bone marrow where cells multiply quickly and likewise children and fetuses are at extreme risk. A large radiation exposure increases the risk of cancer but still is unlikely since even a whole body dose of 300 times the average background radiation would only increase once lifetime cancer risk by 5 percent. However, at high doses ,whole-body injury can cause radiation illness. Acute radiation illness occurs through three stages. The early symptoms include nausea, vomiting, fatigue, loss of appetite and diarrhea. Then there usually is a symptom-free period followed by one of three syndromes. The onset of these symptoms as well as severity and speed of progression are a direct indication of the severity of exposure. The least lethal of syndromes is the hematopoietic syndrome which affects the bone marrow, lymph nodes and spleen. These cases cause nausea, vomiting, fatigue within hours of exposure and last less than 48 hours. Over the next symptom-free week or so, white and red blood cells as well as platelets die and are not replaced, leading to infection, bleeding and severe weakness. If people survive this after six weeks or so the body will slowly begin to produce cells again. The next syndrome, the gastrointestinal syndrome, is due to damage of the

lining of the digestive tract which requires five times the radiation exposure as the hematopoietic syndrome. This causes severe vomiting and diarrhea in less than an hour and lasts 48 hours followed by a four-to-five days period of no symptoms until the gi tract cells die off. Then severe bloody diarrhea occurs with severe dehydration and overwhelming intestinal infections leading to a 50 percent mortality rate. The most severe exposures result in the cerebrovascular syndrome. These cases develop confusion, nausea, vomiting, diarrhea, seizures, and shock resulting in death within hours and up to two days later. There are no specific tests to diagnose radiation exposure but swabs of the nose and throat can be checked for radioactivity as well as whole body Geiger counter readings. Usually exposure to radiation is obvious due to the personâ&#x20AC;&#x2122;s history for example in a nuclear plant meltdown. Also doctors can check white blood cell counts after 48 hour of the exposure in which the lower the cell counts the worse the exposure. Most importantly, after a suspected exposure the public should listen to public health officials for instructions, stay indoors, close windows, and stay in lowest and most central part of their house or shelters if ordered to evacuate. Self- decontamination by changing clothes and showering is recommended and simple. Potassium Iodide pills are available from pharmacies and health officials and can prevent damage from radioactive iodine release but not from other radioactive materials such as those from nuclear plant accidents similar to Fukushima.

Current events should make the public aware of nuclear risks and need for education on this industry since the need for alternative energy sources continues to grow. The recent nuclear disaster in Japan according to officials poses no direct risk to the US including Hawaii. Recent radiation levels have only increased by less than five percent on the US West coast, with any future radiation release from Japan would be dramatically diluted after traveling across thousands of miles of ocean water with negligible radiation exposure to the US. Finally, on a positive note, the recent disaster should stimulate education and a review of our current nuclear energy systems therefore preventing the US from experiencing such a life-threatening event.

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Clinically Integrating Your Medical Practice:

Now is The Time to Begin Delivering a Better Quality of Care by Broad & Cassel, Frederick Segal, Esq. and Mike Segal, Esq.

linical integration is defined by the Advisory Board Company as “a strategy in which physicians – sometimes in partnership with a hospital or a health system – make significant collective commitment to performance improvement and investment in infrastructure to facilitate gains in quality and efficiencies.” The concept of clinical integration has been discussed extensively in the past few years. The healthcare landscape has begun to shift toward delivering a better quality of care at a lower cost. Clearly hospitals and physicians are at the core of the process. Clinical integration is being discussed largely as a principal need for an Accountable Care Organization (ACO). An ACO will be required to be large, so it can provide a full array of healthcare services. However, ACOs may take years to come to fruition in South Florida and, given their complexity and cost, who knows if they will succeed. This does not mean, however, that medical practices – both independent and hospital owned – should not begin to absorb clinical integration concepts. In fact, forwardlooking practices are starting to do just that! Below are some tips on how to make your practice more clinically integrated: • Begin to Convert to Evidence Based Medicine by Adopting Clinical Protocols- Clinical integration requires a more standardized form of care, through clinical protocols. • Set Meaningful Performance Goals- Create clinical standards for your practice and then, through your IT, by which your practice should adhere.

• Get Moving on IT- Whether you like it or not, the push towards advanced technology for your practice is only going to increase. 2011 is the first year in which stimulus funds are available if “meaningful use” standards are met. • Accountability and Physician Oversight-Create accountability in following protocols and achieving standards. The protocols must be followed or consequences must occur. Revising partnership agreements to reflect the consequences of not meeting performance goals is a great start. • Select Capable Physician Partners- Obviously many physicians of small practices that have been practicing with the same partners for years cannot start from ground zero. But when selecting new partners or hiring new physicians keep in mind that you will want physicians who are capable of achieving the performance goals you have created. • Attempt to Negotiate Managed Care Contracts that have Incentives Around the country, managed care plans are negotiating contracts that provide rewards for increasing quality and reducing costs. They are called “pay for performance” contracts. Look into this. There are many more essential measures a medical group may begin to implement in order to move forward toward clinical integration. The push toward clinical integration is not a fad that will soon dissolve into thin air. Physicians need to begin focusing on their future.

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Medical Student’s letter to politicians Dear Politicians, not a into this profession during its time of chaos was I am a second year medical student. Entering classmates bers of the healthcare team, I and my fellow decision made lightly. As newly inducted mem system; the into care; we are not yet fully indoctrinated share the idealism inspired by the delivery of ment of ical, and social tripwires encapsulating the treat we do not fully understand the financial, polit but the r time, we will learn the skills to treat patients, our patients. We are in many ways naïve. Ove you ions decis the on ily ledge to help people rests heav extent to which we will be able to use that know re futu the considering legislation, please keep in mind make today. You are deciding our fate. When deeply affect. doctors and patients whom your policies will be people; many of whom have given up a lot to My classmates are intelligent, compassionate to be system by the time we will be practicing is yet here, knowing that the state of our healthcare At the field, because as cliché as it may be, we care. determined. Yet, we all chose to come into this an get tice, prac and with increasing exposure to real same time, we push forward with this idealism nts. w to navigate our way toward helping our patie increasing sense of the rules that we must follo s in the be treated like a chess game. But in many way As most would agree, life and death should not n actio rn gove that of competing interests and alliances healthcare debate it becomes one. The tangle ing mov d, resources and the layout of the public moo becomes so convoluted that given the limited egy, but sacrifices in services. forward requires not only good timing and strat e that we y strategies of how to go about our next mov We want to help people. But there are so man ics. Like me, expected to have to think heavily about polit are paralyzed from moving forward. I never inadequate the political system because there seems to be many young physicians may be turned off by course of the ge truth, and because it is difficult to chan physician representation, an over distortion of s who ician its own inertia. Unfortunately, the more phys a political machine so massive that it rolls on n, policies are in the conversation. Lacking representatio are repelled by politics, the less involved we ers work re thca ard unopposed. With more heal detrimental to our patients’ care can move forw be. g on health policy, the better the outcome will involved in understanding, shaping and votin This is why I have chosen to write today. are far e fire on any side of already heated debate; there My hope with this letter is not to throw mor your mind hope here is simply to ask that before you set more eloquent speakers for that purpose. My doctors y think about and try and understand what we as to how these decisions will be dealt to reall true stay and try to and for the newly shaping policies do, what we want to do, and what we can do, place. to the principles that guided us here in the first ciple, the reason why we entered We want to help people. It is our guiding prin . Please work with us so that we willingly into years of sacrifice and hard work that lives up to our oath and ideals. can deliver care to those in need in a manner I appreciate you taking the time to read this. Sincerely, Dyani Loo

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r School of Medicine of Regional Medical Camp

Medical Student, University of Miami, Mille

A New Member’s Perspective By: Robert Hunter, M.D.

s my family and I planned our move from New Jersey to South Florida, I worried about the usual stressors associated with such a big move. Where would we live? Where would the kids go to school? Would we develop close friends like the ones we left behind? While these issues were forefront on my mind, the most challenging aspect of the move ultimately proved to be professional rather than personal. I made the difficult decision to leave an academic position to start a solo private gynecology practice. While I was certain of my decision to alter my career path, and even enjoyed the administrative challenges of starting a practice from the ground up, I found myself feeling very alone from a professional standpoint. I didn’t anticipate the deep sense of loss in leaving a familiar hospital, colleagues, scores of trusted nurses and residents, and a chair and vice-chair who devoted tremendous resources toward my development as a physician, educator, and administrator. Nothing underscored this profound emptiness more than when a local practitioner commented, “welcome to the trenches,” upon meeting me.

Additionally, membership in the Palm Beach County Medical Society has exposed me to its numerous community outreach activities. I have had the opportunity to participate in Project Access, a program by which the Medical Society demonstrates its commitment to those in need of healthcare services. Moreover, the Medical Society’s legislative programs have provided me with important insights into the local, state, and national political climate. This information has been of benefit to me as I navigate my practice through the changing healthcare landscape. While I still cherish and nurture my past professional relationships, I now look forward towards my future in South Florida. My membership in the Palm Beach County Medical Society has given me a great opportunity to be active in the medical community. I am looking forward to further establishing my roots with a group that so clearly demonstrates its warmth, energy, and concern towards its members and the community it serves.

I immediately began to doubt my decision to branch out on my own. Given that I was committed to my new practice, I had no choice but to establish new roots. In New Jersey, I never gave any consideration to joining the local medical societies. My academic institution and the ties that I developed during my nearby training were sufficient for my professional needs. Lacking these ties, I turned to the Palm Beach County Medical Society. I was overwhelmed by the warm and attentive greeting I received from the staff in response to my membership inquiry. Before even completing my application, I received a complete address listing of all the local physicians to contact in order to announce the opening of my new practice. Additionally, I was invited to upcoming events, and personally introduced to existing physician members by the staff when I had the good fortune to attend. Many of these introductions led to patient referrals. The members and staff subsequently encouraged me to become more active in the Medical Society. This led to a recent appointment to the Council on Communications. I am excited by the prospect of serving this committee and engaging in dialogue with members of the greater medical community.

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Med Memo

March - April 2011

TWO NEW COST SAVING MEMBER BENEFITS – SIGN UP TODAY JOIN US FOR A “LISTEN AND LEARN WORKSHOP” • Palm Beach County Medical Society Health Plan • Electronic Health Record (HER) Incentive Assistance Learn how you can meet “meaningful use,” quality for funding from Medicare and Medicaid, and participate in the PBCMS Health Plan. April 25, 5:30 – 7:00 PM, Doubletree Hotel, 4431 PGA Blvd., Palm Beach Gardens April 26, 5:30 – 7:00 PM, Hilton Garden Inn, 8201 Congress Ave., Boca Raton April 27, 5:30 – 7:00 PM, Hilton Palm Beach Airport, 150 Australian Ave. WPB Register on line at www.pbcms.org or call 561-433-3940 for additional information SAVE THE DATE – 5TH ANNUAL FUTURE OF MEDICINE SUMMIT October 27-29 (Thursday – Saturday). Palm Beach County Convention Center.

OFFICE MANAGER’S INSTITUTE PROGRAMS Office Manager’s Programs are held at the Airport Hilton WPB, 1:30 am – 1:00 pm. $25 Members & Staff, $35 Nonmembers & Staff. For additional information contact deannal@pbcms.org or call 561-433-3940 April 6, “Hi-Tech Low Cost Ways to Market Your Practice” May 4 , “Quickbooks” June 1, “IT Security & Disaster Preparedness & Recovery” EDUCATIONAL OPPORTUNITIES Family Medicine Spring Forum April 29 – May 1, 2011. The Westin Diplomat Resort & Spa, Hollywood, Florida. For additional information visit www.fafp.org Primary Focus Symposium June 10 – 12 (Friday-Sunday) Hawks Cay Resort, Duck Key, Florida For additional information contact juliez@baptisthealth.net or call 786-596-7710

Featuring nationally recognized speakers, the 3 day Summit will focus on: Prevention & Wellness, Physician Viability, Access to Care, and Quality and Patient Safety. Sponsorship opportunities available. For additional information call 561-433-3940. Please join us for: An Educational Opportunity Dinner and Presentations Dr. Mark Brody President, Brain Matters Research Medical Director, The Memory Program at Bethesda Memorial Hospital “Research: Now and For the Future” Dr. Juergen H.A. Bludau Clinical Chief and Director, Clinical Geriatric Services Brigham & Womens’ Hospital, Division of Aging “Treating Patients with Alzheimer’s Disease” Wednesday, May 4th, 2011• 6:30 p.m. – 8:30 p.m. The Breakers Resort and Spa, Circle Ballroom RSVP Required • Jennie Clark, 561-683-2700 • Business Attire Generously Sponsored By: J. P. Morgan Palm Beach County Medical Society Visiting Nurse Association

Larry Gorfine, M.D.; Governor Rick Scott and Malcolm Dorman, M.D.

This activity has been planned and implemented in accordance with the Essentials Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the DADE COUNTY MEDICAL ASSOCIATION and Palm Beach County Medical Society. The DADE COUNTY MEDICAL ASSOCIATION is accredited by the FLORIDA MEDICAL ASSOCIATION to provide continuing medical education to physicians. The DADE COUNTY MEDICAL ASSOCIATION designates this educational activity for a maximum of 2 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Members of the Medical Society visit local and state politicians

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Alan B. Pillersdorf, M.D.; Representative Laurie Berman; Stephen Babic, M.D. and James J. Bynres, M.D.

Stephen Babic, M.D.; Alan B. Pillersdorf, M.D.; Tenna Wiles; Representative Dave Aronberg and James J. Byrnes, M.D.

OnCall I Mar-Apr 2011

Med Memo

March - April 2011

Members of the Medical Society gather for Doctorâ&#x20AC;&#x2122;s Day at the National Croquet Club

Charles Flack, M.D. (Left); Medical Students enjoy croquet at the PBCMS Doctors Day Celebration (Bottom Right)

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Tax Status for Newly Created Entities Under Health Reform By Alpern Rosenthal

he Patient Protection and Affordable Care Act of 2010 is expected to change the landscape of health care through the creation of new entities and modes of operation. However, the details of how to operate and structure such entities are still not certain as new healthcare entities are expected to take both taxable and tax-exempt forms.

respect to the tax planning of such organizations, Treasury officials warned that entities structured as tax-exempt organizations will require particular attention. Specifically, organizers of ACOs with a tax-exempt component will need to ensure that all the arrangements are fair, that charitable assets are protected, and that charitable activities are being conducted.

Treasury Hints IRS Will Closely Examine New Tax-Exempt Entities In Particular

According to the Act, ACOs are based on the concept that by working together to keep patients healthy, there is an opportunity to generate savings. This could be accomplished through reduced hospital stays or duplicative tests that would save Medicare funds so that a portion of the shared savings would be distributed to members of the ACO.

In recent comments at a Washington D.C. legal forum, Treasury Department officials reiterated that nonprofit organizations will be at the forefront of the creation and implementation of some of the new entities created by the 2010 healthcare reform law. However, regarding tax treatment, the Treasury admitted that it is not yet clear whether certain types of organizations will be exempt or non-exempt in nature. A Treasury official within the Office of Tax Policy stated that it will be important for practitioners who are experts in tax-exempt structures to be involved because the language and intent of the Patient Protection and Affordable Care Act calls for “nonprofit organizations or some kind of entity, or in some cases new tax-exempt entities,” to be part of the healthcare regime. The Treasury official stated that the Internal Revenue Service is currently working with Health and Human Services to develop regulations and implement requirements of the Act. In particular, among the new entities the law calls for are accountable care organizations (ACOs) in which groups of service providers and suppliers work together to manage the care of Medicare beneficiaries. According to the Treasury, “It’s not clear what type of entity this would be and certainly it’s not clear what its tax status would be.” The Treasury official offered that what should evolve are tax-exempt hospitals getting together with doctors and medical service providers to address community health needs more effectively. However, with

Most recently, the IRS did recently provide guidance on qualified nonprofit health insurance issuers that are expected to qualify as tax-exempt as described in Internal Revenue Code Section 501(c)(29). IRS Notice 2011-23, released March 10, explains the requirements for tax-exemption, annual filing requirements, as well as the effective date of exempt status for such organizations. Takeaway for Healthcare Organizations The Patient Protection and Affordable Care Act provides a framework for significant and substantial changes to the healthcare industry. Healthcare organizations should familiarize themselves with the potential implications of the new law and its provisions as well as engage in proactive planning and compliance with respect to the implementation of new activities and entities. For any questions on this topic, or to discuss the impact of the new law to your organization, please contact Tammy Clarke at Alpern Rosenthal at 561-689-7888 or tclarke@alpernfl.com. The service professionals at Alpern Rosenthal have a variety of experiences within the healthcare provider, medical practices, long-term care and life sciences industry sectors. Please visit us on the web at www.alpern.com for more information.

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The Medical Advocacy Group continued from pg. 8 in Palm Beach County. Our alliance with the county hospitals will also continue and we will work towards re-establishing “RetroPayment” for the hospitals. With the future proposed formation of Accountable Care Organizations (ACOs), a strong and mutually cooperative alliance with hospitals may prove to be very beneficial to doctors. To continue these and other future needed activities, we need the support of all practicing physicians. We need volunteer physicians to become active committee members and become the future PBCMS Board members. We need the financial support of all physicians to pay their PBCMS dues and additionally contribute to the Medical Advocacy Group. Political activism is expensive. However, the investment of $45,000 by physicians last year created a return of up to several million dollars to our members for 2011 only! I ask each physician to contribute at least $100 to the MAG. If you are able to contribute more, send your check to the PBCMS with an indication that the money is for the MAG and its continued Medical Advocacy activities. With your support, we will continue to work for physicians and their patients.

PBCMS Circle of Friends Acevedo Consulting Coding & Compliance Specialists 561-278-9328 jacevedo@acevedoconsulting.com Alpern Rosenthal Accounting & Tax Consultants 561-689-7888 tclarke@alpernfl.com Anderson Moore Construction 561-753-7400 jschumacher@amcbuild.com Avisena Revenue Cycle Management 305-446-8599 bfoster@avisena.com Broad & Cassel Attorneys at Law 305-373-9430 msegal@broadandcassel.com Danna-Gracey Medical Malpractice & Workmen’s Compensation Ins. 561-279-6906 matt@dannagracey.com FPIC Medical Malpractice Carrier 800-741-3742 hakes@fpic.com Gulfstream Business Bank 561-665-4212 jchen@gsbb.com Ironstone Bank 561-253-8135 laura.king@ironstone.com Managed Care Advisory Group (MCAG) 800-355-0466 jgadd@mcaginc.com Northwestern Mutual 561-622-4699 david.coldwell@nmfn.com 561-962-2931 david.laser@nmfn.com Professional Economic Growth Group (P.E.G.G.) 561-841-3844 sesso.peter@palmail.com Proffitt Management Solutions Business Coach 561-582-6060 nancy@proffittmanagement.com Shutts & Bowen, LLP 561-835-8500 tmonaghan@shutts.com

Suntrust Bank 954-765-7194 elizabeth.breslin@suntrust.com The Florida Healthcare Law Firm 561-455-7700 jcohen@floridahealthcarelawfirm.com Thinsolutions Remote Control IT Management 941-741-4287 lmellgren@thinsolutions.com VNA of Florida Home Health Agency 772-286-1844 rob.sommer@vnaflorida.org Windstream Communications 954-727-2121 barbara.burns@windstream.com I 24 I

Palm Beach County Medical Society Membership Applicants William F. Clayton, M.D. (Retired) Phone: (561) 432-4389 Specialty: Allergy Medical School: Not Provided Internship: Not Provided Residency: Not Provided Board Certification: Yes Date of Birth: 03/18/40 Jacalyn Ann Danton, D.O. 1800 N. Federal Highway Boca Raton, Fl 33418 Phone: (561) 368-0242 Fax: (561) 368-2264 Specialty: Family Practice Medical School: Philadelphia College of Osteopathic Internship: Parkview Hospital 1977 Residency: Not Provided Board Certification: American Osteopathic Board of Family Practice Hospital Affiliations: None Provided Date of Birth: 05/23/46 Name: Brian Feinstein, D.O. 4205 W. Atlantic Avenue #B201 Delray Beach, Fl 33445 Phone: 888-357-3376 Specialty: Dermatology Medical School: Nova Southeastern University 1998 Internship: Broward General Medical Center 2003 Residency: Broward General Medical Center 2008 Board Certification: American Osteopathic Board of Dermatology / American Osteopathic of Family Practice Hospital Affiliations: None Provided Date of Birth: 12/31/1976

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Andrea Klemens, D.O. 1875 NW Corporate Blvd, Boca Raton, FL 33431 Specialty: Endocrinology Medical School: NY College of Osteopathic Medicine 1987 Internship: Massapequa General Hospital 1987-1988 Residency: Cabrini Medical Center 1988-1991 Fellowship: Medical College of Georgia 1991-1993 Board Certification: American Board of Internal Medicine Internal Medicine & Endocrinology, Diabetes and Metabolism Hospital Affiliations: MDVIP Date of Birth: 12/30/1961 Name: Stasha Lynn Martella, P.A. Phone: (215) 205-7981 Specialty: Emergency Medicine Date of Birth: 01/18/1982 Name: Sumathi Raja, M.D. (Resident) Phone: (561) 398-2432 Office Phone: (561) 548-1467 Fax: (561) 548-3655 Specialty: Internal Medicine Date of Birth: 03/15/1979

OFFICE SPACE FOR RENT OR SALE Office space for rent or sale, 3000 sq. ft. located on Glades Road, Boca Raton, Florida. Ready to use, has cardiology nuclear camera, ultrasound and ekg equipment, four exam rooms with tables. Easy access to I-95, minutes from Boca Raton Regional Hospital. For further information call 561-750-8676 or 561-212-6411. MEDICAL OFFICE SPACE AVAILABLE Prime central location, near Good Samaritan Medical Center on North Olive. Good parking available. Fax inquiries to 561-659-0629. MEDICAL OFFICE SPACE AVAILABLE 1400 sq foot medical office fully equipped perfect for internist or group, centrally located off Palm Beach Lakes Blvd in West Palm Beach, available full or part time for lease or sale. Call 685-2613 JUPITER MEDICAL OFFICE FOR SALE OR LEASE Across the street from Jupiter Hospital, ground floor, approximately 1500 sq. ft. furnished, x-ray ready and move in ready, new tile floors and bathroom, light and bright. Call 561-747-2322

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The Future

When the government made money available to help doctors make the move to electronic health records (EHR), they entrusted just a few organizations with the funding and training to help doctors make that transition.

The Team

South Florida Regional Extension Center is the local organization that has been selected to help you transition to EHR and use it in a meaningful way to improve patient care and safety. That’s why the Palm Beach County Medical Society (PBCMS) has partnered with and supports the REC. Our highly trained specialists will help you ask the right questions to select the best EHR solution for your practice and help you reach the government standards for EHR meaningful use.

The Cost For the first 2,500 priority primary care physicians who sign up with the South Florida REC, this critical service is 100% FREE. There is no need to hire expensive consultants or search through a multitude of vendors. The South Florida REC will save you time and money in your transition to EHR. Not only that, The South Florida REC will help speed your journey toward meaningful use and the government incentives that go along with reaching that goal.

The Incentive

Practices that accept Medicaid are eligible to receive up to $63,000 in incentive money once they reach the government standards for meaningful use. Practices that accept Medicare are eligible to receive up to $44,000 in incentive money once they reach the government standards for meaningful use.

The Regional Extension Center

Because the REC is funded, trained and approved by the Office of National Coordinator, we are the recognized experts on EHR selection and implementation and the government’s standards for meaningful use.

SOUTH FLORIDA

REGIONAL EXTENSION CENTER®