Oncall 14 q2 lr by Palm Beach County Medical Society

The Official Publication of the Palm Beach County Medical Society

THE NEW MEDICAID Special Feature: Heroes in Medicine Awards

Quarter Two 2014

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PRESIDENT’S REPORT Ronald Zelnick, MD

Quarter Three 2013

President, Palm Beach County Medical Society

Frustrated Physicians Today’s physicians are frustrated with many issues in medicine. In 2003, the Florida Medical Association, Governor Bush and the Florida State legislature made great efforts in passing laws to provide caps to stem the tide of medical malpractice cases. This year has seen an activist Florida Supreme Court strike down those noneconomic caps in a medical malpractice wrongful death case. On a national level, this year the American Medical Association worked extensively to lobby Congress to repeal the Sustainable Growth Rate (SGR). The Congressional Budget Office estimates that the repeal of the SGR would cost $116 billion over 10 years. A bill passed several committees in Congress, with bicameral and bipartisan support. However, negotiations came down to the wire, and there was no repeal of the SGR. Instead, another one-year doc-fix was passed in an effort to prevent a 24% pay cut to Medicare reimbursements for physicians’ services. Also passed was a one-year delay in the implementation of ICD10, which was scheduled to be effective October 1, 2014. The fate of ICD10 remains unclear. New meaningful use requirements for Electronic Medical Records (EMR) have been frustrating for physicians. EMR

systems in both office and hospital settings are often not compatible, and not user-friendly. Many physicians have already replaced costly systems in their offices. Stimulus funds would have been better spent on a national, standardized personal health record for in-patient, out-patient and drug data that could be entered and available in real time. A national, standardized system would eliminate duplication of data entry. Florida has not accepted $51 billion in Medicaid expansion funds, offered over a 10 year period. The Affordable Care Act (ACA) provides for Medicare-Medicaid parity for primary care for two years, but does not include specialty care. Florida Medicaid pays approximately 60% of Medicare rates, and Medicaid patients are being moved into HMOs, where reimbursements may be even lower. Palm Beach County Medical Society will be presenting a forum on Medicaid expansion on May 22, 2014. Most recently, physician extenders have been lobbying the state legislature for the ability to practice independently of physician supervision, by arguing that their services are needed to provide care in physician-shortage areas. The FMA continues to lobby for supervision of physician extenders, in order to provide quality care in the state. These scope of practice issues remain in the forefront of healthcare issues before the legislature.

Practicing physicians in Florida continue to face challenges in running their offices. Price controls on physician reimbursements set by the health-care insurance industry, as well as government reimbursement rates in Medicare and Medicaid, have hindered physicians’ ability to run their offices profitably. Physicians have adapted their business models by forming large group practices, concierge practices, cash-only practices, and have opted out of Medicare and Medicaid. The impact of trends to end fee-for- service models and replace them with value-based payment models, such as Accountable Care Organizations (ACOs) and bundled payments, remains unclear. The jury is still out on whether these new models will provide costeffective quality care. Changes to rules regarding Maintenance of Certification requirements for Board certification are of concern to Palm Beach County physicians. Many physicians feel these additional requirements are costly and extremely time-consuming, which take away from time for patient care. The PBCMS and FMA continue to lobby against the use of certification requirements for licensure. What can physicians do? Health care constitutes 17% of the GDP. We need organized medicine on a state and federal level to take a strong, unified stance with regard to the practice of ( Continued on Page 30 )

QUARTER TWO 2014

ON CALL MAGAZINE

Palm Beach Illustrated is proud to support

Palm Beach County Medical Society 561.659.0210 | palmbeachillustrated.com

CONTENTS Pbcms Staff

Board of Directors

Tenna Wiles, CEO

Ronald Zelnick, MD President Stephen Babic, MD President-Elect James Goldenberg, MD First Vice-President Shawn Baca, MD Secretary Brandon Luskin, MD Treasurer K. Andrew Larson, MD Immediate Past President Marc Hirsh, MD Member at Large Vijay B. Harpalani, MD Member at Large

Tennaw@pbcms.org Deanna Lessard, Director of Member Services & Education Deannal@pbcms.org Helena Edie, Finance Finance@pbcms.org Mindi Tingler, Administrative Assistant Mindit@pbcms.org Lauren Tome, Meeting and Events Coordinator Laurent@pbcms.org Nicola Chung, Project Access Program Director Nicolac@pbcms.org Lizbeth Gali, Project Access Administrative Assistant Lizabethg@pbcms.org Melissa Nicoleau, Project Access System Coordinator Melissan@pbcms.org

Features

08 09 10 13 19 20 23

Sadia Peck, Senior Project Access Program Coordinator Sadiap@pbcms.org Marianne Sierra, Project Access Health Navigator Mariannes@pbcmss.org Thomas Sebastian, Project Access System Navigator Thomass@pbcms.org John James, Director of Disaster Services Johnj@pbcms.org Natalie Gonzalez, Administrative Assistant Natalieg@pbcms.org Stuart Miro, MD, Triple Aim Diabetes Initiative Stuartm@pbcms.org

H. Daniel Adams Vincent Apicella, DO Sandra Blair Michael Dennis, MD Roger Duncan, MD Brad Feuer, DO James Howell, MD Tulisa Hanflink LaRocca, MD Beth-Ann Lesnikoski, MD Alan Pillersdorf, MD Jack Zeltzer, MD

Medicaid Changes Coming to Palm Beach County Medicaid Expansion Fails in 2014 Legislative Session Heroes In Medicine Palm Beach County Medical Society Services Annual Report Telemedicine Exceptional Physicians 2013 BDO Survey of Board Compensation Practices

Articles

03 26 28

Presidents Report MED MEMO MED Society News

Sherra Sewell, Marketing and Events Sherras@pbcms.org

Board of Trustees

On Call Magazine is designed by Form G Design

Brent Schillinger, MD Chair Jose F. Arrascue, MD Steven Babic, MD Shawn Baca, MD Malcolm Dorman, MD James Goldenberg, MD Lawrence Gorfine, MD K. Andrew Larson, MD Alan Pillersdorf, MD Ronald Zelnick, MD Jack Zeltzer, MD

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Subscriptions to On Call are available for an annual rate of $50. For more information contact PBCMS at (561) 433-3940. The opinions expressed in On Call are those of the individual authors and do not necessarily reflect official policies of Palm Beach County Medical Society or its committees. On call is owned and published four (4) times per year by Palm Beach County Medical Society, Inc., Forest Hill Blvd., #101, West Palm Beach FL33406. (561) 433-3940 & (561) 276-3636. ÂŠCopyright 2013 Palm Beach County Medical Society, Inc.

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Medicaid Changes Coming to Palm Beach County By Leon Fooksman Big changes are coming this summer to the Medicaid system in Palm Beach County, as a majority of individuals receiving the health care services for the poor are moved out of a fee-for-service toward a new managed care program. The change is part of a new Florida program called Statewide Medicaid Managed Care which aims to move Florida’s 3.5 million Medicaid recipients into privately-managed health plans with the goal of lowering costs while coordinating care, managing chronic disease, and maintaining or improving the quality of care. The new program is not linked to National Health Care Reform, or the Affordable Care Act passed by the U.S. Congress. It’s been in the works since the State Legislature approved it in 2011 to transform the coverage for low-income residents, mostly children and pregnant women, along with the disabled. More than half of those enrolled in Florida Medicaid are youth under the age of 21. Patients will now be grouped into one of Statewide Medicaid Managed Care‘s two components: Managed Medical Assistance Program for adults and children, and Long-term Care Program for the elderly. Locally, all Medicaid recipients will be transitioning into one of four managed care plans: Humana, Sunshine State, Prestige Health Choice, and Molina Healthcare of Florida. “This new program will create efficiencies for recipients and providers including enhanced prompt payment requirements– all with budget neutrality,” said Melanie Brown-Woofter, director of community relations for Agency for Health Care Administration, which manages Florida’s Medicaid system. Under the new program, physician reimbursement will be negotiated. 8

ON CALL MAGAZINE

According to Florida Medical Association: “There is a new performance standard that plans can meet by paying physicians at or above Medicare rates for similar services. Plans that don’t meet this performance standard after two years of continuous operation may be fined by the Agency.”

have not picked one, which means that a computer will assignment one of the plans to them, taking into account the patient’s location, current medical status and other needs. The remaining 35 percent, who already were enrolled in a managed care plan, decided to stay with their current insurer.

In addition, Statewide Medicaid Managed Care’s projected efficiencies are expected to redirect resources and increase compensation for physicians, according to Brown-Woofter.

“This is a historic transition. The train has left the station and everything has gone to managed care,” Kearns said. “There will be an emphasis on continuum of care.”

For patients, the new program means that there will not be limited medically necessary services or there won’t be changes to Medicare benefits or choices.

Indeed, the new program is aiming to preserve continuity of care, BrownWoofter said. That will happen because recipients will keep their primary care providers, maintain their current prescriptions, and have uninterrupted, ongoing course of treatment. As part of the new plans, she added, physicians and other providers must get paid fully and promptly to avoid any cash flow or payroll issues.

These issues were discussed on May 22 at the Palm Beach County Medical Society event, “Legislative Wrap Up: What Happened? What's Next?" Presentations were made by Brown-Woofter; Kevin Kearns, President and CEO, Health Choice Network and Prestige Health Choice; Jeff Scott, JD, Florida Medical Association; and Ronald J. Wiewora, MD, MPH, CEO of Health Care District of Palm Beach County. Much of the state has already transitioned into Statewide Medicaid Managed Care. Most of north and central Florida made the transition in May, and the Tampa Bay area launched in early June. By August, nearly all Medicaid recipient plans will be run by private insurers, including those in Palm Beach County. Medicaid recipients in Palm Beach County got notified about the change in late May. Palm Beach County is in the last region of Florida to implement Statewide Medicaid Managed Care. As of late May, according to media reports, 25 percent of Medicaid enrollees have chosen a plan, and 40 percent

QUARTER TWO 2014

Medicaid Expansion Fails in 2014 Legislative Session By Leon Fooksman

FAQ

Agency for Health Care Administration’s frequently asked questions and answers concerning Statewide Medicaid Managed Care:

Question #1 During the transition to the new program, how will providers know whether to continue services?

When the Florida Legislature ended its recent 2014 session, one of the most important issues to physicians failed before it began: expanding Medicaid eligibility and accepting federal money. It was the second year in a row that legislators resisted efforts to expand Medicaid through the Patient Protection and Affordable Care Act and accept the $51 billion in funds from the federal government.

Answer Providers should keep previously scheduled appointments with recipients during transition.

Question #2 How will providers know whether to continue services?

The Legislature’s position has been to shun the expansion in favor of shifting Florida’s 3.5 million Medicaid recipients into a privatized managed care system as a way to lowering costs while coordinating care, managing chronic disease, and maintaining or improving the quality of care.

Answer Providers should keep previously scheduled appointments with recipients during transition.

Question #3 In providing continuity of care, will there be reimbursements for physicians?

But transitioning to the Statewide Medicaid Managed Care system has not resolving the quality, safeguards, access to care, and proper reimbursement for physicians, according to a resolution submitted to the Florida Medical

Association and supported by Palm Beach County Medical Society, Broward County Medical Association, and Dade County Medical Association. Florida’s Medicaid reimbursement rates to providers, such as physicians, are among the lowest in the nation, according to the resolution. Providers account for only about five percent of the Medicaid budget, but are entrusted and responsible to safeguard and provide quality care and access for patients while directing and attempting to reform the other escalating costs and efficacy of care. As a consequence of the system in place, many patients are challenged in obtaining both specialty and primary care, as few doctors are willing to participate in Medicaid HMOs or PSNs, due to the low reimbursement rate, according to the resolution. Meanwhile, medical care access through emergency rooms is on the rise, and many other costs are increasing, too. The Medicaid expansion is expected to correct this. But that won’t happen at least this year.

Answer Providers will receive payment for services conducted during the transition.

According to the health care advocacy group, Florida Chain, the health care expansion bills (SB 710/HB 869) were filed early in both the House and Senate, but neither bill was heard in a single committee, which meant the “discussion” ended before it even started.

Leon Fooksman is a journalist, blogger and president/CEO of Digital Storyline, which specializes in creating dynamic web content for organizations in the health care field. QUARTER TWO 2014

ON CALL MAGAZINE

Palm Beach County Medical Society Services held its annual Heroes in Medicine Awards luncheon on May 8th with record attendance. The event celebrated an amazing group of Heroes and recognized Heroes of the Year in select categories. Special thanks to Rendina Companies for serving as Grand Benefactor, Honorary Hosts Dr and Mrs. Alan Pillersdorf, and Chair Greg Quattelbaum and Co-Chair Christine Brooks, ARNP. For a full list of 2014 Heroes, Sponsors and Host Committee please visit; www.pbcms.org/heroes. Also, visit our Facebook: www.facebook. com/PalmBeachCountyMedicalSociety to view the photos from May 8th.

Greg Quatelbaum Chair and Christine Brooks Co-Chair

Dr. Alan Pillersdorf and Richard Rendina

2014 HEROES IN MEDICINE The Bruce Rendina Legacy Award

Healthcare Educator

Provider Non-Physician

Richard Rendina *

Miguel Benavente, MD * Bradley S. Feuer, DO, JD Mario Jacomino, MD

Mary Jean Houlahan, RN * Rodney Dunetz, AP, DOM, Dipl. Ac. Angelica Ligas, RN

Healthcare Innovator

Community Outreach

Fernando Recio, MD * Brian Bernick, MD Ronald Davis, PhD Jay Feinberg

Glades Initiative, Inc. * Daniel Ramos - Pat Reeves Village The Childrenâ&#x20AC;&#x2122;s Healing Institute Charisse Van Biesen - The Lords Place

Physician National/Local Larry Bush, MD * Roberto Acosta, MD Jeffrey Davis, DO Michael Gervasi, DO Faustino Gonzalez, MD

Physician International Clifford Salinger, MD * Kenneth Jeffers, MD John Strasswimmer, MD

Bruce Rendina Professional

Student

John Couris * Todd Blum Thomas Cleare, PhD

Cy-Anne Small * Stephanie England Cindy Laing Nathaniel Forman

Humanitarian Sally D. Chester, RN *

Lifetime Achievement James W. Lea, MD *

Philanthropy Nancy Hogan *

ON CALL MAGAZINE

QUARTER TWO 2014

2014 HEROES OF THE YEAR

Richard Redina

Miguel Benavente, MD

Mary Jean Houlahan, RN

Larry Bush, MD

Fernando Recio, MD

Karis Engle

Clifford Salinger, MD

John Couris, CEO Jupiter Medical Center

Cy-Anne Small

Sally D. Chester, RN

James Lea, MD

Nancy Hogan

QUARTER TWO 2014

ON CALL MAGAZINE

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2014 Annual Report

Innovation, Collaboration, Solutions Palm Beach County Medical Society Services, the charitable arm of the Palm Beach County Medical Society, was created in 2001 to expand the reach of physicians in the community with a vision “ To Create a Healthier Community.”

Our Accomplishments • Launched Triple Aim Diabetes Program in collaboration with Palm Beach County Health Care District, University of Miami Residency Internal Medicine Program at JFK, FAU Diabetes Education Program • Implemented Care Coordinator position for Diabetes Program • Promoted the creation of Health Care Emergency Response Coalitions nationally • Expanded Project Access Network with value reaching over $10 million • Initiated CMS designated Health Care Navigator Program • Welcomed two new members to 1919 Society • Partnered with University of Miami Medical School MD/MPH Capstone Program • Provided donated services by Medical Reserve Corps Volunteers of $68,541 • Sold 600 copies of the HERC Book, “Establishing A Healthcare Emergency Response Coalition” • Partnered with “Health Department on Healthy Weight Coalition”

Board of Directors Douglas Dedo, MD President / Chair

Michael Dennis, MD Vice President

Ivy Faske, MD Secretary

Don Chester Treasurer

Brent Schillinger, MD Immediate Past President

From the Chair Looking back on the past year, we see an impressive list of accomplishments. While we are proud of our efforts, there is more work to be done. We take seriously the responsibility we have to advance and enhance the quality and access to health care in Palm Beach County. Working in partnership with health care and community leaders, we have championed efforts to develop innovative and collaborative solutions. Douglas Dedo, MD, President PBCMSS

These efforts would not be possible without the generous support of foundations, grants, physicians, businesses and donors. Looking forward, we are committed to exploring new ideas and building new partnerships to meet the healthcare challenges of our community. I invite you to join with us on this journey. Together we are creating a healthier community.

Doug Dedo, MD Chair

William Adkins, MD Alina Alonso, MD Jose F. Arrascue, MD Brenda Atkins Yolette Bonnet Tammy B. Clarke Cynthia Clayton, MD Ron Davis, PhD Judith B. Goodman, Esq. Matt Gracey Daniel Higgins, MD Robert Hill Stuart B. Himmelstein, MD James T. Howell, MD Leslie Mills, DO Alan B. Pillersdorf, MD Greg Quattlebaum Heather Siegel Miller, Esq. Andrea Stephenson, MBA, MHS Jim Sugarman Kimberly Warth Maureen Whelihan, MD Marisa Vinas (Medical Student)

Innovative Programs The Future of Medicine Founded by Jose Arrascue MD, the Future of Medicine Initiative has brought together community healthcare leaders to define issues, establish partnerships and implement strategies for change. The most recent initiative is the Triple Aim Initiative.

The Future of Medicine Summit

Jose Arrascue MD Chair Future of Medicine, Triple Aim Initiatve

chaired by Michael Dennis, MD, is now in its eighth year. The Summit brings together national and community healthcare leaders to explore the “hot topic” issues facing health care. A special focus on medical education is provided with the Medical Student and Resident Poster Symposium.

Triple Aim Initiative is a collaboration with the University of Miami/JFK Internal Medicine Residency Program, the Health Care District of Palm Beach County and Florida Atlantic University Clinic, and Project Access.

Michael Dennis MD, Chair Future of Medicine Summit,

Project Access Project Access is a network of physicians who donate care to low income uninsured residents of Palm Beach County. To date Project Access volunteers have provided over $10.4 million in care to over 8,000 patients.

HERC HERC is a nationally recognized coalition of more than 60 public health agencies, 15 hospitals in the county and two specialty care hospitals, physician offices, law enforcement officers and emergency responders. HERC exists to coordinate and improve the delivery of health care emergency response planning, preparedness and response.

Ivy Faske, MD, Chair Project Access,

Medical Reserve Corps MRC volunteers work to improve the health and safety of our community by organizing and utilizing public health and other volunteers to respond to disasters and other public health needs.

Rebecca Creighton, Chair HERC

Hippocrates Society Collaboration and partnership are the core values of the Hippocrates Society. We are honored to recognize the following hospital medical staffs for their participation in the Hippocrates Society. With their support, programs such as the Future of Medicine, Heroes in Medicine, and scholarships for medical education are possible.

• Bethesda Health Medical Staff • Boca Raton Regional Hospital Medical Staff • Delray Medical Center Medical Staff • JFK Medical Center Medical Staff • Jupiter Medical Center Medical Staff • Wellington Regional Medical Center Medical Staff

1919 Society Since 1919, PBCMS physicians have dedicated themselves to their patients and the community. The 1919 Society is a Leadership Giving Society which has demonstrated a long-term commitment to our community. Thank you to 1919 Society Member.

Dr. Jose F. Arrascue Dr Jeffrey Berman Dr. Clarence L. Brumback (Deceased) Dr. James J. Byrnes (Deceased) Dr. Michael Dennis Dr. Malcolm Dorman Dr. J. John and Judy Goodman

Dr. Howard Green Dr. Beth-Ann Lesnikoski Dr. Alan and Rhona Pillersdorf Dr. Brent Schillinger Dr. Ida Sebastian Dr Ronald Zelnick

Heroes In Medicine For the 11th year, the Annual Heroes in Medicine Award luncheon recognized the outstanding individuals and organizations who have made a significant contribution to health care and have demonstrated a commitment to improving the health of Palm Beach County. This yearâ&#x20AC;&#x2122;s Heroes in Medicine set records in attendance and in dollars raised, providing needed resources for Project Access. Special Recognition to Honorary Hosts Dr and Mrs Alan and Rhona Pillersdorf and Grand Benefactor Rendina Companies.

TOP ROW L TO R: Thomas Cleare, PhD, Dr. Faustino Gonzalez, Dr. Clifford Salinger, Dr. Miguel Benavante, Todd Blum, Daniel Ramos, John Couris, Dr. Larry Bush, Dr. Michael Gervasi, Dr. Jeffrey Davis, Dr. Brian Bernick, Dr. Alan Pillersdorf, Dr. John Strassimmer, Dr. Rodney Dunetz, Dr. Robert Acosta BOTTOM ROW L TO R: Sally Chester, RN, Nancy Hogan, Angelica Ligas, RN, Mary Jean Houlihan, RN, Karis Engle, Cy-Anne Small, Dr. James Lea

Recognizing Commitment Volunteers are the heart of our organization with over 1,500 volunteers participating in our programs. The Annual Recognition Dinner pays tribute to our volunteers.

Andrew O'Leary, MD, Kishore Dass, MD

2014 Heroes of the Year The Bruce Rendina Legacy Award

Bruce Rendina Professional

Richard Rendina *

John Couris * Todd Blum Thomas Cleare, PhD

Physician National/Local Larry Bush, MD * Robert Acosta, MD Jeffrey Davis, DO Michael Gervasi, DO Faustino Gonzalez, MD

Physician International Clifford Salinger, MD * Kenneth Jeffers, MD John Strasswimmer, MD

Humanitarian Sally D. Chester, RN *

Lifetime Achievement James W. Lea, MD *

Provider Non-Physician Mary Jean Houlahan, RN * Rodney Dunetz, AP, DOM, Dipl. AC. Angelica Ligas, RN

Cynthia Geraldo & Eric Downes

Community Outreach Glades Initiative, Inc. * Pat Reeves Village The Childrenâ&#x20AC;&#x2122;s Healing Institute Charisse Van Biesen

Healthcare Educator Miguel Benavente, MD * Bradley S. Feuer, DO, JD Mario Jacomino, MD

Healthcare Innovator Fernando Recio, MD * Brian Bernick, MD Ronald Davis, PhD Jay Feinberg

Student Cy-Anne Small * Stephanie England Cindy Laing Nathaniel Forman

Philanthropy Nancy Hogan *

James Howell, MD, Michael Gervasi, DO, Brent Schillinger, MD

Our Funders

Moving Forward

Tenna Wiles CEO PBCMSS

The transformational changes in health care have a major impact on the access and delivery of quality care in our community. With a focused vision of advancing public health and medical education through physician directed initiatives, Palm Beach County Medical Society Services will remain committed to engage the community and bring together innovations and solutions. With change comes opportunity, and we believe that by working together we can help to shape solutions to improve health care in our community.

Admirals Cove Cares Charitable Foundation B4BC The Ernst & Gertrude Ticho Charitable Foundation Florida Department of Health

Tenna Wiles, CEO

Health Care District of Palm Beach County

Income Summary

Health Council of Southeast Florida

• Grants % 58.65 • Fund Raising - Special Events 28.44 • Contributions 11.5 • In Kind Income Adver/Printing 1.29 • Royalties 0.06 • Annual Recognition Dinner 0.01 • United Way Donations 0.01 • Interest Income 0.01

Jarden Consumer Solutions Community Fund JFK Medical Center National Association of County & City Health Officials (NACCHO) Michael Dennis, MD

Total

$769,665.80 Palm Healthcare Foundation Quantum Foundation Rendina Companies United Way of Palm Beach County

Expense Summary

Urban Areas Security Initiative (UASI)

• Salaries and Benefits • Contracted Services • Program Expenses Direct • Fund Raising Cost • Occupancy Expenses • Design/Print & Postage • In Kind Advertising/Printing • Office • Travel • Accounting • Other Total

% 43.95 16.69 14.79 12.82 5.70 1.69 1.29 1.21 0.81 0.57 0.48

Many thanks to their Generosity

$766,463.16

Palm Beach County Medical Society Services is a 501c3 charitable organization which relies on the generosity of our donors. Please visit us at www.pbcms.org to learn more about our programs. If you would like to learn how you can support our mission, please contact us at 561-433-3940 or pbcms.org.

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Telemedicine:

It’s a Necessity in the State of Florida but Board Decision Shows that Legislation is Needed for Expanding Telemedicine in the State of Florida by Heather S. Miller, Esq. and Stephen H. Siegel, Esq., Broad and Cassel, Florida With Florida's demographics changing and health care provider shortages on the rise, telemedicine enables patients who are in remote areas of Florida or who do not have access to specialists to obtain services. This same technology also provides a means for physicians and nurse practitioners to monitor the progress of patients with chronic conditions or who have difficulty in traveling, both of which are going to become increasingly prevalent as our population ages. While the current Florida landscape does not currently support substantive expansion of telemedicine services, given the fact that the percentage of individuals over the age of 65 will increase more than 24% by the year 2030 and telehealth could reduce costs by more than $1 billion, momentum in favor of telemedicine has been building over the past few years. Cost savings and economic development opportunities have lead policymakers to spearhead efforts to remove barriers to telehealth through proposed legislation. The coverage of telehealth services is getting much attention in the Florida Legislature. The public and health industry push for telemedicine has made it a top priority of the 2014 Legislative Session. There are currently four bills – SB 70, HB 167, CSHB 751, and SB 1646 –pending in the Legislature that would expand the ability of physicians to provide telemedicine services in the state and be reimbursed for such services. Against this backdrop of legislative activity, Florida already regulates the practice of telemedicine. Section 64B89.014(1), F.A.C., (the "Rule"), states that "[p]rescribing medications based solely on an electronic medical questionnaire constitutes the failure to practice medicine with that level of care, skill and treatment which is recognized by reasonably prudent physicians as being

acceptable under similar conditions and circumstances, as well as prescribing legend drugs other than in the course of a physician's professional practice." The Rule establishes 3 prerequisites for a physician to use "electronic or other means" to provide treatment (excluding an "emergency situation"): 1. A "documented patient evaluation, including history and physical examination..."; 2. A discussion with the patient "regarding treatment options and the risks …"; and 3. A contemporaneously maintained medical record. One of the aspects of the Rule that has caused confusion is the requirement for a "physical examination" in order to prescribe medications or other treatments using telemedicine. Specifically, must there first be a face-to-face encounter between the prescribing physician and the patient? A recent Declaratory Statement issued by the Florida Board of Medicine (In re: Petition for Declaratory Statement of Jose Garcia, M.D., Final Order No. DOH-14-0226-DS-MQA (2/17/2014)), provides some guidance on this question. In Garcia, the Board reviewed the provisions of Section 64B8-9.014 in light of Dr. Garcia's proposal to use telemedicine to treat patients located in rural areas or during hours when his offices were not open. The Board observed that the Rule "does not set forth a blanket prohibition on the use of telemedicine technology to provide medical care to patients." Accordingly, based on the information in his Petition, the Board concluded that Dr. Garcia's "proposed practice plan … does not reveal any practices that would violate" the Rule.

Although a cursory reading of Garcia may lead some to conclude that the answer to the question raised above is "no", an inperson examination is not a prerequisite to treating a patient via telemedicine, a closer reading reveals a that to be an incomplete understanding of this decision. Unfortunately, the Board chose not to include a statement of the facts it was asked to consider in this Declaratory Statement. Dr. Garcia's "proposed plan", as described in his Petition included the following: "Telemedicine would only be available to existing clinic patients who have been seen personally by a clinic medical provider prior to the telemedicine visit." Thus, a prudent reading suggests that the Board views a prior face-to-face encounter as a prerequisite to treating a patient by means of telemedicine. ( Continued on Page 30 )

QUARTER TWO 2014

ON CALL MAGAZINE

A BIG SALUTE TO OUR EXCEPTIONAL PHYSICIANS! It's such an honor to be recognized for excellence by your peers! Congratulations from the Palm Beach County Medical Society. And thank you Palm Beach Illustrated for your leadership and partnership.

Exceptional Physicians

Honorable Mention

Cardiovascular Disease

Anesthesiology

Mark H. Rubenstein, MD

Roger Duncan, MD

Hospice & Palliative Medicine

Cardiovascular Disease

Daniel Fortier, MD Faustino Gonzalez, MD Richard Levene, DO Infectious Disease

Larry Bush, MD Nephrology

Jack Waterman, DO Jose Arrascue, MD Neurology

Fred Boltz, MD James Goldenberg, MD Ophthalmology

Michael Patipa, MD Steven Rosenfeld, MD Physical Medicine & Rehabilitation

Mark A. Rubenstein, MD Plastic Sugery

Hatem Abou-Sayed, MD David Bogue, MD Dov Eidelman, MD David Lickstein, MD Alan Pillersdorf, MD Psychiatry

Steve Pollack, MD Mark Simon, MD Clinical Cardiology Electrophysiology Robert Fishel, MD Colon and Rectal Surgery, MD Andrew Ross, MD Ronald Zelnick, MD Dermatology

Rheumatology

Ira Pardo, MD Surgery

Marc Feinberg, MD Mark Goldstein, MD Neurology Casandra Mateo, MD Obstetrics & Gynecology Melissa Friedman, MD Ophthalmology Monique Barbour, MD Lee Friedman, MD Lawrence Katzen, MD

Jeffrey Marcus, MD

Mark Michels, MD

Michelle Muhart, MD

David Mittleman, MD

Steven Rosenberg, MD

Orthopaedic Surgery

Abbey Strauss, MD Pulmonary Disease Jermey Breit, MD Michael Falkowitz, MD William Ludwig, MD Ralph Palumbo, MD Radiation Oncology Tim Williams, MD Rheumatology Shawn Baca, MD Joseph Forstot, MD Surgery Arul Chidambaram, MD Daniel Higgins, MD

Diagnostic Radiology

David Campbell, MD

Mariano Ibarrola, MD

Walter Forman, MD

Michael Cooney, MD

K. Andrew Larson, MD

Don Goodwin, MD

Eric Shapiro, MD

Miguel Lopez-Viego, MD

Joseph Kleinman, MD

Ryan Simovitch, MD

Barry Miskin, MD

Richard Weiner, MD

Jefferson R. Vaughan, MD

Family Medicine Robert Campitelli, MD Jorge Inga, MD Gynecology William Casale, MD

Robert Briskin, MD

Otolaryngology Carolyn Agresti, MD David Lehman, MD Nathan Nachlas, MD Ellis Webster, MD Pain Medicine/Anesthesiology

Rohit Dandiya, MD

Bruce Hindin, DO

Valentina Gherghina, MD

Douglas Maclear, DO

Edward Jeryan, MD Seba Krumholtz, MD

Pediatrics Philip Colaizzo, MD Plastic Surgery

Jose Carlos Lira, MD

Rafael Cabrera, MD

Charles Metzger, MD

Dana Goldberg, MD

Richard Raborn, MD

Ernesto Hayn, MD

Elisabeth McKeen, MD

Alberto Navarro, MD Jana Rasmussen, MD Richard Schwartz, MD

ON CALL MAGAZINE

Jacqueline Pevny, MD

Clay Baynham, MD

Medical Oncology

Psychiatry

Brent Schillinger, MD

David Hevert, MD

Joseph Colletta, MD Amy Mostafavi, MD George Mueller, MD Jack Zeltzer, MD

Hitesh Kapupara, MD

Andrea Colton, MD

Internal Medicine

Stefan Pasternack, MD

Nephrology

QUARTER TWO 2014

Jonathan Wideroff, MD Surgery of Hand/Orthopaedic Surgery Roberto Acosta, MD Thoracic and Cardiac Surgery Malcolm Dorman, MD Thoracic and Cardiac Surgery Richard Faro, MD Urology Ross Cohen, MD George Patsias, MD

South Miami Heart Center

Comprehensive Cardiovascular Symposium (Eighth Annual) Friday-Saturday, May 16-17, 2014 ■ Trump Doral National, Miami, Florida (10.5 CME/CE) ■ SouthMiamiHeart.BaptistHealth.net State of the Science Symposium:

Critical Care Best Practices (Fifth Annual) Saturday, June 14, 2014 ■ Baptist Hospital, Auditorium (7 CME/CE) ■ CriticalCare.BaptistHealth.net CLI Miami:

The Miami Critical Limb Ischemia Symposium

Saturday and Sunday, June 7-8, 2014 ■ The Biltmore Hotel, Coral Gables, Florida (10.5 CME/CE) ■ CLIMiami.BaptistHealth.net

Primary Focus Symposium (13th Annual) Friday-Sunday, June 27-29, 2014 Marco Island Marriott Beach Resort, Marco Island, Florida (12 CME/CE) ■ PrimaryFocus.BaptistHealth.net More CME opportunities at BaptistHealth.net/CME

CME@BaptistHealth.net ■ 786-596-2398

Connect with us BaptistCME

Rodney Dunetz, AP, DOM, Dipl.AC

Acupuncture Physician, Doctor of Oriental Medicine

Rodney Dunetz, AP, DOM, Dipl.AC

Acupuncture Physician, Doctor of Oriental Medicine

2013 BDO Survey of Board Compensation Practices by Tammy B. Clarke, CPA, MTx

Many companies will be holding their annual shareholder meetings, at which board compensation will likely be a topic of discussion. The annual BDO 600 survey provides an overall look at what type of compensation is standard for board of directors at middle market healthcare companies. We also examine compensation trends across seven other industries in the 2013 BDO Survey of Board Compensation Practices of 600 Mid-Market Public Companies report. If you would like a hard copy of this report, please contact me at the The fourth edition of the BDO 600: 2013 Survey of Board Compensation Practices of 600 Mid-Market Public Companies examines the director compensation trends in publicly-traded companies with annual revenues from $25 million to $1 billion in the energy, healthcare, manufacturing, real estate, retail and technology industries; and publicly traded companies with assets between $50 million to $2 billion in the banking and financial services industries. Information for the study was drawn from proxy statements that were filed between May 15, 2012, and May 15, 2013. Board director pay remains relatively static in the healthcare sector, with average total compensation decreasing slightly to $146,636 from $148,272 last year. The one percent decrease contrasts with increases seen in several other surveyed sectors. While healthcare board director compensation ranks third in overall board member compensation, the technology industry receives the highest average

Board of Directors Compensation by Industry 2011-2012 $154,480

$174,407

$146,636 $117,437

$91,038

$133,148

$117,060

$64,716

Energy

Personal Services Banking

Personal Services Non Banking

Healthcare

compensation at $174,407, down from $177,249, a two percent decrease from the previous year. Despite trailing the other industry segments in total compensation, financial services banking and non-banking companies saw significant upward movement with 13 percent and seven percent increases in compensation from last year, respectively. “Director pay in healthcare seemed to level off this year,” says Randy Ramirez, senior director in the Global Employer Services practice at BDO. “Moving forward, compensation is likely to become more volatile as the industry faces continued uncertainty in the face of a shifting paradigm in healthcare.” Average total director compensation in healthcare companies ($146,636) continues to fall just behind the energy and technology sectors. Board member compensation in the healthcare sector is likely driven by the significant shifts in the

Manufacturing

Real Estate

Retail

Technology

sector, where reimbursement changes and the enactment of the Affordable Care Act, has created particular uncertainty for healthcare organizations, as they try to predict the ultimate impact on their business. Director compensation in healthcare is weighted toward non-cash options, with 63 percent of compensation awarded in the form of full-value equity and option awards. Average full-value stock awards alone jumped to $64,408 from $58,193 last year, showing an 11 percent increase. This trend in reduced fixed income compensation may help remind directors of their fiduciary duty to act in the best interest of the company. It also serves the need of healthcare organizations to maintain cash reserves as they face significant uncertainty under the Patient Protection and Affordable Care Act. ( Continued on Page 30 )

QUARTER TWO 2014

ON CALL MAGAZINE

TY N U Y ’S O C IET H C AC SO E B AL M L DIC A P E M

YOUR AD IN

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TO OUR CHIEF MEDICAL OFFICER

Faustino Gonzalez, MD, FACP, FAAHPM

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We operate to make home financing simple and painless for you!

Fifth Third Mortgage recognizes the special financial and time management needs of physicians today. Our DOCTOR LOAN PROGRAM provides New and Established Doctors (MD, DO or DPM) with targeted benefits and simple solutions to meet your home financing needs. The Benefits: YOUR TIME / YOUR PLACE A dedicated Mortgage Loan Originator can meet with you when and where works best within your busy schedule YOUR INDUSTRY / OUR KNOWLEDGE We have an extensive understanding of the Healthcare and Residency process YOUR OPTIONS Fixed and Adjustable Rate Loans* with No Private Mortgage Insurance required**

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You may be able to get financing up to 100% of the home value on a new purchase up to $650,000. Or refinance a 100% loan-to-value up to $650,000, 90% up to $1 million, or 85% up to $1.5 million.

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*After the ARM period, it is possible that the borrower’s payment and interest rate may increase substantially over the remaining term of the loan. **Terms and conditions apply. The information contained is subject to change without notice. Loans are subject to credit review and approval. If the borrower can document that the student participate in our automatic payment program and requires automatic payment deduction from your qualifying Fifth Third account. $50 minimum required to open a new checking account. Cincinnati, Ohio 45227 an Illinois Residential Mortgage Licensee. Fifth Third Mortgage is the trade name used by Fifth Third Mortgage Company and Fifth Third Mortgage-MI, LLC. Fifth Third Equal Housing Lender. and Fifth Third Bank are registered service marks of Fifth Third Bancorp. Member FDIC. R101310426C

MED MEMO Quarter Three 2013

SAVE THE DATES December 6, 2014

PBCMS Annual Installation Dinner "Starfishand Snowflake Gala" The Kravis Center, West Palm Beach More info: www.pbcms.org/events/annual-gala

October 9-10, 2014 Future of Medicine

The Kravis Center, West Palm Beach More info: www.pbcms.com/events/future-of-medicine

Stephen Babic, MD Ivy Faske, MD James Goldenberg, MD Donald S. Grossman, MD Marc Hirsh, MD James Howell, MD Andrew Larson, MD Jeffrey F. Linder, MD Brandon Luskin, MD Harish Madhav, MD Emanuel Newmark, MD Sonya Pease, MD Norman Henry Pevsner, MD Mark Rubenstein, MD Richard G. Shugarman, MD Kenneth Woliner, MD Jack Zeltzer, MD Ronald Zelnick, MD

Alan Pillersdorf MD to be installed as FMA President

Congratulations to the Harold Strasser MD Memorial Scholarship

Congratulations to PBCMS Past President, Alan Pillersdorf MD. Dr Pillersdorf will be the third physician from Palm Beach County to be installed as President. PBCMS will be sending 20 delegates to the FMA Annual Meeting in Orlando, July 2527. Please join us as we celebrate this outstanding honor and accomplishment. PBCMS will be sending 20 delegates to represent Palm Beach County physicians. The meeting will be held at the Hilton Orlando Bonnet Creek 14100 Bonnet Creek Resort Lane, Orlando. For additional information go to www. celebratemedicine.org

Rood Emmanuel is our 2014 Harold Strasser Memorial Scholarship winner. A graduate of Inlet Grove High School, Rood he will be attending the University of Florida in Gainesville He has completed certifications as an EKG technician, and as a medical assistant. He volunteers as a math tutor, coaches young children in basketball and volunteers at La Posada Nursing home. His also participated in Varsity Basketball. He will be pursing the medical field to become a doctor and hopes to help the poor. He has risen above all with his dedication to school, and volunteerism while keeping up his grades and never losing sight of his dream. Congratulations to Rood Emmanual and best wishes on winning this scholarship!!

Thank you PBCMS Delegates Jose Arrascue, MD Shawn Baca, MD 26

ON CALL MAGAZINE

QUARTER TWO 2014

PBC Visits Tallahassee Palm Beach County physicians recently visited Tallahassee and met with Representative Bill Hager. From left, Jeff Berman MD, Brent Schillinger, MD; Ronald Zelnick, MD; Representative Hager; Shawn Baca, MD and Stephen Babick, MD. Alan Pillersdorf, MD, FMA President-elect was also in attendance.

The Great Give Laurie George, president of United Way of Palm Beach County Community Foundation president, Brad Hurlburt celebrate the resultsfor the 2014 Great Give Over $2 million was raised in the inaugural 24 hour giving event. Special thanks to the PBCMS Donors who raised $1,650 for Project Access. List of donors will be attached in separate email

CLASSIFIEDS

Meet Our Partners Hospice of Palm Beach County

MSPC and PBC Plus

Hospice of Palm Beach County is a leading provider of hospice care in our community. We put the needs of patients and families first - committed to doing whatever it takes to provide compassionate care and ensure the highest possible quality of life. We care for all who want and qualify for our services, regardless of ability to pay. We offer the physical, emotional and spiritual care that brings comfort and dignity to those with terminal illness and their loved ones. Our multi-cultural staff respects all religions and cultural traditions. We offer emotional support through grief support services including group counseling.

Medical Specialists of Palm Beaches, Inc is a clinically integrated healthcare network of over seventy physicians and thirty locations offering medical, therapeutic and diagnostic care. As the largest multi-specialty group in Palm Beach County, MSPB has partnered with PBC Plus, a Management Services Organization, which has strong relationships with insurance companies and Medicare. Primary care physicians and medical specialists work together to provide patients a continuum of coordinated care across the healthcare spectrum to consistently deliver the best medical services. For more information on Medical Specialists of the Palm Beaches, visit www.MSPB.md or call 561-966-7700.

VINTAGE WINE BUYERS, LLC, is in the business of buying wine collectors cellars, either partial or complete. We will help you inventory, appraise, and pay you the most competitive prices available. We also may have wines for purchase as well. Contact Ed Gutman at 410-303-2525 or email to leg7915@verizon.net.

Advertise Here

ON CALL is a quarterly publication, advertising rates and deadlines can be found at: www.pbcms.org/advertise

MED SOCIETY NEWS Quarter Four 2013

A Warm Welcome To Our Newest Members Susan Jane Boston, MD West Palm Beach Specialty: Endocrinology

Mary C. Labanowski, MD West Palm Beach Specialty: Internal Medicine

Paul Acevedo, MD West Palm Beach Specialty: Neurology

Michelle Marie Dompenciel, MD Palm Beach Gardens Specialty: Neurology

Alexandra Miguelina Soriano Caminero, MD West Palm Beach Specialty: Neurology

Ankush Kumar Bansal, MD Miami Specialty: Internal Medicine

Tarah Lynn Freyman, DO Palm Beach Gardens Specialty: Family Medicine Danita Brooks Jones, DO Palm Beach Gardens Specialty: Neurology

Elliot Joseph Wasser, MD West Palm Beach Specialty: Diagnostic Radiology Sarah Wiggill, MD West Palm Beach Specialty: Family Medicine

Larry Bush, MD Atlantis Specialty: Infectious Disease Monique Samuel, DO (resident) Lakeside Medical Center Specialty: Leonard Zullo, MD (retired) Wellington

BDO IS PROUD TO SUPPORT

PALM BEACH COUNTY MEDICAL SOCIETY

(Continued from Page 3)

( Continued from Page 19 )

( Continued from Page 23 )

medicine, reimbursement, and liability issues. This year, I have met with Governor Scott and Legislators in Florida. We need to continue to educate our legislators on issues that affect physicians and the patients of Florida. They need to know that their policies have a real impact on real people.

Some of the pending legislation addresses this very issue but until such legislation is passed, a prudent reading of the Rule includes an understanding that the phrase "documented patient evaluation, including history and physical examination" means a prior face-to-face encounter with the patient.

BDOâ&#x20AC;&#x2122;s national team of professionals offers the hands-on

There is support for a constitutional amendment to deal with malpractice caps. The state of Texas is a model for Florida. Since its passage in 2003, Texas has doubled the number of physicians practicing in the state.

Telehealth is emerging as an integral part of the healthcare delivery system. Physicians, hospitals, medical homes, and accountable care organizations need to evaluate telehealth and determine how to integrate this technology into their business and be ready to implement changes when legislation is passed.

experience and technical skill to address the distinctive business needs of our healthcare clients. We supplement our technical approach by analyzing and advising our clients on the many elements of running a successful healthcare organization. The BDO Healthcare practice provides services in acute care, home care and Hospice, hospitals, physician practices, preferred provider organizations and more. For additional information on BDO services for the healthcare

But, we need all practicing physicians to join their county medical societies, state societies and the AMA. Our strength is in numbers. We need strong political support. Advocacy does matter! It starts with you.

ON CALL MAGAZINE

BDO is the brand name for BDO USA, LLP, a U.S. professional services firm providing assurance, tax, financial advisory and consulting services to a wide range of publicly traded and privately held companies. For more than 100 years, BDO has provided quality service through the active involvement of experienced and committed professionals. The firm serves clients through 49 offices and over 400 independent alliance

Cassel, Florida hmiller@broadandcassel.com or shsiegel@

firm locations nationwide. As an independent Member Firm of

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BDO International Limited, BDO serves multinational clients

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through a global network of 1,264 offices in 144 countries.

News 2013 Vol. 1. CRITICAL CONNECTIONS TO CARE:

Health Outcomes and Generate Savings, Florida Tax Watch, March 2014.

or 561-689-7888.

Heather S. Miller, Esq. and Stephen H. Siegel, Esq., Broad and

Expanding the Use of Telemedicine in Florida will Improve

Ronald Zelnick MD FACS, FASCRS

industry, please contact Tammy B. Clarke at tclarke@bdo.com

QUARTER TWO 2014

UNCOMPROMISING

IN FLORIDA, WE PROTECT OUR MEMBERS WITH THE BEST OF BOTH WORLDS: NATIONAL RESOURCES AND LOCAL CLOUT

As the nation’s largest physician-owned medical malpractice insurer, with 75,000 members, we constantly monitor emerging trends and quickly respond with innovative solutions. And our long-standing relationships with the state’s leading attorneys and expert witnesses provide unsurpassed protection to our over 15,000 Florida members. When these members face claims, they get unmatched litigation training tailored to Florida’s legal environment, so they enter the courtroom ready to fight—and win. Join your colleagues—become a member of The Doctors Company.

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