On Call - The Journal of Palm Beach County Medical Society (Quarter One 2012) by Palm Beach County Medical Society

ON CALL

ON CALL MAGAZINE QUARTER ONE 2012 / PRESIDENT’S REPORT

magazine

The Official Publication of the Palm Beach County Medical Society

WELCOME NEW 2012 PRESIDENT Jack Zeltzer, MD

Quarter One 2012

Find out why we are the only agency endorsed by the Palm Beach County Medical Society. We make it our practice to genuinely care about yours. As a long-time supporter of the Palm Beach County Medical Society, we do much more than just negotiate the best med mal rates available. We are financially and actively involved, both locally and statewide, in seeking solutions to some of healthcare’s most pressing issues. Call us today to see what we can do for you.

Delray Beach • Orlando • Miami • Jacksonville 800.966.2120 • info@dannagracey.com • www.dannagracey.com

Did you receive money back on your premium last year? Many doctors have through the Palm Beach County Medical Society Workers’ Compensation Program. The rates for all physicians throughout the state are set by the State of Florida. Your practice will pay the same price no matter where you choose to secure coverage. However, under the OptaComp program, you may be eligible for a potential dividend of up to 24.8%. Your membership with the PBCMS can provide savings that can be paid back in dividends. OptaComp has returned a dividend for 12 straight years, with over $4 million over the past six years to Florida medical societies’ members: $600,000 of that went to PBCMS members. The OptaComp (rated “A” by A.M. Best) program is endorsed by the PBCMS and is offered by Danna-Gracey, Inc. For more information, please call Tom Murphy at 800.966.2120.

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President’s REPORT Jack Zeltzer, MD

Quarter One 2012

President, Palm Beach County Medical Society

ONE OFTEN HEARS THE TERM... “Generational Shift” to mark the change in concepts from one generation to the next.

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ON CALL MAGAZINE QUARTER ONE 2012 / PRESIDENT’S REPORT

It occurred to me one day when wondering why Physicians are no longer active in “Hospital Governance” that it is because of this Generational Shift. When I sit at Med Exec meetings now, I realize that the members are all significantly younger and are of the mindset that they have no influence or interest in setting the Hospital agenda as they no longer view themselves as Creators or Controllers of the Hospital’s destiny. Nor do they see their destinies entwined with the Hospitals’. They see the Hospital as a Corporate facility of which they only make use. This is because they have entered into practice with a New Generational Mindset. Like the tale of Exodus in the Bible, wherein the Isrealites were made to wander in the Desert for 40 years so that those entering the Promised Land would be a New Generation devoid of those who participated in past transgressions, so too has a New Generation of Physicians been created. They have no connection to the 40 years of Medical Wandering and have been effectively purged of the Old Traditions. Unfortunately this has had a negative impact for physicians and their future.

The Old Traditions that have been expunged came from the concept of Patient Care first. Back then the primary bond was between Physician and Patient. The Hospital was a secondary source of care and while often owned by Physicians, was dependent on Physicians supporting their services. This meant that the Hospitals were fundamentally dependent on Physicians for guidance and direction to ensure patronage, proper patient care and plan their future growth. Physicians and Medical Staff Governance defined the destiny of these Institutions. Then came the Exodus of Physician Governance and the 40 years of wandering. As Insurance entities, HMO’s and similar entities gained control of the patient, the patient/physician relationship was fractured, thus allowing the marginalisation of Physician input in Hospital Governance and a shift of the Hospital’s eyes toward the Payor and not the Patient or his advocate, the Physician. Medicine became a Corporate Industry, and the patient a commodity to be measured in the number of covered lives that could be contractually bartered as Physicians became Providers and Vendors. During this Forced March, as happens historically, some resist and are dealt with, some retire, and some become resigned to the new System. In the end, those on the Trek are inconsequential. It is the New Generation, those born at the end of the Journey, without recollection, knowledge or concern for Past Traditions, who blithely follow the new paradigm, that the new System desires. And so a New Generation of leaders sit on Medical Executive all too often drinking the Corporate Kool-Aid and never realizing that within themselves still remains the Power to effect Change.

ON CALL MAGAZINE QUARTER ONE 2012 / THIS ISSUE

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FEATURES

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This Issue 21

Alpern Rosenthal is a top 100 accounting and business consulting services firm, with offices in West Palm Beach, FL, Philadelphia, PA, and Pittsburgh, PA. For more information on Alpern Rosenthal, please contact Tammy Clarke at 561.689.7888 or tclarke@alpernfl.com. Visit us on the web at www.alpern.com.

Heroes are people who put others before themselves. They embrace the opportunity to help others and are willing to work far beyond expectations to make a difference in the world—without seeking the spotlight. Now it’s time to shine on them!

ARTICLES 2 12

PRESIDENT’S REPORT

MED MEMO

MED SOCIETY NEWS: NEW MEMBERS

CLASSIFIEDS

Nominations Deadline February 16, 2012 & Finalists Announced mid-March 2012 Awards Luncheon May 9, 2012, Kravis Center Cohen Pavilion Luncheon tickets & Sponsorships available. Call 561-433-3940 or visit www.pbcms.org. Award Categories

Community Outreach Hero Bruce Rendina Professional Hero Health Care Provider Hero (Non-Physician) Physician Hero (Local/National) Physician Hero (International) Student Hero

NEW BOARD

THE ROAD AHEAD: BOARD PRIORITIES FOR 2012

2012 SURVEY RESULTS

PHYSICIANS LEADING CHANGE: TO WHAT END? BY ALICE GOSFIELD

BECOMING A VOLUNTEER/ AFFILIATE FACULTY MEMBER BY RICHARD GREENWALD, MD

STATE OF THE FLORIDA MEDICAL MALPRACTICE INSURANCE MARKET 4TH QUARTER, 2011 BY MATT GRACEY

PBCMS ACTIVITY IN THE AMA

DANGERS OF GOING BARE BY ROBERT E. WHITE, JR.

A TRADITION OF CARING: NEW BOOK TO HERALD MEDICAL HISTORY OF PALM BEACH COUNTY

This Issue

Hearts—Hope—Healing—Heroes Salute the Heroes Among Us!

Grand Benefactor: Rendina Companies

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2011 Heroes

ADVOCACY UPDATE: YOUR VOICE DOES MATTER BY STEPHEN BABIC, MD, LAWRENCE GORFINE, MD, SHAWN BACA, MD

Considering

Help at Home?

ON CALL MAGAZINE QUARTER ONE 2012 / DIRECTOR’S DESK

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Palm Beach County Medical Society

DIRECTOR’S

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Our nation’s health care delivery system is changing dramatically.

Much like physicians, leaders are not born, but rather

Health Care Providers Must be Ready.

Yes, some have the natural charisma which is often

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a leadership characteristic, but that is certainly not

n Creating Accountable Care Organizations n Navigating Antitrust Concerns n Understanding the New Health Reform Law (ACA) n Providing Guidance Regarding Clinical Integration n Advising on Stark and Anti-kickback Regulations n Creating Medical Homes n Implementing Payment Bundling n Instructing on Compliance with HITECH Act

BOCA RATON n DESTIN n FT. LAUDERDALE n MIAMI n ORLANDO n TALLAHASSEE TAMPA n WEST PALM BEACH

they are developed through training and experience.

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Palm Beach County Medical Society is

looking for leaders – both experienced and those with aspiration. You don’t need to return to school to add to your MD or DO degree (and take on the associated student loans) – your membership in PBCMS provides both the training and opportunity for physicians to develop and practice leadership skills.

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Relevance, a “bold, no-nonsense look at the realities of today’s association environment – and what it will take for associations to prosper in the future.” The authors provide compelling new ways for association volunteers and staff to govern and manage their associations to keep them relevant. One suggestion is to help member volunteers develop the skills your advocate for the future of the profession. PBCMS is

1 in 2 The chances of needing some form of long term care insurance 1 Do you know the cost of care? How will you pay for it?

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to serve on one of the committees that helps guide your Society. Committees include: Communications & Technology, Finance & Governance, Leadership Development, Legislation & Physician Advocacy, Medical Education, and Membership.

leader, Dr. Jack Zeltzer, and realize within yourselves

Endorsed by the Palm Beach County Medical Society turning potential into performance

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7 6

still remains the Power to effect Change.

2012 BOARD OF DIRECTORS Jack Zeltzer, MD President K. Andrew Larson, MD President Elect, Chair, Leadership Development Council Ronald Zelnick, MD First Vice President, Chair, Council on Membership & Member Services Stephen Babic, MD Second Vice-President, Chair, Council on Legislation & Physician Advocacy Malcolm Dorman, MD Secretary, Co-Chair, Council on Finance & Governance James T. Howell, MD Treasurer, Chair, Council on Finance & Governance James J. Byrnes, MD Past President, Leadership Development Hatem Abou-Sayed, MD William R. Adkins, MD Jose F. Arrascue, MD Shawn Baca, MD Jeffrey Bishop, DO Mark Brody, MD Jeff Davis, DO Michael Dennis, MD Roger Duncan, MD Karen Flannery, MD Randy Gershwin, MD James Goldenberg, MD Lawrence Gorfine, MD Richard Greenwald, MD

Daniel Higgins, MD Beth Lesnikowski, MD Brandon Luskin, MD Harish Madhav, MD Alan B. Pillersdorf, MD Mark Rubenstein, MD Brent Schillinger, MD Richard Shugarman, MD Andrew Shapiro, MD David Soria, MD Joan St Onge, MD Maureen Whelihan, MD Jeffrey Wisnicki, MD Kenneth Woliner, MD

Palm Beach County Medical Society

2012 BOARD OF TRUSTEES Jose F. Arrascue, MD Stephen Babic, MD James J. Byrnes, MD Malcolm Dorman, MD Lawrence Gorfine, MD K. Andrew Larson, MD

Alan B. Pillersdorf, MD Richard Raborn, MD Brent M. Schillinger, MD Maureen Whelihan, MD Ronald Zelnick, MD Jack Zeltzer, MD

ON CALL magazine

STAFF Tenna Wiles, CEO Tara Auclair Ryan, Director of Marketing & Community Relations Ashley Eckes Lee, Director of Public Health & Disaster Services Deanna Lessard, Director of Member Services & Education Nicola Chung, Project Access Program Director John James, Project Access System Navigator Maria Turkki, Project Access Program Coordinator Sadia Peck, Project Access Program Coordinator Mindi Tingler, Administrative Assistant Natalie Gonzalez, Administrative Assistant, PBCMS Services Lauren Tome, Receptionist Patricia Beeler, Receptionist Managing Editor: Tara Auclair Ryan Subscriptions to On Call are available for an annual rate of $50. For more information contact Tara Auclair Ryan at 561-433-3940 x15. 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., 3540 Forest Hill Blvd., #101, West Palm Beach, FL 33406. (561) 433-3940 & (561) 276-3636. ©Copyright 2012 Palm Beach County Medical Society, Inc.

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DULY NOTED-BOARD NEWS / ON CALL MAGAZINE QUARTER ONE 2012

DULYNoted

Congratulations to the 2012 PBCMS Board of Directors JACK ZELTZER, MD President

K. ANDREW LARSON, MD President Elect, Chair, Leadership Development Council

Palm Beach County Medical Society & Palm Beach County Medical Society Services

Board News

STEPHEN BABIC, MD Second Vice-President, Chair, Council on Legislation & Physician Advocacy

Honor the Physicians of Palm Beach County

Doctorâ&#x20AC;&#x2122;s Day Cocktail Reception Thursday, March 29, 6pm to 8pm Falls Golf & Country Club, 6455 Jog Road, Lake Worth, FL 33467 www.fallscountryclub.org

MALCOLM DORMAN, MD Secretary, Co-Chair, Council on Finance & Governance

JAMES T. HOWELL, MD Treasurer, Chair, Council on Finance & Governance

No charge for PBCMS Members RSVP at www.pbcms.org, by calling 561-433-3940 or emailing pbcms@pbcms.org Complimentary Valet Parking

We thank you for your dedication to your patients and the active role you play in our community. RONALD ZELNICK, MD First Vice President, Chair, Council on Membership & Member Services

JAMES J. BYRNES, MD Past President, Leadership Development

HATEM ABOU-SAYED, MD

RANDY GERSHWIN, MD

BRENT SCHILLINGER, MD

WILLIAM R. ADKINS, MD

JAMES GOLDENBERG, MD

RICHARD SHUGARMAN, MD

JOSE F. ARRASCUE, MD

LAWRENCE GORFINE, MD

ANDREW SHAPIRO, MD

SHAWN BACA, MD

RICHARD GREENWALD, MD

DAVID SORIA, MD

JEFFREY BISHOP, DO

DANIEL HIGGINS, MD

JOAN ST ONGE, MD

MARK BRODY, MD

BETH LESNIKOWSKI, MD

MAUREEN WHELIHAN, MD

JEFF DAVIS, DO

BRANDON LUSKIN, MD

JEFFREY WISNICKI, MD

MICHAEL DENNIS, MD

HARISH MADHAV, MD

KENNETH WOLINER, MD

ROGER DUNCAN, MD

ALAN B. PILLERSDORF, MD

KAREN FLANNERY, MD

MARK RUBENSTEIN, MD

Palm Beach County Medical Society Services

You are Invited PBCMS Services Annual Dinner to Recognize Volunteers, Board Members, Physician Leadership, and Community Partners Thursday, March 8, 2012, 6:00pm

Atlantis Country Club, 190 Atlantis Boulevard, Atlantis, FL 33462 Guest Speaker:

David J. Bjorkman, MD, MSPH, Dean, FAU Charles E. Schmidt College of Medicine Cost is $50 per person. RSVP to PBCMS at 561-433-3940, or register online at www.pbcms.org. Sponsorship Opportunities available. Contact Tara Auclair Ryan at tarar@pbcms.org or 561-433-3940 Ext. 15.

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ON CALL MAGAZINE QUARTER ONE 2012 / FEATURE ARTICLE

DULY NOTED-BOARD NEWS / ON CALL MAGAZINE QUARTER ONE 2012

DULYNoted

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New Survey on Physicians:

Board News

Mixed Reaction to Changes in Medicine By:Leon

Fooksman

A majority of Palm Beach County physicians recently surveyed said the current state of the health care industry is on the wrong track. Most doctors also said President Obama’s health care reforms will weaken the financial position of their practices. At the same time, many of the same physicians polled in the annual Palm Beach County Medical Society member survey assessed the current state of their own practices as being on the right track or as neutral. And most doctors said they were satisfied or very satisfied with their jobs.

Board of Director’s PRIORITIES FOR 2012 PUTTING THE MEDICAL SOCIETY ON A NEW TRACK FORWARD For the Palm Beach County Board of Directors there is arguably no greater priority than to position the organization for the future through the development of innovative programs and services to provide value to our members. Over the years the Society has undergone numerous changes. These have been incremental changes, but now physicians are being confronted with the need to make changes of an entirely different magnitude. To remain relevant and vital, to meet the needs of our members, and to advance our mission in an environment of dramatically reduced sources of funding require that we look at things differently. The Board of Directors began its journey at a Planning Retreat in January when they examined programs and services, established priorities and embarked on the track of transformational change. Change begins with the establishment of organizational priority areas and the reorganization of Board and Committees. Each Council is charged with establishing specific measurable goals and work plans to address the priorities of the Board.

Participation on the Councils is open to PBCMS members: • Council on Administration & Finance: Jim Howell, MD, Chair, Hatem Abou-Sayed, MD Co-chair • Council on Member Services: Ron Zelnick, MD • Council on Advocacy: Stephen Babic, MD Chair, Shawn Baca, MD Co-chair • Council on Medical Education: Richard Greenwald, MD Chair, Joan St. Onge, MD Co-chair • Council on Communication: Maureen Whelihan, MD Chair • Council on Physician Leadership: Andrew Larson, MD Chair

TOP BOARD PRIORITIES • Define improved organizational operations processes and technologies • Revise organizational by-laws to provide for increased organization efficiency and effectiveness • Implement Physician Leadership Development Program • Expand engagement and involvement with medical school and residency programs • Increase physician advocacy engagement • Develop value added practice management programs and services • Strengthen public relations and marketing efforts

e invite and encourage you to become W engaged with your Society. You have the opportunity to shape the future of the medical profession.

These seemingly contrary views of today’s state of medicine aren’t surprising, considering the major shifts in health care policy in Florida and Washington, D.C., Medical Society leaders say. These changes have reshaped the medical profession in recent years, leaving many local physicians confused, nervous and at times angry over their long-term ability to care for patients. “Most doctors feel unhappy with the state of medicine today and where we’re going,” said Dr. Jack Zeltzer, president of Medical Society. “It quantifies what we’ve been hearing in our conversations.” President-elect Andrew Larson agreed: “There’s been a lot of changes. Many doctors today aren’t able to think outside the box. They are losing their ability to think innovatively.” Only a small fraction of Medical Society members responded to the 16-question survey taken in December. But judging from previous surveys, the answers reflect the general attitude among many doctors in the area. More than 75 percent of doctors surveyed assessed the current state of the health care industry as heading in the wrong track, while 11 percent said it was headed in the right track. On the same note, nearly 56 percent said the health care reforms were weakening their practices’ financial positions, while nearly 7 percent said it improved their practices. As for the current state of their practices, 37 percent said they were heading in the right track, verses 20 percent who said they were on a wrong track. About 30 percent said they were neutral. And concerning job satisfaction, 36 percent said they were satisfied with their jobs and another 28 percent indicated they were very satisfied. Some doctors stated their frustration with the Medical Society and the overall leadership in the health care field. Dr. Zeltzer said he’s heard the concerns as well. He said the Medical Society will continue fighting on behalf of doctors on issues like the reduction of Medicare and Medicaid reimbursements. He supports offering more workshops and forums to physicians on making their medical practices more efficient.

Other notable survey results included:

35%

of doctors said they will be positively impacted by the EHR (electronic health record) adoption in the next three years. But a combined ....

64%

of doctors said the episode of care/ bundled payments will have a negative or a strongly negative impact on their organizations. Also, close to

81% 50%

said Medicare / Medicaid / Tricare reimbursement rates will have a negative or a strongly negative impact. said their practices would not be a part of an Accountable Care Organization (ACO) in the next 5 years.

63%

percent indicated that their payer provider relationships would worsen in 2012.

said they would stop accepting new Medicare patients if Medicare reimbursements reduced.

There were many opinions on what actions the Medical Society should take in addressing many of the challenges facing the profession. Among the comments from doctors were:

“ Educate physicians on what the Affordable Care Act really entails.” “Find a way to collectively bargain in a legal way.” “Form our own ACO.” “Seminars to alternatives to Medicare & ACOs.” “ Organizing strikes and walk outs among physicians and their patients - get the media involved.” On a good note, the survey, he said, indicated that plenty of doctors believe their practices are going in the right direction. So it would make sense, he continued, to find out from those doctors what works best in their practices and then share that information with other members who are struggling. A lot of doctors feel threatened these days by all the changes in health care, Dr. Larson said. Still, he suspects most physicians want to remain in the profession. As a result, it’s imperative that organizations like the Medical Society fight for important issues like preserving physicians’ autonomy and enabling private practices to remain a financially viable option, Dr. Larson said.

Leon Fooksman is a writer for On Call. He can be reached at leon@digitalstoryline.com.

ON CALL MAGAZINE QUARTER ONE 2012 / ADVOCACY UPDATE

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AdvocacyUpdate YOUR VOICE DOES MATTER Stephen Babic, MD, Lawrence Gorfine, MD, Shawn Baca, MD

Palm Beach County Medical Society, Council on Legislation & Physician Advocacy

The PBCMS Council on Advocacy is off to an energetic start in 2012. Under the leadership of Stephen

development of a Resolution to the FMA to seek legislation to suspend physician payments into the NICA Fund and to call for

Babic, MD, the Council has reorganized to enhance effectiveness

a long term actuarial study. The NICA Trust Fund started in 1988

in the local, national and state legislative arenas. Larry Gorfine,

with $20 million and now has over $784,000,000. The payout last

MD, will lead our legislative efforts while Dr. Babic will continue

year was approximately $13.1 million.

to spearhead the growth and development of MEDPAC. Shawn Baca, MD, has been appointed Co-Chair. The Medical

With the Medicare Sustainable Growth Rate (SGR) cuts that

Advocacy Task Force will continue its efforts in collaboration with

were scheduled to go into effect March 1, PBCMS leaders Drs.

hospitals to engage in health policy issues in Palm Beach County.

Zeltzer and Arrascue traveled to Washington, DC, to meet

Council members include Brandon Luskin, MD, Alan Pillersdorf,

with our Congressional representatives and attend the AMA

MD, Richard Shugarman, MD, Jose Arrascue, MD, and Mark

Advocacy Conference. Through the advocacy efforts of PBCMS,

Rubenstein, MD. In partnership with MEDPAC the Council sponsored The State of Medicine & Legislative Dinner on

FMA, AMA, and other Specialty

“We in America do not have government by the majority. We have government by the majority who participate.”

January 5 at the Airport Hilton. Over 100 members and guests

Ralph Kobo, MD, Vice-President of the Florida Medical Association and Chair FMAPAC, as well as Representatives

Shutts & Bowen LLP

Joe Abruzzo, Mac Bernard, Lori Berman, and Steve

is a Proud Sponsor

on the critical health care issues facing Congress. Pete

www.shutts.com 800.325.2892

of the

former IBM executive, provided his insight on navigating

Fort Lauderdale 954.524.5505

Palm Beach County

Miami 305.358.6300

Medical Society

Orlando 407.423.3200 Tallahassee 850.521.0600 Tampa 813.229.8900 West Palm Beach 561.835.8500 Amsterdam 011.3120.661.0969

Perman. Congressman Alan West engaged our members Martinez, Palm Beach Medical College Chairman and

maintained Medicare physician payments and avoided the 27.4% Medicare pay cut.

-Thomas Jefferson

heard important messages from

Founded 1910

Societies, we have successfully

change and the important role physicians can have in

DID YOU KNOW? • The average age of a Congressional Legislative Aide is 27 • The average Congressman works 70 hours per week • On average 6,000 communications are received per month • There has been no increase in Congressional office staffing since 1973 • Congressmen have an average of 13 meeting per day • 13 Recess Sessions are scheduled for 2012

shaping their future. Special thanks to Larry Gorfine, MD, for his presentation on “How to Opt Out of Medicare.”

5 Rules for Influencing Legislators: •L earn about your legislators – know their positions, check

PBCMS President Jack Zeltzer, MD, participated with Dr. Babic, Dr. Gorfine, Tenna Wiles, CEO, and Don Mathis at Palm Beach County Days in Tallahassee. Palm Beach County leaders and elected officials participated in the 2 day event. In addition to

out their websites. •B e a “normal expert.” You should have a general overview of the issue you are discussing. •C ommunicate frequently – attend local town hall

meeting with the PBCMS Delegation, a meeting was held with

meetings or schedule a meeting at a local office, get to

James A. Farrell, Esq. Timothy E. Monaghan, Esq.

Bud Kniep, Chief of Staff for Chief Financial Officer Jeff Atwater, to

know the staff, and use social media.

discuss the issue of The Florida Birth-Related Neurological Injury

• F ollow up to get firm answers.

525 Okeechobee Boulevard, Suite 1100 West Palm Beach, Florida 33401

Compensation Association (NICA), a priority issue for the Council.

• Tell a personal story.

The PBCMS Executive Committee approved the

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ON CALL MAGAZINE QUARTER ONE 2012 / FEATURE ARTICLE

FEATURE ARTICLE / ON CALL MAGAZINE QUARTER ONE 2012

15 14

The Power of Physician Values Whether physicians are employed or independent has nothing to do with the potential for health systems and hospitals to transform into high value and high quality enterprises. Those organizations which have demonstrated their ability to produce value assert that “Physician leadership is critical in developing two characteristics which are critical to supporting their ethos: collaboration and accountability.” These organizations have deeply embedded cultures which are physician driven. This does not mean that they have neither chief information officers, nor chief financial officers, nor non-physician administrators in the C-Suite. It means that their physicians are fully engaged with them in governance and operations and drive the clinical culture of these institutions.

By:

Alice G. Gosfield

In the one thousand pages of the health reform legislation that have nothing to do with the individual insurance mandate, the vision for America’s health care system is quite different from anything seen before in federal law. There is a significant and fundamental emphasis on the efficiency of care, its value, its effectiveness, and above all its quality. In fact, the word “quality” including high quality, quality improvement, quality reporting, quality measures, quality data, quality of care and quality performance appears no less than 483 times... The following article is a reprint. The original article was published in Maryland Medicine: the Maryland State Medical Journal, Volume 12, Number 3 in 2011. All rights to reprint this article have been given by MedChi, the Maryland State Medical Society. It may not be copied without permission from MedChi.

What Is Happening

For the first time in American history, pursuant to the legislation, the government has published a national quality improvement strategy which is not limited to Medicare and Medicaid patients. As part of the value proposition the legislation posits, hospitals are facing a 1% cut across the board in their Medicare DRG payments, no payment for preventable readmissions, and no payment for a targeted list of hospital acquired conditions. Moreover, under the value-based purchasing program, as calculated for measures associated with a specified list of conditions, top performing hospitals will be paid more than their more mediocre peers. Unbeknownst to many physicians, they also will be subjected to a valuebased modifier for Medicare fee-for-service payment, which form of payment will certainly remain in place for the foreseeable future. While both hospitals and physicians under these programs will be measured initially for their quality alone, for admissions in 2014 for hospitals, and in the same time frame for the physician fee schedule, both will be

measured for their efficiency and paid differentially, depending on their scores. For physicians, their efficiency will be determined under a government sponsored, publicly transparent episode grouper which is already in development. This software package will be applied to Medicare claims to identify high value and low value physician performance. Hospitals and health systems are employing physicians in record numbers. Often they are entering into lucrative (to the physicians) contracts that may or may not be financially sustainable in a qualitydriven world where hospitals see far fewer of the admissions which are their bread and butter today. When diabetics are well taken care of in the community, hospitals ought not see many admissions for diabetes, for diabetic stroke, for amputations and the like. There is much discussion of new payment models, although few concrete proposals have emerged. While physicians are anxious about all of these changes and mistrustful of many hospital initiatives, this moment of ambiguity is an opportunity.

The primacy of physicians in these organizations has occurred not only because many of them were created by physicians 75 or more years ago. Rather, these organizations – such as the Scott and White Clinic, Mayo, the Marshfield Clinic, the Billings Clinic and others – have embraced the idea that physicians hold a unique place in health care. First, they have plenary legal authority which means they have the broadest scope of authority of anyone in the health care system. Hospitals neither admit patients, nor order services, nor discharge patients. Physicians do. Virtually everything that happens in a hospital is ultimately derivative of a physician order. Most patients experience the health care system through their relationship with a physician. The physician is often the portal to the rest of the system making referrals and writing orders that engage all the other providers. Because of this primacy, while many changes in health care can be effected without direct physician involvement, what the current environment demands will not happen without the enthusiastic engagement of physicians. But merely being involved is not enough.

Toward What End The real challenge for physicians is not to lead for the purpose of mere power, but to lead for the purpose of creating true clinical integration. This term, while frequently used in today’s dialogues, is rarely defined. The activity of clinical integration that will be so critical for physician and health care delivery success generally is “Physicians working together systematically, with or without other organizations or professionals, to improve their collective ability to deliver high quality, safe, and valued care to their patients and communities.” Real clinical integration — not an antitrust concept, but a deep way of reorganizing clinical processes, compensation, administrative support systems and more — can bring the unique values of physicians to the forefront of health care. Even as those values are critical to improving quality and value, to succeed in the new measured and publicly reported health care system, physicians will need to deploy team based multi-disciplinary approaches to care, with a very clear focus on the patient. In the developing health care delivery context where all providers will be measured, the results will be transparent and will affect payment; so scoring well will matter. There are three long-standing truisms about quality measurement: (1) You cannot improve what you do not measure. (2) What gets measured gets done. (3) So, be careful what you measure. Clinical integration is fundamentally about developing data on which physicians can alter their clinical and administrative processes to improve performance. The goal is to facilitate better coordination and interaction among all the parties involved with the patient. The speed and depth with which physicians take up this challenge will have a major impact on the delivery of health care in this country. To standardize more and more to the evidence base while custom-crafting the art of medicine—the application of science to the specific needs of an individual patient—will be the hallmark of successful patient-focused 1

Minott et al, “The Group Employed Model as a Foundation for Health Care Delivery Reform,” The Commonwealth Fund, Issue Brief (April 2010) http://www.commonwealthfund.org/~/media/Files/Publications/ Issue%20Brief/2010/Apr/1389_Minott_group_employed_model_hlt_reform_ib_v2.pdf (hereafter, “Minott”)

health care. Only physicians can really make this happen, regardless of their organizational context. No matter the setting in which physicians deliver care – whether in small practices, as employees of health systems, in large multi-specialty groups, as the organized medical staff, or in some new organizational configuration with a hospital, in an ACOlike program or a co-management contract – clinical integration will be important. There are at least 17 attributes of clinical integration, the manifestations of which are slightly different depending on context. There is a new, free self-assessment tool available which presents three stages of evolution, from just getting started to fully committed and engaged around these attributes. The document looks at these issues from two perspectives: the stand-alone physician group or health system employed physicians on one hand, and then the organized medical staff or newly coalescing hospital-physician organization. It has proven useful as a starting place for physicians who want to lead the next steps for change, to provide focus on what it will take to get to a new vision of their practice or healthcare delivery context. Using the tool to start a conversation with other physicians with whom physicians seek to work in common cause can be a form of yeast, so to speak, helping physicians to begin to craft a new vision as well as to begin to identify steps to get there. Where physicians seek to clinically integrate with their hospital or health system partner, it is particularly important for both parties to have direct and frank communication about past efforts at change. It is unusual, in American health care, to find a hospital or health system that has not had some adverse event in trying to engage physicians with them. It is important to identify where past grievances lie in order to confront them and put them in the past. Using a historical assessment tool , dialogue among physicians and with hospital administrators and board members can facilitate their ability to both arrive at a common vision of a new future and be able to articulate the purposes of the engagement with each other. To get beyond these mere assessments of the current state to actual changed programs, processes and initiatives will require will, energy and time. Physicians often feel that these are the scarcest commodities in their lives. But without the drive to make things better for themselves and their patients, and the willingness to commit to change, physicians will inevitably find themselves in a sadly, traditionally passive posture, where they may find themselves soon whining more than they have before, as the maelstrom of change they fear sweeps them up in ways they can no longer influence. No matter what legislative or budgetary changes unfold in the coming months, this moment in health care change is one of real opportunity for physicians. Knowing that clinical integration is the key to the future provides a predicate for physicians to lead themselves and with others to make health care safer, more effective, of higher quality, and real value. There will never be a moment like this again. Physicians should step up and act. Alice G. Gosfield, a health lawyer in Philadelphia, representing primarily physicians, physician groups and physician organizations, has been rated as one of the top 25 health lawyers in the country. Alice G. Gosfield JD 2309 Delancey Place Philadelphia, PA 19103 (215) 735-2384 Fax: (215) 735-4778 agosfield@gosfield.com www.gosfield.com 2

Gosfield and Reinertsen, “Achieving Clinical Integration With Highly Engaged Physicians,” (November 2010) http://www.gosfield.com/PDF/ACI-fnl-11-29.pdf,

Gosfield and Reinertsen, “Clinical Integration Self Assessment Tool (v 2.0)”, (2011) http://www.uft-a.com/CISAT.pdf

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ON CALL MAGAZINE QUARTER ONE 2012 / FEATURE ARTICLE

FEATURE ARTICLE / ON CALL MAGAZINE QUARTER ONE 2012

Becoming a Volunteer/Affiliate Faculty Member

By:

Richard Greenwald, MD

There are now 4 medical schools (colleges) with students studying in Palm Beach County. In each instance, it is the school which must credential and appoint faculty whether they are employed or voluntary, financially compensated or uncompensated. Hundreds of Palm Beach County physicians are already participating in these programs. While procedures differ somewhat from school to school, the basic principles are similar. Faculty is recruited, vetted and appointed to fill identified needs in the teaching program. Faculty must be credentialed, developed and evaluated in accordance with standards set by the appropriate national accrediting organizations. The faculty needs of each program change with the student’s educational progress. In the first 2 years of the curriculum, there is a large need for community faculty preceptors. These physicians generally work with students in their offices and are largely involved in teaching history taking, physical examination and “doctoring” skills—the beginnings of the art, ethics, communication and professional relationships in medicine. They are generally, internists, family physicians or internal medicine specialists. They may be in solo practice, a private practice group or in a hospital or other group based setting. In the first 2 years, other specialty physicians typically make more “cameo” appearances as lecturers in different modules, assistants in anatomy courses, etc.

With the blossoming and maturation of what is now a variety of undergraduate (medical school) and graduate (residency) medical education programs in Palm Beach County, your society is often asked

“how do I get involved?”

This changes as the students become more heavily involved in all of the clinical clerkships with which you are familiar. This takes place in the third year. By the fourth year there is even further need for involvement of specialists and subspecialists with the development of “electives” running the entire gamut of disciplines. There is an extensive role for community based affiliated faculty in all of these areas. Each program has its own “points of contact” for interested physicians. The schools look to the CMO’s at affiliated hospitals to make suggestions as to qualified, interested potential faculty. The various course or clerkship directors are also involved in faculty recruitment and selection. Schools do review unsolicited requests for appointment, but these are generally granted only if there is a teaching role for the applicant to fill. Residency training programs also require community faculty. In those instances, your contacts include the hospital where training is taking place and the residency program coordinators. Once again, appointments are need and qualification based. Criteria for faculty, training, evaluation etc. are defined by the program and particular accrediting group. Palm Beach County Medical Society recognizes the importance of all of these educational programs and new residency

programs now in development to the future of the practice of medicine in Palm Beach County. We applaud those who are willing to give of their time and mentoring expertise to help train the next generation of physicians. The following is a list of contacts for the undergraduate and graduate education programs in Palm Beach County. If you are interested, you may contact them directly or work through your hospital CMO. FAU Charles E. Schmidt College of Medicine Barbara T. Locastro-Garofalo Assistant to the Senior Associate Dean of Medical Education and Faculty Development (561) 297-0237 blocastr@fau.edu Nova Southeastern University College of Osteopathic Medicine Debbi Cohn Steinkohl Administrative Director IGC & Community Service Programs (954) 262-1441 steinkol@nova.edu Palm Beach Centre for Graduate Medical Education Rachel Finn, MHA Regional Medical Education Coordinator (561) 863-2315 rachel.finn@hcahealthcare.com St. Mary’s Medical Center University of Vermont College of Medicine Medical Student Education Program Michelle Vincent Administrative Assistant (561) 882-4534 michelle.vincent@tenethealth.com University of Miami Regional Campus Joseph Sollecito Administrative Assistant Medical Education (561) 447-6551 jsollecito@med.miami.edu Wellington Regional Medical Education Program/ LECOM Connie Tuller Medical Education Coordinator (561) 798-8504 connie.tuller@ushinc.com

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State of the Florida Medical Malpractice Insurance Market 4th quarter, 2011

“Who will blink first?”

There is a hard market coming, so

get ready now.

By:

Matt Gracey of Danna Gracey

The present state of the malpractice-insurance market is still favorable to doctors purchasing coverage, but the signs of deteriorating conditions continue to build. The most concerning forecast is that Florida’s Supreme Court now seems very likely to overturn the 2003 significant tort reform of the caps on noneconomic damages, which has led to an almost-50% drop in many doctors’ premiums since the caps’ enactment. The overturn is predicted to happen this coming summer of 2012, if not sooner. The retroactivity of the cap was recently overturned by the Florida Supreme Court, as were caps in several other states in the last few years. Given that we are at the natural end of our “soft” market conditions that have been so favorable to doctors, I predict that the cap overturn will be the event that insurers, but more importantly, reinsurers, use as the reason for increasing premiums rather rapidly. In the last year or two the soft-market-condition’s pricing has mostly leveled off as insurers realize that the cycle is changing in claims, but none of them want to be the first to increase prices given the stiff competition in the market now, with over 50 insurers of many sizes and experience offering doctors coverage in Florida. I term this the “Who will blink first?” phase of our market cycle. As the soft market has continued on shaky legs in the last few quarters, we have actually seen a few new carriers enter the marketplace, which will probably just hasten the beginning of a harder market since the newer entrants are offering even lower pricing to compete with the established players. Speaking of established players, the recent purchase of First Professionals Insurance Company (FPIC) by California-based insurer The Doctors Company (TDC) makes TDC the insurer of the most doctors in the country, but eliminates one of Florida’s last highly rated insurers domiciled in Florida. Medical Protective is by far the very-highest-rated malpractice-insurer in Florida and the entire country, with an A++ rating from A.M. Best and a renewed commitment to Florida after being purchased by Warren Buffett’s Berkshire Hathaway a few years ago from GE, which had forced them to all but leave the state back in our last medmal crisis. The leaders of Medical Protective are now publicly committing their strength and long experience to staying the

course through our next crisis, which will be unfolding soon after the caps are overturned.

So, as we continue for a bit longer in the last gasps of the favorable “soft” market, my advice is to do the following: 1. Switch your coverage to a highly rated carrier (financial stability). 2. Switch your coverage to an insurer with great claims experience (your reputation is at stake). 3. Switch your coverage to an insurer with a real commitment to Florida doctors (avoid shopping for a new insurer in the middle of a difficult market). 4. Pay even more attention to good risk-management practices (hard markets are even harder on those with recent claims). 5. Find a way to get more negotiating power if you are not practicing in a large group. You can do this by joining a Risk Purchasing Group or creating one with your peers (large numbers = lower premiums). 6. Find an independent, knowledgeable, trustworthy, and specialized broker to guide you (a little help when out of your core competency is always good). 7. Work on a connection for channeling divine intervention as our next malpractice-insurance crisis begins to unfold (more help is even better). Matt Gracey, Jr. is a medical malpractice insurance specialist with Danna-Gracey, an independent insurance agency based in downtown Delray Beach with a statewide team of specialists dedicated solely to insurance coverage placement for Florida’s doctors. To contact him call (800) 966-2120, or email: matt@dannagracey.com.

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ON CALL MAGAZINE QUARTER ONE 2012 / FEATURE ARTICLE

FEATURE ARTICLE / ON CALL MAGAZINE QUARTER ONE 2012

PBCMSActivity in the AMERICAN

MEDICAL ASSOCIATION By:

Mark Rubenstein, MD, Jose Arrascue, MD, & Alan Pillersdorf, MD

Palm Beach County Medical Society (PBCMS) is well represented on an active basis in the American Medical Association (AMA). While a sentiment of disdain is felt by a portion of PBCMS members relative to AMA participation, we feel it is imperative to remain engaged as the AMA is the single most powerful physician voice in the country. AMA membership is voluntary and open to any physician in good standing. The policy making division of the AMA is the House of Delegates which is comprised of specialty organizations and state societies who maintain active AMA membership. Each state that maintains a percentage of membership is eligible to elect delegates to the House of the AMA. Three PBCMS members are honored to have been elected to the Florida State Delegation from the Florida Medical Association (FMA). House of Delegates members act as a communications, policy, and membership link between the AMA and grassroots physicians, and serve as a key source of information on AMA activities, programs, and policies. Delegates and alternate delegates are also a direct contact for individual members to communicate with and contribute to the formulation of AMA policy positions, the identification of situations that might be addressed through policy implementation efforts, and the implementation of AMA policies. AMA delegates or alternates must be elected or selected by the principal governing body or the membership of the sponsoring organization. The AMA encourages that at least one member of each delegation be involved in the governance of their sponsoring organization. The three active delegates/ alternates from Palm Beach County are currently Jose “Paco” Arrascue, Alan Pillersdorf, and Mark Rubenstein. Each of us has served as President of PBCMS. In addition to FMA committee duties, Dr. Pillersdorf is currently the FMA Secretary, while Dr. Arrascue represents District F on the Board of Governors and Dr. Rubenstein serves on the Council for Medical Economics. Delegates and alternates are responsible to regularly communicate AMA policy, information, activities, and programs to constituents. We relate constituent views and suggestions, particularly those related to implementation of AMA policy positions, to the appropriate AMA leadership, governing body,

or executive staff. Among the most important member obligations is to attend the House of Delegates meetings for two weeks per year to represent the voice of physicians in Palm Beach County and the State of Florida. During the 2010 meeting of the FMA House of Delegates, there was a resolution that discussed the relationship between the FMA and the AMA. Many delegates were upset with some of the AMA’s policy making decisions, and a vote of “no confidence” was sent to the AMA Board of Trustees. The FMA House voted to continue to send a delegation to the AMA to ensure that the voice of Florida physicians remains audible nationally. FMA delegation leadership has built coalitions with other states to bring much needed change to the AMA. Change at the national level will not happen instantly, but our delegation is extremely focused, qualified, and unified in these efforts to make the AMA a more effective policy making body representing the interests of physicians in this country. This is why we remain committed and give our time and effort to participate. Your FMA delegation has exposed defects of the Patient Protection and Affordable Care Act (PPACA). FMA level activities include developing resolutions to seek repeal of the Independent Payment Advisory Board (IPAB). The 2011 AMA Annual Meeting in Chicago ended with a “call to action” to the nation’s physicians to “move forward” and work for changes in the health care system. The outgoing President of the AMA, Dr. Cecil Wilson from Winter Park, FL, cited the importance of Medicare private contracting as part of the necessary change. The legislation proposed in the US House and Senate was a direct result of a resolution from the Florida Delegation that was adopted last year. On 5/5/11, Dr. Wilson presented an oral statement of the AMA before the House Energy and Commerce Health Subcommittee entitled “The Need to Move Beyond the SGR.” Prior to that the Executive Vice President and CEO of the AMA (at the time Michael Maves, MD), responded to the bipartisan letter from the Committee on Energy and Commerce requesting suggestion to develop a pathway toward reforming the Medicare physician payment system. Dr. Maves sent a nine page letter to the Chairman of the Committee, and the request included repeal of the sustainable growth rate (SGR). Recently,

efforts resulted in successfully maintaining physician Medicare payments. On 6/17/11, the AMA released a state-level study entitled “The Economic Impact of Office-Based Physicians,” providing powerful data demonstrating how office-based physicians helped to strengthen their state and local economies by creating jobs, generating output, supporting wages and benefits, and generating state and local tax revenue. This was a collaborative effort between the AMA and 47 state medical associations. Drs. Arrascue, Pillersdorf, and Rubenstein attended the 2011 AMA Interim Meeting in New Orleans, and twelve resolutions were brought from the Florida House of Delegates. A resolution initially drafted by Dr. Stephen Babic from PBCMS relating to in-patient vs. out-patient hospital medical care was nearly unanimously supported, and the resolution (11808) was adopted as amended. The AMA will now work with all governmental agencies to assure that both patients and physicians are treated fairly in delineating the hospital admission status of patients, and ensuring a transparent and administratively simple process. The AMA House of Delegates adopted Resolution 810 (“Empowering State Choice”). This resolution advocates that state governments be given the freedom to develop and test different models for covering the uninsured, provided that their proposed alternatives a) meet or exceed the projected percentage of individuals covered under an individual responsibility requirement while maintaining or improving upon established levels of quality of care, b) ensure and maximize patient choice of physician and private health plan and, c) include reforms that eliminate denials for pre-existing conditions. The AMA HOD also adopted Substitute Resolution 216 in an effort to STOP the implementation of ICD-10. At print time Centers for Medicare and Medicaid (CMS) hinted at a delay in the October 2013 implementation of the ICD-10. The most important resolution identified by our FMA delegation at a recent AMA meeting was submitted by our own South Florida Caucus (Dade, Broward, and Palm Beach County Medical Societies). It was initially entitled “AMA to Make Private Contracting Its Highest Priority.” During this interim AMA meeting, the resolve clauses were modified for clarity, and modifications led to substitute resolution 203: A Grassroots Campaign to Earn the Support of the American People for the Medicare Patient Empowerment Act. The Resolve, which

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was ADOPTED nearly unanimously by the floor of the House of Delegates, and SUPPORTED by every major state in the country, was: “RESOLVED, That our AMA now initiate and sustain our well-funded grassroots campaign to secure the support of the American People for passage of the Medicare Patient Empowerment Act in congress as directed by the I-2010 HOD meeting through policy D-390.960.” We charged AMA executive leadership to make the resolution passed in 2010 the “highest priority” for them to address immediately and was considered a major victory for our patients and FMA physicians. Within one week of the interim meeting, the AMA Chair of the Board of Trustees, Dr. Robert M. Wah, publicized the board’s actions and launched the campaign at the AMA’s National Advocacy conference in February 2012. This action is a coordinated effort among delegations of California, Texas, New York, and most prominently Florida. We have made it clear that Florida supports our mission to “help physicians practice medicine.” We are committed to providing valuable input into the difficult process of shaping health care policy on behalf of the members of PBCMS and the FMA. Each of us on the delegation is dedicated to the cause.

“ A RESOLUTION INITIALLY DRAFTED BY DR. STEPHEN BABIC FROM PBCMS RELATING TO IN-PATIENT VS. OUT-PATIENT HOSPITAL MEDICAL CARE WAS NEARLY UNANIMOUSLY SUPPORTED”

ON CALL MAGAZINE QUARTER ONE 2012 / FEATURE ARTICLE

THE

It Takes Great Doctors To Make A Great Hospital. And We’ve Got The Greatest Of All.

DANGERS

YET ANOTHER LARGE VERDICT HAS BEEN RENDERED AGAINST A BARE FLORIDA DOCTOR... Most recently, in September 2011, a jury found an OB/GYN and his professional association responsible for failing to detect physical disabilities of a child before it was born and awarded $4.5 million to the parents. In the past few years, several Florida physicians have been involved in trials that resulted in multi-million dollar plaintiff awards. Six of those medical malpractice trial verdicts were in excess of $30 million. Jury awards continue to escalate, creating increased incentive for attorneys to aggressively target doctors in Florida. While a recent national study found that 20 percent of malpractice claims against doctors lead to a payment to the patient, claims against doctors in Florida result in a payment to the patient in over 50 percent of claims. Each year about 1 in 14 doctors is the target of a claim, and most physicians and virtually every surgeon will face at least one claim in their careers. Clearly, the probability of a claim is high, and purchasing malpractice coverage should always be a serious consideration.

In Recognition Of Doctor’s Day, Thank You Docs, For Practicing At Jupiter Medical Center. Jupiter Medical Center is honored to have the caliber of care provided by our staff of over 550 physicians. Our doctors have been educated at renowned schools of medicine, Fellowship-trained at notable institutions, and have an unmatched depth of knowledge, skill and experience. We’re proud to call them ours. Thanks for caring for our patients, the Medical Center and our community.

1210 S. Old Dixie Highway, Jupiter, FL 33458 • (561) 263-2234 • jupitermed.com

Many physicians and surgeons don’t fully understand the dangers of going bare, and several popular myths need to be dispelled. Myth number one. Carrying malpractice insurance will make me a target for a lawsuit. Florida’s plaintiff’s bar is fully aware of the monster it created. Its old habit of only suing doctors with insurance is a thing of the past. Several years ago, the plaintiff’s bar began suing bare physicians and trying the case against the bare doctor if he or she refused to settle. Many bare doctors have paid six-figure amounts to settle cases, on top of six-figure legal bills to their defense lawyers. In many cases, the amounts paid add up to decades of insurance premiums for the bare doctor involved. Myth number two. Florida’s cap on medical malpractice awards protects me from paying an excessive plaintiff award. The cap applies only to non-economic awards. The

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OF GOING BARE By:

cap does not apply to economic awards. Economic awards are often multiples of non-economic awards rendered. Further, in McCall v. USA, a case scheduled for oral argument in Florida’s Supreme Court in February 2012, physicians face the prospect that the cap on non-economic damages they have enjoyed since 2003 will be declared unconstitutional, and the cap will be rendered null and void. Myth number three. If I get sued and the outcome results in a plaintiff award that is greater than the amount of my ability to pay, I can declare bankruptcy to protect my personal assets. If a bare physician qualifies for certain bankruptcy laws, those laws impact the applicability of the important homestead exemption for the physician’s personal residence. Under the law, full exemption has specific requirements that could be significantly limited. Bankruptcy laws make planning difficult and limit your ability to discharge debts. Even with bankruptcy, the judgment is in place for 10 years, so any asset obtained within the 10 years can be transferred to the plaintiff. In many cases, the 10year obligation can be extended for an additional 10 years. Myth number four. If I lose the case, my existing practice will allow me to maintain future income. On the contrary, judgment obligations have the potential to negatively impact your income indefinitely. All of your professional association’s account receivables could be attached to pay a judgment if not properly leveraged. If you don’t pay a court judgment, arbitration award or settlement arising from a malpractice judgment, you risk suspension of your medical license by the Florida Board of Medicine. “BARE INSURANCE”—ADEQUATE PROTECTION? A reputable carrier hires defense attorneys to represent you throughout the entire length of the claims process regardless of whether the costs of that defense exceed a potential settlement or policy limit amount. There are some defense attorneys who specialize in defending bare doctors

Robert E. White, Jr.

Sr. Vice President, Regional Operating Officer The Doctors Company/FPIC/APAC

through a retainer contract or insurers that provide “defense costs only” policies as an alternative to purchasing medical malpractice insurance. They argue that exposure can be reduced by paying a prepaid defense retainer as a way to reduce significant attorney fees. They also argue that buying “bare insurance” may reduce the amount of a judgment against a physician. Although they admit that it is not a cap on liability, they hold the belief that Florida doctors are savvy when it comes to their personal assets, thereby protecting the doctor from the obligation to pay an award in excess of $250,000. Those attorneys have overlooked important consequences of a large judgment against a bare doctor: • Although the retainer reduces significant attorney’s fees, unlike full professional liability insurance, the pre-paid defense retainer and the defense-only policy have a limit that may not cover all of the expenses associated with the defense for a case that goes all the way to trial. The physician is responsible for the balance. • Even if a physician has protected all of his or her personal assets, the first $250,000 of the plaintiff award must be paid within 60 days. DEFENSE COSTS It’s very common for physicians and surgeons to equate insurance simply with paying a claim. However, in addition to the indemnity payment, defense costs must also be considered. A topquality, well-financed defense through a two-week trial will cost approximately $150,000 to $200,000. Defense costs can, and frequently do, exceed the amount paid to the plaintiff. It is not uncommon for defense costs to exceed the policy limits. Additionally, Florida physicians now have the right to consent to settlement in the insurance policies of some insurance carriers. Significant costs can also be incurred after the trial, even if the case is not appealed. If the lawsuit results in a verdict for the plaintiff, the plaintiff’s attorney has the right to file a motion to recover some of the costs the plaintiff incurred as a result of (cont.)

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ON CALL MAGAZINE QUARTER ONE 2012 / IN MEMORIAM

FEATURE ARTICLE / ON CALL MAGAZINE QUARTER ONE 2012

(THE DANGERS OF GOING BARE.. cont.) trying the case. Those costs are generally in the range of $50,000 and can exceed $100,000 in some cases. NON-PAYMENT OF A CLAIM— ANOTHER POTENTIAL CONSEQUENCE Payment on the judgment or arbitration award must be made within 60 days after the date the judgment was made. For bare physicians who have endured the costs of a trial, bond obligations, and potential appeal, making such a payment on the judgment within the 60-day requirement may be extremely difficult, if not impossible. CONCLUSION Without medical professional liability insurance, a physician carries the full responsibility for the costs associated with a claim, regardless of whether the claim is arbitrated, settled, defended in a trial, or subsequently appealed. Even the reversal of a plaintiff award could have a significant, if not devastating, impact on the doctor’s financial status, including personal assets. Those who decide to go bare and believe purchasing bare insurance is sufficient need to be aware that bare insurance most likely will not adequately cover all of the costs associated with a claim. They also must consider that the provider of prepaid legal services or a defense-only policy may have economic incentive to take short cuts in the defense since the provider does not have to face the financial consequences of a large plaintiff’s award. While the bare doctor can sue the provider for a less-thanadequate defense (at the doctor’s ongoing expense), the outcome of that lawsuit will still be uncertain, and relief, if any, will be years away. The ability to afford the expenses related to a claim is only one of many challenges for bare physicians. There is almost always an emotional toll; physicians are committed to providing the best possible care for patients. When a patient is harmed or perceives there has been inadequate care, the stress associated with the lengthy claims resolution process can be overwhelming. Going bare is a significant professional and personal risk. A reputable professional liability insurance company is not only your best protection against a claim, but it also reduces the emotional toll because you have the peace of mind of knowing that you have a knowledgeable ally directing and financing your defense.

TRADITION OF

CARING

New Book to Herald Medical History of Palm Beach County Have you ever wondered who was the first doctor in Palm Beach County? r what was the purpose O of Southeast Florida State Sanatorium in Lantana? And why exactly did the Health Care District of Palm Beach County form? Many of those questions will be addressed in a new book heralding the 93-year history of the Palm Beach County Medical Society and the greater medical community of Palm Beach County. “A Tradition of Caring: A History of Medicine in Palm Beach County” is the working title of the book scheduled to be published next spring. A special committee of Medical Society is being formed to oversee the book’s content, said John Compton, publisher and owner of Legacy Publishing Company in Birmingham, Alabama, which will publish the book. Legacy Publishing has published 12 other history books throughout the United States, including a medical

Emergency Hospital, ca. 1914.

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Memorium

In 1951, long before it was fashionable, the late Dr. Carl Brumback identified 56 local health hazards, including raw sewage being dumped into the Intracoastal Waterway.

history of Jacksonville, which will be published this summer. The book’s author, Leon Fooksman, is a longtime local journalist, who covered Palm Beach County for the South Florida Sun Sentinel for nearly a decade. He welcomes ideas and suggestions for the book. He can be reached at: fooksman18@gmail.com. With narrative writing and historic photographs, the approximately 250page volume will be the first extensive exploration of the key physicians, events and issues that shaped the history of the county’s medical profession.

“This book will be a fascinating look at the origins and growth of medicine in one of our nation’s most notable and interesting communities,” Compton said. It starts with the 1882 arrival of Dr. Richard Buckley Potter to Lake Worth, the county’s first community that later became the Town of Palm Beach. The book goes on to chronicle Palm Beach County’s growth through the 1920s and the opening of its first large hospital, Good Samaritan Hospital in West Palm Beach. The manuscript

Good Samaritan Hospital, 1920s.

PBCMS recently lost two of its valued members.

weaves through stories of continued expansion in the 1950s of existing and new hospitals, including Southeast Florida State Sanatorium for tuberculosis patients (later renamed A.G. Holley Hospital). Later chapters tackle the impacts of Medicare and Medicaid reimbursement on the medical community in the 1960s, the start of HMOs in the 1970s, and the 1989 establishment of the Health Care District of Palm Beach County to provide medical assistance for the poor and uninsured. The final sections will explore contemporary issues in local medicine like swine flu, diabetes, and AIDS, as well as President Obama’s Patient Protection and Affordable Care Act of 2010.

Carl Brumback, MD Carl Brumback, “The People’s Doctor” who passed away in January 2012 at age 97, was Palm Beach County’s first public health physician. Over the years his accomplishments were many, and his legacy of prevention and advocacy will save lives well into the future.

The book will also feature individual histories of physicians, medical practices, and other health care professionals who have impacted medicine in Palm Beach County in recent decades. Compton is now meeting with local physician practices and health care institutions to secure underwriting for the book. If your medical office is interested in learning more about this project, contact Compton at the Medical Society office at 561-433-3940 ext. 18 or at johncomp63c@ aol.com.

Pine Ridge Hospital, 1950s.

David Wulkan, MD David Wulkan, MD succumbed to leukemia in November 2011. Dr. Wulkan was a general and vascular surgeon in Boca Raton for over 26 years. Dr. Wulkan had a tremendous impact on his colleagues and was passionate about the practice of medicine.

St. Mary’s Hospital, 1950s.

Southeast Florida State Sanatorium, 1950.

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MED MEMO / ON CALL MAGAZINE QUARTER ONE 2012

Med memo

Quarter One 2012

SAVE THE DATES March 29, 2012, 6-8 p.m. Annual Doctor’s Day Celebration, Falls Golf & Country Club, 6455 Jog Rd. Lake Worth

OFFICE MANAGERS INSTITUTE SERIES 11:30am – 1:00pm, Lunch is included $25 charge for PBCMS members and their staff $35 charge for non-members and their staff

May 9, 2012. 9th Annual Heroes in Medicine Awards luncheon, Kravis Center Cohen Pavilion

March 7: How to Handle Difficult Employment Situations, Hilton Palm Beach Airport, 150 Australian Ave., West Palm Beach

September 27-28, 2012. Future of Medicine Summit VI, Palm Beach County Convention Center December 1, 2012. Annual Gala, Kravis Center Cohen Pavilion EDUCATIONAL OPPORTUNITIES Thurs., March 29, 5:30-8:30pm. Immunization: Public/Private Partnership, 2012 Immunization Update for Providers. CMEs and CEUs offered. Palm Beach County Health Department Auditorium, 800 Clematis Street, West Palm Beach. To RSVP or for more information call 561-840-4568. Sat., April 21, 10:00am-3:00pm. Stomach Cancer Education Symposium. The Westin Diplomat, 3555 S. Ocean Drive, Hollywood, FL 33019. 5 AMA PRA Category 1 Credit(s) TM. Also suitable for nonphysician medical professionals, patients, families, and caregivers. No cost. For more information visit www. cantstomachcancer.org or call 954-475-1200.

March 21: ICD-10 Coding Tips to Avoid Denials, Delray Beach Country Club, 2200 Highland Ave., Delray Beach April 4: Stark and Anti Kick Back Laws & Other Hot Legal Issues, Hilton Palm Beach Airport, 150 Australian Ave., West Palm Beach May 2: Managed Care Contracting – It’s More Than Just the Rate, Hilton Palm Beach Airport, 150 Australian Ave., West Palm Beach May 18: Accountability – People Do Exactly What We Let Them Do, Delray Beach Country Club, 2200 Highland Ave., Delray Beach June 6: Managing Your Denials, Hilton Palm Beach Airport, 150 Australian Ave., West Palm Beach Register at www.pbcms.org CHANGE IN ON CALL PUBLISHING SCHEDULE Starting in 2012 On Call will be published quarterly, rather than every other month as has been done in the past. New advertising rates will apply and will be distributed.

Photos from the 2012 Palm Beach County Medical Society and MEDPAC Legislative Reception and State of Medicine Dinner on January 5, 2012

Building Stronger Communities Together Patricia C. Corbett and Morgan Stanley Smith Barney is proud to support the Palm Beach County Medical Society Patricia Corbett, CFP® Vice President Financial Advisor 595 S. Federal Highway, 4th Floor Boca Raton, FL 33432 561-393-1535 patricia.c.corbett@mssb.com www.fa.smithbarney.com/pattycorbett

NY CS 6693029 04/11

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ON CALL MAGAZINE QUARTER ONE 2012 / NEWS & CLASSIFIEDS

NEWS & CLASSIFIEDS / ON CALL MAGAZINE QUARTER ONE 2012

Med SocietyNews PALM BEACH COUNTY MEDICAL SOCIETY NEW MEMBERS December 2011 to February 2012 Alain Alvarez, MD 15300 Jog Road, Suite 101, Delray Beach, FL 33446 Phone: 561-819-3100 Fax: 561-819-3119 Email: dralvarez@arcdelray.com Specialty: Rheumatology Medical School: University of Miami 2000-2005 Residency: Mayo Clinic 2005-2008 Fellowship: University of Minnesota 20092011 Board Certification: American Board of Rheumatology Hospital Affiliations: Andrew R. Berkman, MD 5401 S. Congress Ave., Suite 201, Atlantis, FL 33462 Phone: 561-641-7848 Fax: 561-641-0574 Email: arbmd1@gmail.com Specialty: Internal Medicine Medical School: University of Miami 2006 Residency: University of Florida College of Medicine 2006-2009 Board Certification: American Board of Internal Medicine Hospital Affiliations: JFK Medical Center Ania D. Carlson, MD 900 NW 13th Street, Suite 302 Boca Raton, FL 33486 Phone: (561) 362-2969 Fax: (561)362-2970 Email: daniellecarlson690@gmail.com Specialty: Anesthisiaology & Pain Medical School: University of Miami 1996-1999 Internship: Michigan State University 1995-1996 Residency: University of Miami 1996-1999 Fellowship: University of Conneticut 2000-2001 Board Certification: American Board of Anesthesiology , Nuclear Medicine, & Pain Management Hospital Affilitation: Boca Raton Outpatient Sugery & Laser Center, Jackson Memorial Hospital Michael S. Falkowitz, MD 951 NW 13th Street, Suite 2A, Boca Raton, FL 33486 Phone: 561-391-5771 Fax: 561-391-8619 Email: mfbr100524@aol.com Specialty: Pulmonary Disease Medical School: Suny Health Science Center Internship: Bronx Municipal Hopsital 1975-1976 Residency: Bronx Municipal Hospital 1976-1978 Fellowship: Bronx Municipal Hospital 1978-1980 Board Certification: American Board of Internal Medicine, Pulmonary Disease, Hospice and Palliative Medicine Hospital Affiliations: Delray Medical Center & Boca Raton Community Hospital Maged Habib, MD 2300 S Congress Ave Boynton Beach, FL 33426 Phone: 561-742-1944 Fax: 561-742-0525 Specialty: Ophthalmology Medical School: Ain Shams University/ Cairo 1989 Internship: Beth Isreal Medical Center 19921993 Residency: New York Eye & Ear 1993-1995 Fellowship: Nassau County Med Cnt 95-98 & LSU Eye Cnt 98-99 Board Certification: Ophthalmology Hospital Affiliations: Bethesda Memorial Hospital

Abraham Obuchowski, MD 5301 S. Congress Avenue, Atlantis, FL 33462 Phone: 561-548-3727 Fax: 561-548-1238 Specialty: Radiology Medical School: St. Georges University 1978-1982 Internship: New York Methodist Hospital 19821983 Residency: New York Methodist Hospital 1983-1986 Fellowship: Long Island Jewish Medical Center 19961998 Board Certification: American Board of Radiology & Diagnostic Radiology Hospital Affiliations: JFK Medical Center

Henry M. Haire, MD (Semi-Retired) 450 N. Federal Highway, Suite 1112N, Boynton Beach, FL 33435 Phone: 850-264-1489 Email: hmhmd1@gmail.com Specialty: Internal Medicine Medical School: University of Miami 1971 Internship: Harborview Medical Center 1971-1972 Residency: University of Washington Medical Center 1972-1975 Fellowship: University of Washington Medical Center 1975-1977 Board Certification: American Board of Internal Medicine Hospital

Julieta Oneto, MD 5301 S. Congress Avenue, Atlantis, FL 33462 Phone: 561-548-3727 Fax: 561-548-1238 Email: Specialty: Radiology Medical School: Universidad Del Salvador 1996-2002 Internship: Mount Sinai Medical Center 2003-2004 Residency: Mount Sinai Medical Center 20042008 Fellowship: Miami Childrens Hopsital 2008-2009 Board Certification: American Board of Radiology & Diagnostic Radiology Hospital Affiliations: JFK Medical Center

Vijay B. Harpalani, MD 300 Burns Road Suite 202, Palm Beach Gardens, FL 33410 Phone: 561-624-1991 Fax: 561-626-7661 Specialty: Internal Medicine Medical School: Stanley Medical College Residency: University Hospital- Suny Stony Brook Board Certification: American Board of Internal Medicine & Family Medicine Hospital Affiliations: Palm Beach Gardens Medical Center & Jupiter Medical Center & Kindred Hospital

Amar Suhas Patel, MD 5301 S. Congress Ave., Atlantis, FL 33462 Phone: 561-548-3727 Fax: 561-548-1238 Email: Specialty: Radiology Medical School: University of South Florida 2002 Internship: UF and Shands Jacksonville 20022003 Residency: UF and Shands Jacksonville 2003-2006 Board Certification: American Board of Radiology & Diagnostic Radiology Hospital Affiliations: JFK Medical Center & Northwest Medical Center

Stuart Knott, MD (Retired) Phone: (561) 989-0676 Fax: (561) 542-6552 Email: saknott@mac.com Specialty: Opthalmology Medical School: Cornell University Medical College 1958-1962 Internship: Henry Ford Hospital 1962-1963 Residency: Henry Ford Hospital 1963-1967 Board Certification: American Board of Opthalmology Hospital Affiliations: Craig Thomas Kolodziej, MD 5301 S. Congress Avenue, Atlantis, FL 33462 Phone: 561-548-3727 Fax: 561-548-1238 Specialty: Radiology Medical School: University of Illinois 2003 Internship: Wistein Pennsylvania Hopsital 2003-2004 Residency: Boston University Medical Center 2004-2008 Fellowship: Boston University Medical Center 2008 Board Certification: American Board of Radiology & Diagnostic Radiology Hospital Affiliations: JFK Medical Center & North West Medical Center Marcos Agustin Nores, MD 5301 South Congress Ave., Atlantis, FL 33462 Phone: 561-548-4900 Fax: 561-5484902 Specialty: Cadiothoracic Surgery Medical School: Universidad de Buenos Aires 1989 Internship: St. Elizabeth Medical Center 1992-1993 Residency: Cedars Sinai Medical Center 1993-1998 Fellowship: George Washington Univ 982000 & Cleveland Clinic Board Certification: American Board of Surgery - Surgery & American Board of Thoracic Surgery Hospital Affiliations: JFK Medical Center

David Paul Ritter, MD Phone: 561-994-0230 Fax: 561-9940950 Specialty: Anesthesiology Medical School: University of Texas Health Science 1988 Internship: University of Alabama Hospital 1988-1989 Residency: Methodist Hospital 1989-1990 Fellowship: University of Kansas 1990-1994 & Ohio State University 1994-1996 Board Certification: American Board of Surgery Hospital Affiliations: West Boca Medical Center, Naples Day Surgery Sharif Salehi, MD 4300 South US Hwy 1, Jupiter, FL 33477 Phone: 561-548-3549 Fax: 561-548-3591 Specialty: Emergency Medicine Medical School: Oregon Health Science University 1994 Internship: Thomas Jefferson University 1994-1995 Residency: Thomas Jefferson University 19951997 Board Certification: American Board of Emergency Medicine Hospital Affiliations: JFK Medical Center

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Angela Savino, MD 5301 S. Congress Ave., Atlantis, FL 33462 Phone: 561-548-3727 Fax: 561-548-1238 Specialty: Radiology Medical School: New York University 1978-1982 Internship: Mount Sinai Medical Center 1982-1983 Residency: Long Island College Hospital 1984-1987 Fellowship: North Shore University Hosital 1987-1988 Board Certification: American Board of Radiology Hospital Affiliations: JFK Medical Center Kenneth R. Stein, MD 6808 N. State Road 7, Coconut Creek, FL 33073 Phone: 954-570-5560 Fax: 954-5715240 Email: mercedesh@diagnosticprofessionals.com Specialty: Radiology - Diagnostic Radiology Medical School: Downstate Medical Center 1978 Internship: Brookdale Hospital 1978-1979 Residency: Kings County Hospital 19791982 Fellowship: University of Miami/Jackson Memorial Hospital 1983 Board Certification: American Board of Radiology, Diagnostic Radiology, & Neuroradiology Hospital Affiliations: Holy Cross Hospital Kurt L. Wiese, MD 1050 NW 15th St., Boca Raton, FL 33486 Phone: (561) 393-8224 Fax: (561) 367-9727 Email: dock57@ att.net Specialty: Infectious Disease Medical School: Cornell University Medical College 1978-1982 Internship: University of VA Medical Center 1982-1983 Residency: University of VA Medical Center 1983-1985 Fellowship: University Hospital of Cleaveland 1986-1988 Board Certification: American Board of Internal Medicine & Infecticous Disease Hospital Affiliations: Bethesda Memorial Hospital, Boca Raton Regional Hospital, Delray Medical Center

Residents

Alyn Casal-Fernandez, MD Phone: (305) 562-7663 Email: tapinmotion@yahoo.com Specialty: Preventive Medicine Medical School: Resident Tulisa Hanflink LaRocca, MD 160 JFK Drive, Atlantis, FL 33462 Phone: 561-548-1450 Fax: 561-548-1459 Specialty: Internal Medicine Hospital Affiliations: JFK Medical Center Berry Pierre, DO Phone: (561) 644-8200 Email: bppierre@ gmail.com Specialty: Internal Medicine Medical School: Resident

Classifieds Office Space Available Long time practicing physician would like to share office space and parking with another physician. Great location near Good Samaritan Medical Center. Contact John Schmid at 561-832-3212. Great East Boynton Beach Location! Fully built-out medical suite for lease. Directly across from Bethesda Hospital. Thoughtfully designed, extremely attractive. 6 exam rooms and several professional offices. Includes specimen lab, large business office and nurseâ&#x20AC;&#x2122;s station. Fully wired for EMR. Approx. 2700 sq. ft. available April 1, 2012. Call Julie at 561-742-2324 ext 107. Medical Suite 1840 Forest Hill Blvd., 1,200 sf with 3 exam rooms, 2 offices, reception and business areas; ample parking; $1,925 per month. Call 561-801-0544 or joemschneider@yahoo.com.

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