On Call - The Journal of Palm Beach County Medical Society (Quarter Three 2013) by Palm Beach County Medical Society

The Official Publication of the Palm Beach County Medical Society

SUMMIT VII

Quarter Three 2013

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.

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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 Andrew Larson, MD

Quarter Three 2013

President, Palm Beach County Medical Society

The Future of Medicine is upon us now. I am more excited about this year’s Future of Medicine Summit VII than I have ever been. This year the format is streamlined; we are packing an array of passionate and distinguished speakers into a summit beginning with early registration and our annual student and resident poster symposium at 4pm on Thursday October 10th and concluding with a working reception featuring guests of honor Dr. Alan Harmon, FMA president and Florida Surgeon General Dr. John Armstrong among others, from 5 to 6 pm on Friday the 11th. This year the entire summit will be held at the Kravis Center’s more intimate Cohen pavilion as opposed to the Palm Beach County Convention Center across the street. On Thursday, our VIP dinner featured speaker is Dr. Ardis Dee Hoven, MD, currently serving as president of the American Medical Association. Dr. Hoven is only the third woman to serve in this capacity and we are honored that she has accepted our invitation to be part of Palm Beach County’s premiere medical showcase event. We will also be meeting with and hearing from the deans of several of Florida’s prestigious medical schools at the VIP dinner in line with our forward-thinking summit themes, “Innovative Minds, Extraordinary Care, Outstanding Medical Education, and Quality Focused Professionals.” I believe our VIP dinner will offer a unique opportunity to learn more about organized medicine’s national priorities as we physicians continue to navigate the constantly evolving Affordable Care Act and the hurdles it places upon us. We will also have the opportunity to learn

about the latest advances in the medical curricula available to Florida’s future physicians and hopefully appreciate how medical education has in many ways improved for the better. As in the past many local medical students and residents will be in attendance. Friday’s speaker lineup is every bit as impressive and as in the past CME credits will be available to all in attendance. Morning lectures are offered on the topics of Innovations in Health Care Delivery, Achieving the Triple Aim (improving patient experience, improving population health benefits, and reducing health care costs), and how the coming revolution in “Patient Purchased Physician Care” will affect those of us used to performing in an environment in which patients traditionally did not choose their physicians based on cost. I am interested in speaker Brian Klepper, PhD’s thoughts on this subject as this model for the future may well change the way I must practice medicine. Dr. Daniel Kraft, chair of the FutureMed program at Singularity University will also be speaking Friday morning. I had the opportunity to hear him speak at the AMA’s leadership conference in February and I believe his hour-long talk was the finest I have ever heard. Dr. Kraft is truly in tune with where medicine is headed from a technological standpoint. If you are the science-type tired of hearing about boring topics like insurance and bundled payment models and you want to be truly entertained and educated about the future of medicine itself (think Tricorders and the like) this is the lecture to attend.

If past performance is predictive this will be an awesome presentation. Following lunch we have assembled impressive panels which include local entrepreneurs, Scripps scientists, and Palm Beach County physician leaders and educators for CME sessions pertaining to the latest advances in pain medicine, infectious disease management, and Parkinson’s disease. Following these panel discussions a concluding reception will close out the conference in time for dinner with the family on Friday. I believe the accelerated format of this year’s summit will allow for more physician participation than ever before. The leadership committee has been working very hard to bring together an impressive speaker panel and to solicit the participation of numerous sponsors for the event. We encourage you to learn more about our sponsor’s offerings during breaks in the Friday sessions and prior to dinner on Thursday. As president of the Palm Beach County Medical Society I would like to recognize and also thank Dr. Michael Dennis and Dr. Jose Arrascue for their continued efforts to make our annual Future of Medicine summit a success. Please join me on October 10th and 11th at the Kravis Center as to take the opportunity to meet some fascinating people and learn more about the future of medicine. Yours in good health,

Andy Larson President PBCMS

QUARTER THREE 2013

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Making a Difference With Project Access UPDATE: Impact of the Affordable Care Act Frequent Malpractice Risks Faced by Office Practices Revealed in Survey The Future of Medicine Summit VII Compensation Plans Are Stronger When Healthy Practice Formulas Are Exercised 2013 FMA Annual Meeting Report Collect More by Working Smarter!

ARTICLES

03 President's Report 07 In Memoriam 21 MED MEMO 22 MED Society News About the Cover:

(left to right) Daniel Kraft, MD, medical technology innovation expert with Singularity University; Brian Klepper, PhD, health care economist with We Care TLC; Ardis D. Hoven, president of the American Medical Association and Randy Van Straten of Bellin Health are among the prestigious speakers at the Future of Medicine Summit VII.

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Brokers welcome. Broker must accompany client during client’s initial visit to this community. Both the client and Broker must execute the Developer’s Registration Form on the initial visit. Broker must also execute the Developer’s Broker Participation Agreement. Canyon Trails is being developed by Boynton Beach Associates XXIII, LLLP. Valencia Reserve and Valencia Cove is being developed and sold by Boynton Beach Associates XIX, LLLP. The complete offering terms are in an offering plan available from Sponsor. File No. H09-0015. Valencia is designed for residents aged 55 & older and is intended to meet the exemption under the Federal Fair Housing Act. The homes at The Preserve at Bay Hill Estates are being sold by Palm Beach West Associates III, LLLP. The Bridges is being developed and sold by Boca Raton Associates VI, LLLP. Oral representation cannot be relied upon as correctly stating representations of the developer. For correct representations, make reference to the documents required by section 718.503, Florida statutes, to be furnished by a developer to a buyer or lessee. Prices subject to change without notice. ©2013 1100-740 8-8-13

In Memoriam James Byrnes, MD

Board of Directors K. Andrew Larson, MD President

Ronald Zelnick, MD President Elect

A PBCMS Past President and Beloved Friend James Byrnes, MD, passed away on Sunday, July 21 at Bethesda Hospital surrounded by his family. Dr. Byrnes will be remembered for his kind and gentle spirit, his love of medicine, commitment to his family, friends and patients and his tireless efforts on behalf of physicians, Bethesda Hospital and the Medical Society. James Byrnes, MD, age 61, of Boca Raton was chief of staff at Bethesda Hospital in Boynton Beach. He was the son of Virginia and the late Edward Byrnes of Laurel, New York. He is also survived by three brothers, Jack, Richard and Tom, and his partner Anthony Reyes.

The James Byrnes, MD, Medical Education fund has been established in honor of Dr. Byrnes. Contributions will support programs for Palm Beach County medical students and residents. Tax deductible donations should be made to: PBCMS JByrnes Fund, 3340 Forest HIll Blvd. Ste 101, West Palm Beach, FL 33406.

Steven Babic, MD First Vice President

“He was an example of what we all should strive for in being a physician.”

James Howell, MD Second Vice President

James Goldenberg, MD Secretary

“Dr. Byrnes was an incredible man. Kind, warm, sensitive, thoughtful. Who inspired us to strive to be better. He was one of the physicians who inspired me to be involved in the PBCMS. We will all miss him.”

Shawn Baca, MD Treasurer

Jack Zeltzer, MD Immediate Past President

Sandra Blair Alliance Representative

Lisa Oliveri Medical Student

“I want to pay my respects to this wonderful physician with a truly caring heart. What a loving family and what an outpouring of love from his patients. His family told me that, to a person, his patients said not only was he their trusted doctor, but he was also their friend. He will be sorely missed.” “The Ringmaster has left the Circus Floor. Dim the house lights, bring the Tent down, and let’s travel. The Show must go on. “

Tulisa La Rocco, MD Resident

Beth-Ann Lesnikoski, MD Marc Hirsh, MD Hatem Abou-Sayed, MD Kishore K. Dass, MD Jeffrey Davis, DO Michael Dennis, MD Roger Duncan, MD Richard Greenwald, MD Aviv Katz, DO Brandon Luskin, MD Andrew Shapiro, MD Kenneth Woliner, MD

Board of Trustees Brent Schillinger, MD Jack Zeltzer, MD Lawrence Gorfine, MD James J. Byrnes, MD Alan Pillersdorf, MD Jose F. Arrascue, MD Malcolm Dorman, MD K. Andrew Larson, MD Ronald Zelnick, MD Steven Babic, MD James Howell, MD James Goldenberg, MD

QUARTER THREE 2013

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Making a Difference With Project Access Do you have uninsured patients in your office? Are they getting the care the need? Project Access may be able to help. Project Access is a coordinated system of volunteer physician care, hospital care, diagnostic services, and medication assistance for the low-income uninsured residents of Palm Beach County. The program is administered by the Palm Beach County Medical Society Services, Inc., a 501(c) 3 corporation. Project Access mission is to obtain access to health care for the uninsured residents of Palm Beach County. With the assistance of 650 volunteer physicians and providers, the program served over 6,500 individuals with medical needs and found a long term healthcare plan for them. The program has donated a total value of over $9.5 million, an average of $1.2 million per year. Before being accepted as a Project Access participant, individuals undergo a screening process to determine eligibility. In order to be eligible, the patients must: 1. Be a resident of Palm Beach County. 2. Have income that does not exceed 200% of the federal poverty level. 3. Not qualify for any federal, state or county health coverage. The program also provides free preventive, personalized care and focuses on wellness through prevention and early detection of Diabetes, Hypertension and Heart diseases. In addition, the program recently provides Mental Health screening and services for the uninsured residents of Palm Beach County. Project Access provides a short term plan with a long-term solution. While patients are under Project Access care, the staff works with them to find other ongoing care within six to nine months.

Physicians/ Providers Benefits â&#x20AC;˘ The program enables physicians and other healthcare providers to provide pro bono care to needy patients in the community through an organized system that is simple and protective of the providers. â&#x20AC;˘ The Department of Health provides sovereign immunity protection for the physician and facility when treating Project Access patients. â&#x20AC;˘ Physicians are eligible to receive up to 5 CME every two years for providing pro bono care. The physician and facility has complete control of the number of patients they will accept. We ask no commitment to a minimum. If you have questions about the program and would like to participate as a physician or provider please call Nicola Chung, Program Director, at (561) 433-3940 extension 26. If someone is uninsured and would like be screened for eligibility, please call Project Access staff at (561) 433-3940 extension 29.

UPDATE: Impact of the Affordable Care Act by Sheryl Southwick, Director of Compliance, TriNet HR Corporation On July 2, 2014, the Treasury Department announced a delay in the Affordable Care Act (ACA) employer shared responsibility provision, also referred to as the “employer mandate” or “pay or play” provision and the Internal Revenue Service (IRS) subsequently issued regulatory guidance.

This delay gives employers an extra year – until January 1, 2015 – to comply with the employer shared responsibility provision and the associated reporting requirements. While this delay provides relief for large employers that were scrambling to comply with the requirement to offer health coverage or face potential penalties, it did not delay any other ACA provisions scheduled to go into effect in the upcoming months. Businesses of all sizes still need to take action.

Which ACA provisions were delayed? As background, under the ACA a large employer with 50 or more full-time equivalent employees may be subject to a penalty if a full-time employee receives a premium tax credit or costs sharing subsidy through a Marketplace and the employer:

i Failed to offer minimum essential health care coverage to at least 95% of its full-time employees and their dependent children up to age 26 (spousal coverage not required); or

ii Offered eligible employer-sponsored coverage that is not “affordable” (employee premium exceeds 9.5% of the employee’s household income) or does not offer “minimum value” coverage (the plan’s share of the total allowed cost of benefits is not at least 60%).

The Notice specifically states that employer shared responsibility penalties will not be assessed for 2014 if a large employer fails to offer affordable and minimum value coverage. The Notice also confirms that penalties will not be applied during 2014 for failure to comply with the reporting requirements that are designed to provide the IRS with data required to enforce the employer mandate. The IRS intends to issue proposed regulations for reporting coverage information during the summer of 2013. Employers and other reporting entities are encouraged to voluntarily comply with the reporting rules during 2014. Both employer shared responsibility and the information reporting requirements will be fully effective for 2015.

Impact on other ACA Provisions Transition relief for employer shared responsibility and reporting requirements have no impact on the effective date or application of any other ACA provisions. Below are several key provisions employers will need to be aware of or act on now or in the near future. The state and federal run Marketplaces are schedule to begin open enrollment on October 1, 2013, with coverage effective January 1, 2014 (Marketplaces were previously referred to as “Exchanges” by the ACA.). The Marketplaces are designed to allow individuals to compare health plans, find out if they are eligible for tax credits, and enroll in an individual health plan. Certain individuals, who do not have group or employer-based coverage, or whose employer-based coverage isn’t affordable, may be eligible for a subsidy or premium credit toward their purchase

of a health plan through the marketplace. Premium costs are still unknown. The application process for subsidies and premium credits is lengthy and includes a section that the applicant’s employer is required complete. So you should be planning to start completing Marketplace application paperwork beginning this fall. Beginning October 1, 2013, the Affordable Care Act (ACA) requires employers subject to the Fair Labor Standards Act (FLSA) to provide a notice to current and new employees regarding health plan coverage options available through Marketplaces. Employers must provide the notice to all current employees by October 1, 2013. Also beginning October 1, 2013, employers must provide the notice to all new employees at the time of hire (for 2014, within 14 days of the employee’s start date). Employers must provide the notice to each employee, regardless of whether the employee is enrolled in the plan or whether the employee works part-time or full-time. There has been no delay to the “individual mandate” that most taxpayers (excluding those with certain exemptions) will be assessed a “shared responsibility” penalty for any months during which they or their spouse or dependents lack “minimum essential coverage.” So be prepared for questions from your employees about how the health coverage your company offers compares to the new Marketplace plans.

QUARTER THREE 2013

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Frequent Malpractice Risks Faced by Office Practices Revealed in Survey Contributed by The Doctors Company.

The survey found that medical record documentation, medication management, and communication are other top areas of risk. The most frequent malpractice risks medical office practices face are related to lab tests/referrals and scheduling/ follow-up, according to a nationwide survey of practice environments conducted by The Doctors Company. Your office practice can follow these steps to lessen risks:

Lab Tests/Referrals and Scheduling/Follow-Up • Ensure that the office staff knows how to reconcile tests, referrals, and consult orders with the results when received, and have a process in place in case of discrepancy. • Communicate all test results to patients. • Don’t rely on a return appointment or a “hold” on a medical record as a reminder that a test was not performed or the patient was not contacted about results. • Tell patients to contact your office if they have not received test results by a specified date. • Send letters to patients who fail to follow up and cannot be reached by phone; file all documentation in the medical record. • If using an electronic medical record, utilize the test-tracking capability.

Medical Record Documentation • Document allergy information in the same place on all medical records. • Keep a current list of all medications. • Maintain a current problem list with dates of problem identification, reviews, and resolutions. • Use the patient’s own words when documenting. • Indicate in writing or electronically that all results of tests, consultants, and referrals were reviewed. • Document all after-hours patient calls.

Medication Management • Ensure that the patient understands the reason for the medication, how to take it, and when to contact your office about side effects. • Store medication samples, syringes, and prescription pads securely. • Label all syringes and administer medications immediately—and don’t leave them unattended. • If you prepare medications to be used later, sign or initial the label and include the name of the medication, dosage, and date. • Maintain refrigerated medications at the correct temperature and keep a record of who performs the checks and what was discarded. • Ask verbal orders to be repeated back. • Identify all high-alert medications and follow guidelines to ensure they are ordered, stored, dispensed, and administered correctly. • Refer to your state law to determine which staff can call in new prescriptions and refills.

Communication • Document all advice in the patient’s record. • Ensure that a licensed provider responds when the patient’s question is outside the scope of office staff knowledge. • Document the level of understanding during the informed consent process. • Use open-ended questions. • Incorporate a standard communication protocol to enhance the handoff process and reduce errors of omission. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.

QUARTER THREE 2013

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Committees

The New Reality: Palm Beach County Leading The Way • • • •

Innovative Minds Extraordinary Care Outstanding Medical Education Quality Focused Professionals

Summit Schedule Michael Dennis, MD Summit Chair

Jose F. Arrascue, MD Future of Medicine Chair

Leadership Jose F. Arrascue, MD, Future of Medicine Chair James T. Howell, MD, Co-Chair Michael Dennis, MD, Summit Chair Stephen Babic, MD Ronald Davis, PhD Malcolm Dorman, MD James Goldenberg, MD Brent M. Schillinger, MD Gaetano J. Scuderi, MD Joan E. St. Onge, MD John Vara, MD Jack Zeltzer, MD

Host Jean Acevedo Peter Anderson Kerri Burke Elizabeth “Liz” Cayson Sally D. Chester, RN Madelyn Christopher Patty Corbett Randie Dalia Cathi Dorn Patricia Ernst Anita Finley Leon Fooksman Elizabeth Houlihan Mary Helen Johnson Roger Kirk Thomas J. Leach Michelle Maloney Heather S. Miller Tom Murphy Susan Nefzger Jon Sajeski Judi Schumacher Kelly Skidmore Rob Sommer Ben Starling III Lynn Stockford Jamie Titcomb 12

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Thursday October 10, 2013 3:00 pm . . . . . . . . . . 5:00 - 6:00 pm . . . . . . 6:00 - 8:00 pm . . . . . .

Registration/Exhibit Hall Opens James J. Byrnes, MD Poster Symposium Judging VIP Reception VIP Dinner and Program (tickets sold separately) Michael Dennis, MD (Moderator) Ardis D. Hoven, MD, President, AMA Deans of the Florida Medical Schools: Joshua Hare, MD; John Rock, MD; Robert George, DO; David J. Bjorkman, MD; Deborah German, MD; Anthony Silvagni, DO

Friday October 11, 2013 8:00 - 8:30 am . . . . . . Registration, Continental Breakfast & Exhibit Hall 8:30 - 8:45 am . . . . . . Welcome and Opening Comments Michael Dennis, MD, Summit Chair Jose F. Arrascue, MD, Chair, Future of Medicine Initiative K. Andrew Larson, MD, President, Palm Beach County Medical Society 8:45 - 9:30 am . . . . . . “Innovations in Health Care Delivery: Achieving the Triple Aim” Randy Van Straten, Bellin Health Scott Good, Crescendo Consulting 9:30 - 10:15 am . . . . . “What a Purchaser Patient Awakening Will Mean for Physicians” Brian Klepper, PhD, Health Care Performance, We Care TLC 10:15 - 10:30 am . . . . Break & Exhibit Hall 10:45am-12:00 pm . . “Future of Medicine: Emerging Medical Technology” Daniel Kraft, MD, Executive Director, Future Med, Singularity University 12:00 - 1:00 pm . . . . . Exhibit Hall, Reception Lunch: “Physician Practices, Patients & Obamacare?” Timothy B. Norbeck, CEO, The Physicians Foundation 1:00 - 2:15 pm . . . . . . Parkinson’s Disease: James Goldenberg, MD Carlos Singer, MD, University of Miami Health System Philip LoGrasso, PhD, Scripps Florida Kenneth Marek, MD, Institute for Neurodegenerative Disorders; Bruno Gallo, MD, Leonard M. Miller School of Medicine 2:15 - 3:30 pm . . . . . . Infectious Disease: Jose F. Arrascue, MD; Larry Bush, MD; Timothy Tellinghuisen, PhD, Scripps Florida 3:30 - 4:45 pm . . . . . . Pain Medicine: Gaetano Scuderi, MD, Cytonics Corporation Ray Alvarez, MD, Coastal Pain Solutions 5:00 - 6:00 pm . . . . . . “Medicine and Policy” Alan Harmon, MD, President, FMA John H. Armstrong, MD, FACS, Florida Surgeon General Mark Pafford, Florida State Representative Gina Petredis, Cleveland Clinic Florida Ron Wiewora, MD, MPH, Palm Beach County Health Care District Reception QUARTER THREE 2013

SUMMIT VII

October 10 - 11, 2013 The Kravis Center, Cohen Pavillion West Palm Beach Florida

Join us for the new reality in health care! Never before has the pace of change in health care been so dramatic. In Palm Beach County, we are making great strides in areas of innovation, quality of care, medical education and professional expertise. Anticipating the largest attendance ever, the Palm Beach County Medical Society is hosting the Seventh Annual Future of Medicine Summit. During this Summit, we will explore how Palm Beach County is leading the way to improve our community’s access to quality care. We hope you will join us for this exciting slate of speakers and topics.

Featured Speakers This year’s Summit boasts some of the most cutting edge and prestigious speakers we’ve ever had. Here is a brief snapshot of four of them.

Daniel Kraft, MD Daniel Kraft is a Stanford and Harvard trained physician-scientist, inventor, entrepreneur and innovator. Dr. Kraft has over 20 years of experience in clinical practice, biomedical research and healthcare innovation. Daniel chairs the Medicine track for Singularity University and is Executive Director for FutureMed, a program which explores convergent, exponentially developing technologies and their potential in biomedicine and healthcare.

Brian R. Klepper, PhD Brian R. Klepper is a health care analyst, commentator and entrepreneur. He is Principal and Chief Development Officer for WeCare TLC, LLC, an onsite primary care clinic and medical management firm based in Longwood, FL, and Managing Principal of Healthcare Performance Inc., an advisory practice based in Atlantic Beach, FL.

Randy Van Straten As Vice President of Business and Personal Health Solutions at Bellin Health, Randy Van Straten has developed a highly successful strategy that is helping employers not only control, but in some cases lower their health care costs, all while improving the health of the companies’ employees and their family members. Randy’s Business Health Solutions team works directly with employers to identify areas of health risk and then create solutions that improve health while controlling costs.

Ardis D. Hoven, MD Ardis Dee Hoven, MD, an internal medicine and infectious disease specialist in Lexington, Ky., became the 168th president of the American Medical Association in June 2013. Dr. Hoven has been a member of the AMA Board of Trustees (BOT) since 2005, serving as its secretary for 2008–2009, chair for 2010–2011, and immediate past chair for 2011–2012.

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Compensation Plans Are Stronger When Healthy Practice Formulas Are Exercised Many of today’s physician practices are undertaking an ambitious task of reevaluating their compensation formulas. Most formulas for compensating physicians were developed before the managed care era. In the course of about 15 short years, the business environment for physician practices has changed dramatically: • Shrinking reimbursements and new rules by both the government and carriers have resulted in a smaller revenue pie for many practices. • Mergers and acquisitions have left many practice groups with the challenge of coordinating the compensation formulas of two or more practice groups. • In the managed care environment, the varying levels of contributions made to a practice by physicians, both production and non-production oriented, may have greater ramifications to the bottom line than they previously did. Certainly the easiest path to follow is to not make any changes. However, we are beginning to see frustration by some physicians in group practices that are not addressing these issues openly. All compensation formulas should be reviewed, and possibly revamped, to meet today’s needs of providing incentives for the behavior that will not only reward individual efforts but also support the strategic objectives of the practice. 14

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All physicians of the practice should have the opportunity to give their opinions of the adequacy of the existing compensation system. The discussion itself, even if no changes are made, can be healthy for the group. Physician compensation formulas fall on a continuum between two common models: • Equal compensation for all senior associates. • Compensation based entirely on production, e.g., number of patients seen, number of procedures or relative value units performed, income generated or income collected. There are potential drawbacks for both of these models. We find that a mixed model does the best job of linking incentives with strategic objectives of the practice. One impediment to developing a compensation formula may be the group’s information system. Many physician practice groups have information technology systems that do not have the necessary detail to handle sophisticated models. However, fairly simple changes to existing systems as well as supplementing with off-the-shelf software may assist with the process. Another impediment may be tackling the project totally internally. The independence of thought of internal staff or physicians involved in this process may be questioned by some physicians. Here are a few key concepts that physician practice groups should

QUARTER THREE 2013

Tammy Clarke of Alpern Rosenthal

think about when reevaluating their compensation formulas: • Some measure of work units should still be the major factor in compensation. Work units could represent up to 60-80 percent of the compensation model. • Make sure that you select only two, or at most three, other factors, so the model is not too complicated to understand and apply. • You may want to include a small percentage of equal compensation to encourage team efforts. • Only address more sophisticated issues such as utilizing relative value units if your information systems can produce reliable data efficiently. However, begin the process of tracking the necessary information now. ( Continued on Page 20 )

2013 FMA ANNUAL MEETING REPORT Thank you to the PBCMS Delegates for attending the Florida Medical Association Annual Meeting Special recognition to the PBCMS members who represented physicians at the FMA Annual Meeting in Orlando July 26-28: Stephen Babic, MD, Cynthia Clayton, MD, James Goldenberg, MD, Ernesto Hayn, MD, Marc Hirsh, MD, James Howell, MD, Andrew Larson, MD, Beth-Ann Lesnikoski, MD, Norman Henry Pevsner, MD, Mark Rubenstein, MD, Ken Woliner, MD, Ron Zelnick, MD, Jack Zeltzer, MD and Medical Student Lisa Oliveri. FMA Representatives are Jose Arrascue, MD, Ronald Giffler, MD and Alan Pillersdorf, MD.

The following PBCMS physicians were appointed to serve on FMA Councils and Committees: • Jose F. Arrascue, MD

Council on Medical Services and Health Care Delivery Innovation, ACA Implementation Subcommittee, Task Force on the Future of Medicine

• Jeffrey Mark Berman, MD Committee on Accreditation and CME

• Vincent A. DeGennaro, MD Committee on Finance & Appropriations Secretary, Board of Past Presidents

• Ronald F. Giffler, MD Chair, Committee on Finance & Appropriations

• Peter Lamelas, MD Council on Medical Services and Health Care Delivery Innovation

• Mark A. Rubenstein, MD Chair, Council on Medical Services and Health Care Delivery Innovation

• Alan B. Pillersdorf, MD Committee on Federal Legislation Committee on Finance & Appropriations 16

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Florida Medical Association Installs W. Alan Harmon, M.D., as 137th FMA President The Florida Medical Association installed Jacksonville physician W. Alan Harmon, M.D., FACP, as its 137th President this evening during the 2013 FMA Annual Meeting in Orlando. Dr. Harmon is known among his colleagues as a dedicated physician leader who has made many contributions to organized medicine. “Dr. Harmon has served the medical profession at the county, state and national levels, and he is committed to making Florida a better place for physicians to practice medicine,” said FMA Executive Vice President Timothy J. Stapleton. “His knowledge of the many complex issues facing doctors today is a great asset to the FMA.” Board certified in internal medicine and gastroenterology, Dr. Harmon practices with the Borland-Groover Clinic in Jacksonville. He graduated with honors from the University of Florida College of Medicine in 1976, and he completed his residency in internal medicine and a fellowship in gastroenterology at the University of Alabama in Birmingham. Dr. Harmon has served on numerous FMA committees as well as the FMA Board of Governors and the FMA PAC Board of Governors. He has been a delegate from the FMA to the American Medical Association, and he also served as FMA Treasurer from 2007 to 2011. He is a Past President of the Duval County Medical Society, the Florida Society of Internal Medicine and the Florida

QUARTER THREE 2013

Gastroenterological Society. Dr. Harmon is a Fellow of the American College of Physicians and was elected last year to the AMA Council on Medical Service. Dr. Harmon succeeds Vincent DeGennaro, M.D., who served as FMA President from 2012-2013. Other FMA officers for 20132014 are: President-Elect Alan Pillersdorf, M.D.; Vice President Ralph J. Nobo Jr., M.D.; Secretary John Katopodis, M.D.; Treasurer Ronald Giffler, M.D.; Speaker David J. Becker, M.D.; and Vice Speaker Corey L. Howard, M.D. A full report of the actions of the House of Delegates will be posted on line at www.pbcms.org

Congratulations! Alan B. Pillersdorf, MD Voted FMA President Elect. Alan Pillersdorf MD was elected President – Elect and Mark Rubenstein was elected Alternate Delegate to the AMA. Alan Pillersdorf, MD

Mark Rubenstein, MD

A family tradition of medicine: N. Henry N. Henry Pevsner, MD, FACR; Deborah L. Pevsner, MD; Rachel Pevsner Crum, DO; Ramsey K. Pevsner, DO, PhD Marc Petroski & David Peck of TriNet and Tammy Clarke of Alpern Rosenthal attend Circle of Friends luncheon.

James Howell, MD; Mark Hirsch, MD; Governor Rick Scott; Jose F. Arrascue

PBCMS Delegation Attends Good Government Lunch

Palm Beach County Medical Society

Member Dinner Meeting Health Care Fraud & Abuse Join Your Colleagues for a Special Program on Thursday, September 19, 2013 6pm - 8pm at the Airport Hilton 150 Australian Ave, West Palm Beach, FL Members . . . . . . . . . . . . . . . . . . . . . . . . . Free Non Members, Spouses and Guests . . . . . $35 Guest Speaker Wilfredo A. Ferrer United States Attorney for the Southern District of Florida

Registration Required Please register online at www.pbcms.org or call 561-433-3940

CLASSIFIEDS Need Space Board Certified Plastic Surgeon looking for 1-2 half days/wk shared office space in Boca Raton, Delray or Boynton Beach. Please contact at boyntonplastics@gmail.com

For lease 1500 sq. ft. First Floor with 3 exam rooms and large waiting room in Jupiter Lakes Medical Park. Available full or part time. Please call 561-747-2322

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Collect More by Working Smarter! By Juan H. Kouri, MHSA, ProMD

How much money is your practice leaving uncollected? “Maybe you should just let someone else do it” Outsource your pain and increase collections. A Practice Management Company will take a cut off the top of what it collects for you. But if they don’t produce, they don’t get paid. This keeps them highly motivated to collect your revenue. If you don’t get paid they don’t either. If you are collecting less than 95% of what your contracted rates allow, including the patient’s responsibility, you should be concerned. The Medical Group Management Association (MGMA) has established receipts collections benchmarks for medical practices. Your practice should collect at least 90% of the expected amount within six months of the date of service and 95% or more of the expected amount within nine months of the date of service. Achieving and maintaining these levels is not easy and requires a concerted and dedicated effort from your entire staff as well as a sound and efficient practice operation and supervision. Staff turnover, knowledge of your practice management system, proper insurance eligibility verification, changes in insurance plans payment and coverage policies, are things you shouldn’t have to worry about on a daily basis. Practice Management Companies (PMCs), like ProMD Practice Management, a locally based, multi-specialty PMC, can do a better job than practices can on their own. Not only do they specialize in getting revenue in the door, but they also have economies of scale that allow them to offer a more consistent, effective approach using start-of-the-art technology. Health plans have complex rules that are changing all the time,

If any of these things apply or your office manager doesn’t know them, you should look into outsourcing: Billing • Is your overall collection rate declining? • Are your accounts receivable (A/R) too high? • Are you experiencing an increased number of denied claims? • Are you facing a major investment in new hardware or software? • Are you finding that the number of staff needed to get the job done is growing? • Is turnover requiring too much time and attention?

Management • Are you unable to find the right person to help manage the business? • Do practice demands keep you from monitoring your manager’s performance? • Do you have the sense that the staff is running the practice - not you? • Do you periodically need access to higher level advice than your current management can provide? • Are you planning to expand or contract the practice? • Do you have multiple people performing tasks that could be handled by a single, more experienced manager? • Do you feel that your practice’s cost structure is too high, but you can’t determine what to do to resolve those concerns?

making it difficult for practices to prevent claims denials that increase staff work. Most practices, however, do their own receivable and collections management in an unrefined environment, they don’t even realize the opportunities they’re missing. They only look at cash coming in the door. This is one key difference between a PMC and a billing service: Whereas the latter merely handles billing, usually for a percentage of collections similar to that taken by a PMC, a PMC partners with a practice to improve its internal processes. Some PMC’s also provide a practice management system and will train your staff to use it properly. ProMD Practice Management is now a proud member of the Circle of Friends of the Palm Beach County Medical Society (PBCMS). As a special introduction to the PBCMS, we are

offering members an exclusive Billing & Collections Promotion: in addition to the special discounted rate only available to PBCMS members, ProMD is offering the first Month free of charge. ProMD is a full service Practice Management Company where your bottom line is our bottom line; we make your Practice more profitable. ProMD was started by physicians, who understood the value of quality management, for physicians who would share in the same values and have a track record of increasing Practice receipts by 20%. Our primary focus is to tailor our services to meet the needs of your practice by working with your management and staff to develop and enhance your practice effectiveness and cost efficiency. This allows you to concentrate on what you do best, to provide quality medical services to your patients. Please visit www.promd.us to find out more.

QUARTER THREE 2013

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( Continued from Page 14 ) • Accept that some subjective factors will need to be included but make sure that you have a system or procedure in place to review the subjective factors. These subjective factors could include the following: • Patient satisfaction • Peer review • Development of new referrals or referral sources • Administrative duties and governance at the practice or hospitals • Community involvement • Development of new strategic revenues

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• Participation in addressing compliance issues • Opening a new satellite office The process of revising a compensation system should have physician involvement from the very beginning as well as an independent party who will begin the process by developing an understanding of the culture of the group as well as its strategic objectives. It is important to remember that no compensation model is perfect and that all will, to some degree, reflect the subjective views of the partners. But the compensation formula is one of the most powerful tools that a physician practice has for focusing the efforts of your physicians. The effort expended now to

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

make changes may be very worthwhile to the future success of the practice. Alpern Rosenthal, a Top 100 Accounting Firm, provides a full range of accounting, auditing, tax, business advisory and consulting service to a diversified client base of privately-held and public companies, as well as large number of not-for-profit organizations. The professional and support staff provides innovative and customized solutions for a number of industry niches, including healthcare, construction, energy, not-forprofit, manufacturing, real estate, and technology. For more information contact Tammy Clarke (561) 689-7888, tclarke@alpernfl. com or visit www.alpern.com

The latest news & information on PBCMS

Med memo Quarter Three 2013

SAVE THE DATES September 19, 2013

Member Dinner Meeting West Palm Beach, Airport hilton More info: www.pbcms.org

October 10-11, 2013 Future of Medicine

West Palm Beach, Kravis Center More info: www.pbcms.org/FutureofMedicine

Membership Campaign Off to Great Start The Medical Society kicked off our annual summer membership campaign in May setting a goal to recruit 100 new members by December 31st 2013. As of August lst we are more than half way there with 64 new members. Please help us reach our goal by referring your colleagues. Every new member who joins by August 31st will be entered in a drawing to win an iPad mini. If you have questions please call Deanna Lessard, Director of Member Services at 433-3940 ext 28.

PBCMS ANNUAL

That 70’s Gala

presented by the Palm Beach County Medical Society & Services

November 23, 2012, 6:30 p.m West Palm Beach, The Kravis Center

GALA INFO

Nicola Chung and Tenna Wiles receive donation from Ilene Mercier

A Special Thank You to Ilene Mercier at B4BC “Two Wheels One Cause,” hosted an event that was created solely for the purpose of helping uninsured individuals with breast care issues, who do not have the means to help themselves. The success event was held on Sunday, July 21st at Johnny Q’s in Lake Worth and raised over $8,000. All proceeds from this event are being donated directly to Project Access to assist uninsured patients with diagnostic needs relating to breast care.

Certified Medical Business Manager Offered by Florida Atlantic University, in partnership with Broward County Medical Association, the Palm Beach County Medical Society and the Dade County Medical Association, the Certified Medical Business Manager (CMBM) program is a fourmodule, comprehensive, specialized business program for medical industry professionals. Focusing on the skills, tools, and characteristics needed to manage a successful medical business or practice, CMBM instructors are industry professionals who bring the knowledge you and your practive need to succeed Dates: Sept. 10 - Dec. 3 2013 Times: Tuesdays 6:30 pm - 9:30 pm Hours: 36/ 3.6 CEUs Sessions: 12 Location: Florida Atlantic University, Boca Raton Campus Fee: $1,100 / $850 (BCMA, DCMA, PBCMS members) More Info: Robert Munoz 561-297-2571 Rmunoz@fau.edu www.faucmbm.com

Palm Beach County Medical Society and Palm Beach Medical Group Management Association are proud to announce our 2013-2014 Health Care Connection Series. We have recruited leading experts in the medical, legal and financial industries to help save you time and money. Lunches are held on the lst Wednesday (except January) of every month from ll:30 a.m. to 1:00 p.m. at various locations throughout the county. • October 2nd Countdown to ICD-10 • November 6th Reducing Stress in the Workplace • December 4th HIPAA It’s a Commandment Not a Suggestion • January 8th Billing & Coding 2014 • February 5th Understanding Health Benefits in the Wake of Health Reform • March 5th Don’t be a Doer, Be a Leader • April 2nd Ask the Experts - Collections, Protecting Assets & Internal Controls • May 7th Practice Management Techniques – Budget, Expenses & Staffing • June 4th Regulatory Update CMS 2013-2104 - Anticipated Changes & Impact In today’s ever changing environment it’s crucial you stay informed! For locations, speakers and special pricing for members please visit our website www.pbcms.org or call Deanna Lessard at (561) 433-3940 ext 28.

QUARTER THREE 2013

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MED SOCIETY NEWS Quarter Three 2013

A Warm Welcome To Our Newest Members Accamma Abraham, MD Atlantis Specialty: Internal Medicine

Pamela Myers, MD Boynton Beach Specialty: Internal Medicine

Brian Costell, MD Boca Raton Specialty: Neurology

Alan L. Mitchell, MD Boca Raton Specialty: Ophthalmology

Laurence Ehrlich, MD Boynton Beach Specialty: Internal Medicine

Sasson Moulavi, MD Boca Raton Specialty: Family Medicine

David R. Feldman, MD West Palm Beach Specialty: Diagnostic Radiology

Thomas Niederman, MD Boynton Beach Specialty: Hematology-Oncology

David Felker, MD Boynton Beach Specialty: Internal Medicine

Brett Osborn, DO West Palm Beach Specialty: Neurological Surgery

Lawrence Fiedler, MD Boca Raton Specialty: Gastroenterology

Richard Paley, MD West Palm Beach Specialty: Emergency Medicine

Michael F. Gervasi, DO West Palm Beach Specialty: Administration

Anjan Patel, MD Boca Raton Specialty: Family Medicine

Steven Gervin, MD Pembroke Pines Specialty: Neurological Surgery

Stephen Servoss, MD Boca Raton Specialty: Cardiovascular Disease

John Girard, MD Boca Raton Specialty: Internal Medicine

Nirmala Shanmugam, MD Atlantis Specialty: Gastroenterology

David Ijac, MD Boynton Beach Specialty: Internal Medicine

Roger Shelling, MD Boca Raton Specialty: Urology

Rizwan Karatela, MD Atlantis Specialty: Cardiovascular Disease

Henry Silverman, MD Specialty: Family Medicine

Cristina Bunton, MD Hospital: University of Miami Miller School of Medicine, Palm Beach Regional Campus JFK Medical Center Stephen Daniel, MD Hospital: University of Miami Miller School of Medicine, Palm Beach Regional Campus JFK Medical Center Lisa Gleitmann, MD Hospital: University of Miami Miller School of Medicine, Palm Beach Regional Campus JFK Medical Center Kandace Kichler, MD Hospital: JFK Medical Center & University of Miami Palm Beach Regional Campus Diana Marian, MD Hospital: University of Miami Miller School of Medicine, Palm Beach Regional Campus JFK Medical Center Chetan Patel, MD Hospital: University of Miami Miller School of Medicine, Palm Beach Regional Campus JFK Medical Center Kartik Valluri, MD Hospital: University of Miami Miller School of Medicine, Palm Beach Regional Campus JFK Medical Center Prakhar Vijayvargiya, MD Hospital: University of Miami Miller School of Medicine, Palm Beach Regional Campus JFK Medical Center This list is accurate as of July 31st 2013

RESIDENT David Mandell, MD Boynton Beach Specialty: Otolaryngology

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Martin Aldana, MD Hospital: University of Miami Miller School of Medicine, Palm Beach Regional Campus JFK Medical Center QUARTER THREE 2013

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