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

The Official Publication of the Palm Beach County Medical Society

Quarter Four 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.

The Providers’ Insurance Specialists ��Healthcare ��

Delray Beach • Jacksonville • Miami • Orlando • Pensacola 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.

The Providers’ Insurance Specialists ��Healthcare ��

President’s Report Andrew Larson, MD

Quarter Three 2013

President, Palm Beach County Medical Society

I want to thank my colleagues... I want to thank my colleagues for entrusting me with the presidency of our society and I want to thank our chief executive officer Tenna Wiles for her guidance this past year. Certainly it has been an exciting one with the amount of change in the health care environment perhaps greater than in any one year since I joined the society in 2004. With the near constant media attention being afforded to the implementation of and the controversy surrounding the Affordable Care Act we physicians have had a louder political voice than in years past and a greater opportunity to be culturally relevant.

We need to take advantage of this unique opportunity to insert ourselves as major players in forming the shape of health care for years to come. Our society’s leadership and the leaderships within the Florida Medical Association and the American Medical Association have wisely decided to avoid taking an obstructionist stance but instead have lobbied to improve access for the public to high quality health care and made efforts to make sure that implementation of the Affordable Care Act will indeed improve the physician patient relationship and allow the practice of medicine to continue to be a viable career path for young people choosing to enter our profession. We need to press on in these efforts. Certainly there will be times when it becomes necessary to modify or even

remove provisions of the Affordable Care Act. There will be a time when new provisions need to be added. We need to collectively be aware and vigilant that these changes will indeed work and will in the net improve the delivery of medicine. We need to educate our representatives about the potential pitfalls of legislation that might not achieve its perhaps noble intentions. If we as physicians taking part in organized medicine do not speak up, less informed, less educated, albeit louder and better financed, interests will do the speaking for us. Many examples come to mind. The electronic medical records industry has lobbied heavily to force physicians and facilities to purchase expensive charting equipment and the purchase of software to chart electronically is now de facto law if you want to participate in government funded health insurance plans. Unfortunately, the greatest beneficiaries of this law have been software vendors and not so much physicians and their patients. Probably the most frequent complaints I have heard this year from physician society members is the inadequacy of these vendors’ products. They do not work as advertised, the vendor goes out of business, they require constant expensive upgrades and maintenance, and most grossly dangerous to the public they do not communicate with each other. They are failing to provide the promised cost savings in reducing medical errors and eliminating duplication of tests and services for that very reason.

We as physicians need to take leadership here. Instead of being obstructionist and turning our backs on any attempts to further implement electronic medical records we need to take action to protect the public by making them better. There is no reason laws cannot be drafted that force vendors’ systems to be compatible with each other or that require the vendors have sufficient capital to support their physician customers for the long term. So far we have dropped the ball on this issue but it is not too late if the will is there. Another example might be in the area of quality reporting and in choosing quality measures in the first place both at the private industry level and the government level. Nobody would argue that higher quality health care is a laudable goal but we as physicians have so far lost the lead on this issue. Insurance companies, for example, are allowed to grade doctors based on quality metrics that are available neither to the physician nor the public. How can the physician learn to improve their quality if they don’t even know the definition of quality? Furthermore, is the insurance companies’ definition of quality really representative of the type of quality care the public deserves? As an example, one insurance company stopped letting their customers come to me for weight loss surgery. The reason was that our center was doing more gastric banding surgery than stomach stapling surgery. ( Continued on Page 20 )

QUARTER FOUR 2013

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FEATURES

No-Show New Patients May Leave Physicians at Risk Growing a Community of Creative Entrepreneurial Physicians.... One Meeting at a Time.

13 Don’t Change WHAT You Think…

15 16

13 21

Change HOW You Think That 70's Gala The Future of Medicine Summit VII

Holistic Approach: An Integrated Financial Plan For Medical Professionals Now is Not the Time for Investment-Centric Solutions Five Inadvertent HIPAA Violations by Physicians

ARTICLES

03 President's Report 07 Directors Desk 25 Med Memo 26 Med Society News

15 23 About the Cover:

New 2014 PBCMS and PBCMS Services Board Installation was held at That 70's Gala. Front row from left: William Atkins, MD; Alan Harmon, MD, FMA President; K. Andrew Larson, MD; Ronald Zelnick, MD; Stephen Babic, MD; Alan B. Pillersdorf, MD; Michael Dennis, MD Back row from left: Greg Quattlebaum; Yolette Bonnet; Shawn Baca, MD; Stuart Himmelstein, MD; Lisa Oliveri; Matt Gracey; Judy Goodman. See page 15 for more on the Gala. PBCMS STAFF Tenna Wiles

CEO

Tennaw@pbcms.org

Deanna Lessard

Director of Member Services & Education

Deannal@pbcms.org

John James

Director of Public Health & Disaster Services

Johnj@pbcms.org

Helena Edie

Finance

finance@pbcms.org

Nicola Chung

Project Access Program Director

Nicolac@pbcms.org

Subscriptions to On Call are available for an annual rate of $50.

Melissa Nicoleau

Project Access System Coordinator

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For more information contact PBCMS at (561) 433-3940.

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Marketing and Events

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The opinions expressed in On Call are those of the individual

Thomas Sebastian

Project Access / Triple Aim Navigator

Thomass@pbcms.org

authors and do not necessarily reflect official policies of

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Senior Outreach Coordinator

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Palm Beach County Medical Society or its committees.

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CREDITS James Garvin

DIRECTOR’S DESK

Tenna Wiles, CEO

CEO, Palm Beach County Medical Society

Board of Directors K. Andrew Larson, MD President

Directors Desk - Making A Difference.

Ronald Zelnick, MD President Elect

Steven Babic, MD PBCMS Past President Jack Zeltzer challenged us two years ago with the inspiring “Starfish Story”. The message of the story is that one person has the power to make a difference. We are extremely blessed to have members, board members, donors, community partners, and volunteers that have taken that extra step to volunteer their time, services and contributions to help PBCMS and Services fulfill their mission. Your contributions have helped make Palm Beach County Medical Society and Services a leading medical association. Thanks to you, we have touched hundreds of lives- providing care to the uninsured supporting medical education, coordinating disaster services, and advocating for physician led quality health care., and serving as the “voice of medicine” in Palm Beach County. We exist to serve our physicians and our community. In these uncertain and interesting times the Society counts on your support – now more than ever. Your contribution is extremely important as it provides resources that make an immediate impact.

There are many ways you can contribute – volunteer your services for Project Access, HERC or the Medical Reserve Corp, step forward to serve on a Council or Committee, participate in leadership, make a financial donation.

First Vice President

James Howell, MD Second Vice President

James Goldenberg, MD Secretary

Shawn Baca, MD Treasurer

Your gift can make all of the difference. As the medical profession continues to evolve, PBCMS is committed to staying at the cutting edge- for you, for your patients, for the community. Please help to make this possible with your contribution.

Jack Zeltzer, MD Immediate Past President

Sandra Blair Alliance Representative

Lisa Oliveri Medical Student

Tulisa La Rocco, MD Resident

I promise you, your contribution will make a world of difference.

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

Thank you so much for your help

Tenna Wiles CEO

To make a financial contribution visit www.pbcms.org To learn more about volunteering contact Tenna Wiles at tennaw@pbcms.org or 433-3940 ext 11

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 QUARTERTHREE FOUR 2013

ON CALL MAGAZINE

No-Show New Patients May Leave Physicians at Risk Contributed by The Doctors Company.

Physicians face certain risks and responsibilities when collecting patient information prior to the patient arriving for his or her appointment. A new patient may complete an online intake formbut not show up for the appointment. Or a new patient may complete a paper record with an intake history but then leave before being seen. The data that is collected, either electronically or on paper, is in the hands of your office practice. As a physician, you now face a dilemma. What is your responsibility for the information provided by a patient whom you have not seen? Whether or not you review this information, you face a risk if the patient believes that a physicianpatient relationship has been established. And if the patient has indicated a serious medical condition and you don’t take action consistent with the community standard of care, then you are potentially liable.

To avoid this risk, place a disclaimer on any data-collecting instrument. The following are recommendations for disclaimers for both electronic and paper forms:

Electronic Form Disclaimer Please be advised that by using this form to contact our office(s), we are not confirming an appointment nor establishing a physician-patient relationship. As a user of this mode of communication and of our website, you assume all risks with placing confidential information into this portal. Our office will follow up with you within 24 to 48 business hours. This form of communication is not intended for acute, emergency, or life-threatening health conditions. If you believe you are having a health emergency, contact 911 or go to your nearest emergency department.

Paper Form Disclaimer Please be advised that completing preliminary health and insurance

questionnaires does not establish a physician-patient relationship with this practice. Dr. <X> will review your health history and conduct an initial evaluation to determine whether you are a suitable candidate and whether the practice will accept you as a patient. Protecting the confidentiality of all patients—whether they are established clients or no-shows—is important to minimize the risk of a malpractice suit. Another way to minimize your practice liability is to do a loss prevention checkup. The Doctors Company offers a “Patient Safety Interactive Guide for Office Practices,” which includes a checklist to ensure you and your office staff are protecting the confidentiality of all patients under the Health Insurance Portability and Accountability Act (HIPAA). Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/ patientsafety.

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Growing a Community of Creative Entrepreneurial Physicians.... One Meeting at a Time. By Steven Hacker On Saturday December 7th, Dr. Steven Hacker will be hosting his third symposium at The Delray Beach Marriott for physicians interested in pursuing entrepreneurial aspects of their career. "Doctors are a creative bunch," says Dr. Hacker, founder of The Medical Entrepreneur Symposiums "and these meetings are geared towards those physicians inspired to create better solutions to problems they have encountered every day in their practice, with their patients, in surgery, using technology or in their personal life." This upcoming symposium is focused entirely on providing physicians access to entrepreneurial resources, knowledge, and fellow physicians that have succeeded in their efforts to create successful businesses outside of their practice. "This meeting is unique as physicians don't get this type of education from a clinical meeting," says Dr. Hacker and he should know having started and sold several companies outside of the realm of his practice. "Doctors learn from other doctors, that is in our culture, and that is why we will be having a unique faculty consisting of physicians, like Keynote Speaker, Dr. Ed Goldman, co-founder of MDVIP. Our faculty consists of physician entrepreneurs who have successfully built and sold their companies and will share their "war stories" and perspectives on what it takes to grind out , grow and sell a company." Additionally, the Saturday meeting, will include a session entitled "The Elevator Pitch Sessions" where selected entrepreneurs may present their businesses, start-ups, or inventions in a

"Shark Tank" like format to a panel of experienced entrepreneurs and Angel Investors. "These presentations are a great way to generate interest from colleagues, or Angel Investors, or just get critical feedback from experienced entrepreneurs. In our last meeting, this open session was filled to standing room only and the physicians in the audience learned as much as the presenter." Lastly, physicians will have a chance to interact with sponsors in an intimate non pressured atmosphere. Last meeting this was a huge success as Brain Foster, Director of Client Solutions at CareCloud says "Our company was asked to participate in The Medical Entrepreneur Symposium in 2013 and it was overall a great experience. The show was professionally organized and packed with educational opportunities for the attendees. The talk I gave on Sunday morning was well attended and I came away with some good contacts -- one of which wound up becoming a client. I recommend the show, whether you are going as an attendee, a speaker, or a sponsor." Or, for those physicians looking for capital for projects, Jason Biro, Bank of America Practice Solutions, "We attended the April meeting and were able to secure project loans for physicians that needed capital and attended Dr. Hacker's symposium." The Medical Entrepreneur Symposium is being held on Saturday, December 7th, from 7am to 4 pm at The Delray Beach Marriott and Palm Beach County Medical Society Members will have special access to registration discounts by entering PBCMS2013 upon registering online at www.TheMedicalEntrepreneur.com.

ON CALL MAGAZINE

Don’t Change WHAT You Think… Change HOW You Think By Nancy Proffitt, MBA, CBC Executive Business Coach Proffitt Management Solutions

The way you think has gotten you this far – and that’s great. You are smart and successful. You have strong skills, innovative ideas and you’ve worked hard to get where you are. But if you want to get even farther, you need to be a better manager. And that means thinking differently. You are a thinker. You think about where you want to go next and you think about how you are going to get there. Now think about this: if you want to get the most out of people, you need to let THEM think for themselves. It is time to for you to get out of the way. You have hired smart people and trained them well. So leave them alone! Focus on ways you can support them instead of telling them what to do and how to do it.

more likely to stay with you longer. Unfortunately, current statistics showing that almost 75% of workers are not engaged at work. That means 3 out of 4 of the people who work for you are phoning it in – and that costs you money. So this change in thinking isn’t just about you and your own personal growth… it’s also about the success of your businessdepartment – or work team..

not just what someone is saying, but also where they coming from. Don’t miss an opportunity for some fresh perspective.

In addition to contributing to overall happiness and success in the workplace (which is huge for everyone) and increasing employee productivity and retention (an enormous cost savings)… letting your employees do the thinking for you is good for your business in yet another important way. You only know what you know. It is important to look at a problem – and a solution - from someone else’s perspective.

Your thinking is what brought you here… your thinking differently is what will take you to where you want to go next. Ask yourself…

Perspective is a tricky thing. You can never be certain you have it – and it is nearly impossible to know the exact moment you lose it.

Nancy Proffitt, MBA, Certified Business Coach is the president of Proffitt Management Solutions and Proffitt Management Leadership Institute, an internationally recognized Executive Coaching firm dedicated to growing profits and success by unleashing the full potential of individuals and organizations. She may be reached at 561-682-6060 or email: Nancy@proffittmanagement. com . Visit our website at www. proffittmanagement.com

Remember… it all comes back to “Thinking Differently”. So don’t spend so much time focusing on the “thinking” that you overlook the importance of the “differently”.

Am I really letting my team think for themselves? What can I do this week to get a fresh perspective from my team on a specific project?

Here’s what you can do to help: • Keep them focus on solutions, not problems • Encourage them to think for themselves instead of following directions – even your directions • Let them think all the way through a solution – even if you see it is not the best one – so they can learn from the process • Be positive and encouraging about what you see going right • Be accessible – let them ask questions and come to you for guidance rather than instructions Letting employees take ownership — and allowing them the room to do the job they were hired to do – is not always easy. But giving people more responsibility and support has been proven to make them happier and more engaged. Engaged employees are productive employees. These are the people who want to do a great job… and who are

This is business, and you want to think clearly and objectively. And for the most part you do. But even the most pragmatic of us think with both our heads and our hearts. Like it or not. The truth is, you are never truly able to separate your emotions from your decisions (and this, by all accounts, means you have a conscience and is in fact a very good thing). Yet as employers/bosses or leaders we tend to be focused on WHAT people are doing or thinking rather than on WHY they doing or thinking it. And discounting the WHY is a big mistake. Everyone you work with is there to do a job, but they bring their own personal experiences and point of view to work with them. Take the time to understand

QUARTER FOUR 2013

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Twelfth Annual Cardiovascular Disease Prevention International Symposium n

Thursday-Sunday, February 6-9, 2014 Fontainebleau Hotel Miami Beach, Florida n

Michael Ozner, M.D.

Symposium Directors

Theodore Feldman, M.D.

Arthur Agatston, M.D.

Khurram Nasir, M.D.

Registration online now at MiamiCVDPrevention.BaptistHealth.net. For information, contact the Baptist Health CME Department at 786-596-2398.

The Palm Beach County Medical Society and Services celebrated its new board and officer installation at the 2013 That 70’s Gala on Saturday, November 23, at the Kravis Center. K. Andrew Larson, MD was honored for his service as 2013 president and Ronald S. Zenick, MD was installed as the 2014 board president. Jack Zeltzer, MD was also honored with the Excellence in Medicine Award.

Excellence in Medicine Award Jack Zeltzer, MD The Excellence in Medicine Award honors a physician who exemplifies the highest values of altruism, compassion, leadership and dedication. PBCMS proudly presents the 2013 Award to Dr Jack Zeltzer, known for his commitment to medicine, outstanding leadership and advocacy for physicians and patients. Originally hailing from Montreal, Quebec, Canada, Dr Zeltzer is a highly regarded Surgeon. Board Certified in Surgery since 1978 he attended McGill University in Montreal, Quebec, Canada, where he completed both his undergraduate studies as well as Medical School. Dr. Zeltzer has served as Chief of Surgery at Wellington Regional Medical Center and JFK Medical Center. He has served on the PBCMS Board since 2007, president in 2012 and as a Board of Trustees member. Representing Palm Beach County as an FMA Delegate, Dr Zeltzer has been appointed to serve on the Advisory Council on Scope of Practice. A champion for maintaining the strength and integrity of the medical profession, Dr Zeltzer has been instrumental in exploring innovative practices to enhance quality and improve patient outcomes.

Over 300 guests at “That 70’s Gala” on enjoyed an evening filled with 70’s games shows, live music, dancing, a wine grab, auctions and a special ceremony recognizing the PBCMS outgoing and incoming presidents.

2014 PBCMS President Ronald S. Zelnick, M.D., F. A.C.S., F.A.S.C.R.S Dr Ronald Zelnick is a native of New York, City and graduated Phi Beta Kappa from George Washington University. Hecompleted his medical education at Albany Medical College, Albany, New York, and his General Surgical residency at Long Island Medical Center and a Fellowship in Colon Rectal Surgery at Henry Ford Hospital, Detroit Michigan. Dr. Zelnick is a is member of numerous medical organizations and has been a member of the Medical Staff of Jupiter Medical Center and the Palm Beach Gardens Medical Center since 1991. He has served on the Palm Beach County Medical Society Board since 2009 in other leadership roles. During his spare time, he enjoys playing golf, boating, attending baseball games, traveling and fishing local waters QUARTER FOUR 2013

2014 Board of Directors Ronald Zelnick, MD President Stephen Babic, MD President-Elect James Goldenberg, MD First Vice-President Shawn Baca, MD Secretary Brandon Luskin, MD Treasurer K. Andrew Larson, MD Immediate Past President Marc Hirsh, MD Member at Large Vijay B. Harpalani, MD Member at Large Vincent Apicella, DO Michael Dennis, MD Roger Duncan, MD Brad Feuer, DO James Howell, MD Beth-Ann Lesnikoski, MD Alan Pillersdorf, MD Jack Zeltzer, MD

ON CALL MAGAZINE

Ardis D. Hoven, MD, President AMA, delivers the keynote speech.

SUMMIT VII

October 10 - 11, 2013 The Kravis Center, Cohen Pavillion West Palm Beach Florida The 2013 Future of Medicine Summit featured some of the most highly recognized national and local health experts in their fields. More than 400 guests attended the event, which included a dinner focused on medical education, a medical student and resident poster symposium and a full day of thought-provoking speakers and discussions. American Medical Association President Ardis D. Hoven was the keynote speaker for the dinner followed by a panel discussion by Deans of the area medical schools. Fridayâ&#x20AC;&#x2122;s program addressed an array of issues and showcased innovations in health care. Thank you to all who participated.

Michael Dennis, MD, Summit Chair with Jose Arrascue, MD, Future of Medicine Chair

Alan B. Pillersdorf, MD; Jose Arrascue, MD; Stephen Babic, MD; Shawn Baca, MD and Ralph Palumbo, MD

Joan St. Onge, MD and Richard Greenwald, MD Co-Chairs (far left) of the PBCMS Council on Medical Education present awards to the winners of the 2013 Future of Medicine James J. Byrnes, MD Poster Symposium

Daniel Kraft, MD of Singularity University and TedTalk speaker, gives presentation on Emerging Medical Technology

Scott Good of Crescendo Consulting discusses the Triple Aim initiative

A packed house learns about Triple Aim metrics

Caron Hanley Center was among more than 30 exhibitors

Larry Bush, MD participates on Infectious Disease panel

Brian Klepper, PhD of We Care TLC, speaks about Health Care Performance

Holistic Approach: An Integrated Financial Plan For Medical Professionals By Ashley Ayer

From the moment you take the Hippocratic Oath, you dedicate yourself to making sure you deliver the best care possible to your patients. But today, with so many factors that require your attention—from sweeping changes in health-care policy to office technology upgrades to the everpresent grind of insurance paperwork—a doctor’s time has never been in more demand. An integrated financial plan will help ensure your financial well-being, so you can focus on your patients.

Debt Management According to the Association of American Medical Colleges, by the time physicians finish training, most have accumulated significant debt: In 2009, 79% of doctors entered their earning years owing more than $100,000 in student loans. Financing or buying into a medical practice often leads to bigger debt.

Risk Management As every doctor knows, patient care means exposure to huge liability risk. Insufficient insurance coverage can be catastrophic to your family, your medical practice and you. Because coverage needs shift as you reach different stages in your career—and as changes occur in the industry, the law and the economy— regular review of your coverage is crucial to protecting your assets.

Cash Management At no time in recent history have doctors had a more challenging time managing their cash flow. Not only are the costs of 18

ON CALL MAGAZINE

practicing medicine at an all-time high, but, there’s often a long delay between providing treatment and receiving payment from patients or reimbursement from health insurance companies. As a result, medical practices frequently run short on operating capital and physicians often find themselves with cashflow problems.

Retirement Planning The commonly held perception of a retired physician is that after decades of doing work of the highest order, she finally has time to enjoy the fruits of her labor and that she has the financial means to enjoy life on her own terms. What you may be surprised to learn is that many physicians don’t save enough during their prime earning years to meet their retirement goals. Traditional retirement plans are generally insufficient to cover your needs.

Estate planning1 The same economic issues that make saving for retirement a challenge can impede your ability to build significant wealth to benefit the next generation. And the same solution—strategizing early on—can mitigate those issues by allowing more time to generate assets that can eventually be transferred to heirs.

Top Priorities For Individuals Setting goals at each stage of your career is essential to successful planning. With an advisor by your side you can translate goals into action on a predetermined timetable.

Stage 1: Early Career 1. Structure debt repayment by consolidating outstanding loans and credit-card balances and opting for a low-interest, strategically scheduled payback plan.

QUARTER FOUR 2013

2. Optimize risk management by purchasing medical malpractice, disability and life insurance policies that are commensurate with industry standards and the value of the assets you need to protect. 3. Develop a savings plan for discretionary purchases. 4. Establish a retirement strategy, targeting a retirement age and setting up a career timetable and exit strategy. 5. Calculate the income you’ll need to maintain your preferred standard of living during retirement. 6. Set up a tax-advantaged retirement plan to supplement any traditional plans you’ve invested in. 7. Draft a power of attorney and have a will drawn up, detailing your wishes in the event you become incapacitated or pass away. 8. Develop a working plan for transferring wealth at the end of your life.

Stage 2: Mid-Career 1. Review the adequacy of malpractice, disability and life insurance policies. 2. Rebalance your investment portfolio annually to maintain diversification and accommodate any changes in risk tolerance and long-term goals. 3. Refine your retirement plan. 4. Develop a more detailed exit strategy, taking into account the impact your retirement will have on your practice as you wind down and stop working. 5. Review and make necessary adjustments to your wealth-transfer plan. 6. Start a gradual intergenerational transfer of wealth. ( Continued on Page 22 )

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( Continued from Page 3 ) Internal insurance company records (not looking at my practice specifically but at their customer base as a whole) showed that the revision and reversal rate was higher for banding than for stomach stapling. These additional procedures presumedly cost the insurance company more money. Of course it is true that banding has more revisional procedures than stapling but the risk of major lifealtering complications is lower. To be fair to the public we should let an educated consumer make the proper choice for himself or herself based on the individual patients’ needs not simply define quality based only on what saves the company the most money. Perhaps it’s time to force insurance companies to make their measures of quality and their physician grading systems public knowledge.

ON CALL MAGAZINE

Government quality metrics are inching in a non-physician friendly direction, too. When enforced quality starts to infringe upon the art of medicine we need as a profession to become more vigilant. Some quality measures such as providing counseling on smoking cessation are universally appropriate. However, more and more quality guidelines are starting to involve personal choices where quality might mean different things to different people and where I worry quality might be coming to be defined by organizations whose motivation may in part be financial. Do all patients need costly prophylactic anticoagulation? Are there unknown risks down the road? Do all patients need drug therapy for certain diseases, heart disease and diabetes for example, when the literature is rife with studies showing that better nutrition is safer and more

QUARTER FOUR 2013

powerful therapy? Are we entering an age where we brand physicians who stray from industry dogma as low quality doctors? There is definitely room for physician leadership on these issues and many more. If you are not involved with organized medicine, why not? Times are changing fast and we physicians have a unique opportunity in the next few years to be part of the solution. I for one will remain involved in our society. Our work is important and does make a difference. Thank you all again for giving me this wonderful opportunity to have served as your president. Yours in good health,

Andy Larson President PBCMS

Now is Not the Time for Investment-Centric Solutions By: Peter Anderson, MBA, Wealth Adviser, United Capital Financial Advisers, LLC

2008 was a painful year for many investors. The triedand-true investment strategies of decades past buckled under the intense conditions that were experienced in world markets at the time. Diversification was not the answer. All asset classes declined and offered no buffer to the freefall that depicted the returns of many investors’ portfolios. At that time, even gold and commodities, the traditional “safe haven” investments collapsed and supposedly safe hedge funds, whose job was to protect portfolios from markets such as these, imploded. So what was the lesson from this period? The lesson to be learned from this period is that investment solutions only act as one control dial that we, as investors, have over our financial lives.

Risk Is Not the Only Dial Life is all about choices. Not only is the level of risk an important choice, but also how much we spend, save, the timing of the events we plan for our lives, as well as what assets we leave behind. In establishing your investment strategy prior to the turbulence of 2008, chances are that you completed some sort of “Risk Tolerance Questionnaire”. These questionnaires range from being quite simple to extraordinarily complex. However, the complexity in determining your risk profile does not change the fact that risk is only one component of the full suite of mechanisms that an individual has to control the fulfillment in their financial lives.

SPENDING

Lifestyle Level

SAVINGS

Money dedicated for investment

TIMING

When you want the event to occur

RISK

The level of volatility in your investment portfolio

LEGACY

Assets you want to transfer to heirs

A basic question to ask is, “what happens if you feel you can ‘tolerate’ a certain level of risk, but everything you want to accomplish financially can be done with less risk?” This question lies at the heart of why this message is so important – after clearly outlining your financial goals, you may be able to adjust the other control dials to accomplish these goals without taking as much risk in your investments. This idea could have saved many investors from much of the pain they experienced in 2008. The accompanying chart identifies these other dials. Multiple controls allow an investor to adapt to changing life and market conditions by having the flexibility to either turn up or down one of these 5 dials. Our level of spending is one of the most apparent controls that exist in our financial lives. This dial dictates how much we wish to spend in retirement and the general lifestyle that we wish to maintain. The level of our savings controls the contributions that we’re able to make towards our retirement lifestyle goals. The legacy that we aim to leave decides the assets that we’re able to transfer to

heirs, as well as causes and organizations that are important to us. Lastly, timing is the dial that decides our work timeline as well as the points in our lives that we wish to implement various major choices that carry large financial implications, like retirement or the purchase of a vacation home. Each and every one of these controls has direct implications on the others. Designing a master plan that incorporates each allows for a much more dynamic plan which is more capable of weathering adverse circumstances.

A Flexible Plan We’re currently experiencing another interesting time for investors. In May of this year, the Dow Jones Industrial Average exceeded a benchmark that it has never crossed before…15,000, and closed on September 18th at an all time high of 15,676.94. While just a few years ago, many were afraid to stay in the markets due to losses, now, investors are afraid to stay out of the markets due to the possibility of missing gains. Although few would have predicted both swings, the moral is the same – a strategy that is solely focused on ‘outsmarting’ the markets is one that is doomed to fail. ( Continued on Page 25 )

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( Continued from Page 18 )

Stage 3: Later Years 1. Implement your retirement plan, drawing on payouts from earlier investments to support your chosen lifestyle. 2. Devote time to reinforcing your personal and professional legacy. 3. Finalize your estate plan. 4. Dedicate time to favorite charities. 5. Consider honorary roles in the industry, such as serving on a hospital board of directors. SunTrust has intimate knowledge of the full spectrum of issues physicians face. Our Medical Specialty Group has been serving the needs of doctors and medical practices for close to 20 years. Our team includes an extended network of specialized professionals and allows us the versatility to customize solutions to meet every aspect of your financial needs. That, in turn, frees you to focus on delivering high-quality care to your patients.

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To find out more about what the SunTrust Medical Specialty Group can do for you, contact Ashlea Ayer, Medical Client Advisor, SunTrust Private Wealth Management, Licensed Insurance Agent, SunTrust Investment Services, Inc. at 954.765.7380 or ashlea.ayer@suntrust. com.

estate and financial planning, only an attorney can draft legal documents, provide legal services and give legal advice. Clients of SunTrust should consult with their legal and tax advisors prior to entering into any financial transaction or estate plan. Because it cannot provide legal services or give legal advice, SunTrust’s services or advice relating to “estate planning” or “wealth transfer planning” are limited to (i) financial planning, multi-generational wealth planning, investment strategy, (ii) management of trust

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• May Lose Value

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SunTrust Private Wealth Management Medical Specialty

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QUARTER FOUR 2013

The latest news & information on PBCMS

Five Inadvertent HIPAA Violations by Physicians By Tracey Haas, DO, MPH and Co-Founder, DocbookMD

Doctors do not plan ahead to violate HIPAA, but in this digital age, they may be doing it because they did not plan ahead. The recent final rule of the HITECH Act outlines that even if the physician is unaware of the violation, they may be fined a civil penalty of $100 - $50,000 per violation. It is time for even the most resistant doctors to pay attention to how they handle protected health information (PHI). Here, we will outline five common ways physicians are breaking HIPAA/ HITECH privacy and security rules, and may not even know it.

ONE Texting PHI to members of your care team. It’s a simple scenario: you’ve just left the office, and your nurse texts you that Mr. Smith is having a reaction to the medication you’ve just prescribed. She has included his name and phone number in the text. You may know that texting PHI is not legal, but feel justified because it is a serious medical issue. Perhaps you even believe that deleting the text right away will protect you – and Mr. Smith. In reality, this text message with PHI has just passed from your nurse’s phone, through her phone carrier, to your phone carrier, and then to you – four vulnerable points where this unencrypted message could either be intercepted or breached. In a secure messaging app, this type of message must be encrypted as it passes through all four points of contact. Ideally, both sender and recipient should be

verified and have signed a business associate agreement (BAA).

today to see how they are protecting you at both ends of the communication.

TWO

FOUR

Taking a photo of a patient on your mobile phone. To some this will sound silly, to others, it is as common as verifying a rash with a colleague or following the margins of a cellulitis day by day. Simple enough, but if these photos are viewed by eyes they are not intended for, you may be in violation of your patient’s privacy. It’s important to be aware of where and how patient information and images are stored. Apps that allow you to take a secure photo are just as important as sending the message securely. DocbookMD allows photos to be taken within the secure messaging app itself – never stored on your phone or within your phone’s photo album. Always use this type of feature when taking any photo of a patient or patient information.

Allowing your child to borrow your phone that contains PHI. Many folks allow their kids to play with their phones – maybe play games on apps while in the car. If your phone has an app that can access PHI, then you may be guilty of a HIPAA breach if the information is viewed by or sent to someone it is not intended for. The simple fix is to utilize the pin-lock feature on your messaging app – and for double-protection, always password protect your phone!

THREE Receiving text messages from your answering service. Many physicians believe if they receive a text message from a third party, like an answering service, they are not responsible for any violation of HIPAA – this is simply not true. Many services do send a patient’s name, phone number and chief complaint via SMS text. The answering service may verify it is encrypted on their end, but if PHI pops onto the physician’s screen, it is certainly not secure on their end – and this is where the physician’s responsibility lies. Talk with your answering service

FIVE Not reporting a lost or stolen device that contains PHI. Losing your smartphone or tablet is a pain for many reasons, but did you know that if you have patient information on that device, you could be held responsible for a HIPAA breach if you do not report the loss right away. The ability to remotely disable anapp that contains or handles PHI is an absolute must for technology that handles communications in the medical space. Be sure to ask for this feature from any company claiming to help you be HIPAAcompliant in the mobile world. Remember: Being HIPAA-compliant is an active process. A device can claim to be HIPAA secure, but it is a person who must ensure compliance. DocbookMD partners with your local medical society to bring you a free, HIPAA-secure messaging app, that uniquely provides you extra security to avoid each of these potential pitfalls. Do not hesitate to reach out to us today for more information! www.docbookmd.com 1-888-930-2048 References:The ONC’s official site for mobile devices and HIPAA: http://www.healthit.gov/providers- professionals/ your-mobile-device-and-health-information-privacy-andsecurity?gclid=CLvawcuVt7cCFStp7AodZGQAUg

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Med memo Quarter Four 2013

SAVE THE DATES Januaray 8, 2014

Biling & Coding 2014 Atlantis Country Club (ll:30 am - 2:00 pm) More info: www.pbcms.org

Januaray 23, 2014

The State of Medicine Dinner Airport Hilton, West Palm Beach (6:00 pm - 8:00 pm) More info: www.pbcms.org

March 8, 2014

Heroes in Medicine Awards Nominate a Hero! More info: www.pbcms.org

Emergency Responders Ramp Up The Palm Beach County Medical Reserve Corps (MRC) is a cadre of medical and non-medical volunteers who donate their time and expertise to promote healthy living throughout the year and prepare for and respond to emergencies. In September, the PBC MRC added 43 new members as FAU Medical Students were orientated into the program. The Medical students also recently attended “Start Triage & Emergent Patient Care in a Disaster Setting” taught by David Sandau at the FAU Simulation Lab. As they practiced on mannequins, their objective was to identify and implement mass casualty triage concepts and treatment, and implement care for these patients in disaster situations with limited resources. Special thanks to Dr. George Luck, Eric Downes and Cynthia Giraldo for their assistance in coordinating both the orientation and the training

Recognizing a Special Volunteer Rebecca Blitman is currently a volunteer for the Palm Beach County Medical Society. She has always felt the desire to ‘give back’, which is why she earned her Master’s Degree in Public Administration, worked for the State of Florida Department of Transportation, and most recently as Associate Director for Broward County Transit. For over 12 years, her position with the County entailed managing BCT’s various financial divisions, including Purchasing, Accounts Payable, Accounts Receivable, Inventory Control, Grants Management, the Money Room, as well as budgeting, accounting, auditing and human resources/staff management. In moving to Palm Beach, Rebecca and her husband Jeffrey decided that she would leave that 60+ hour a week position so that she could spend more time with family, including her stepdaughter Sydney. In addition to the PBCMS, Rebecca volunteers for Luv-APet, ASecondChance, and is the Auction Chair for the American Cancer Society’s Diamond Ball.

2014 MEDPAC Board of Directors Brent Schillinger, MD, Chair Jeffery Berman, MD, Co-Chair Jose Arrascue, MD Stephen Babic, MD Shawn Baca, MD Malcolm Dorman, MD Stuart Himmelstein, MD Mark Hirsh, MD James Howell, MD Beth-Ann Lesnikoski, MD Alan Pillersdorf, MD Mark Rubenstein, MD

Questions about the Affordable Care Act? If you have questions about the Affordable Care Act, Health Insurance Plans, or would like to be enrolled, contact the Palm Beach County Medical Society Services office to schedule an appointment to speak directly with the Navigator. Marianne 561-433-3940 x14

( Continued from Page 21 ) A plan that strives to adapt to the markets is one that has proven to achieve greater success for investors and retirees. Having multiple control dials within hands’ reach allows for an individual to make feasible goals and prudent responsive decisions, all with the same goal in mind…living the financial life that you want. To take advantage of your complimentary initial consultation as a Palm Beach County Medical Society member, please call or email me today, at peter.anderson@ unitedcp.com. About the Author: Peter Anderson, MBA is a Wealth Adviser with United Capital Financial Advisers, LLC. Peter has extensive knowledge and expertise catering to the unique financial needs of high net-worth individuals and specializes in helping the physician community address their financial challenges. He can be reached at either 561.314.4711 or peter.anderson@ unitedcp.com. Disclosure United Capital Financial Advisers, LLC (“United Capital”) provides advice and makes recommendations based on the specific needs and circumstances of each client. For clients with managed accounts, United Capital has discretionary authority over investment decisions. Investing involves risk and clients should carefully consider their own investment objectives and never rely on any single chart, graph or marketing piece to make decisions. The information contained in this newsletter/email is intended for information only, is not a recommendation to buy or sell any securities, and should not be considered investment advice.

QUARTER FOUR 2013

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MED SOCIETY NEWS Quarter Four 2013

A Warm Welcome To Our Newest Members Gauri G. Agarwal, MD Boca Raton Regional Hospital Specialty: Administrative Medicine

Chinyere Chris Mbaeri, MD Wellington Specialty: Family Medicine

Hymin Zucker, MD, CHCQM Palm Springs Specialty: Administrative Medicine

Rafael Alvarez, MD Coastal Pain Solutions, Jupiter Specialty: Pain Management

James W. McCauley, MD Boca Raton Specialty: Internal Medicine

RESIDENT

David N. Buchalter, MD Delray Beach Specialty: Orthopedic Surgery

Maria Moutinho, MD Oakland Specialty: Pediatrics

Robert R. Campitelli, DO West Palm Beach Specialty: Family Medicine

Emmanuel Orelus, MD Palm Beach Gardens Specialty: Internal Medicine

Rachel Ciaccio, MD Boca Raton Specialty: Obstetrics and Gynecology

Paul David Rosenblum, MD North Palm Beach Specialty: Ophthalmology

Brian E. Coleman, MD Delray Beach Specialty: Orthopeadic Surgery

Bassam Sayegh, MD Jupiter Specialty: Vascular Surgery

Trudell A. Doctor, MD Delray Beach Specialty: Internal Medicine

Vinay Sharma, MD Boynton Beach Specialty: Radiology - Radiation Oncology

Neil G. Goldhaber, MD Boynton Beach Specialty: Otolaryngology

Eugene Sheih, MD Jupiter Specialty: Radiology - Radiation Oncology

Thomas Jacob Klein, MD Loxahatchee Specialty: Radiation Oncology

Surendra Sirpal, MD Lake Worth Specialty: Internal Medicine

Ashley Lankford, MD Wellington Specialty: General Surgery

Russell D. Weisz, MD Delray Beach Specialty: Orthopedic Surgery

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

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Jasmin Maria Martinez-Castellenos, MD- UM Joseph Cherian, DO-PBCGME Sandeep Dayanand, MD- UM Georgy Kasper, MD-UM Veronica Klammer, DO- PBCGME Yu Song, MD- UM

MEDICAL STUDENTS Andrew C. Berry- KCUMB Kelly Jean Grannan- UM Jason Heffley- UM Isaac Lee-UM Michael Maguire- UM Ryan McPherson-KCUMB Michael Krishna Rao- UM Jean-Jacque Vel- Nova

CLASSIFIEDS Medical Office Condo For Sale A 4,000 square feet medical and professional office condo next to Good Sam Hospital is for sale or lease. To find out more information please contact Sherry at 561-762-8145.

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