St Louis Medical News August 2013

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PHYSICIAN SPOTLIGHT

MEETING THE RESIDENCY CHALLENGE

Family Medicine Residency Uptick

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Janiece Stewart, MD ON ROUNDS

SLU’s unique program addresses shortage of PCPs in inner-city areas

By LyNNE JETER

When Christine Jacobs, MD, joined the Saint Louis University (SLU) School of Medicine, she did the math and knew an increase in the number of family medicine residency slots in St. Louis was imperative to address the shortage of physicians in inner-city areas.

Jacobs, an associate professor of family medicine at SLU, started the Saint Louis University Family Medicine Residency Program in St. Louis in 2011, a unique collaboration with Family Care Health Center, a community health center in St. Louis, and SSM St. Mary’s Health Center to provide residents with training in and around the city with a diverse patient population.

ICD-10: Are You Ready?

With the rapidly approaching ICD-10 ‘go live’ date of October 1, 2014, medical practices should be well on their way in preparing for the transition ... 14

Financial Rx with Dr. Bob Orthopedic surgeon turned financial advisor lends insight into retirement planning for physicians selling practices With more than half the nation’s hospitals planning to acquire medical practices this year, physicians contemplating a switch from practice partner to hospital employee will benefit greatly from focusing on an often overlooked key component of the due diligence process: retirement planning ... 15

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Q&A with Bob Heaney, MD

SLU associate dean for GME shares insights on gap between medical graduates and residencies We now have about 128 PGY-1 (first-year) residents. Because SLU is private, and the School of Medicine is the institutional sponsor for our GME program and not one of our affiliated teaching hospitals, we have more flexibility and a good group of affiliated teaching hospitals in the metro area. Saint Louis University Hospital (a Tenet Healthcare facility) is our primary teaching hospital.

By LyNNE JETER

St. Louis Medical News spoke with Robert M. Heaney, MD, assistant vice president for medical affairs, senior associate dean for GME and veterans’ affairs, for the Saint Louis University (SLU) School of Medicine, about the gap of medical graduates and residencies, the national physician shortage, and steps that are being taken to grow a strong local physician workforce.

How has the number of residency slots changed at the SLU School of Medicine?

Dr. Robert M. Heaney

Now Available!

Who are your other hospital partners?

The largest is SSM Healthcare; we provide the medical staff and residency training for Cardinal Glenn (CONTINUED ON PAGE 12)

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PhysicianSpotlight

Janiece Stewart, MD

By LUCY SCHULTZE

For Janiece Stewart, MD, recognizing sports medicine as an open door for female physicians meant having an admired mentor cross the threshold before her.

“It was great to see a woman in a maledominated field be so successful,” said Stewart, who had the opportunity to train under a female sports-medicine specialist during her last year of residency.

Stewart, now a sports medicine specialist for Alton Memorial Hospital in Edwardsville, Ill., worked alongside Kathy Weber, MD, MS, of Rush University Medical Center in Chicago during her training.

“She was the only woman in a very large group, and she maintained her own,” Stewart said. “She was a strong woman.

People sought her out and respected her.

“She also exposed me to different levels of patients — from professional players to everyday athletes. That was really a stimulus for me.”

Today, Stewart practices as part of BJC Sports Medicine and Orthopedic Specialists in Edwardsville. She also keeps office hours at Alton Orthopedic Clinic. She serves as head team physician for Southern Illinois University Edwardsville.

A native of Belleville, she is a graduate of Belleville East High School and received her undergraduate degree from the University of Illinois at Urbana-Champaign. Since her father was in the U.S. Air Force, she had spent a decade away from home, in Colorado and Germany, before returning with her family to Belleville in the mid-1980s.

Stewart aspired to become a physician since her earliest years, through a fascination with the inner workings of the human body.

“I think it was about seventh or eighth grade when we were exposed to dissecting in science class,” she said. “I thought to myself: ‘How would I get to do this with humans?’

From around that time, I was focused on going to medical school and becoming a doctor.”

Stewart earned her medical degree and completed an internal medicine-pediatrics residency at Rush University Medical Center. She was initially focused on becoming a surgeon — but soon decided the operating room wasn’t for her.

“I realized I didn’t like that as much as being out in a clinic setting, interacting with patients,” she said.

After her sports-medicine rotation gave her a new direction, Stewart went on to complete a fellowship at San Jose-O’Connor Hospital in California. She returned to Belleville in August 2012 to begin her practice.

She is board certified in internal medicine and sports medicine.

Stewart’s practice is part of BJC Medical Group of Illinois. Her clinic in Edwardsville also includes orthopedic surgeon Aaron Omotola, MD, and physician assistant Casey Newgent, PA-C. The group shares responsibility for covering multiple high schools and colleges in the area. stlouismedicalnews

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Stewart has served as team physician for Saint Louis University, the Gateway Grizzlies, and Collinsville and Belleville East high schools. Her role as head team physician for Southern Illinois University Edwardsville takes her to the campus training room each Thursday afternoon, in addition to covering athletic events.

“The students are very respectful and appreciative,” she said. “It’s always good when we get to see someone who’s had an injury get back to being able to play in a healthy manner.”

Stewart’s practice focuses chiefly on treating injuries related to the muscles, bones, tendons, ligaments and joints — and not necessarily just those suffered while

playing sports. She is additionally trained to address issues associated with nutrition and sports psychology, as well as to counsel athletes on injury prevention.

Stewart sees active adults and children in club teams in addition to competitive athletes.

“The nice thing about sports medicine is, everybody is fairly healthy and eager to get back to their sport or activity,” she said.

“For the most part, everybody’s motivated to get better.”

Stewart’s own experience in athletics included a stint in competitive gymnastics during her youth, before she was sidelined by a knee injury. When her family returned to the United States from Germany, she was exposed to more athletic opportunities and began playing volleyball and running track.

Today, aside from a pickup game of volleyball or kickball during the summer months, she stays active by working out five or six times a week. Her ongoing interest in sports, though, blends the line between work and leisure.

“When I am at sporting events, it almost doesn’t feel like work, because I enjoy being there and watching the games or matches of whatever I’m covering,” she said.

In addition to her interest and training, Stewart brings to her practice the experience of having been an athlete — particularly, a female athlete.

“Understanding the female body and the mental aspect of being a female in sports is very helpful,” said Stewart, whose patient

roster includes female athletes who play in male-dominated sports.

“It’s important to consider how various medications and hormones can affect the female body differently than they do the male body, and how the structure of a woman’s body is different from a man’s,” Stewart said. “Some conditions you also see more commonly in women than men. So there are many reasons why you might have to treat conditions differently.”

While Stewart is herself in the minority as a female physician in the field of sports medicine, she is encouraged to believe she’s part of a growing trend.

“Every year when we go to our conferences, you see more and more women who are practicing sports medicine or who are interested in it,” she said.

“I think that as more female sports reach the professional level, you’ll start to see more female sports-medicine physicians as well.”

Sports-medicine conferences offer a chance to network with physicians in the field from throughout the country — and, for Stewart, a chance to reconnect with the doctor who introduced her to her specialty.

“I call her and see her at sports-medicine conferences,” Stewart said. “She’s been a mentor to this day.”

Outside of work, Stewart enjoys traveling and spending time with family and friends. Her time in California has made her thankful to be closer to her family, including her parents, brothers, niece and nephew.

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Asset Protection Planning for Missouri Residents, Part 1

By JIM BLASÉ

Missouri residents are uniquely positioned by very favorable asset protection laws - perhaps the most favorable in the country. These laws include not only the complete employment of the “tenancy by the entirety” form of asset titling and transfer on death (TOD) and pay on death (POD) forms of asset registration, which when combined properly allow Missouri married couples to easily protect their assets from lawsuits while they are both living, but also recent asset protection statutes authorizing the Missouri Asset Protection (MAP Trust), which was enacted by the Missouri legislature in 2004, as well as the Qualified Spousal Trust (QST), which was passed by the Missouri legislature just two years ago.

Tenancy by Entirety Property Tenancy by entirety property is property titled jointly in the name of a husband and wife, in a state which recognizes the same as protected from creditors of either spouse individually, i.e., as opposed to being protected from a joint claim against both spouses. Missouri is one of only 20 states and the District of Columbia which recognizes tenancy by the entirety property for both real property and personal property. (Illinois recognizes this form of ownership for a couple’s principal residence, and Kansas does not recognize tenancy by the entirety for real or personal property). In Missouri, any property owned in the joint names of a married couple is presumed to be tenancy by entirety property, which is not the case in Illinois.

As a result of the rise in the federal estate tax exemption to the $5.25 million level (per spouse), combined with the new spousal portability election, holding property in tenancy by entirety form is now much easier to do than it was even a dozen years ago, when the estate tax exemption was only $675,000. Twelve years ago many couples were forced to sever all or some of their tenancy by entirety property and divide the same between the two of them, in order to achieve a total estate tax exemption of $1,350,000. As a direct consequence of this division, the couple had now exposed their assets to lawsuits against either spouse.

Today, with a “relatively” permanent $5.25 million federal estate tax exemption, as well as the addition of the spousal portability election, most Missouri married couples will no longer need to divide their assets between themselves, in order to avoid estate taxes at the surviving spouse’s death.

As a consequence, the couple can now keep their assets titled in joint names, and thereby qualify for Missouri’s full tenancy by the entirety protections.

The only disadvantage to this approach to titling comes after the death of the first spouse to die, when now the assets are fully subject to the creditors of the surviving spouse, and without additional planning will be subject to probate when the surviv4

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AUGUST 2013

ing spouse dies. It is also still possible that a successful joint action can be filed against the couple. Fortunately, Missouri has several other laws which can readily be used to address each of these issues.

Transfer on Death and Pay on Death At least 17 states currently have TOD statutes. Missouri permits TOD or POD forms of registration on virtually every asset conceivable, including real estate, motor vehicles and watercraft). Illinois, on the other hand, only recently passed legislation which permits real property TOD registrations for “residential real estate” only. The question is: How can Missouri’s expansive TOD and POD legislation help insulate a Missouri resident’s assets from lawsuits?

The addition of the TOD or POD registration to assets titled in a Missouri married couple’s joint names is what creates the level of asset protection. Adding a TOD or POD designation to assets titled in tenancy by entirety form allows a Missouri married couple to not only minimize their exposure to lawsuits, but also to eliminate probate at each of their deaths. Probate is avoided at the first death as a result of the joint titling, and probate is avoided at the second death as a result of the second-to-die TOD or POD registration.

On the other hand, one of the best asset protection uses of TOD for Missouri married couple residents involves severing the joint titling of the couple’s automobiles.

Most married couples tend to title their automobiles in joint names. The problem this creates is that if either spouse is involved in an automobile accident, and if there is any defect in the automobile (e.g., worn brakes) which contributes to the accident, both spouses can be founded liable for the accident.

If the couple is jointly liable, then the plaintiff may be able to recover against all of the couple’s joint assets. If, however, each spouse owns the car he or she primarily drives in his or her own name, and titles it TOD to his or her spouse or to another individual or entity, the chances for a successful joint lawsuit against the couple are minimized. TOD registration of automobiles is accomplished at the client’s local Missouri department of motor vehicles office, and typically involves only a nominal fee as well as a nominal amount of time.

TOD and POD designations on a couple’s jointly-owned assets generally will not protect against joint lawsuits while the couple is married; nor will the designations protect the surviving spouse’s assets after the first spouse’s death. The following discussed additional Missouri laws are needed to achieve this greater level of protection The MAP Trust The MAP Trust affords a settlor establishing and funding the same full creditor protection, provided the following trust drafting guidelines are adhered to:

• The trust must be irrevocable and incapable of being amended by the settlor; • The settlor may not be the sole beneficiary of either the income or principal of the trust; • The trust must contain a spendthrift clause applicable to the settlor’s interest in the trust; and • The settlor may not retain a right to receive a specific portion of the income or principal of the trust pursuant to the trust instrument; in other words, any interest of the settlor in the trust must be a discretionary interest only.

Although the settlor may not amend the terms of the MAP Trust, the settler may redirect where the trust assets pass at his or her death.

The advantages of the MAP Trust over relying exclusively on tenancy by the entirety protections include: • MAP Trust assets are insulated from joint lawsuits as well as suits against either spouse; • MAP Trusts provide full creditor protection for the surviving spouse, as opposed to tenancy by the entirety titling which provides no protection for the surviving spouse; • MAP Trusts provide the only avenue for protection for a single individual, unless the individual is a surviving spouse and his or her predeceased spouse established a spendthrift trust for his or her benefit.

The biggest drawback to a MAP Trust, however, in addition to the fact that it is irrevocable, is that the settlor of the trust should not serve as trustee (although the statute actually does not prohibit this). Thus, a friend or relative would need to serve as trustee of the MAP Trust, which means that this trustee’s permission will be required before any discretionary distributions may be made to or for the benefit of the settlor. For some clients, this is not a big deal; for others, it is a deal breaker.

The biggest advantage of the MAP Trust is that it protects the assets of single people from lawsuits, as well as married couples. As such, the availability of the MAP Trust for residents of Missouri who are single should be raised at every opportunity. Married couples should also be made aware that the MAP Trust is the only technique which will provide full asset protection against joint lawsuits as well as suits against the surviving spouse.

The QST A QST is simply a modified version of the traditional revocable trust agreement or agreements married couples have executed in the past. The purpose of the QST is to preserve the creditor protected character of tenancy by the entirety property when the same is transferred by the Missouri couple either to a joint QST, or to a two separate shares version of the QST (the latter of which essentially amounts to nothing more than one separate revocable trust for each spouse). If a QST satisfies all of the statutory requirements, any tenancy by the entirety property transferred to it thereafter has the

same immunity from the claims of the separate creditors of the couple as would have existed if the couple had continued to hold that property as husband and wife as tenants by the entirety, so long as the property, proceeds, or income continue to be held in trust by the trustee of the QST. The emphasis of the QST is on tenancy by the entirety property transferred to the trust. An extremely careful funding system must therefore be followed in order to ensure a proper tracing of trust funding, if necessary down the road, and clients need to be reminded that the QST will not avoid joint claims against both spouses.

The statute makes clear that the exempt status exists only while the husband and wife are both alive and remain married. Thus, after the death of the first spouse, the special tenancy by the entirety protection no longer exists. However, if the “two-share version” of the QST is employed by the couple, the decedent spouse’s share of the QST will remain creditor protected for the surviving spouse, as a standard “spendthrift trust.”

The surviving spouse can then elect to establish a MAP Trust at that time, with his or her own separate share assets.

Where estate taxes are an issue, married couples are commonly required to divide property previously held as tenants by the entirety in order to minimize estate taxes. In the past this process destroyed the creditor protection which tenants by the entirety property ownership possesses for claims against only one spouse. Under the new law, however, if properly structured and funded, a “two-share” QST funded with tenancy by entirety property can not only minimize or eliminate the married couple’s potential estate tax liability, but it will also preserve the status of the transferred tenancy by the entirety property as protected against the claims of future creditors of either spouse.

Note that, similar to tenancy by the entirety, a QST does not protect against joint claims against a married couple. Unlike tenancy by the entirety property, however, the two-share QST should at least protect approximately one-half of the couple’s assets from creditor attack after the first spouse to die’s death. The two-share QST therefore has utility even if the couple is not in a taxable estate situation.

Significantly, a two-share QST can accomplish its goals without destroying the status of the transferred property for Missouri marital property purposes, in the event of a divorce. Under prior law, dividing tenancy by the entirety property between two revocable trusts would potentially have had marital property consequences, and the same rule would apply if tenancy by the entirety property were divided between two MAP Trusts.

James G. Blasé, CPA, JD, LLM, is a Principal with Blase & Associates, LLC Attorneys at Law in St. Louis. He can be reached at www.blaselaw.com

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MEETING THE RESIDENCY CHALLENGE

Q&A with Kathryn Diemer, MD

Washington University seeks to retain more than one-third of medical graduates

By LyNNE JETER

The volume of residency applications has continued to increase, as medical schools strive to bridge the gap between the rising number of medical graduates and the limited number of PGY-1 (firstyear) residency positions.

St. Louis Medical News spoke with Kathryn M. Diemer, MD, assistant dean, associate professor, and clinical director of Dr. Kathryn Diemer the Bone Health Program for the Washington University School of Medicine, about how the national trend is impacting the St. Louis area.

Nationally, what trends are you seeing in the gap between the number of medical graduates and residency positions?

The number of residency applications has continued to increase through the National Resident Matching Program (NRMP). (See box.) Overall, 3,000 more active applicants participated in the match, but only 1,439 more positions were available for applicants to match into. The NRMP charts outcomes through the

Missouri’s Medical Training Institutions

match, which shows how, for the first time, there were more U.S. seniors needing a residency position than open positions.

Missouri has a slightly higher than average percentage of active physicians who are International Medical Graduates (IMGs), according to 2010 data from the Association of American Medical Colleges (AACM). How does the IMG group impact the overall picture?

In Missouri, graduates from international medical schools, other than Canada, are often required to have training at an approved residency program in the United States. They also have to take all the same licensure exams as required for U.S. graduates: U.S. Medical Licensing Exam (USMLE) Step 1, 2CK, 2CS and Step 3.

The clinical skills testing is required for both U.S. medical students and international graduates. It assesses the ability of examinees to apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision, and includes emphasis on health promotion and disease prevention.

Step 2 ensures that due attention is devoted to the principles of clinical sciences and basic patient-centered skills that provide the foundation for the safe and effective practice of medicine.

Step 2 CS uses standardized patients to test medical students and graduates on their ability to gather information from patients, perform physical examinations,

Missouri Physician Workforce Statistics State population: 6 million Total active physicians: 14,825 PCPs: 5,043 Total female physicians: 4,200 Total medical or osteopathic students: 3,832 Total residents: 2,632 SOURCE: Association of American Medical Colleges, 2011.

and communicate their findings to patients and colleagues, according to the USMLE website. What’s important is that the applications for licensure are the same for U.S. and IMG graduates – with very high standards. So, we can be assured that the international medical graduates are held to the same standard and are certainly qualified to practice.

Missouri had 3,832 total students enrolled in medical or osteopathic schools in 2010. In 2000, that number was 3,447, an 11 percent increase. What has attributed to the change?

The increase is related to increases in class sizes at most schools; additional medical schools haven’t opened.

In 2010, Missouri ranked 11th in the number of residents and fellows on duty in Accreditation Council for Graduate Medical Education (ACGME)-accredited programs (per 100,000 population by degree type). I’d value your input on this high ranking.

Missouri has four accredited medical allopathic medical schools (Washington University, Saint Louis University, University of Missouri-Columbia and University of Missouri-Kansas City. There are two osteopathic schools – at Kansas City University and Kirksville (see sidebar).

Missouri’s retention rates for physicians staying where they received their most recent GME training remains average. What challenges do medical schools face in the St. Louis area to retain more of those newly minted physicians?

We’re going to need more primary care doctors if access to health insurances increases. At Washington University, about one-third of our graduates stay at Wash University for their residency programs. Missouri, with so many teaching hospitals, has a large number of residency positions. The reason many students choose to stay is because of the excellent training they can get and, honestly, the cost of living in St. Louis makes it an easy place to buy a nice house on a resident’s salary. So, Missouri needs to continue to (CONTINUED ON PAGE 6)

Columbia: University of MissouriColumbia School of Medicine, founded in 1845, suspended in 1855, reorganized in 1872. Clinical teaching was suspended from 1909 to 1957.

Kansas City: Kansas City University of Medicine and Biosciences College of Osteopathic Medicine, established in 1916.

Kansas City: University of MissouriKansas City School of Medicine, established in 1971.

Kirksville: A.T. Still University Kirksville College of Osteopathic Medicine, established in 1892. It’s acknowledged as the world’s oldest school of osteopathic medicine.

St. Louis: Saint Louis University School of Medicine, created in 1901 via merger of Marion-Sims Medical College and Beaumont Hospital Medical College as Marion-Sims-Beaumont Medical College. In 1903, it became the Medical Department of Saint Louis University.

St. Louis: Washington University School of Medicine, founded in 1891 as the Medical Department of Washington University, created by affiliation with St. Louis Medical College, which absorbed Missouri Medical College in 1899.

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PHYSICIANS BUSINESS CONFERENCE Tools for Success

Seminar Registration Underway You can now register by phone or on-line for the business of health care seminars to be presented at the Physicians Business Conference Saturday, October 26 and Sunday, October 27.

The conference will be held at the Sheraton Westport Chalet in St. Louis, MO. Physicians from Missouri and Southern Illinois can create their own educational experience by selecting from seminars described in the program.

Seminar Selection Physicians and business administrators can view the seminar descriptions in monthly copies of St. Louis Medical News or by visiting the publication’s web site at www.saintlouismedicalnews.com. Details of seminar content, speaker information and day and time of presentation are listed in the conference program found on the web site.

Registration Select your seminars by number and follow instructions on the web site to register for your selected seminars. Or, you can register by phone by calling 615-844-9307. A Medical News representative will walk you through the registration process.

We Recommend You Register As Early As Possible Since Seating At Individual Seminars Is Limited AUGUST 2013

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Q&A, continued from page 5

Family Medicine Residency, continued from page 1

have high quality residency training programs, which gets them to come to Missouri for training. Once they’re here, we need to be sure there’s affordable housing, great schools and that we offer what the trainees are looking for to stay and start their post-residency lives.

“I looked around and noticed there weren’t any family medicine residency training programs in the city of St. Louis,” said Jacobs, who relocated to the metro area in 2008 after 19 years of training residents in Chicago. “St. Louis was a relative desert as far as the pipeline of primary care physicians was concerned.

Fortunately, the Saint Louis University School of Medicine thought starting another primary care residency program was a worthwhile investment.”

Jacobs applied for a 5-year grant from the U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA) for a “Longitudinal Underserved Community Curriculum,” a set of educational experiences focused on community health, particularly in urban underserved settings.

“I designed the curriculum because in many cases, medical students are thrown into residency situations caring for underserved populations in high volume settings without the necessary resources,” explained Jacobs. “Those physicians burn out quickly. We take the time to teach them different aspects of community health and caring for high needs patients. For example, in their second year, residents take a day each month to focus on an area of community health such as homelessness, addiction, or pediatric nutrition. Or they may spend a day in Jefferson City talking to legislators about Medicaid expansion.

These sessions give residents a context for the patients they treat, and they don’t feel isolated while they’re working hard, caring for underserved patients, or feel that nobody appreciates them.”

Because national training grants are highly competitive, SLU leaders were ecstatic when Jacobs’ was approved.

“It’s a program with exciting components that keeps our residents fresh and enthusiastic through their years of training,” said Jacobs.

Every family medicine resident must log 1,650 outpatient visits during their

What movement at the state and national level needs to happen to increase the supply of PCPs?

There’s going to be a need for more training positions in primary care across the country. The question will be: who pays for it? At a time when state and federal budgets are being cut, it’s hard to know where the money would come from. The average medical student debt is significant, so we need to have jobs available both for residency positions and after training.

Missouri Statistics 40,335 registrants (1,958 more) 34,355 active applicants (3,000 more) 17,487 U.S. allopathic medical school seniors (960 more) 2,677 osteopathic medical school students/graduates (317 more, highest ever) 5,095 U.S. citizen international medical school students/graduates (U.S. IMGs) (816 more) 7,568 non-U.S. citizen international medical school students/graduates (IMGs) (740 more) Available residency positions increased to 29,171, 2,399 (9 percent) more than in 2012, when 26,772 positions were offered. The increase is due primarily to implementation of the All-In Policy, which resulted in some specialties offering significantly more positions in 2013.

Internal Medicine offered 1,000 more positions, Family Medicine offered 297 more, and Pediatrics offered 141 more than the prior year.

SOURCE: National Residency Matching Program.

3-year residency, focusing heavily on ambulatory care.

“If you can’t do the ambulatory part well, you’ve basically failed, so we’ve put a lot of energy and thought into how to train our residents,” she said. “Our family doctors are very well prepared for their eventual career.”

To help residents avoid burnout, compassion fatigue coaching is a very special component of the training program, Jacobs said.

“That’s a major goal of the training grant,” she explained. “We start their residency with an entire month of introduction to ambulatory care, and during that time, we talk with residents about their lives, families of origin, what brought them into medicine, and their stressors.

As training goes on, residents support groups meet every month. We also have a behavioral medicine curriculum where residents learn how to handle all sorts of family dynamics and their own reactions to those dynamics. With this component of the program, they’re much more likely to be able to enjoy their career.”

Other benefits of the unique program: mentors in community health centers and inter-professional training.

“We train family medicine residents alongside pharmacists, nurse practitioners, and behavioral health providers,” she said. “They’re able to learn alongside experienced providers who enjoy this work, and it makes a big difference. Our residents feel they’re a part of the medical community and the local community. At the end, they’ll be well equipped to serve underserved patients.”

PGY-1 Family Medicine Residents These residents are from St. Louis medical schools and the residency programs in which they are training:

Saint Louis University School of Medicine: Bendert, Kristin: Oregon Health & Science University Bezek, Katelyn: Allina in Minnesota Bryant, Andrew: Mercy Hospital in St. Louis Buller, Sarah: Brown Medical School, Memorial Hospital in Rhode Island Du, Stephanie: Kaiser Permanente in Orange County, California Eckelkamp, Joseph: Mercy Hospital in St. Louis Fox, Alex: University of Utah Affiliate Hospitals Hoff, Anthony: University of Minnesota Medical School Huck, Garrett: Nellis Air Force Base in Nevada Ironside, Abigail: Texas A&M, Scott & White Kaiser, Charity: Northwestern McGaw, Northwestern Memorial Hospital VA in Illinois Kalsi, Neil: Northwestern McGaw, Northwestern Memorial Hospital VA in Illinois Kim, David: Methodist Hospital in Sacramento, California Kim, William: Kaiser Permanente in Orange County, California

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Email subscribe@medicalnewsinc.com for information.

Kirkpatrick, James: University of Missouri in Kansas City Lao, Melissa: Mercy Hospital in St. Louis Nimmagadda, Sri: Community Hospitals in Indiana *Pugh, Jackson: Saint Louis University (SLU) Szafranski, Karl: Greenville Hospital System, University of South Carolina Tichenor, Vincent: Scott Air Force Base in Illinois *Wedell, Christopher: SLU White, Broc: Utah Valley Regional Medicine Center

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*Wan, Betsy: SLU

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Witt, Doyle: University of Missouri in Kansas City

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PHYSICIANS BUSINESS CONFERENCE TOOLS FOR SUCCESS

SEMINAR PROGRAM & REGISTRATION OCTOBER 26 & 27, 2013 | SHERATON WESTPORT LAKESIDE CHALET PRESENTED BY ST. LOUIS MEDICAL NEWS

BUILD YOUR OWN EDUCATIONAL EXPERIENCE Physicians and healthcare business managers may choose from a lineup of seminars detailed on the next page of this program to develop the tools they need to provide financial solutions to many post-health reform challenges.

More than 20 seminars in 11 business categories will cover myriad subjects on the business side of healthcare. Local experts in each field will present the conference seminars specifically designed for St. Louis healthcare professionals.

REGISTRATION BEGINS NOW Because seating is limited for each seminar, we strongly encourage healthcare professionals to register early to ensure a seat in their choice of seminars.

Complete registration information and seminar costs follow the list of individual seminars and their content, beginning on the next page. Seminars are listed chronologically by day.

Select your seminars by number and follow the step by step registration procedure whether you are registering by phone or web site.

SEMINAR DETAILS INSIDE Seminar content details, along with bios of the individuals and organizations involved in the presentation, are listed on the adjacent page of this program guide.

Because seminars will be presented on a category of business information instead of an individual company and its services, healthcare professionals will gain insightful knowledge about each subject to then make informed choices about the company best-suited to provide services and solutions for them. This style of presentation will create a truly educational experience for each seminar.

Attendees may register online at www.saintlouismedicalnews or via phone at 615-844-9307. stlouismedicalnews

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PHYSICIANS BUSINESS CONFERENCE

SEMINAR CONTENT AND DETAIL Saturday SEMINAR 1 SATURDAY 8:30 A.M. – 10:00 A.M. 1.5 HOURS PERSONAL FINANCIAL MANAGEMENT FOR PHYSICIANS This workshop focuses on a physician’s personal finance practices. Topics of discussion include creating a retirement plan, choosing a financial planner, the personal benefits of medical real estate investments, managing debt, and the importance of disability income insurance.

Speaker: Jeremiah Dellas, a wealth management advisor at Fifth Third Bank, responsible for the development and ongoing coordination of investment management, insurance planning, wealth planning, and private banking services for high net worth clients.

SEMINAR 9 SATURDAY 8:30 A.M. – 10:00 A.M 1.5 HOURS THEY DIDN’T MENTION THIS IN MEDICAL SCHOOL DEALING WITH LAWYERS AND LAWSUITS From records requests to lawsuits, dealing with lawyers and malpractice lawsuits can be an unavoidable part of the practice of medicine. This seminar will discuss potential issues when interacting with lawyers before a lawsuit is filed, as well as what to expect if you are sued or contacted by the Board of Registration for the Healing Arts. Topics include potential pitfalls when responding to records requests and subpoenas or providing opinions or depositions, what to expect if you are named in a lawsuit or contacted by the Board of Healing Arts, and an update on tort reform in Missouri.

Speaker: Mark A. Gonnerman, Founding member of Gonnerman Reinert LLC Gonnerman Reinert LLC defends doctors and other healthcare providers from initial claims through trial. Gonnerman Reinert LLC serves as lead counsel for Missouri Phrofessionals Mutual.

SEMINAR 7 SATURDAY 10:00 A.M. – 11:00 A.M. 1 HOUR ASSET PROTECTION PLANNING The United States is an increasingly litigious society. Many individuals are interested in methods available to avoid the loss of family wealth to creditors, bankruptcy and divorce. There are several popular estate and gift tax planning tools for protecting your assets. This session provides attendees with an overview of some of the methods for protecting family wealth.

Speaker: Steven M. Laiderman, Principal of The Laiderman Law Firm PC Laiderman Law Firm is an estate planning, probate and business law firm based in St. Louis. His business practice focus also extends to business tax planning, entity creation, succession planning, and the negotiation of business sales and acquisitions.

SEMINAR 10 SATURDAY 10:00 A.M. – 11:30 A.M. 1.5 HOURS IMPLICATIONS OF POPULATION HEALTH MANAGEMENT FOR PHYSICIANS AND HOSPITALS In light of healthcare reform legislation, spiraling healthcare cost increases, and the looming retirement of the Baby Boomer generation, there is an increasing focus on managing population health. But what that means – and what it means for physicians and hospitals – is less clear.

This session defines what is required to manage population health, the key milestones on the way there, and what doctors need to know.

Speaker: Glenn Mitchell, MD, MPH Dr. Mitchell is a Senior Consultant at Numerof & Associates, Inc. He was formerly Chief Medical Officer at Mercy Health System. NAI is a strategic management consulting, bringing a unique cross-disciplinary approach to a broad range of engagements designed to sharpen strategic focus, increase revenues, reduce costs, and enhance customer value.

Panelists - Thomas H. Hale, MD, PhD Thomas Hale, MD, is executive medical director for Mercy’s Telehealth Services, a position he assumed in June 2009.

Edwin Trevathan, MD, MPH Edwin Trevathan, MD, MPH is currently the Dean of the Saint Louis University College for Public Health and Social Justice, where he is also a Professor of Epidemiology, Pediatrics, and Neurology John Ellena, MD Dr. Ellena is Medical Director, BJC Medical Group.

SEMINAR 17 SATURDAY 11:00 A.M. – NOON 1 HOUR SURVIVING THE CHAOS WHILE MAINTAINING YOUR INDEPENDENCE AND INCREASING YOUR INCOME This session will review major drivers of practice revenue, profitability and growth. We will review opportunities to maximize revenue and profitability on current operations and talk about exploring opportunities to expand business through new ancillary offerings and through leveraging existing resources (staff, equipment, and space). We will also review the changing Medicare and private insurance payment environment including those that tie payments to quality and cost effectiveness. We will explore how independent physicians can participate in Accountable Care Organizations (ACO) and the key elements for success.

Speaker: Mike Linder, Owner and CEO/President of St. Louis based KSL Billing + Management KSL is a revenue cycle management company serving nearly 300 physicians across Missouri, Illinois, and Kansas.

SEMINAR 20 SATURDAY 11:00 A.M. – NOON 1 HOUR NAVIGATING YOUR REVENUE STREAM – BEST PRACTICES FOR MAXIMIZING CASH FLOW Effective revenue cycle management (RCM) will increase your net collections and assure prompt payments. Your revenue cycle is driven by medical procedure codes, detailed documentation, data capture, complex reimbursement guidelines and denial management…and your personal efforts can affect these outcomes. This fast-paced, practical workshop offers RCM strategies that physicians and managers can execute immediately to maximize reimbursements, sustain cash flow, improve liquidity and increase profitability. Learn proven methods for converting your medical procedures to cash.

Speakers: Alan F. Dombrowski, vice-president of Hawthorn Physician Services Corporation, a nationally-recognized healthcare revenue cycle management company headquartered in St. Louis. Alan is a certified billing and management executive with more than 25 years in healthcare business management.

Craig A. Williams is director of sales for Hawthorn. He began his 30-year healthcare career with Blue Cross and Blue Shield of Indiana where he served as manager of Medicare claims processing and as professional provider representative for the Medicaid program of Indiana.

Stan Hosler joined Hawthorn in 2012 as a sales and marketing associate, responsible for new business development in the southeastern states. He has more than 15 years’ experience at Contel Corporation and Coca-Cola Company.

SEMINAR 4 SATURDAY 1:00 P.M. – 2:30 P.M. 1.5 HOURS OPERATIONAL AND LEGAL MATTERS REGARDING HIPAA COMPLIANCE This panel discussion will explore HIPAA compliance and cover data protection and transfer issues; business associates compliance determination; security breach and reporting; employee hiring, training and monitoring; employee handbook, policies and procedures; corrective action options for violations; and employee best practices.

Moderator: Ron Present, Health Care Industry Group Leader, Brown Smith Wallace Panelists: Gerry Richardson, Partner, Evans and Dixon Tony Munns, Member, Brown Smith Wallace

SATURDAY SEMINAR GRID 8:00

8:30

9:00

9:30

10:00

10:30

11:00

11:30

SEMINAR 1

SEMINAR 9

1:00

1:30

2:00

2:30

3:00

3:30

4:00

4:30

5:00

5:30

EXHIBIT HALL OPEN 4 HOURS SEMINAR 2

LUNCH SEMINAR 17

SEMINAR 10

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12:30

SEMINAR 4

SEMINAR 7

8

12:00

SEMINAR 20

1 HOUR

SEMINAR 12

SEMINAR 6

SEMINAR 8 SEMINAR 22

SEMINAR 14

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TOOLS FOR SUCCESS

The 2013 St. Louis Physicians Business Conference seminars will be presented in segments of an hour to one-and-a-half hours. Regardless of length, all seminars are priced the same. Lengthier seminars will typically headline multiple speakers.

SEMINAR 12

SEMINAR 6

SATURDAY 1:00 P.M. – 2:00 P.M. 1 HOUR CONSUMER-DRIVEN HEALTHCARE – WHAT YOU NEED TO KNOW Trends point to an increasingly consumer-driven model for healthcare. As consumers bear more of the cost burden of their own healthcare, they will demand more information about cost, quality and outcomes than they have historically. This session will walk through what this shift will mean for providers and how they should prepare.

Speaker: Kim E. White, MBA Kim E. White is a Consultant at Numerof & Associates, Inc. NAI is a strategy consulting firm focused on organizations in dynamic, rapidly changing industries. Working globally across the healthcare industry, NAI brings a unique cross-disciplinary approach to a broad range of engagements designed to sharpen strategic focus, increase revenues, reduce costs and risk, and enhance customer value.

SATURDAY 3:30 P.M. – 5:00 P.M. 1.5 HOUR MARKETING A CLINICAL PRACTICE This seminar will cover strategies for the small to medium sized practice and include discussions on medical ethics, market research, patient outreach, professional networking and costeffective advertising. In addition to the primary speakers, representatives from an advertising agency and a market research company will join the discussion.

Speakers: Jacqueline Stack, PhD, Senior Director Marketing and Communication, Faculty Practice, Washington University Physicians Sarah Gladson, Director of Marketing and Communications SLUCare, The Physicians of Saint Louis University

SEMINAR 14 SATURDAY 4:00 P.M. – 5:00 P.M. 1 HOUR THE PHYSICIAN PRACTICE AS EMPLOYER Subjects that will be covered in the seminar will include interviewing techniques; recruitment agreements; non-competes; retention of employees and benefit packages; negotiations; and establishing compensation packages.

Speakers: Elizabeth Ortmann Vincenzo, Esq., Senior Director of Compliance at Express Scripts Diane Robben, Esq., Partner, Sandberg, Phoenix & von Gontard, P.C.

SEMINAR 2 SATURDAY 2:30 P.M. – 3:30 P.M. 1 HOUR BUSINESS FINANCIAL MANAGEMENT FOR PHYSICIANS This workshop focuses on the business financial aspect of managing a practice. Key topics include qualifying for a business loan, understanding the P&L, Revenue Cycle Management, Accounts Receivable and Reimbursement Concerns, and Managing Debt and Growth.

Speaker: Mersed Halilovic Halilovic is a business banking officer at Fifth Third Bank, focusing on the healthcare industry. He provides customized solutions around credit and capital for small to medium size businesses.

SEMINAR 8 SATURDAY 2:30 P.M. – 4:00 P.M. 1.5 HOURS AN OUNCE OF PREVENTION IS WORTH A POUND OF CURE – TIPS FOR MINIMIZING YOUR RISK OF A MALPRACTICE CLAIM Although some malpractice lawsuits are unavoidable, oftentimes small changes in your practice can prevent a patient from turning into a plaintiff. This seminar will discuss issues that commonly lead to medical malpractice lawsuits, and provide tips on how to minimize your risk. Topics include communicating with patients, charting and EMR issues, obtaining informed consent, and dealing with the disgruntled or non-compliant patient.

Speaker: Mark A. Gonnerman, Founding member of Gonnerman Reinert LLC Gonnerman Reinert LLC defends doctors and other healthcare providers from initial claims through trial. Gonnerman Reinert LLC serves as lead counsel for Missouri Professionals Mutual.

SEMINAR 22 SATURDAY, 2:00 P.M. – 3:30 P.M. 1.5 HOURS FOUR RISKS TO YOUR WEALTH Asset Protection is key to the preservation of a physician’s wealth. Physician’s invest years in their education and practice and dedicate themselves to achieving success in their profession. However, the failure to plan for unforeseen events can result in the loss of professional reputation and wealth. There are four primary ways that wealth may be lost: mismanagement, lawsuits, taxes and divorce. With proper planning it may be possible to minimize the risk of loss of wealth in these four areas. In today’s litigious society, one accident or mistake could lead to claims against your practice and wealth.

Speaker: Rodney S. Ferguson, ChFc, CLU Rod is principal and founder of Ferguson Financial Group, LLC, a financial planning firm. Ferguson Financial Group is a District Agency for the New York Life Insurance Company. Rod specialties include working with small business owners and professionals in the area of estate, business succession, retirement and risk management planning.

Sunday SEMINAR 16 SUNDAY 10:00 A.M. – 11:00 A.M. 1 HOUR USING SOCIAL MEDIA TO ENHANCE PATIENT EXPERIENCE AND INCREASE REVENUE Attendees will leave this seminar understanding how a social media strategy can directly impact revenue, initiate community dialogue, provide important patient information, and result in revenue-enhancing referrals. Case studies will be presented to illustrate healthcare industry social media success and generate discussion. Attendees will get a better understanding about the future of social media in medicine as well as the competitive power of social media to compete for patients. Discover best management practices for your social media involvement and how to reach your current and prospective patient base effectively.

Speakers: JoAnna Dettmann and Kaysha Kalkofen Co-founders of St. Louis based digital marketing firm tSunela bring a great deal of internet marketing and social media experience to this discussion about why social media strategies must be a part of every healthcare provider’s marketing and communications plan. Dettmann and Kalkofen have many healthcare clients and speak nationally on social media subjects.

SEMINAR 13 SUNDAY 10:30 A.M. – NOON 1.5 HOURS PRACTICAL ASPECTS OF THE LIFE CYCLE OF A MEDICAL PRACTICE A panel of physician practice advisors will comment on effectively managing a practice from start up to maintenance. This will include topics such as hiring the right experts, legal structure, taxes, credentialing, space and equipment, financing, hospital and other affiliations, billing/ coding, compliance, revenue cycle analysis, auditing to increase profits, malpractice insurance, and reimbursement.

Speakers: Tony Soukenik, Partner, Sandberg, Phoenix & von Gontard, PC Bhavik Patel, Partner, Sandberg, Phoenix & von Gontard, PC Eric Humes, CEO, Omniscient HC and Keystone IT Chastity Werner, Health Care Consultant, Anders Michael Abrams, Managing Partner, Numerof & Associates

SUNDAY SEMINAR GRID 8:00

8:30

9:00

9:30

10:00

10:30

11:00

11:30

12:00

12:30

LUNCH SEMINAR 11

1:30

2:30

3:00

SEMINAR 15

3:30

4:00

4:30

5:00

5:30

SEMINAR 21 SEMINAR 3

1 HOUR

SEMINAR 5

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EXHIBIT HALL OPEN 3 HOURS

SEMINAR 13 SEMINAR 16

1:00

SEMINAR 18

SEMINAR 19

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SEMINAR CONTENT AND DETAIL SEMINAR 11

SEMINAR 18

SUNDAY 11:00 A.M. - NOON 1 HOUR REDUCING COSTS ACROSS SERVICE LINES Cost reduction is a perennial topic for healthcare providers. But the methods used historically have not typically focused on the leading factor in cost generation: clinical decision making.

This session will walk through a systematic approach to reducing costs that addresses this sensitive area, the key considerations you’ll need to take into account, and steps you can take to build consensus within your practice or organization.

Speaker: Jill E. Sackman, DVM, PhD, Senior Consultant at Numerof & Associates, Inc. NAI is a strategy consulting firm focused on organizations in dynamic, rapidly changing industries. Working globally across the healthcare industry, NAI brings a unique cross-disciplinary approach to a broad range of engagements designed to sharpen strategic focus, increase revenues, reduce costs and risk, and enhance customer value.

SUNDAY 2:30 P.M. – 3:30 P.M. 1 HOUR 2013 HEALTHCARE REAL ESTATE STRATEGIES This informative seminar will investigate how real estate occupancy costs can be a source for improving your practice bottom line. Topics covered will include: The current medical office market conditions; The impact the market has on real estate occupancy costs; Various occupancy choices based on career stage and market conditions; The pros and cons of leasing vs. purchasing vs. development; and real estate exit strategies.

Speaker: Ann Dulle Ann Dulle is a senior associate and member of the National Healthcare Services Group of CBRE Inc., a Global Fortune 500, publicly traded company. Her architectural career, which included planning services for medical office practices, spanned 13 years, and then transitioned to commercial real estate property management in 2001 with Equity Office Properties and Duke Realty.

SEMINAR 15

SEMINAR 21

SUNDAY 1:00 P.M. – 2:30 P.M. 1.5 HOURS IS THERE A DOCTOR IN THE HOUSE? Exclusive home mortgage financing programs with low down payment options for Physicians will be featured. One of the area’s top realtor teams will discuss the dos and don’ts of buying and selling luxury homes. Also, representatives from Wells Fargo Advisors and Wells Fargo Business Real Estate will be on hand to discuss how to finance and protect your practice.

Speakers: Michael Burge, Sales Manager, Wells Fargo Home Mortgage Michael Burge is a Professional Mortgage Banker with nearly 30 years of industry experience. He was the Founder and First President of the Missouri Association of Mortgage Professionals and was recruited by Wells Fargo specifically for his expertise in serving healthcare professionals.

Donna Heinrich, VP, Wells Fargo Business Real Estate Finance Donna Heinrich has been in the banking industry for 30 years. Donna has been at Wells Fargo for 16 years with the last 7 years at Wells Fargo Business Real Estate Finance.

Charles Grbcich, VP and Investment Officer, Wells Fargo Advisors Charles G. (Chuck) Grbcich is dedicated to providing exceptional service to his clients. Since entering the brokerage business, he has specialized with rollover retirees, mid-level corporate executives, and families committed to achieving their financial goals. Mr Grbcich also works with corporations assisting with their 401k plans, pensions, and other financial needs.

SUNDAY, 3:30 P.M. – 5:00 P.M. 1.5 HOURS FOUR RISKS TO YOUR WEALTH Asset Protection is key to the preservation of a physician’s wealth. Physician’s invest years in their education and practice and dedicate themselves to achieving success in their profession. However, the failure to plan for unforeseen events can result in the loss of professional reputation and wealth. There are four primary ways that wealth may be lost: mismanagement, lawsuits, taxes and divorce. With proper planning it may be possible to minimize the risk of loss of wealth in these four areas. In today’s litigious society, one accident or mistake could lead to claims against your practice and wealth.

Speaker: Rodney S. Ferguson, ChFc, CLU Rod is principal and founder of Ferguson Financial Group, LLC, a financial planning firm. Ferguson Financial Group is a District Agency for the New York Life Insurance Company. Rod specialties include working with small business owners and professionals in the area of estate, business succession, retirement and risk management planning.

SEMINAR 5 SUNDAY 1:00 P.M. – 2:00 P.M. 1 HOUR MEDICAL MARKETING IN THE DIGITAL AGE This seminar will explore the development of websites and social media for the small to medium sized practice. Medical marketing experts will discuss developing a practice web site “somewhere between a brochure and the Library of Congress.” A social media discussion will discuss the pros and cons of getting out there and the perfect fit.

Speaker: Jacqueline Stack, PhD, Senior Director of Marketing and Communication, Faculty Practice, Washington University Physicians

SEMINAR 3

SEMINAR 19 SUNDAY, 4:00 PM. - 5:00 P.M. 1 HOUR BUSINESS TECHNOLOGY FOR PHYSICIANS Have you begun using a computer to record patient information? Are you starting to see the benefits of this new medium? Are you aware of the risks? This seminar walks you through where we have been, where we are today and where technology is leading us in the future.

This presentation will recap HITECH and the recent changes to the HIPAA laws and what this means for your practice’s technology architecture. We will also explore the future modalities of data collection, aggregation and analytics. Data and the ease of accessibility through mobile platforms are a driving force behind the success of tomorrow’s healthcare.

Speaker: Eric W. Humes As CEO of Keystone IT, Eric Humes has established his company as a thought leader in healthcare IT. As a technology firm, Keystone focuses on the quality and efficiency of patient care as its number one priority. Keystone IT provides strategic consulting, support and cloud services to physician practices and hospital systems throughout the Midwest.

SUNDAY 2:30 P.M. – 4:00 P.M. 1.5 HOURS CULTURAL AND LEGAL IMPACT ON PHYSICIAN CONSOLIDATION This topical panel discussion will discuss cultural changes of FFS to PFP; loss of independence; physician group conflict – new/tenured and primary/specialists; corporate environment changes; practice transitions legal issues; physician employee transitions; and benefit transitions.

Moderator: Ron Steinkamp, Principal, Brown Smith Wallace Panelists: Brian Rogers, Partner, Evans and Dixon Ron Present, Health Care Industry Group Leader, Brown Smith Wallace

CONFERENCE COMMITTEE MEMBERS

St. Louis Medical News would like to thank the committee members below for their dedicated support constructing the conference seminars.

Dawn Van Houten, FIFTH THIRD BANK

Ron Present, BROWN SMITH WALLACE

Larry Henry, ST. LOUIS MEDICAL NEWS

Ray Harter, MPM INSURANCE

Elizabeth Vincenzo, EXPRESS SCRIPTS

Jon Rehg, SANDBERG PHOENIX

Jackie Stack, WASHINGTON UNIVERSITY IN ST. LOUIS

Lauren Bowman, EVANS & DIXON

Diane Robben, SANDBERG PHOENIX

Marshall Burstein, NEW YORK LIFE

Eric Humes, KEYSTONE IT CONSULTING

Michael Burge, WELLS FARGO HOME MORTGAGE

Michael Abrams, NUMEROF & ASSOCIATES

Sarah Gladson, ST. LOUIS UNIVERSITY

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TOOLS FOR SUCCESS

REGISTRATION FOR CONFERENCE AND SEMINARS Follow the simple registration steps below to create your personal educational experience at Physicians Business Conference. Registration for seminars will automatically create a conference badge for you that will admit you to the PBC Exhibit Hall.

EXHIBIT HALL

HOW TO REGISTER 1

SELECT SEMINARS Review the seminar information, choose your seminars by day and

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REGISTER ONLINE Go to the St. Louis Medical News web site at

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time and make note of each seminar number chosen. Because several seminars will be given concurrently, be careful not to pick seminars presented at the same time.

www.saintlouismedicalnews.com. Access the conference registration form where indicated on the site. Fill out the registration form completely, listing each seminar by number. We will use this information to confirm your registration by email. The complete conference program, seminar information and registration form is on the web site. You can pay for all seminars selected by credit card on this secure site.

REGISTER BY PHONE Call (615) 844-9307 to register by phone. An authorized Medical News representative will walk you through the registration process, review your seminar choices by seminar number, get your contact information and credit card information.

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CONFIRMATION During the registration process, you will be asked several questions – name, address, phone number and email address – to confirm registration and seminar selection.

You will receive confirmation of selected seminars and procedures for entrance to those seminars.

St. Louis Medical News will hold this personal information in strict confidence. It will not be disclosed to any other organization.

An exhibit hall at the 2013 St. Louis Physicians Business Conference will highlight companies and organizations that provide services and products to healthcare professionals, providing attendees the opportunity to gain additional detailed information focused on the business side of healthcare.

Entrance to the exhibit hall is free; attendees must have a badge to gain access.

Badges are available at conference registration to qualified healthcare professionals.

Seminar attendees automatically receive a conference badge.

SEMINAR PRICES Seminars begin at $25 each, with a price reduction based on volume of seminars. The discounted seminar cost rewards participants for purchasing multiple seminars by giving them additional FREE seminars. The following table demonstrates the seminar discount structure.

Seminars Purchased

Cost

Free Seminar(S)

Total # Seminar(S)

Cost Per Seminar(S)

1

$25

0

1

$25

2

$50

0

2

$25

3

$72

1 FREE

4

$18

4

$96

2 FREE

6

$16

5

$112

3 FREE

8

$14

6

$120

4 FREE

10

$12

Each additional seminar purchased (more than 10) $8 EACH

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Q&A with Bob Heaney, continued from page 1 Children’s Medical Center. The second largest is St. Mary’s Health Center for OB/ GYN and women and children’s health.

The third largest is the St. Louis VA. Unlike Medicare, the VA has been willing to increase its funding for GME. We’ve been able to partner with them for several years to help increase both the number of training programs and residents in each of those programs. We also partner with Mercy Health System, an independent sponsor with some of their own residency training programs. We also work with St. Elizabeth’s across the river in Belleville (Ill.). Scott Air Force Base is an interesting partnership to help support family medicine training, both for the Air Force and the civilian region.

Our most recent new venture into residency training has been a new family

Congressional Action Status To address the gap of medical school graduates who won’t match to a residency program, legislation was reintroduced in March in both houses of Congress to create new residency positions for Medicare-supported training slots via the Resident Physician Shortage Reduction Act of 2013. Senators Bill Nelson (D-Fla.), Chuck Schumer (D-NY) and Harry Reid (D-Nev.), and Representatives Aaron Schock (RIll.) and Allyson Schwartz (D-Pa.) led the reintroduction of the bills (S. 577, H.R. 1180) to create the additional GME positions, according to the AMA. (At press time, GovTrack estimated a 1 percent chance of S. 577 moving from the Senate Finance Committee, and a zero percent chance of H.R. 1180 moving from House committees.)

medicine residency program based at St. Mary’s Health Center that partners with a federally qualified health center (FQHC) to help serve city residents and occasionally some of those who are, relatively speaking, underinsured. We also go to 14 other places for other rotations in various specialties. While we have a medium-sized GME enterprise – about 610 people in 60 programs – we have a regional reach and GME touches a lot of communities around town, as it should.

What are your thoughts on the high percentage of medical graduates going out of state for residency training?

While states will fairly commonly invest in medical schools, they don’t sometimes realize the more immediate ROI is to support residency training programs in the community. Trainees are more likely to stay in the region where they receive residency training than medical school education. Residency training is a very intense experience. You begin to learn about the physician community and about the people you’re caring for in a way that’s qualitatively and quantitatively different than being a medical student. You’re responsible to the patients, their families and the communities. They can be very grateful and you become connected. You also learn who’s practicing good medicine in town, where the needs are. You can make connections with group practices, which is typically how pediatricians coming out of residency training programs interview with pediatric groups.

Other than SLU’s new family medicine residency program (see sidebar), how are residency programs trending?

Five years ago, we started a new emergency medicine program at Saint Louis University Hospital at six persons per year.

We’re mulling establishing a public health and preventive medicine program focused

on pediatric care with our Cardinal partner because there’s such a terrible need in the community. Asthma is one of the scourges of St. Louis. Among children, it’s at the tipping point of major health concerns. Also equally troubling are sexually transmitted diseases and the like. Public health initiatives are being considered or undertaken.

Both houses of Congress have once again introduced bills to increase residency slots (see box).

Political pundits aren’t giving it much of a chance to pass. Are you optimistic that, if it doesn’t pass this year, at least the environment is more favorable for passage soon?

We’re strongly in support of the national legislation, as is the AAMC (Association of American Medical Colleges). It’s come up a lot over the last 10 years, and always gets batted down even though the AAMC president frequently heads to Congress and often testifies about the looming physician shortage and how the GME positions are the choke point, and how the number of physicians needs to be expanded to meet crucial needs in communities.

The most recent bill is the most substantial we’ve seen. There hasn’t been really anything in recent years that looked like it had a chance to get out of committee. One of the reasons: people are trying to figure out on a very broad basis what needs to be done to protect the Medicare trust fund. It just hasn’t made a lot of sense to the lawmakers because they couldn’t see through to the fact that it’s going to save money on the other side. If you think about it, one of the difficulties is that Medicare has been doing its part for eligible people 65 and older or are disabled, but when you talk about a better-performing healthcare system that provides more timely care so that diseases don’t get worse, or provides preventive care so that people don’t get diseases, you’re talking about care for children and young adults. While it’s certainly

in Medicare’s enlightened self-interest to train future physicians that’ll be taking care of their beneficiaries, the Medicare-eligible, and those who’ll be enrolled in the future.

A lot of unmet medical needs aren’t for Medicare patients.

What needs to be done to improve the outlook?

States are taking a look at how to meet those needs, to make sure there’s a healthier citizenry, and hopefully a better state economy. Unfortunately, Medicare has the same demographic problem as Social Security. When it was initially designed, no one anticipated an average life expectancy of 78. Now it makes sense for Medicare to be training geriatricians and gero psychiatrists.

We’ve talked about them as specialties, but they’re really providing primary care services for the geriatric population. Incentivizing special training to meet the special needs of the older population is something that’s been recognized in a small way.

(CONTINUED ON PAGE 13)

NRMP Main Residency Match for Missouri by Specialty Positions v. Positions Filled Anesthesiology: 32 of 33 Anesthesiology*: 4 of 6 Child Neurology: 7 of 12 Dermatology*: 14 of 14 Emergency Medicine: 28 of 28 Family Medicine: 55 of 59 Internal Medicine: 169 of 169 Internal Medicine/Pediatrics: 13 of 13 Neurological Surgery: 5 of 5 Neurology: 17 of 18 Obstetrics and Gynecology: 32 of 32 Orthopedic Surgery: 19 of 19

Now Available Free!

Otolaryngology: 9 of 9 Pathology: 17 of 20 Pediatrics: 74 of 74 Physical Medicine and Rehabilitation: 6 of 6 Plastic Surgery (Integrated): 4 of 4

Register online at StLouisMedicalnews.com to receive your FREE new digital edition of Medical News optimized for your computer, tablet and smart phone!

Plastic Surgery*: 2 of 2 Psychiatry: 31 of 31 Radiation Oncology*: 4 of 4 Radiology-Diagnostic: 9 of 11 Radiology-Diagnostic*: 21 of 24 Surgery-General: 32 of 41 Transitional Year: 8 of 8

You will continue to receive your monthly print copy in the mail, but now Medical News will be available to you wherever you go.

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Vascular Surgery: 1 of 1 *PGY-2 SOURCE: National Resident Matching Program

Editor’s note: Next month, St. Louis Medical News will address the 30 unfilled residency slots in the state.

AMA’s Short List Nationally, to help fill the gap between first-year residents and residency slots, the American Medical Association (AMA) in mid-January announced a $10 million competitive grant initiative, “Accelerating Change in Medical Education,” to be distributed over the next five years to fund projects that support a significant redesign of undergraduate medical education. Eighty-two percent of the nation’s 141 accredited medical schools submitted proposals.

At its annual meeting in June, the AMA selected 28 applicants to submit full proposals. Of those, only three schools are in Medical News markets, two in North Carolina and one in Florida. Missouri was not on the list.

Medical schools invited to submit full proposals: • Duke University School of Medicine • Florida International University Herbert Wertheim College of Medicine • Indiana University School of Medicine • Jefferson Medical College of Thomas Jefferson University • Mayo Medical School • Michigan State University College of Human Medicine • New York University School of Medicine • Oregon Health & Science University School of Medicine • Pennsylvania State University College of Medicine • Rush Medical College of Rush University Medical Center • Sanford School of Medicine of the University of South Dakota • Southern Illinois University School of Medicine • State University of New York

Upstate Medical University College of Medicine • The Brody School of Medicine at East Carolina University • The Warren Alpert Medical School of Brown University • University of California - Davis School of Medicine • University of California - San Francisco School of Medicine • University of Colorado School of Medicine • University of Connecticut School of Medicine • University of Massachusetts Medical School • University of Miami Leonard M. Miller School of Medicine • University of Michigan Medical School • University of Minnesota Medical School • University of Toledo College of Medicine • University of Utah School of Medicine • University of Wisconsin School of Medicine and Public Health • Vanderbilt University School of Medicine • Yale University School of Medicine Collaboratives: • Baylor College of Medicine Texas A&M Health Science Center College of Medicine • University of Minnesota Medical School University of California - San Francisco School of Medicine University of Colorado School of Medicine University of Utah School of Medicine • Texas Tech University Health Sciences Center School of Medicine Medical College of Wisconsin Mercer SOURCE: American Medical Association.

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Q&A with Bob Heaney, cont. from page 12 Ten to 15 years ago, training in geriatrics began to count as a primary care specialty, and Medicare paid a little more to teaching hospitals for GME expenses.

Instead of $35,000 for a resident FTE in a specialty area, it’s $38,500 for a primary care internist, family medicine physician, pediatrician and geriatrician. About a year ago, they also made general surgery a primary care discipline. It surprised a lot of people, but if you look at the physician workforce, many understand the population is growing faster than physicians are available to serve them. The number of general surgeons has been steadily decreasing over the last five to 10 years, and they’re becoming increasingly scarce. One reason why: the practice of surgery has become sub-specialized, so fewer physicians are remaining general surgeons. Even though there’s a need for cardiovascular, colorectal, and pediatric surgeons, there’s also a need for general surgery. Medicare has been taking some action. stlouismedicalnews

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How has the federal freeze on residency positions since 1997 impacted medical schools?

As a teaching hospital, you can add resident positions. Most places have been adding GME positions over their cap, on their own bottom line. State institutions are supporting some of it. Private institutions are doing it because it’s the right thing to do and it’s in their best interest in terms of providing better patient care and being recognized as a competitor in their market. The piece that isn’t as well understood is that hospitals that don’t have a medical GME cap on their cost report are technically called ‘virgin hospitals.’ If they were to get into the GME business, they’d have to build the infrastructure to do it right, and helping them do that is one of the things we’ve been able to do as a School of Medicine. Medicare can freeze existing positions, but by law, if a hospital that doesn’t previously have positions decides to get into the game to allow those new positions, there’s a way to build out.

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AUGUST 2013

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ICD-10: Are You Ready?

By BILL HEFLEY, MD

With the rapidly approaching ICD-10 ‘go live’ date of October 1, 2014, medical practices should be well on their way in preparing for the transition. With implementation of ICD-10, physician offices accustomed to the 13,000 ICD-9 codes must be prepared to transition seamlessly to a new set of 68,000 codes. More specifically, a physician or billing clerk currently using ICD-9 to properly code the diagnosis of ‘patella fracture’ must choose between two possible codes; when utilizing ICD-10 that number explodes to 480 codes. Yes. Get ready.

In 1992 the World Health Organization (WHO) published the International Classification of Diseases, Tenth Revision.

The U.S. made modifications to the WHO ICD-10 creating the ICD-10-CM (Clinical Modification) which is the diagnosis code set that will replace ICD-9-CM Volumes 1 and 2. The Department of Health and Human Services (HHS) published a regulation requiring the replacement of ICD-9 with ICD-10 and later pushed back the compliance date one year to October 1, 2014. Farzad Mostashari, MD, the National Coordinator for Healthcare Information Technology, asserted last month that there would be no extension of the deadline.

While many physicians see the transition to ICD-10 as an unnecessary burden, other physicians and industry stakeholders believe that the ICD-9 code sets are obsolete and inadequate. ICD-10 codes have more characters and a greater number of alpha characters creating space for new codes and flexibility for future medical advances. ICD-10 has increased specificity that will improve the ability to identify diagnosis trends, public health needs, epidemic outbreaks, and bioterrorism events.

In addition, ICD-10 will improve claims processing, quality management and benchmarking data.

A successful ICD-10 transition requires exhaustive preparation by medical practices. Yet recent research by the Medical Group Management Association indicates that only 4.7 percent of practices reported that they have “made significant progress” when rating their “overall readiness level for ICD-10 implementation.”

The research was derived from respondents in 1,200 medical practices in which

Myths Associated with ICD-10 The Go-Live date will most likely get delayed again The only staff members affected will be coders and billing specialists My EMR and PM vendor will be automatically compliant General Equivalence Mappings are a good solution to coding an individual clinical chart After October 1, 2014 payers and clearinghouses will aid practices by automatically cross-walking submitted 9 codes to 10 codes

more than 55,000 physicians practice.

Preparing to practice medicine in the world of ICD-10 is no small undertaking.

It will require time and money. Having an experienced billing clerk “coder” in the practice will no longer be sufficient to generate accurate codes. Simply converting the practice’s ICD-9 superbill to ICD-10 is problematic. Many industry experts don’t see the superbill being preserved at all. The American Academy of Professional Coders (AAPC) recently issued a two page ICD-9 superbill which when crosswalked to ICD10 became nine pages long. Another industry consultant sites an example of a two page ICD-9 superbill translating into a 48page ICD-10 superbill.

Preparation for the medical practice begins with internal training and testing of all parties involved in producing proper coding. Administrators must establish a training and implementation schedule; set deadlines; create a project team; identify training resources; perform documentation gap analysis; evaluate and modify the practice’s forms; budget for transition expenses; communicate with practice management (PM) software and EHR vendors; assess hardware and software update requirements; and arrange testing with clinical and billing staff, PM and EHR vendors, clearinghouses and major health plans.

Providers must be trained on the changes

in clinical concepts and the level of detail in ICD-10, so that their documentation supports the ability to code to the highest level of detail. For many specialties, it is highly recommended that physicians take anatomy and physiology refresher courses. Billing staff must increase their knowledge of anatomy and physiology, learn and adopt a completely different coding system and be able to code to the greatest level of detail.

Training options include sending staff for offsite training, hiring an outside trainer to come to the practice, online training, webinar training and book-based training.

Frequent testing and trial coding for all staff is also highly recommended in the months leading up to the ICD-10 ‘go live’ date.

In addition to internal preparation, medical practices must also arrange testing with their PM vendor, EHR vendor, clearinghouse and major health plans.

Many PM vendors and EHR vendors will not be ready to meet the October 1, 2014 ICD-10 compliance date. Practices must communicate with their vendors months in advance to schedule software upgrades and testing to assure readiness. If the practice’s PM or EHR vendor is not going to be prepared for the ICD-10 launch, the practice will need to make plans to switch in time for the transition date. Many practices with in-house billing departments will weigh the benefits of outsourcing the practice’s revenue cycle management.

Costs associated with the preparation for the ICD-10 transition are not insignificant. Industry experts suggest budgeting $200,000 to $280,000 for an eight-physician practice. Expenses include training, testing, hardware upgrades and PM/EMR software upgrades. In addition to the one-time costs associated with implementation, many practices will experience ongoing, recurring costs related to the need for increased coding staff, consulting services, subscriptions to print and software-based coding aids and reduced productivity as a result of increase need for documentation and coding complexity.

The ICD-10 transition will undoubtedly eclipse Y2K and the HIPAA 4010 to 5010 transition in terms of the impact on the healthcare industry. Unprepared practices will face painful disruptions in cash flow and a chaotic scramble to regain practice productivity. Even well-prepared practices that execute ICD-10 implementation flawlessly will likely experience some disruption in cash flow. Remember, a successful revenue cycle requires every entity in the claims processing chain to be fully prepared for ICD-10. The PM system, EMR system, clearinghouse and payer must all communicate properly electronically and adjudicate ICD-10 claims correctly. Some bugs are inevitable. Practices should have in place a line of credit sufficient to cover three months operating expenses prior to ‘go live.’ Preparation will take considerable planning, time and money and should begin immediately. October 1, 2014 is just around the corner.

Bill Hefley, M.D., is President and CEO of MedEvolve, providers of Practice Management Software, EHR, and billing services to thousands of physicians across the US. In addition, he has an orthopedic surgery practice in Little Rock, specializing in minimally invasive surgeries for the knee, hip and shoulder including arthroscopic and joint replacement procedures.

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PUBLISHED BY: SouthComm, Inc. CHIEF EXECUTIVE OFFICER Chris Ferrell PUBLISHER Jackson Vahaly jvahaly@southcomm.com ASSOCIATE PUBLISHER Larry Henry lhenry@medicalnewsinc.com Ad Sales: 314.917.6107 NATIONAL EDITOR Pepper Jeter editor@medicalnewsinc.com LOCAL EDITOR Lynne Jeter lynne@medicalnewsinc.com CREATIVE DIRECTOR Susan Graham susan@medicalnewsinc.com 931.438.8771 GRAPHIC DESIGNERS Katy Barrett-Alley Amy Gomoljak Christie Passarello CONTRIBUTING WRITERS Lynne Jeter, Cindy Sanders, Lucy Schultze ACCOUNTANT Kim Stangenberg kstangenberg@southcomm.com CIRCULATION subscriptions@southcomm.com —— All editorial submissions and press releases should be emailed to: editor@medicalnewsinc.com —— Subscription requests or address changes should be mailed to: Medical News, Inc. 210 12th Ave S. • Suite 100 Nashville, TN 37203 615.244.7989 • (FAX) 615.244.8578 or e-mailed to: subscriptions@southcomm.com Subscriptions: One year $48 • Two years $78 SOUTHCOMM Chief Executive Officer Chris Ferrell Chief Financial Officer Patrick Min Chief Marketing Officer Susan Torregrossa Chief Technology Officer Matt Locke Business Manager Eric Norwood Director of Digital Sales & Marketing David Walker Controller Todd Patton Creative Director Heather Pierce Director of Content / Online Development Patrick Rains St. Louis Medical News is published monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm, Inc. ©2013 Medical News Communications.All rights reserved. Reproduction in whole or in part without written permission is prohibited. Medical News will assume no responsibilities for unsolicited materials.

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Financial Rx with Dr. Bob

Orthopedic surgeon turned financial advisor lends insight into retirement planning for physicians selling practices

By LYNNE JETER

With more than half the nation’s hospitals planning to acquire medical practices this year, physicians contemplating a switch from practice partner to hospital employee will benefit greatly from focusing on an often overlooked key component of the due diligence process: retirement planning.

“Much of the information available on the sale of medical practices deals with the technical considerations – how to prepare the practice for sale, how to value the practice, and what the documents should specify – while retirement planning may be in the afterthought category,” said Bob Tucker, MD, a former orthopedic surgeon, now an accredited Dr. Bob investment fiduciary and Tucker vice president of Plancorp, a CEFEX-certified financial advisory firm based in St. Louis. “Going to work for a new employer, you have to come up with perhaps a whole new way of funding a retirement plan. Dollars you’ll be saving going forward will likely be handled differently than with money already saved.”

St. Louis Medical News spoke with Tucker, known as “Dr. Bob,” about insights into physician retirement planning, his shift from practicing medicine to financial planning, and the sometimes tricky business of securing the right financial advisor.

When physicians are considering selling their practice, what are some important considerations for retirement planning?

If the transaction to sell the practice results in a “liquidity event” and the physician will receive a significant lump sum, the overlying theme is ‘what are you going to do with the money?’ Is it money you intend to live on? Give to your children? To charity?

There may also be a lump sum in the retirement plan of the physician’s practice that may have to be dealt with. Most retirement plans today are a combination of profit-sharing and 401k plans. If a physician who owned a corporation (or was an employee of an owned corporation) had a retirement plan such as that, a number of decisions need to be made. It’s possible the previous employer might still be in business, even if the practice has been sold and there may be some mechanisms whereby the retirement plan can remain in place. It’s also possible to take that retirement plan balance as a lump sum and roll it over into an IRA. Or also roll it over into the retirement plan with the new employer. There are some circumstances where some or all of the balance might be taken out of the plan as a distribution. stlouismedicalnews

It’s not always a straightforward decision.

This is where tax implications investment selection and the cost to maintain an account all must be considered.

For example, if I have a practice with a profit-sharing plan and a 401K and I’ve got a large sum of money, I’ll look carefully at the options the new employer offers, which may be very low cost and provide a good option for investing moving forward. The opposite could also be true, with the options not being very good. Perhaps they’re high-cost investments, not carefully monitored, and not consistent with my investment strategy.

In a situation like that, it may be better to roll over that lump sum into an IRA that I am responsible for managing. Am I comfortable managing the money myself?

Do I already have a relationship with a financial planner or advisor who can manage that money for me? Can I do it in an efficient way that’s still likely to improve my chances of a successful retirement?

Physicians are sometimes reluctant to ask for financial planning assistance. Why?

Anecdotally, my impression is that physicians by their training are taught to make decisions on their own. They’re taught to think in terms of making important decisions in a crisis situation very quickly. Those are a couple of reasons why physicians tend not to seek the advice of a financial advisor.

That said, more physicians today seem to be concerned with lifestyle than when I went through training 30 years ago. They want to concentrate on their family and practice and they’re more willing to turn over their financial affairs, or at least get help.

The MedEvolve Solution Fully Integrated EHR/PM/RCM ICD-10 Ready n Turnkey Billing and Collections n Improved Bottom Line n Peace of Mind n

The choice of a financial advisor is also interesting. Physicians are taught to be very trusting. We tend to believe what our patients tell us. We tend to try to develop a relationship of trust with our patients. I think physicians at times take that same premise of trust into their personal relationships when maybe they need to be a little bit more cautious. Physicians historically have been a target because they have very high income, and very good prospects for more income. Let’s face it.

Physicians always don’t have the best reputation as businessmen.

With various structures available concerning the management of retirement investments, what should a physician consider?

Going to work for a new employer, especially a not-for-profit organization or large corporation, will likely entail the need for a very thorough review of not only their retirement plan and salary deferral options, but also of their entire benefit plan offering. This can be time consuming and confusing for someone not experienced in looking at these options.

to Jeff’s philosophy. As I worked with him more, I learned a lot, and referred some of my associates and a number of family members to him.

Jeff approached me about the possibility of doing something like this when I was ready to leave medicine. He dangled that carrot in front of me. I went back to school and got my graduate business degree. About seven years ago, I left my orthopedic practice because it was the right time for various reasons, none of them to do with the practice itself. I’d accomplished goals for myself that I had established, and finished some projects for my group and was looking for another challenge. I joined Plancorp as an advisor, the firm where my wife and I had been clients for years.

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Not many MDs are financial advisors. What sparked your interest in making a change?

I met Jeff Buckner (founder and chairman of Plancorp) very early in my career.

He was about my age, just starting a financial advisory practice. He had a unique twist in that he wasn’t selling products at all, which was very unusual in the early 1980s. Most financial advisors at that time had a commissioned product at the end of their financial plan. I was very attracted

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MedEvolve offers the complete solution for the medical practice: Electronic Health Records, Practice Management Software and Revenue Cycle Management. See why thousands of physicians trust MedEvolve as their practice partner.

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“MedEvolve’s PM software and Revenue Cycle Management services have absolutely improved our practice’s collections. MedEvolve really does stand out not only in software performance, but particularly in customer service.”

- Barry S. Seibel, MD Ophthalmic Surgeon Beverly Hills, California

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