Oncall 16 q2 final

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QUARTER TWO 2016 THE OFFICIAL PUBLICATION OF THE PALM BEACH COUNTY MEDICAL SOCIETY

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QUARTER TWO 2016THE OFFICIAL PUBLICATION OF THE PALM BEACH COUNTY MEDICAL SOCIETY

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James Goldenberg, MD President, Palm Beach County Medical Society

President’s Report

I’ve always enjoyed watching baseball. I’m fascinated by the intricate details of the game. I remember the excitement of seeing a stolen base, a successful bunt, or a suicide squeeze play. When playing Little League, I always hoped to execute one of those plays. I practiced and practiced. I learned the signs. During the game, I looked to my coach to make the call.

It seems that to play good ball--you need a good coach. Someone needs to lead the team and make the calls. I’ve often wondered what qualities make a good coach. It seems that one of the most useful qualities of a professional baseball manager is having previously been a professional baseball player.

In 2014, 83% of baseball managers were former players. Significant proportions of coaches in the NHL and the NBA are former players. It has become evident that in order to best lead the team, at some point you must have played on the team.

As I think about medicine and the intricate details of our profession, I wonder what makes a good healthcare leader. The quality I’d like to suggest as most valuable is to have been the lead player on the team--a physician. Who better to lead and coach the medical team?

Healthcare leaders are an experienced and well-trained group. While physicians are one of the most highly trained and rigorously educated professionals, their leadership skills are often self-taught.

The thought of additional training or going back to school can be daunting. Physicians are a busy and hard-working group. It takes discipline to keep up to date on the knowledge required to practice high-quality and safe medical care. Regardless, some physicians choose to get an additional degree to hone their leadership skills. A Masters in Business Administration can take years to accomplish.

There are other opportunities to test the waters of healthcare leadership. The Palm Beach County Medical Society is committed to Physician Leadership training. We would like to create a talented pool of physician leaders to help navigate the changing healthcare landscape.

We are proud to announce the creation of the Palm Beach County Medical Society Physician Leadership Training Program. Funded through a sizable initial grant from the Physician’s Foundation, this program will focus on enrolling and training a diverse group of future physician leaders in South Florida.

Let’s take the talented players who want to become coaches and begin to give them the skills to lead. Let us lead each other with the same expertise and talent we apply to our patients. Let us not depend solely on others to guide us. We should salute our healthcare leaders, we should appreciate them, we should learn from them, but we should not forget that they have never successfully executed a triple play--and we have.

To learn more about physician leadership opportunities, please call the Palm Beach County Medical Society or visit our website at PBCMS.org.

QUARTER TWO 2016 ON CALL MAGAZINE 3

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Since the rates for workers’ compensation insurance are set by the state, prices are the same no matter where you secure coverage. But now, you are eligible for this enhanced 30% dividend, which effectively reduces the true cost of coverage. Other programs may offer similar dividends on an individual basis, but our program is based on the group’s experience and not the individual’s experience. This provides a better chance to not only receive the dividend, but to receive a higher dividend.

AmTrust North America (formerly Comp Options) has been a true partner to the Palm Beach County Medical Society for many years, and now, with the resources of AmTrust - rated “A” (Excellent) by A.M. Best - we are able to provide this exclusive enhanced dividend program that is like no other for Florida physicians and medical practices. To date, these programs have returned a dividend for 12 straight years, with over $8 million over the past five years to Florida medical associations’ members: $1 million of that went to PBCMS members.

The PBCMS Workers’ Comp Insurance Program Has a New Name and an Enhanced Dividend!

All current and new Palm Beach County Medical Society members are eligible for an enhanced dividend of up to 30%.

PBCMS members have received over $1 million and counting!

For more details and to enroll in this beneficial program, please contact Tom Murphy of Danna-Gracey at 800-966-2120, or [email protected].

Delray Beach • Jacksonville • Miami • Orlando • Panama City • [email protected] • 800.966.2120 • www.dannagracey.com

There are many ways you could be wasting money on your malpractice insurance

Isn’t it time you called Matt Gracey, the med mal insurance expert?

Did you know that most doctors unknowingly waste money on malpractice insurance, which is one of the largest expenses in a medical practice each year? Some of the most common ways doctors continually spend too much include:

#6. Not working with the right agent or brokerFind an independent agent specializing in malpractice insurance placement

for your type of practice setting (solo, group, hospital, surgical center, etc.) and one who has an educational approach versus a sales orientation. Your agent should be strong enough within the malpractice insurance marketplace to fully and competently negotiate the best rates for you with the top insurers in your state. With such a large expense and such costly mistakes possible, you deserve the best available assistance.

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QUARTER TWO 2016 ON CALL MAGAZINE 5

Board of Directors James Goldenberg, MD

President

Shawn Baca, MD President-Elect

Brandon Luskin, MD First Vice-President

Marc Hirsh, MD Secretary

Larry Bush, MD Treasurer

Stephen Babic, MD Immediate Past President

Roger Duncan, MD Member at Large

Tulisa LaRocca, MDMember at Large

Michael T.B. Dennis, MDAlan Pillersdorf, MDSumathi Raja, MD

Mark Rubinstein, MDRobert Tomé, MD

Frederick Williams, MDJack Zeltzer, MD

Ronald Zelnick, MDKelly Conroy, Public Member

Matthew Uhde, DO Resident

Christina Mesoraca, Medical Student

Board of Trustees Jack Zeltzer, MD Chair Jose F. Arrascue, MDStephen Babic, MD

Shawn Baca, MDMalcolm Dorman, MD

James Goldenberg, MD K. Andrew Larson, MD

Alan Pillersdorf, MD Ronald Zelnick, MD

Mark Rubenstein, MDBrandon Luskin, MD

PBCMS StaffTenna Wiles, CEO

[email protected]

Deanna Lessard, Director of Member Services & Education

[email protected]

Helena Wiley, Finance

[email protected]

Mindi Tingler, Communications Director

[email protected]

Lauren Stoops, Project Access Program Director

[email protected]

Graciela Gordillo, Project Access System Coordinator

[email protected]

Karen Harwood, MSW, CCM, Care Coordinator

[email protected]

John James, Director of Disaster Services

[email protected]

Stuart Miro, MD, Triple Aim Diabetes Initiative

[email protected]

Jim Sugarman, Development Coordinator

[email protected]

Gwendolyn Marrero, Care Coordinator

[email protected]

Katherine Zuber, Administrative Assistant

[email protected]

Patricia Beeler, Administrative Assistant

[email protected]

Jane Scaturro, Administrative Assistant

[email protected]

On Call Magazine is designed by Forming Brands

[email protected] or www.formingbrands.com

Subscriptions to On Call are available for an annual rate of

$50. For more information contact PBCMS at (561) 433-3940.

The opinions expressed in On Call are those of the individual

authors and do not necessarily reflect official policies of

Palm Beach County Medical Society or its committees.

On call is owned and published four (4) times per year by Palm

Beach County Medical Society, Inc., Forest Hill Blvd., #101,

West Palm Beach FL33406. (561) 433-3940 & (561) 276-3636.

©Copyright 2013 Palm Beach County Medical Society, Inc.

Features

06 Heroes in Medicine

10 Smile! The Doctor Is on Camera: The Pros and Cons of Recording Office Visits and Procedures

12 Today’s Physician Leaders Need Capacity to Listen, Understand and Offer Perspective.

17 Need a Loan for Your Medical Practice? Do a Financial Check-Up Before Applying

19 Accelerate Patient Payments for a Healthy Revenue Cycle

Articles

03 President's Report

21 Med Memo

Contents

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HIM 2016 Chair Nancy Proffitt HIM 2016 Co-Chair Dr. Michael Gervasi

Rhona Pillersdorf, Dr. Alan Pillersdorf,

Richard Rendina, David Rendina

Dr. Larry Bush and Dr. Maria Vazquez-Pertejo Dr. Paco Arrascue and Dr. Alan Pillersdorf (Susan Kaplan photo)

Dr. James Howell, Dr. Charles Flack,

Dr. David Weinstein, Dr. Steven Borzak,

Dr. Hedy Etzael Zaghi, Dr. Rizwan Karatela,

Dr. Benjamin Sakethou

Dr. Jack Zeltzer, Dr. Michael Dennis, Dr.

James Howell presenting Dr. Alonso with

the PBCMSS Hero of the Year Award

Dr. Alan Pillersdorf, Gina Melby, Dr. Kishore

Dass, Dr. Maureen Whelihan, Dr. Alonso

preseting story of how working together

they helped a Project Access patient

With close to 500 people in attendance at the Kravis Center’s Cohen Pavilion, the PBC Medical Society Services honored 41 extraordinary men, women and organizations at the 13th Annual Heroes In Medicine luncheon on Friday, April 15. Individuals and organizations in health care that provide outstanding service to meet needs of people in local, national and/or global communities were recognized.

Dr. Alina Alonso, Director of the PBC Health Department received the Hero In Medicine of the Year award.

Nancy Proffitt, CEO of Proffitt Management Solutions and Michael Gervasi, DO, President and CEO of Florida Community Health Centers, Inc. served as Chairs for the 2016 Heroes in Medicine Awards, Dr. and Mrs. Alan Pillersdorf served as honorary hosts and Rendina Healthcare Real Estate Rendina Health Care Real Estate were the founding and presenting sponsors.

Proceeds from Heroes In Medicine 2016 support Project Access of the Palm beach County Medical Society which provides pro bono care to uninsured children and adults of Palm Beach County.

To read and view a video on the Heroes please go to PBCMS.org

To submit a nomination or become a sponsor for Heroes In Medicine 2017 which will be held on Friday, April 21, 2017 please call 561-433-3940 ext. 17.

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Health Care Provider (Non- Physician)

Bruce Rendina Professional

Student

Healthcare Prevention / Wellness

Project Access

Physician

David Weinstein, MD

Liliana Herrera

Jaime Estremera-Fitzgerald

Steven Borzak, MD Florida Cardiology Group

Palm Beach County Parks and Recreation Department

Health Care Innovation

Andrea Wilson

Christian Moseley

Charles E. Flack, MD

Rita Thrasher Boca Raton's Promise

Robert Parkes, MD

Hedy Etzael Zaghi, MD

Robbin Lee

Julie SwindlerFamilies First of

Palm Beach County

Rizwan Karatela, MD

Denise Bober, Pat CiavolaThe Breakers

B. Benjamin Saketkhou, MD

Community Outreach

John Strasswimmer, MD

Andrew Quinlan

Nicklaus Children's Foundation

Healthy Mothers, Healthy Babies Coalition of Palm Beach County, Inc.

Tommy Schechtman, MD

Wilgens Mistiliens

Florida Institute for Health Innovation

Gary PetersBoca Helping Hands

Health Care Educator

Gerald Robinson, MD

Roy Foster

Jane Miller

Bernardo Obeso, MD

Ferial Andre

Gauri G. Agarwal, MD

William Kaye, MD

Margaret C. Donnelley

Valerie Fiordilino, PA

Marta Galvez

Alina Alonso, MD

Arthritis Foundation

Becky Dymond

Mark Brody, MD

Don Chester Mitch Feldman

2016 Heroes in Medicine

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Smile! The Doctor Is on Camera: The Pros and Cons of Recording Office Visits and Procedures

By Rich Cahill, Vice President and Associate General Counsel, The Doctors Company

“Doctor, can I record our conversation today?”

Have you ever heard that question from a patient or a patient’s family member? The issue of allowing patients to record their appointments requires balancing potential privacy and liability risks with the potential benefits of improved patient recollection of instructions and treatment adherence.

It’s typically not the best course to allow patients to record the appointment. The recording devices could be disruptive and could be potentially intimidating to physicians and staff. In addition, these recordings—unlike the electronic health record—can be altered or manipulated to create an inaccurate portrayal of what actually occurred. These recordings can also easily be streamed or posted online, raising the issue of patient and staff privacy and HIPAA compliance. In addition, recording the visit may inhibit the flow of information between the doctor and patient. Patients may be less likely to be open about sensitive health issues because of the fear that the recording might be listened to by an outside party.

If a patient records a visit without the doctor’s permission, that can result in a loss of trust, which is the basis of a strong physician-patient relationship. Only about a dozen states nationwide prohibit electronic recordings done without the explicit consent of all participants in the encounter. It is important to know the specific laws concerning recordings in the jurisdiction where you practice. Regardless, it is recommended that patients be advised unequivocally that digital recordings by handheld devices such as smartphones are prohibited on the premises in order to protect the privacy of other patients and staff in compliance with federal and state privacy laws.

Post this notice clearly on your practice website, in the conditions of treatment signed by the patient at the outset of the relationship, and as office signage near the reception window. Suspected violations should be handled immediately. If this policy is violated, meet with the patient in a confidential setting to discuss the issue and reiterate the office policy. Depending on the circumstances and the status of the patient’s current episode of care, advise the patient that further violations may result in termination of the physician-patient relationship.

If patients ask to record the visit, encourage them instead to take notes or to have a trusted family member or friend join them for the office visit to help take notes, remember information, and ask questions. Doctors can also encourage patients to be engaged in the conversation with “Ask Me 3,” a program that promotes clear communication through these three main questions:

1. What is my main problem?2. What do I need to do?3. Why is it important for me to do this?

Doctors should also ask patients to repeat back the information shared, and then correct any misunderstandings.

Contributed by The Doctors Company. For more patient

safety articles and practice tips, visit www.thedoctors.com/

patientsafety.

QUARTER TWO 2016ON CALL MAGAZINE8

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End-of-Life Care Conversations: Medicare Reimbursement FAQs

1. Do these new codes need to be used in the context of an illness?

No. In fact, any medical management must be billed separately.

2. What are the new advance care planning (ACP)codes from CMS that became active in 2016?

99497 – ACP, including the explanation and discussion of advance directives, such as standard forms (with completion of such forms, when performed), by the physician or other qualified health professional

99498 – Each additional 30 minutes (list separately in addition to code for primary procedure)

3. How much time must be spent to use the new codes?

More than half of each interval must be used. For example:

• Use 99497 if you meet or exceed 16 minutes. • Use 99497 + 99498 if you meet or exceed 46 minutes.

4. Does the conversation have to be in-person to use the new codes? Does it have to be with the patient?

The conversation has to be in-person (you cannot use the code for telehealth), but it doesn’t have to be with the patient. It can be with a surrogate or family members.

5. What are the documentation requirements?

• Total time in minutes• Patient/surrogate/family “given opportunity to decline”• Details of content (e.g. Who was involved? What was

discussed? Understanding of illness, spiritual factors. Why are they making the decisions they are making? Was any advance directive offered/filled out? Follow-up)

6. What costs might patients incur from these codes?

When a provider discusses advance care planning with a patient at his/her Annual Wellness Visit, there is no cost to the patient. However, if the provider has an ACP conversation at other times, Part B cost sharing applies and the patient may be responsible for copay/coinsurance.

7. How much do payers reimburse for these codes?

99497 = 1.5 RVUs99498 = 1.4 RVUs

8. Are there limits to the number of times that the new codes can be used?

There are no limits to the number of times the codes can be used. ACP can be readdressed as needed with a change in condition. Each time they are used, 99497 should be used for the first 30 minutes and 99498 should be used for each additional 30 minutes.

9. Which health care providers can be reimbursed for having ACP discussions with patients under the new rule? Can physicians charge for the codes if another staff member engages the patient in the ACP discussion?

Physicians (MDs and DOs), nurse practitioners (NPs), and physician assistants (PAs) (i.e. those who are authorized to independently bill Medicare for Current Procedural Terminology (CPT) services) are the only providers who can use these codes.

“Incident to” rules apply in the outpatient setting. This means that a provider can use these codes if they perform an initial service and a non-billing team member (e.g., registered nurse, social worker) helps deliver part of the service, with ongoing direct supervision and involvement of the billing provider. Example: The physician starts an ACP conversation, then says, “I’d like to introduce you to our nurse who will talk with you about choosing a surrogate medical decision maker and discuss with you how you might have a conversation with that person,” then debriefs afterwards with the patient. Work with your local billing expert regarding “incident to” rules.

10. How can physicians bill for these conversations for non-Medicare patients?

If the patient has private insurance, find out if ACP conversations are covered. Otherwise, you can use “counseling and coordination of care” codes, but only in the context of a serious illness.

The changes in Medicare reimbursement policy that went into effect January 2016 provide an opportunity for more clinicians and patients to engage in conversations about preferences for care at the end of life. However, many people are confused about where to start. Whether you are uncertain about the new rules for CMS reimbursements or about starting those conversations with patients, this document will help you understand this new landscape for end-of-life care conversations.

Before getting started, check to see if a local coverage determination has been made, and check with your local billing expert to ensure your practice is compliant with their recommendations. Make sure that the new reimbursement codes have been added to your system’s billing apparatus. These codes may not be available until your facility approves them for use.

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Having the Conversation at Three Life Stages: A Guide for Providers

No Serious Illness Serious Illness Advanced Serious Illness

Sample Case Progression

Ms. Smith is a 68-year-old woman with hypertension, hyperlipidemia, and history of smoking. She was recently diagnosed with emphysema/COPD. She’s coming in for a routine follow-up for her hypertension with her daughter.

At age 71, Ms. Smith developed a COPD exacerbation, which turned into a pneumonia with significant shortness of breath. She was admitted to the hospital. She was sick enough to require BIPAP and was in the ICU. Eventually, she recovered and was discharged home. She is now in your office for routine follow-up.

Now 75 years old, Ms. Smith has had a couple admissions for less severe COPD exacerbations. She was eventually placed on home oxygen, and then about 2 months ago her illness seemed to progress. You talk more, and it becomes clear that she doesn’t want to have to go back to the hospital if it isn’t necessary. She really prefers to stay at home.

Conversation Goals

• Build trusting and respectful relationships

• Learn about the patient as a person

• Establish a surrogate decision maker

• Promote patient-surrogate-family conversations

• Continue to build trusting, respectful relationships

• Continue to learn more about the patient as a person

• Ensure a good understanding of diagnosis, prognosis, and treatment options

• Anticipate emergencies and make a plan when appropriate

• Promote patient-surrogate-family conversations

• Rely on the trusting, respectful relationships that were built

• Keep the focus on the patient as a person

• Ensure a good understanding of diagnosis, prognosis, and treat-ment options before introducing hospice

• Continue to hope for the best, but prepare for when things don’t go well

Examples of What to Say

• Normalize the conversation• Try starting it after family history

“Have you ever thought who would speak for you if you couldn’t speak for yourself? Is it ok if we talk about that?”• If they already have an advance

directive (AD):

“May I see it? What does it say?”

• If they do not have an AD:

“Can I offer you some tools to start thinking about it?”

• Talk about “what matters most”

“Can you tell me your understanding of what happened in the hospital?”

“What was that like for you?”

“How are you doing now?”

“If surrogate decision making was needed, how was that?”

• Identify the values that guided decision making, i.e., “what mattered most”

“You have been in and out of the hospital quite a bit. How has that been?”

“How do you feel about your quality of life?”

“Given everything that has happened, what are you hoping for?”

“Unfortunately, we don’t have any more treatments to help your lungs get better.”

“It seems to me what matters most to you is to [stay out of the hospital, control your symptoms at home, and make the most of each day OR stay out of the hospital but continue to receive treatment] and I think [hospice OR home care] is the best way of doing that.”

Billing Details

New Codes from CMS• Use 99497 if you meet or exceed 16 minutes • Use 99497 + 99498 if you meet or exceed 46 minutes

Documentation Requirements• Total time in minutes• Patient/surrogate/family “given opportunity to decline”• Details of content• Attending MDs and DOs, as well as NPs and PAs

(i.e., those who are authorized to independently bill Medicare for CPT services), are the only providers who can use these codes.

• If medical management billing is based on medical decision making, then you can bill as you normally would in that scenario. On top of that, you should also bill based on time spent for ACP.

• If instead you are billing for the medical management based on time, you should be sure you do not double count the time spent on the advance care planning conversation.

The information contained in this document is based on our best understanding of the new reimbursement codes. It is your responsibility to check with your local billing expert before using the new codes. Please review our full disclaimer of warranties and liability at http://www.ihi.org/pages/termsofuse.aspx

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Giving a lot to the little

561-630-0025 nchcf.org

59567_NCHCF_OnCall_Ad.indd 1 4/4/16 12:43 PM

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In today’s healthcare environment, physician leadership is of vital importance.

With pressure to increase care quality and lower delivery cost, physicians have to develop the skills to lead their staffs as well as get involved in healthcare policy and issues, local physician leaders say. They also have to begin embracing roles where they are directing activities in the boardroom.

But being a leader isn’t just about running teams in hospitals and medical offices. It’s also about being aware of what lies ahead and how one can turn changes and challenges into opportunities for providing better patient care.

Most physicians are natural leaders. They direct clinical care on the wards, in the emergency rooms, and in the offices. Still, not everyone is a born leader, of course -- and not everyone can be trained to become a physician leader. So the challenge for the medical profession is to identify potential leaders early on and then train and support them.

Physician leadership is important because physicians relate best to other physicians, and those who can learn the administrative side can help the healthcare system overcome one of its more persistent challenges – how to bridge the gap that can often exist between administration and clinicians, physician leaders say.

The good news is that many physicians are problem solvers, so moving into executive roles and improving the delivery of healthcare is something many find appealing.

And so, it’s not surprising that the American College of Physician Executives

Today’s Physician Leaders Need Capacity to Listen, Understand and Offer Perspective.By Leon Fooksman

reports that more than 5 percent of hospital CEOs are now physicians. That number is expected to grow rapidly under the value-based system, and as medical schools, including Duke University and University of Kentucky, are including medical leadership training, offering courses such as accounting and management training along with the clinical coursework.

What do our local physician leaders think about all of this?

Palm Beach County Medical Society has asked five physician leaders to define their qualities of a physician leader, and explain what they think are the advantages to being a physician leader. Those physicians are: Tommy Schechtman M.D., of Pediatric Partners, who is president of the Florida Chapter of American Academy of Pediatrics; Alan Pillersdorf, M.D., of Plastic Surgery of Palm Beach and former president of the Florida Medical Association; Carlos J. Lira, M.D., president and chairman of the Board of The Medical Specialist of The Palm Beaches; Steven Rosenberg, M.D., chairman of the Florida Board of Medicine; and Maureen Whelihan, M.D. of Elite GYN Care of the Palm Beaches.

What are the qualities of a physical leader in these changing times in the medical profession?

Tommy Schechtman M.D.: “One has to first recognize that change is inevitable and then embrace the opportunities it brings to improve the quality of healthcare and lives our patients and their families. Leaders need to believe in their own message with both conviction and passion. As physicians, our obligation is to advocate for our patients. As physician leaders, we must advocate for not only our patients by for our colleagues as well.”

Alan Pillersdorf, M.D.: “The qualities of a physician leader in these changing times include the following essentials: being a good listener. Not all Physicians have the same problems, and not all physicians understand where medicine is going. The forces of change in medicine are often promoted by non-physicians who don't practice medicine, and often are looking to save money, at the expense of the patients’ real needs. A physician leader also must be a good communicator.”

Carlos J. Lira, M.D.: “Having the capacity to listen, to understand and to be able to offer perspective. As a leader, you

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have to understand that the many changes occurring in healthcare are creating a genuine sense of frustration among our peers. Most physician concerns and complaints are valid and need to be heard. The key part isto be able to offer a positive perspective and more importantly, to make your colleagues realistically believe that many positive opportunities are arising from these changes -- opportunities that will allow them to continue to practice good medicine, while still being compensated fairly for their efforts.”

Steven Rosenberg, M.D.: “Physician leaders need to be knowledgeable about

the various vectors changing the course of medicine, whether it be Tallahassee, Washington, insurance industry, patients’ expectations, the role of the Internet, legal, etc. In order to be effective, you need to develop relationships with other leaders in all of these areas and hopefully have some influence due to established relationships.”

Maureen Whelihan, M.D.: “The physician leader must be able to evaluate the issues presented by peers as well as patients and find the best way to deliver quality, cost-effective care. One must understand that this is not a sprint but a marathon. Our progress is slow and steady and requires continual drive and commitment. The leader must be able to unite all physician types and relay the important message of participation; whether it be through membership, PAC or volunteering time.”

What are the advantages to being a physician leader?

Tommy Schechtman M.D.: “The rewards are numerous and include the fulfillment of being an innovative and strategic thought leader, being able to mentor the next generation of physicians, nurses and other essential healthcare workers and helping to ensure that our community’s children are healthy for their future success.”

Alan Pillersdorf, M.D.: “The advantages of being a physician leader is being able to mold policy and interact with bad rules and laws. I love being involved with the advocacy of the Florida Medical Association and interacting with elected officials. Physicians who are leaders, have to be willing to spend the time educating lawmakers, go to Tallahassee, and explain why that law is not good for patients or the practice of medicine. It is a big personal sacrifice to do that,

which involves many hours and no compensation -- except the satisfaction of helping physicians practice medicine. Together we are stronger. You can break one stick easily, lash 10 sticks together, and they can't be broken. Physicians must stand together.”

Carlos J. Lira, M.D.: “I believe the most important advantage, and quite possibly the only one, is the opportunity to be an active participant in the many changes that are occurring in the healthcare system. Once more, this is our profession, we know better. It is a major part of our very own day-to-day lives. We deserve to play a key roll. It is my sincere belief that there is no stronger advocate for patients, than their own physicians.”

Steven Rosenberg, M.D.: “The main advantage is to benefit our patients and the profession. There may be some personal satisfaction but there isn't room for egos. The benefit has to be satisfaction in accomplishing something that benefits the future of medical care.”

Maureen Whelihan, M.D.: “The greatest advantage is being at the forefront of change. Being a physician leader forces you to stay on top of all current issues in legislation and healthcare. Talking to peers creates ideas for change and improvement in healthcare for both physicians and patients. Participating at this level helps you understand issues that are unique to certain specialties that may normally go unnoticed. On the contrary, sometimes these issues are in direct conflict with those things you strive for as a physician. Learning that diplomacy takes years!”

Leon Fooksman is a writer for the On Call journal. Email him at

leon@digitalstoryline or tweet him at @compellingstory.

QUARTER TWO 2016 ON CALL MAGAZINE 13

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LEVI & ASSOCIATES I N S U R A N C E I N C .

Our Business is Helping Yours.Representing the Palm Beach County Medical Society

Exclusive Health Trust Plan for Physicians and their Practices2790 North Federal Highway, #300, Boca Raton, FL 33431

Office: 561.353.1234 x 103Cell: 561.445.7008

Email: Barry@LeviInsurance

www.LeviInsurance.com

Nancy Proffitt is an award-winning business growth expert, author and former Fortune 500 company executive.

Congratualtions!

Rosemary Xavier

2016 – 2017 AMA Alliance President

Active in the Alliance for over 20 years, Rosemary has served as Past President of the Palm Beach County Medical Society Alliance, and President of the Florida Medical Association

Alliance and as an Administrator for Florida Anesthesiology and Pain Clinic and advisor to RX Disc Inc.

Rosemary holds a bachelor’s degree in economics. She ismarried to Ravi Xavier, an Anesthesiology and Interventional Pain Management specialist, who is also board certified in

Critical Care Medicine. The couple resides in North Palm Beach, Florida. They have two children, both physicians.

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www.leviinsurance.com/
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Prime location at 2150 South Congress Avenue in West Palm

Beach (between Forest Hill Blvd. and 10th Avenue North just 10

minutes from JFK Medical Center, and 15 minutes from Wellington

Regional Medical Center.

• 2,000 square feet available. • Total square footage is 5,000 sq. ft- split office space with Dr. Graham Whitfield

(Orthopedic Surgeon) and Dr. Laura Kolshak (Orthopedic Surgeon- hand/wrist and forearm).

• Single story building with wheelchair access, fully ADA compliant. • Four exam rooms. • Front business office and back work station. • Employees lounge, kitchen and bathroom. • Large illuminated sign (5’x9’) in front of building facing South Congress Avenue,

ready for your name to be installed!

Contact Dr. Whitfield directly at 561-965-5200 (Office) or 561-315-9728 (Cell) E-mail: [email protected]

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A career as a physician involves years of education and training matched with high, steady income to bolster long-term success. Very few physicians go out of business, so why do some doctors struggle to get a practice loan?

With any business loan, multiple factors – personal and professional – affect whether a bank will approve practice financing. The process and requirements to buy new equipment, for example, is much different than obtaining financing to buy a practice. Consider these factors to help set you up for "yes" before you even apply.

Clearly state the purpose. Financing should align with the needs of the practice based upon a doctor's business plan and future goals. Are you buying or starting a new practice, updating technology, remodeling an office, or looking to sell your practice and retire? Each type of financing carries unique terms, fees, pre-payment options and interest rates. Along with the amount and type of loan (a fixed, long-term loan or a short-term line of credit), consider the payment terms (rate, down payment requirement, monthly payment, etc.) to ensure it is a good fit.

Gather financial documents. Business financing requires more than proof of income or earnings potential, and having the correct business and personal financial documents ready can decrease the time it takes from application to decision. A lender will request information such as two to three years of tax returns, profit-and-loss statements, curriculum vitae and personal assets and liabilities.

It is also important to build or maintain a high personal credit score before seeking a business loan. This is especially important for doctors whose student loan debt from medical school can impact the

ability to start a practice. A lender will create a Global Debt Service Coverage Ratio for the applicant that includes personal (student loans, mortgages, car loans, etc.) and business expenses to ensure that the applicant's cash flow meets a minimum debt-to-income benchmark and that current and future revenue can cover all debts. This ratio helps a banker determine eligibility for credit.

Work with a specialist. Healthcare bankers understand the complexities of payments, insurance and other factors affecting a medical practice's revenue and value. This is especially important when buying or selling a practice, because the specialist will work with a healthcare appraiser who can best determine the practice's Fair Market Value (FMV). FMV uses practice location, marketability, net income margins, number of active patient records, number of new patients monthly and collection sources, setting a mark

for what a buyer or seller can reasonably expect in a transaction.

Apply weeks in advance. The underwriting and approval process timeframe can vary greatly based upon the loan amount and deal structure. For practice acquisitions, buy-ins and start-up financing requests, it is best to apply for financing 30-45 days prior to your estimated closing date. Commercial real estate loans or mortgages often require 60-90 days. Most lenders will hold approvals for 90 days, so apply early and ensure funding is in place before signing contracts or hiring legal assistance.

Preparation and using a reliable, expert resource such as a healthcare specialist banker can take the headaches out of obtaining financing for your medical practice. Understanding the factors that help you achieve approval means you can refocus faster on patient care, billings and more.

Need a Loan for Your Medical Practice? Do a Financial Check-Up Before Applying

By Nicole Hibbs, Business Relationship Manager, and Mike Estes, Healthcare Specialist, TD Bank

QUARTER TWO 2016 ON CALL MAGAZINE 17

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877-227-3890NR#: 30211200/30211245/30211416 HHA#299994406 (Region 9)

www.HorizonCareServices.com

The Health Care District of Palm Beach County launched the county’s Trauma System in 1991. Since then, the dedi-cated professionals in the system have provided care to over 60,000 residents and visitors who suffered life-threat-ening traumatic injuries.

Our pilots fly the two Trauma Hawk air ambulances that transport patients rapidly and safely to the two Trauma Centers in the county – at St. Mary’s Medical Center and Delray Medical Center. We keep the aircraft at the ready, 24/7, at our Trauma Hangar in West Palm Beach. Our Trau-ma Agency funds the system, conducts trauma-awareness programs in the community, monitors quality, and ensures clinical coordination.

When you need us, we’re there! Every year the Health Care District and Dori Slosberg Foundation co-sponsor “Shattered Dreams,” a trauma-awareness program at high schools across Palm Beach County. Through re-enanctments of accidents, the program dramatizes the dangers of reckless, dis-tracted, and drunk driving. Our Aeromedical team and outreach staff partner with local law enforcement officers, fire rescue/EMS agencies, high school student volunteers, and community partners to stage the simulations.

For more information, please visit www.hcdpbc.org/Trauma.

Saving lives when seconds count...for 25 years

Providing the health care safety net for Palm Beach County

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Accelerate Patient Payments for a Healthy Revenue CycleBy Troy R. Huda, Vice President, SunTrust Treasury & Payment Solutions

A Shift in Payment ModelsThe way Americans obtain health insurance has undergone a significant

change in the past five years – transitioning from a wholesale model (insurance sold to employers), to a retail model (insurance sold to consumers). As a result, the volume of patient-initiated payments is skyrocketing.

In 2010, the Medical Group Management Association published a study stating that 10.9% of medical receivables came from the patient1. Today, the American Medical Association reports that patient payments account for up to 25% of a practice’s receivables, more than doubling in the past six years2.It’s not surprising that patient payments also represent, on average, the third largest source of revenue for healthcare providers behind Medicare and Medicaid payments3. With such a rapid rate of growth, you need a strategic plan to be sure your business is ready.

Solutions Healthcare Providers Can Implement NowTo address this new reality, healthcare providers and delivery organizations are incorporating solutions to maximize collections at the point of care, automating processing and reconciliation of payments from patients and insurance payers. Often overlooked are two significant payment methodologies that can help optimize the receivables collection process – Paper Conversion and Paper Suppression/Omni-Channel Payment Acceptance.

Paper Conversion This involves taking paper paymentsand converting them into electronic

transactions. In the case of patient receivables, this process occurs using a healthcare lockbox.

• A healthcare lockbox is a service offered by a bank that receives mailed payments from patients and insurance payers throughout the day, extracts and scans the contents of the envelope, and converts the remittance information into electronic posting files

• The lockbox also acts as a document management and archival system, which mitigates the pain points of managing miscellaneous correspondence workflow and exception processing

Paper Suppression/Omni-Channel Payment Acceptance This. involves reducing acceptance of paper payments and adding the ability to support multiple electronic payment channels, including online. In a recent study, nine out of ten consumers indicated that they want to pay their healthcare bills online4.

• Adopting an Online Bill Presentment and Payment solution enables patients to make payments through a customized website using a debit card, credit card, or eCheck (Automated Clearing House - ACH). The payment settles electronically, and your practice receives an electronic posting file to assist in reconciliation

• Accepting Electronic Funds Transfers (EFT) and Electroni Remittance Advices (ERA) from your payers allows you to receive payments faster, and new tools are available to automatically match the majority of payments to remittance data received from payers

Increase Patient SatisfactionBoth options, Paper Conversion and

Paper Suppression/Omni-Channel Payment Acceptance, deliver similar value to your organization, including increased speed of collection and reduced processing costs. Ultimately, since patients are used to flexibility as consumers in how and where they pay their bills, there is the added benefit of increased patient satisfaction – which is the ultimate goal. It’s a win-win situation for you and your patients.

For additional insights from SunTrust on how implementing

electronic receivables solutions can help accelerate revenue,

contact Ashlea Ayer at [email protected].

References:

1.Medical Group Management Association (MGMA): Practice

Perspectives on Patient Payments, 2010 2.American Medical

Association; ama-assn.org – Advocacy » Advocacy Topics »

Administrative Simplification Initiatives » Managing Patient

Payments 3.Triple-Tree.com: December 17, 2015, Innovators

Wanted: Mounting Patient Financial Responsibility Driving

Provider Demand for Positive Disruption and Change

4.InstaMed: Trends in Healthcare Payments Fifth Annual

Report 2014 5Association for Financial Professionals: 2015

Payments Cost Benchmarking Survey

QUARTER TWO 2016 19

Page 20: Oncall 16 q2 final

Congratulations! Wellington Regional

Medical Center is

proud to honor our CEO,

Robbin Lee, for her

recognition as a hero

in medicine by the

Palm Beach County

Medical Society.Robbin LeeChief Executive Officer (CEO)Wellington Regional Medical Center

Robbin is a Bruce Rendina Professional Hero.

10101 Forest Hill BoulevardWellington, Florida 33414

561.798.8500 | wellingtonregional.com

Creative and strategic thinking make design a tool thatcan overcome the competitive landscape, better your relationship with patients and grow your business. We are DESIGNING BETTER BUSINESS!

CALL 561.630.1939 [email protected] Twitter • Instagram • Facebook @ formingbrands4uwww.formingbrands.com

�In partnership with the Florida Healthcare Law Firm �the Palm Beach County Medical Society is pleased �

to announce the following free upcoming events for members!

“What Physicians Need to Know About Managed Care Contracting” February 24th, 2016 12-1pm EST

Attorney Karina Gonzalez will present a live webinar in follow-up to her January article. �

She will provide a deeper legal look at what providers should be aware of �when reviewing their managed care contracts.

Copy & Paste this link for complimentary registration: �https://attendee.gotowebinar.com/register/6922415629074713858�

“Compliance Measures that Every Physician Practice Should Have in Place” �March 23rd, 2016 12-1pm EST�

Attorney Jacqueline Bain will provide attendees with a comprehensive legal overview on �

regulatory compliance and compliance plan development for practices. Copy & Paste this link for complimentary registration: �

https://attendee.gotowebinar.com/register/1119926631929377281

“Managed Care Contracts: What’s Hiding in Plain Sight?” April 20th, 2016 12-1pm EST

Attorney Dave Davidson of the Florida Healthcare Law Firm will present a live webinar for physicians

about common trap doors in managed care contracts. He’ll discuss the provisions that seem harmless, the hidden provisions that appear to be there but aren’t and how to negotiate it all.

Copy & Paste this link for complimentary registration: �https://attendee.gotowebinar.com/register/3312695865517629185

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Med MemoQuarter One 2016

SAVE THE DATE

June 1, 2016 6:00pm – 8:00 pmYoung Physicians DinnerIII Forks, Palm Beach Gardens

June 8, 2016 11:30 - 1:00 pmHealth Care Connection LuncheonWage and Hour Updates & New Over-time RulesWPB Marriott

June 9, 2016 6:00pm – 8:00 pmCelebrity Bartender Meat Market Palm Beach 191 Bradley Place. Stay for dinner and 10% of your bill will benefit

Project Access/Care Coordination.

September 15 & 16, 2016Future of Medicine Summit X

2016 PBCMS Services and Recognition DinnerPalm Beach County Medical Society Services hosted its Annual Recognition Dinner on Thursday, March 15th at Benvenuto Restaurant. Featured speaker included Michael T.B. Dennis, MD, President of PBCMS Services and Eric Kelly, President of Quantum Foundation. Award Recipients Included:

Project Access Medical Provider of the Year- Dr. David Mittleman and Staff

Project Access Surgical Provider of the Year- Dr. Ramin Abdolvahabi and Staff

Project Access Practice Provider of the Year- ENT Specialists: Dr. Zorik Spektor, Dr. David Mandell and Dr. David Kay

Project Access Hospital of the Year- JFK Medical Center

HERC Member of the Year - Lieutenant David Pervenecki

MRC Member of the Year - Joel ThomasFuture of Medicine Leadership Award- Dr. Frederick Williams

PBCMS Services Member of the Year- Matt Gracey

Doctor’s Day PBCMS celebrated Doctor’s Day with an Italian themed party at Paradiso in Lake Worth.

Dr. Mas Massoumi, Dr. Alan Pillersdorf,

Dr. and Mrs. Charles Moore and

Dr. Benedicto San Pedro

2016 Disaster Preparedness and Annual Recognition Dinner Palm Beach County Medical Society Services 2016 Disaster Preparedness and Annual Recognition Dinner was held on April 28, 2016 at the Airport Hilton. Protective Security Advisor, Gary Warren from The Department of Homeland Security gave an Active Shooter Presentation.

The Conversation Project PBCMS hosted The Conversation Project “Death over Dinner” May 4th at Atlantis Country Club. Working in partnership with the Institute of Healthcare Improvement, the Conversation Project is dedicated to helping people talk about their wishes for end –of –life care. Guides for patients and physicians and guidelines for reimbursement

are available. In addition, PBCMS will provide speakers for community groups and organizations. Featured speakers were Kate DeBartolo, IHI and Jean Acevedo, Acevedo Consulting For more information on The Conversation Project please contact 561-433-3940.

Call for Resolutions and Nominations to FMA House of DelegatesDid you know that Palm Beach County Medical Society has one of the largest delegations to the Florida Medical Association and the American Medical Association? Our Society is respected for its strong leadership in representing physicians and addressing policies impacting our patients.

What issues are affecting your practice at this time? In order to have your voice heard, we encourage you to serve as a delegate in the House of Delegates. Nominations are now open for physicians to serve as Delegate for the FMA Annual Meeting to be held on July 30- August 2 at the Disney Yacht Club, Orlando. This is an excellent opportunity to join with your colleagues in shaping the future of medicine. For additional information contact Katherine by email to [email protected] or by phone 561-433-3940 x13.

Congratulations to the 2016 Harold Strasser Scholarship Winner!

2016 Winner Karine

Kasti and Dr.

Douglas Dedo, MD

Welcome New members William Bean, MD (Retired)Mark Remz, DOMarvin Rotman, MD (retired)

QUARTER TWO 2016 ON CALL MAGAZINE 21

MindiT
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THANK YOU! to all of our supporters who helped us surpass

our goal and raise

$24,000.

Dear Physician, In 2012, the Palm Beach County Medical Society helped create a Health Insurance Co-op for physicians in private practice (and their staff). The program is fully insured by Florida Blue with no assessments for excessive claims, plus it offers a “profit-sharing” feature to offset future rate increases. Although there have been modest rate increases over the years, it wasn’t until last fall, because of the enactment of the Affordable Healthcare Act, that we compared our rates with the standard market. Below is a quick comparison for a physician covering his/her spouse and 2 children with a HSA Compatible Plan:

Co-op HSA

Plan F

Co-op HSA (1) Plan K

Standard Market

Comparison #1

Standard Market

Comparison #2 Deductible $5,400 $5,000 $6,000 $4,000

Co-Insurance 80% 80% 80% 80% Ann OOP Max $12,900 $12,900 $12,000 $12,000

Monthly Premiums Age 38 $875 $721 $1,010 $1,147 Age 48 $962 $793 $1,339 $1,384 Age 58 $1,239 $1,021 $1,878 $1,941

Simply e-mail us at [email protected] for the questionnaire. If your office qualifies, we would be pleased to present our proposal.

Sincerely,

Spencer Barrett, CLU

Spencer Barrett, CLU 3rd Party Administrator

MCMS Inc. Insurance Trust Fund

E-mail: [email protected]

(1) Limited Pharmacy Coverage

Dear Physician, In 2012, the Palm Beach County Medical Society helped create a Health Insurance Co-op for physicians in private practice (and their staff ). The program is fully insured by Florida Blue with no assessments for excessive claims, plus it offers a “profit-sharing” feature to offset future rate increases. Although there have been modest rate increases over the years, it wasn’t until last fall, because of the enactment of the Affordable Healthcare Act, that we compared our rates with the standard market. Below is a quick comparison for a physician covering his/her spouse and 2 children with a HSA Compatible Plan:

Simply e-mail us at [email protected] for the questionnaire. If your office qualifies, we would be pleased to present our proposal.

Sincerely,

Spencer Barrett, CLU

Spencer Barrett, CLU 3rd Party AdministratorMCMS Inc. Insurance Trust FundE-mail: [email protected](1) Limited Pharmacy Coverage

MindiT
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WE HAVE RETURNED OVER $370 MILLION TO OUR MEMBERS THROUGH OUR DIVIDEND PROGRAM.

When our insured doctors in the state of Florida keep patients

safe and keep claims low, we all win. The Doctors Company is

strong, with 78,000 members and $4.3 billion in assets. This

strength allows us to defend, protect, and reward the practice

of good medicine like no other.

5% DIVIDEND FOR QUALIFIED FLORIDA MEMBERS

GOOD MEDICINE HASITS REWARDS—$370 MILLION

UNRIVALED

REWARDS

800.352.0320

WWW.THEDOCTORS.COM

JOIN YOUR COLLEAGUES AT THE DOCTORS COMPANY

5596_FL_PBCMS_UR_Div_2Q2016_ISSUU_flat_f.indd 1 4/21/16 10:05 AM

Page 24: Oncall 16 q2 final

3540 Forest Hill Blvd. Suite 101

West Palm Beach, FL 33406

RETURN SERVICE REQUESTED

PRSRT STD

US POSTAGE

PAID

WEST PALM BEACH, FL

PERMIT NO.515

September 15-16, 2016The Palm Beach County Convention Center - West Palm Beach

For registration or sponsorship opportunities visit www.pbcms.org/events or call 561-433-3940.

Making a Difference in Healthcare.

THE QUEST FOR HEALTHY AGING