2015 OnCall Quarter 1

QUARTER ONE 2015THE OFFICIAL PUBLICATION OF THE PALM BEACH COUNTY MEDICAL SOCIETY

Physician Advocacy in 2015

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Delray Beach • Orlando • Miami • Jacksonville800.966.2120 • [email protected] • www.dannagracey.com

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

Call us today to see what we can do for you.

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The rates for all physicians throughout the state are set by the State of Florida. Your practice will pay the same price no matter where you choose to secure coverage. However, under the OptaComp program, you may be eligible for a potential dividend of up to 24.8%.

Your membership with the PBCMS can provide savings that can be paid back in dividends. OptaComp has returned a dividend for 12 straight years, with over $4 million over the past six years to Florida medical societies’ members: $600,000 of that went to PBCMS members.

The OptaComp (rated “A” by A.M. Best) program is endorsed by the PBCMS and is offered by Danna-Gracey, Inc. For more information, please call Tom Murphy at 800.966.2120.

Did you receive money back on your premium last year?

Many doctors have through the Palm Beach County Medical Society

Workers’ Compensation Program.

The rates for all physicians throughout the state are set by the State of Florida. The rates for all physicians throughout the state are set by the State of Florida. Your practice will pay the same price no matter where you choose to secure Your practice will pay the same price no matter where you choose to secure coverage. However, under the OptaComp program, coverage. However, under the OptaComp program, potential dividend of up to 24.8%.potential dividend of up to 24.8%.

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Stephen Babic, MD President, Palm Beach County Medical Society

President’s Report

As the legislative season gets underway, we, as doctors, need to get involved. Here’s how.

1) One of the most important things a physician needs to do is to get educated about medically related legislation presented at both the state and federal level. This information can be obtained through the websites of the Florida Medical Association and the Palm Beach County Medical Society.

Once appropriate medical legislature is identified, the physician must learn who his local representatives are at both the state and federal levels. With this information, the doctor then needs to contact his or her representatives about those specific issues that are interfering with patient care. This can be done by phoning, mailing or emailing your representative.

2) For us at the Palm Beach County Medical Society, we also would like very much to learn specific examples of policies that are interfering with you and the care of your patients. These communications can be sent to Jeff Scott, the attorney for the Florida Medical Association or to me at the Palm Beach County Medical Society.

3) Our patients are also an important resource who can be enlisted to contact their legislators to help change political policy. They are the ultimate benefactors of flawed healthcare laws and regulations, and they must be part of the struggle to help preserve high quality medical treatment.

4) Doctors need to identify those individuals who, when elected to political office, will be willing to listen to the medical profession and be open to advocating public policy to improve patient care. Learning about these candidates can often be accomplished by joining both state and federal Medical

Political Action Committees. You can also attend fundraisers for local political candidates and show them that the medical community is politically involved and will be attentive to their positions on health legislation.

5) Periodically, physicians run for political office. This is our best opportunity to influence healthcare legislation. We must encourage and support doctors who run for political office.

If you take care of a legislator and/or their family, you may use this special relationship to help inform and focus them on specific health related issues. You may also be able to help coordinate communication between leaders of the medical profession and the legislator.

6) Ultimately, our greatest hope for impact is at election time. The Florida Medical Association and the Palm Beach County Medical Society can help you identify those running for office whom we feel will be best for the medical profession and healthcare reform.

And the most important thing we can all do? Encourage our family and friends to vote!!

QUARTER ONE 2015 ON CALL MAGAZINE 3

561.659.0210 | palmbeachillustrated.com

Palm Beach Illustratedis proud to support

Palm Beach County Medical Society

ON CALL MAGAZINE 5

Board of Directors Stephen Babic, MD

PresidentJames Goldenberg, MD

President-ElectShawn Baca, MD

First Vice-PresidentBrandon Luskin, MD

SecretaryMarc Hirsh, MD

TreasurerRonald Zelnick, MD

Immediate Past President Roger Duncan, MD Member at Large

Larry Bush, MDMichael Dennis, MDJames Howell, MDTulisa LaRocca, MD

Beth-Ann Lesnikoski, MDK. Andrew Larson, MD

Alan Pillersdorf, MDSamathi Raja, MD

Brent Schillinger, MDRobert Tome, MD

John Vara, MDFrederick Williams, MD

Jack Zeltzer, MDMatthew Uhde, DO Resident

Amanda Barnes 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, Administrative Assistant

[email protected]

Lauren Tome, Meeting and Events Coordinator

[email protected]

Lauren Stoops, Project Access Program Director

[email protected]

Graciela Gordillo, Project Access System Coordinator

[email protected]

Melissa Nicoleau, Project Access System Coordinator

[email protected]

Thomas Sebastian, Project Access System Navigator

[email protected]

Clara Yvette Acero, Project Access System Navigator

[email protected]

John James, Director of Disaster Services

[email protected]

Stuart Miro, MD, Triple Aim Diabetes Initiative

[email protected]

Sherra Sewell, Marketing and Promotions

[email protected]

Demi deGioia, Communications Coordinator

[email protected]

Patricia Beeler, Administrative Assistant

[email protected]

Gwendolyn Marrero, Administrative Assistance

[email protected]

On Call Magazine is designed by Form G Design

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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.

QUARTER ONE 2015

Features

07 ACCESS Prescription Card

08 Physicians Making A Difference 11 How to Become a Better Performing Medical Practice

12 Remote Patient Monitoring: Real-Time Patient Data, Real Liability Risks 14 Heroes in Medicine Finalist

15 Physician Advocacy in 2015 20 Diagnosing Ownership of Physician Practice Real Estate

23 Do You Really Know How Your Med Mal Insurer Handles Claims?

Articles

03 President's Report

25 Med Memo

26 Welcome New Members

Contents

Y O U R I N S U R A N C E TO F I N A N C I A L S U C C E S SM E D I C A L B I L L I N G S P E C I A L I S T S

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The Palm Beach County Medical Society has launched an exclusive FREE Prescription Discount Card named ACCESS. This innovative ACCESS card is available at no cost to patients, families, employees and the Palm Beach County community. The card is important as individuals and families look for ways to save costs and are making choices on medications that impact their health.

One out of every four adults in the United States goes without needed prescriptions each year due to cost, and nearly three-quarters of the 77,000 adults surveyed admitted they had not filled their prescriptions, skipped or forgot a dose, or took less than recommended. Lack of compliance with patients not taking their medications not only causes unnecessary hospitalizations but also hundreds of thousands of premature deaths. Reports estimate over $300 billion in additional costs for lack of compliance.

About the exciting new ACCESS card:

• Easy and convenient way to save money on prescription drugs, even specialty drugs – 10% to 75% on the cost of medications• One card covers an entire family• HIPPA compliant, information remains private • Discounts are given at the time of purchase by bringing the card to any one of over 59,000 participating nationwide pharmacies -- which include ALL of the major pharmacy chains and supermarket pharmacies • Over 60,000 drugs are covered -- great savings on nearly every brand name and generic drug

How does this ACCESS card work? The PBCMS has a partnership with one of the largest Pharmacy Benefit Managers in the country, and they are Florida-based too! The discount card was created to

give patients ACCESS to pre-negotiated savings that are passed on to those who utilize the ACCESS card. The card is aimed to lower the cost of prescription drugs to all people regardless if one is insured, uninsured, or insurance does not cover needed prescriptions. There are no limits to the number of prescriptions that can be filled with the ACCESS card, no registration, no hidden fees, and mail order with free standard shipping is also available. Through sophisticated reporting, PBCMS will know the savings provided via the ACCESS cards. However, patient information is never disclosed (only the total dollar savings).

Kudos to the physicians of the Palm Beach County Medical Society! Through their association with the PBCMS, they are providing a vehicle for our community to acquire prescribed medications at more affordable prices. Other people in our community who will benefit from the ACCESS card are:

• Patients /Employees who cannot afford to cover their dependents• Patients /New employees who are in a waiting period for healthcare coverage• Patients who have insurance however have high deductibles, non-covered drugs, high co-payments or a cap on their benefits

KUDOS to the Physicians of the Palm Beach County Medical Society!By Linda Koldenhoven, Kolden Health, LLC President / Owner

Savings Example

Levofloxacin tab 75 mg (common antibiotic)

Retail Price $252.54With ACCESS Card $10.07Total Savings $242.47

Altorvastatin tab 40mg (common cholesterol-lowering)

Retail Price $173.21 With ACCESS Card $15.85 Total Savings $157.36

• Seniors who fall in the “doughnut hole” of their Medicare Part D• Patients who have lost their jobs and cannot afford COBRA

“We see patients over and over again for conditions that are treatable, however sometimes they cannot afford the medications they need,” says Dr. Stephen Babic, President of the PBCMS. It is very exciting that the physicians of Palm Beach County now have an exclusive program through the ACCESS card to make a difference.

Continued on Page 24

ON CALL MAGAZINE 7QUARTER ONE 2015

So many physicians do remarkable work in our community.

They are proactive advocates for their patients, mentors for other health professionals, and promoters of good health for all of us. We are fortunate in Palm Beach County to have an abundance of great physicians.

Still, some physicians go above and beyond their call of duty as health care providers.

As part of our ongoing series in On Call, we profiled two physicians who truly are making a difference in our community:

Abbey Strauss, MD A psychiatrist in Boca Raton who is active in PBCMS as well many other health care organizations and causes.

Evan Peck, MD A sports medicine physician in the Department of Orthopaedic Surgery at Cleveland Clinic Florida. His clinical and research interests include concussion, tendinopathy, and diagnostic and interventional musculoskeletal ultrasound.

We asked Dr. Strauss and Dr. Peck to answer the following questions to get their insight on how to lead in medicine and how to get physicians to do even more for our community.

Physicians Making A Difference Abbey Strauss, MD and Evan Peck, MD

Giving Back to Improve Our Community’s Health

ON CALL MAGAZINE8 QUARTER ONE 2015

Evan Peck, MD

Abbey Strauss, MD

Why is it important to you to give back to our community through your volunteer work at PBCMS and many other organizations? Dr. Strauss: Physicians must interact with people to continuously blend what is needed in medicine, and what is needed in the community, to make both systems work better. Dr. Peck: When you are passionate about something, it comes naturally to do what others might perceive as going the extra mile. So I think the most important thing we all should do in life is find our passions, because those are our greatest opportunities to help the community and the world around us. If we look at great contributors to humankind throughout history, they didn't try to "give back." They were simply passionate about a cause or a belief and that guided them. I certainly can't compare to these individuals, but they are models we all should strive to follow in however small, yet significant, way we can.

What would happen to medicine, in general, if physicians like you weren’t around to volunteer their services for the greater good of the community?

Dr. Strauss: Without a broad interaction, the ‘needs, customs and goals’ of medicine would not understand the ‘needs, customs and goals’ of the community. Physicians have to treat and educate the clinical or other ambiances as much as any individual. Changing a milieu can be effective prevention, rehabilitation or intervention as much as treating a patient. Dr. Peck: While we all need to make a living to support our families, medicine doesn't exist solely as an occupation or profession. Again, I would go back to the idea of being passionate about what you do, and this passion guiding someone toward helping others and improving the world around them. How do we as a community inspire more physicians to give back and donate their time and services?

Dr. Strauss: Let physicians experience the deep satisfaction of giving our skills and talents to our communities -- this experience becomes rewarding in ways that extend into endless personal gratifications.

Dr. Peck: Every physician has something in their DNA that drove them to become one. Sometimes, in modern medicine, with all of the concerns about reimbursement, regulation, liability, and so forth, that passion and those original principles can get lost. It's important to take a step back and remember why you're doing what you're doing. We can't pick every battle out there. But at least pick one, and "win" it. This is not winning as in personal glory; the victory is in finding something that needs improvement and changing it for the better.


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Morgan Stanley is proud to sponsor Palm Beach County Medical Society

Patricia Corbett CFP® Vice President Financial Advisor 595 SOUTH FEDERAL HIGHWAY Boca Raton, FL 33432 +1 561 393-1535 [email protected]

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With the mounting challenges and complexities facing medical practices today, physicians and their practice administrators need to be more vigilant than ever in maximizing the performance of their operations. According to a recent Medical Group Management Association (MGMA) Annual Report - Performance and Practices of Successful Medical Groups, “better-performing” medical practices collected more than 15% above similar practices within the same specialty, and many of those practices had profit margins that were more than 30% above their peers. The “better-performing” practices excelled in four key areas:• Profitability and cost management• Productivity, capacity and staffing• Accounts receivable and collections• Patient satisfaction

The “success stories” and performance information of these practices also reflect that the key quality they share is that they have all created a “culture of quality” within their organizations. Medical groups that have better financial performance than their peers typically exhibit a culture that focuses on the patient and on providing high quality services. They also focus on both physician and staff productivity, and their management is willing to invest in the resources needed to maximize physician and non-physician productivity.

Regardless of the type of practice, the “better-performing” practices consistently had: • Greater provider productivity• Higher employee to provider staffing ratios • Higher overhead percentages (higher expenses yielded even higher revenue and profitability)

Their investment in their staff, facilities and technology paid off in:• Increased productivity• Higher collections• Higher practice profitability (total medical revenue after operating expenses per FTE provider)

Compared with other practices, a higher percentage of the “better-performing” practices:• Acquired equipment and materials to provide new services (40.4% vs. 30%)• Acquired new information technology or billing systems (32.4% vs. 28.7%)• Remodeled existing facilities (77.2% vs. 22.3%)

The “better-performing” practices also had compensation structures that supported higher productivity.• 84.4% of the better performers reported having compensation methodologies based at least 50% on productivity or salary plus incentive vs. 75% of the other practices.• Better-performing practices consistently reported higher staff-to-physician ratios than the other practices.

The “better-performing” practices emphasize the importance of meeting the health care needs of their patients, with 82% reporting that they conduct patient satisfaction surveys and use those results to improve services.

Where should practices begin making changes so that they can achieve similar results? As the MGMA survey demonstrates, cutting costs may not be the best path to financial success.


How to Become a Better Performing Medical Practice By Nancy R. Smit, MBA, RPT, RRT Partner, RS&F Healthcare Advisors, LLC

Three million patients worldwide are currently connected to a remote monitoring device that sends personal medical data to their healthcare provider.1 Each year alone, 600,000 cardiac patients are implanted with pacemakers, one of the most common monitoring devices.2

Remote medical devices help doctors catch potential problems earlier, when they’re easier to treat, and can reduce the number of hospitalizations, improving patient health and containing healthcare costs.

Despite the many advantages, remote patient monitoring has liability risks. Because remote monitoring devices transmit patient data over the Internet or through phone lines, there is a risk of a data breach if the information is not properly encrypted.

Medical devices may be vulnerable to viruses and malware. The U.S. Food and Drug Administration (FDA) noted that providers must take steps to safeguard patient information within their network, such as ensuring antivirus software and firewalls are up to date, monitoring the network for unauthorized use, and reporting any medical device cybersecurity problems to the device manufacturer.

If a remote device fails or malfunctions, physicians may be named in the lawsuit against the manufacturer, under the claim that the physician failed to use the device properly. Physicians should stay up to date on the latest information for the device, including manufacturer’s warnings, the device’s safety record, and the device’s approved uses. Providers should also be aware of any FDA alerts or recalls.

Providers should also be aware of the need for additional staff members to handle the incoming data. In the case of a potential problem, these staff

members should respond either directly to the patient or alert the appropriate professional for intervention. Each practice should have written guidelines for:• Times the device will be monitored.• Which members of the care team will monitor the data at each point in time.• Under what circumstances the appropriate clinician will be alerted to a potential problem.

Successful remote patient monitoring is dependent on each patient’s motivation to actively manage his or her health, as well as the patient’s ability to understand and use the technology. To help ensure patients effectively use remote devices:• Complete and document a thorough informed consent process.• Educate the patient on:

Remote Patient Monitoring: Real-Time Patient Data, Real Liability Risks By Kevin Reynolds, CPA

• How to use the device. Explain the treatment plan, such as at what times the device will be monitored and how alerts will be handled by the healthcare team. • What device failure or malfunction looks like, and what the patient should do if that happens. • How to properly maintain the device.

References

1. Report: 19 million will use remote patient monitoring by

2018. MEDCITY News. http://medcitynews.com/2014/06/

biggest-market-remote-patient-monitoring/. Accessed

December 1, 2014. 2. Remote monitoring proven to

help prolong life in patients with pacemakers. Heart

Rhythm Society. http://www.hrsonline.org/News/Press-

Releases/2014/05/Remote-Monitoring-Pacemakers#_edn1.

Accessed December 1, 2014. Contributed by The Doctors

Company. For more patient safety articles and practice tips,

visit www.thedoctors.com/patientsafety.


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2015 Heroes In Medicine

Palm Beach County Medical Society & Services Invites You To Celebrate

Honoring our outstanding Healthcare Heroes!

Thursday, April 16, 201511:00 am - Reception, 12:00 pm - Luncheon

Kravis Center, Cohen Pavilion 701 Okeechobee Blvd. West Palm Beach, Florida

Mistress of Ceremonies Liz Quirantes, CBS 12 News

RSVP by April 10, 2015561-433-3940 or visit

www.pbcms.org/events/heroes-in-medicine/

Bruce Rendina ProfessionalQuinn Hayes

Davide CarboneJean Acevedo

Julia Belkowitz, MD

Community OutreachCaridad Center

Ronald Surowitz, DOKayla Cares 4 Kids, Inc.

Healthcare EducatorJohn Vara, MD

Julie Servoss, MDRose Ann Roche, RN

James Byrnes, MDHumanitarian Award

Ivy Faske, MD

Honorary HostsDr. and Mrs. Alan Pillersdorf

Healthcare InnovatorMichael Miller

Sara D. Uhrig, OTR/L, CHTCyrus Edward Massoumi

Provider Non-PhysicianJane MillerDuyen Le

Lynne PalmaMichelle O’Boyle

PhysicianCatherine Lowe, MD

William Kaye, MD Marsha Fishbane, MD

Michael Black, MD Marion Webster, MD

Dick Van Eldik, MDDistinguished Service Award

James Howell, MD

Making a Difference AwardHealth Care District

of Palm Beach County

Lifetime AchievementPaul Niloff, MD

StudentAndrea Palestro

Grace CenatNerea Anaya

Rodeania PeartJanie Sanchez

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R E P O R T

Grand BenefactorRendina Healthcare Real Estate

Should physician advocacy be a mandatory part of physician education and practice? If so, what degree of advocacy is expected or appropriate?

As we head into the height of the legislative season -- which often delves into physicians’ roles in the practice of medicine -- Palm Beach County Medical Society asked a local medical leader to reflect on how physicians can be effective advocates for their patients as well as other physicians.

K. Andrew Larson, M.D, former president of PBCMS and chair of PBCMS’ Council on Advocacy and Legislation, offers his insights on the acceptance of advocacy as a professional obligation, a concept that is often undefined in concept, scope, and practice.

What's the best way for physicians to be effective advocates for their patients? Dr. Larson: Physicians should strive to be effective advocates for their patients. This means making sure that when denials for appropriate care occur the doctor’s office has the obligation to either call the medical director to explain the situation or, if appropriate, bring the patient back in to explain why additional testing is not necessary and what alternatives exist.

Physicians have an obligation not to order procedures nor diagnostic testing that is either not required or would represent over-treatment; however, we also have the obligation to fight for our patients’ rights to receive appropriate medical care when it is indicated.

As a bariatric surgeon this is not an uncommon situation for me and in my experience an intelligently worded phone conversation usually achieves the right outcome for physician and patient alike

and, if it does not, at least a clear path for an appeal is usually presented.

So, I suppose the bottom line is don’t be afraid to advocate voice to voice or face to face for your patients if you believe your treatment plan is appropriate and necessary.

And what's the best way physicians can be effective advocates for the medical profession?

Dr. Larson: While not all doctors have the time or the skill set to advocate for the medical profession it is vital that those of us who can, in fact, do. Lawyers lobby the state legislature very aggressively, hospitals lobby aggressively, and insurance companies even more so. In order for us to have a voice in Tallahassee or even here in Palm Beach County we need to be involved and we need to be vocal. This means supporting the efforts of your Palm Beach County Medical Society by being or becoming a member and by responding to our requests for financial support. It also means telling us when there is a problem. We have been able as a society to reverse anti-physician payment decisions made at the Palm Beach County Health Care District level and these efforts were successful in large part because the issue was brought to our attention.

In Tallahassee your Florida Medical Association is powerfully led by Palm Beach County’s own Dr. Alan Pillersdorf as president this year. We need to take advantage of this fact. If there are any issues affecting you that might result in action on our part I need to know about them (through the medical society) so that as chairman of the council on advocacy I can garner support from our South Florida delegation and lobby for our Florida Medical Association to put its resources to work.

Physician Advocacy in 2015 By Leon Fooksman

Leon Fooksman is a writer for Palm Beach County Medical

Society who specializes in blogging and social media

for medical organizations. He can be reached at leon@

digitalstoryline.com or on Twitter at @compellingstory.


Decreasing regulatory burdens and increasing patients’ access to high-quality medical care are priorities for the Florida Medical Association for the 2015 Florida Legislative Session, which goes from March 3 to May 1. According to the FMA, here are its legislative and policy priorities for making it easier for physicians to practice medicine, protect patients, and promote good health.

1. Health Care ReformsPrior Authorization -- Florida should join other states that have taken action to cut red tape by creating a standardized electronic process for submitting requests for medical procedures and prescription drugs.

Fail First Protocols – More safeguards need to be put in place to protect patients from insurance companies making medical decisions that are harmful and clinically inappropriate.

Retroactive Denials – Insurance companies should be required to pay claims when they have given prior authorization and have verified the patients are covered.

Grace Period – Require health plans to provide immediate notice to the physician when the patient enters the 90-day grace period as part of the Affordable Care Act, and to allow the physician to make appropriate payment arrangements with the patient after the first 30 days of this period.

Bait and Switch -- Often, health plans advertise that they have physicians, hospi¬tals, and other health care providers in their networks in order to entice people to buy their products. This can be misleading to patients when the entire advertised networks are not available when they need care. Legislation is necessary to stop these “bait and switch” tactics.

Standardized Medicaid Managed Care

Administrative ProcessesOppose Onerous Mandates on Physician Practices -- The FMA is opposed to adding any mandates such as check¬ing the prescription drug-monitoring database before writing a prescription for an established patient.

2. Increasing Access to Florida’s PhysiciansProvide Appropriate and Fair Funding for Physician Services Under Medicaid

Increase GME Funding and Residency Programs -- Data shows that Florida needs an additional 3,352 residency positions to meet the average national ratio of medical residencies to 100,000 people.

Promote Physician-Led Health Care Teams and Patient-Centered Medical Homes for Every Floridian

Telemedicine – The goal is to expand the use of telemedicine while ensuring high standards and providing appropriate safeguards to protect patient safety and privacy. To achieve this, four components must be established: definition of telemedicine; physician accountability; education; and reimbursement.

Improve Health Care Coverage for Low-Income Floridians -- The FMA supports a “Florida solution” to providing health care to uninsured Floridians with appropriate and fair payment to physicians, a less stifling bureaucracy, and a system that preserves the primacy of the patient-physician relationship.

Improve Rural Access to Care with Loan Forgiveness Programs for Primary Care Physicians

Protect and Promote a Fair Litigation Climate in Florida – It’s critical not to go backward by allowing new causes of actions against physicians who are delivering evidence-based and clinically appropriate care.

Notify Physicians and Patients of Hospital Obstetric Department Closures

Allow Private Contracting for Out-of-Network and Non-Covered Physician Services

3. Ensuring High-Quality Care and Protecting Patients The FMA firmly believes that high-quality care can only be achieved by a well-trained team of professionals under the supervision of a physician. Non-physi¬cian practitioners are valuable members of the health care team but they are limited by their education and training. Physicians are the only members of the health care team who have the broad clinical experience and training to exercise independent judgment and provide overall direction of a patient’s care.

4. Promoting Floridians’ Good HealthStop the Obesity Epidemic – Support Florida Department of Health’s “Healthiest Weight Florida” initiative.

Improve Florida’s Vaccination and Immunization Rates

Needle and Syringe Exchange Pilot Program – Support the Miami-Dade Infectious Disease Elimination Act, which would authorize the University of Miami and its affiliates to establish a needle and syringe exchange pilot program in Miami-Dade County to offer free, clean, and unused needles and syringes in exchange for used needles and syringes to prevent the transmission of HIV/AIDS and other blood-borne diseases.

Cancer Prevention – Tanning Beds -- Supports the efforts of the Florida Society of Dermatology and Dermatologic Surgery and other medical specialty societies to pass legislation that would prohibit minors from using tanning beds.

Top Florida Advocacy Priorities for 2015 By Leon Fooksman


4.The Medicare physician payment system. Congress will need to act early this year to avoid a 21 percent pay cut scheduled to take effect April 1 under the sustainable growth rate (SGR) formula. The AMA and physicians will continue communicating with lawmakers to make reforming the Medicare payment system a priority for the new Congress. In addition to addressing the SGR formula, the AMA will be tackling other issues related to the Medicare fee schedule, including the value-based payment modifier, elimination of the global surgical period, and potentially mis-valued codes.

5. Adequate provider networks. The current trend toward very limited provider networks has necessitated physician action to ensure patients have access to the care they need. The AMA is bolstering its efforts to make sure health insurers are required to maintain adequate networks, provide timely information about the physicians and other providers to whom patients will have in-network access, and comply with all laws and regulations.

6. Prescription drug abuse and overdose. Most stakeholders now agree that the nation's prescription drug overdose epidemic should be addressed primarily through treatment, prevention and education rather than law enforcement. But much work remains to execute solutions in local communities. The AMA will continue to lead policy development on this issue in the states and nationally, and engage physicians in practical activities to prevent prescription drug abuse and allow pain management for patients who need it.

In 2015, the American Medical Association is going to intensify efforts to reduce barriers to providing high-quality care.

According to the AMA, that includes addressing the following through policy and/or legislation:

1. Electronic health records (EHR) and meaningful use. For many physicians, some of the things that need to change about medicine are unhelpful EHR systems and unachievable meaningful use requirements. According to Centers for Medicare & Medicaid Services (CMS), more than 50 percent of eligible professionals will face payment penalties next year because they could not fulfill meaningful use requirements.

The AMA is pushing for the adoption of solutions to the one-size-fits all meaningful use program. In addition, the AMA is building on a new framework for EHR usability that it developed with an external advisory committee.

2. ICD-10 implementation. The AMA has advocated for end-to-end testing, which will take place between January and March and should provide insight on potential disruptions from ICD-10 implementation, currently scheduled for Oct. 1.

3. Federal fraud and abuse programs. While preventing unscrupulous activities in the Medicare system is an appropriate goal, many physicians are being unduly taxed by the "bounty-hunter" efforts of the Medicare recovery audit contractors (RAC). In fact, more than 60 percent of RAC determinations are overturned when appealed. Meanwhile, CMS has a two-year backlog of appeals to sort through. The AMA will continue to push the agency to overhaul this program.

Top Federal Advocacy Priorities for 2015 By Leon Fooksman

Leon Fooksman is a writer for Palm Beach County Medical

Society who specializes in blogging and social media

for medical organizations. He can be reached at leon@

digitalstoryline.com or on Twitter at @compellingstory.


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Physician practices are often presented with opportunities to purchase the building in which they operate. While several benefits exist, owning real estate carries a number of risks. Proper planning mitigates potential for trouble.

Ownership AdvantagesBuilding ownership offers control over expenses and potential to realize appreciation in real estate while having a reliable tenant.

Expenses of operating property, such as mortgage interest, real estate taxes and insurance, can be paid by the practice as rent. Typically, cash profits in rental activity can be shielded from income tax through depreciation treated as taxable income, or “recaptured,” when the property is ultimately sold. Even so, the current benefit outweighs the deferred cost but more on this later.

Any net rental income is subject to income tax but not payroll taxes—unlike W-2 wages paid by the practice to the physician. As a result, payroll taxes are often reduced.

Tax DeductibilityWith few exceptions, rental activities are generally considered passive. If rental losses are generated within an entity, those losses can offset income from other passive activities. Stated differently, a rental loss cannot offset income or wages from one’s practice since this income is derived from an activity in which an individual materially participates (i.e., non-passive).

Net rental losses in a given year are suspended and used only to reduce other passive income in the future or fully recovered when rental activity is completely disposed in a taxable transaction. Should there be ownership of other income earning rental activities,

either commercial or residential, a benefit continues to exist.

However, a rental arrangement between physician practice and physician-owned real estate entity requires losses to be treated as non-passive because the underlying activity is a business in which the owner materially participates. Losses from a self-rental do not offset income from other passive rental activities. Meanwhile, the separation of other passive rental activities enables those losses to offset passive income.

Asset ProtectionTo provide liability protection, property should be owned by an entity separate from the practice to insulate risks from the practice and the rental property.

An entity structured as an LLC for the property affords flexibility and an efficient

Diagnosing Ownership of Physician Practice Real Estate By Kevin Reynolds, CPA

tax structure. Many physician practices are structured as corporate entities (C Corp.) and have unique challenges, such as how income is taxed. Without distinction between character of income, all income is taxed at one rate—currently 35 percent for professional practices. This includes any gain from a sale of real property owned in the corporation. There is also the challenge of double taxation—distributions from the corporation are taxed as dividends to the recipient, including gains from sale of property.

A more tax-efficient entity is a pass-through LLC entity where gains from real estate are taxed at preferable individual rates (currently 15 or 20 percent on capital gains and 25 percent on recaptured depreciation), thus avoiding double taxation.



Reach your Palm Beach County doctors and medical community when you advertise here. Other advertising and supporter opportunities are also available.

Call 561-433-3840 for deatails!

Multi-physician groups, medical practices and health care oriented companies turn to Daszkal Bolton for their

accounting, tax, and advisory needs.

Daszkal Bolton offers local relationships and personal attention from 120 people

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Contact Kevin Reynolds, Health Care Industry Leader,at 561.367.1040 or kreynolds@dbllat 561.367.1040 or [email protected]

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It was the first note I ever got in crayon. “Thank you for making my daddy feel better.” I keep it on my desk, where I pore over patient records and cash flow statements. Because even if the medical field seems to be changing by the day, the reasons I practice never do.

SunTrust Medical Specialty Group provides the dedicated team and tailored solutions to help with your financial needs.

Visit suntrust.com/medicine

Investment and Insurance Products: • Are not FDIC or any other Government Agency Insured • Are not Bank Guaranteed • May Lose ValueSunTrust Private Wealth Management is a marketing name used by SunTrust Banks, Inc. and the following affliliates: Banking and trust products and services, including investment advisory products and services, are provided by SunTrust Bank. Securities, insurance (including annuities) and other investment products and services are offered by SunTrust Investment Services, Inc., an SEC registered investment adviser and broker- dealer, member FINRA, SIPC, and a licensed insurance agency. ©2014 SunTrust Banks, Inc. All other trademarks are the property of their respective owners.

This is a classic story of cheap versus good. With the extremely competitive climate in the Florida professional liability insurance market for physicians and surgeons, one can often lose sight of the most-important factors in choosing an insurance company. With prices falling substantially since 2005, doctors have become used to looking for price discounting and some have fallen into the trap of choosing the cheapest carrier without further consideration. In the long-gone days of most hospitals requiring malpractice insurance coverage, doctors who wanted to practice uninsured just looked for the bare minimum coverage at the lowest price. Those doctors have long ago gone “bare.” For those choosing a less-risky path of purchasing insurance coverage, there is a dizzying array of offers of coverage from a wide variety of insurers and agents.

Identifying the fundamental reasons to purchase coverage is easy: you want to protect yourself from claims by your patients. You want to protect your reputation and your assets in an economical and relatively simple way.

Do You Really Know How Your Med Mal Insurer Handles Claims?

When we as patients visit a doctor we assume that the medical care will be high quality or, at worst, we expect our care to be technically competent. Doctors also expect that when they purchase malpractice insurance the “care” they receive from their insurer when a claim arises will be high quality and legally competent. So how can a doctor really gauge if their insurer or one they are contemplating purchasing coverage with is competent in handling claims given the smoke of many marketing slogans and advertising promises?

As independent specialists in malpractice insurance coverage placement, that is the same question that faces us at Danna-Gracey as well as the other agents and brokers. With our responsibility to analyze each insurer’s performance so we can make competent recommendations to our clients, we turn to the very informative annual reports of the Florida Office of Insurance Regulation.

In 2013 the report shows that the five top admitted insurers with more than $50 million in surplus (Medical Protective, The

Doctors Company TDC, ProAssurance, Mag Mutual, and FPIC [now part of TDC]) handled claims very differently than four active admitted insurers with less than $50 million in surplus (MedMal Direct, PIC, Lancet, and Physicians Professional Liability).

The biggest difference was in two factors related to claims handling, which is where doctors deserve the best, just as patients deserve good medical care. The first was in what percentage of claims were closed with a payment to the plaintiffs. For the smaller insurer group, their average was 80.5% of their cases closed with a payment versus 43% of cases against the larger insurers, so nearly double the cases against doctors insured with these smaller insurance companies were settled with a payment! The second factor is the days it took the insurers to close cases against their insureds. The larger companies closed their cases on average in 854 days (just less than 2.5 years), whereas the smaller companies in this group closed their cases on average in 512 days (about 1.4 years).



Continued from Page 7

Tenna Wiles, CEO of the Palm Beach County Medical Society was very instrumental with bringing the Access card to fruition and is now very excited to provide the cards to ALL of their physicians and the Palm Beach Community. Please contact Deanna Lessard at the office (561) 433-3940 ext. 28 for arrangements to receive the ACCESS cards at your physician’s office or place of business…remember they are FREE, and a huge community benefit from the Palm Beach County Medical Society. Tens of thousands have been printed and are also available for goodie bags, charitable asks, and community gatherings.

Remember, this card will get you ACCESS to amazing savings with no hassle. Please make a difference in our community by providing the ACCESS cards to all patients, friends and employees so we can do our part to eliminate unnecessary disease progression and non-medication compliance. We all want better outcomes for our Palm Beach County patients. Again, I say, thank you and kudos to the physicians of the Palm Beach County Medical Society for providing the ACCESS card to our patients and community.

Continued from Page 11 Sometimes, practices benefit from an outside consultant who can conduct a thorough audit of existing practices, using its experienced and impartial perspective to identify areas where the greatest impact can be achieved.

Quality practice consultants like RSFHA can proactively help you enhance your coding and documentation, evaluate your overhead expenses, audit your billing process, assess and negotiate payer fee schedules and address other


Other ConsiderationsIn Florida, sales tax is due at the rate of six percent on rent paid for the right to use/occupy commercial real property. Taxable rentals include those paid to related parties. The physician-owner contemplating a self-rental should exercise care in setting fair market rent.

Finally, the Patient Protection and Affordable Care Act added a 3.8 percent tax to investment income, including rents, in excess of investment expenses. However, rents derived in the ordinary course of business (e.g., a self-rental between a physician practice and physician-owned real estate) avoid this tax.

While ownership is attractive, its benefits can be missed without a well-planned approach. Consider all potential side effects first and adopt the right treatment with proper dosages to ensure a financially healthy practice today and into the future.

About the author: Kevin Reynolds is the health care industry

leader for Daszkal Bolton, a leading South Florida accounting

and advisory firm. With more than 20 years of experience,

Kevin assists multi-physician practices with profitability

analysis, cash flow planning, compensation formulas, buy-sell

agreements, employment and stockholder agreements, risk

management, and due diligence. Kevin may be reached at

[email protected].

areas that are critical to your practice’s success. RSFHA’s experienced team of practice managers can even provide outsourced practice management. With the increasing complexity of managing a medical practice today, having outside analytical and strategic input and support is more important than ever.

The experienced team at RSFHA helps practices improve their

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The combination of these two statistics lead me to summarize that the smaller insurers of doctors in Florida rush to settle cases so that they can limit their legal fees, to limit their exposure to larger settlements, and to avoid bad-faith claims. Beware of the marketing folks who try to make doctors think such rushed settlements are because they do better or quicker claims analysis or have more aggressive claims management, or that they want to more quickly end the stressful lawsuits against doctors. I believe the real reason that smaller insurers settle claims quickly and more often for significant dollar settlements is that smaller insurers just do not have the financial strength to weather a long and often very expensive defense of their insured doctors. If you want a serious defense of claims that may arise against you, look carefully at the financial size and strength of the insurance company.

Matt Gracey is a medical malpractice insurance specialist with

Danna-Gracey, an independent insurance agency based in

downtown Delray Beach with a statewide team of specialists

dedicated solely to insurance coverage placement for Florida’s

doctors. To contact him call (800) 966-2120, or e-mail matt@

dannagracey.com.

Follow Uswww.facebook.com/PalmBeachCountyMedicalSociety

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Practice Management Resources:The Palm Beach County Medical Society is pleased to announce that we will be rolling out our robust new Practice Management Resource Center this summer. The PMRC will offer up-to-date information to help you and your staff manage the day-to-day operations of your medical practice. It will include resources in Health Care IT, Human Resources, ICD-10, Coding and Billing, Collections and Risk Management along with sample forms and letters. If you have any suggestions on other information you would like to be included please contact Deanna at [email protected] or call (561) 433-3940 ext. 28. Council on Legislation:There are many opportunities to make a difference in shaping the future of medicine -join a PBCMS Council, participate as a delegate to the FMA,

submit your ideas and suggestions. For additional information email [email protected]

Jack Zeltzer, MD is the 2015 Board of Trustees Chairman:

The Board of Trustees serves in an advisory capacity and adjudicate within the Society at the discretion of the Board of Directors

and promote the Palm Beach County Medical Society at the state and national levels of organized medicine. Members of the 2015 Board of Trustees include: Jack Zeltzer, MD (chairman); Stephen Babic, MD; Jose F. Arrascue, MD; Malcolm Dorman, MD; Mark Rubenstein, MD; K. Andrew Larson, MD; Ronald Zelnick, MD; Alan Pillersdorf, MD; James Goldenberg, MD; Shawn Baca, MD; Brandon Luskin, MD.

2015 Physicians Choice:Attention: Board Certified Physicians Practicing in Palm Beach County whom would you turn to if you, a family member or other loved one needed medical attention?

Here’s your chance to honor the peers you hold in highest regard. Palm Beach County Medical Society invites you to participate in the inaugural “Physicians Choice 2015” program, in partnership with Palm Beach Illustrated magazine.Visit www.pbcms.org/physicianschoice.com to learn more now.

2015 State of Medicine & Legislative Dinner:There were more than 100 physicians and guests who attended the 2015 State of Medicine & Legislative Dinner. Robert M. Wah, President of the American Medical Association, was the keynote speaker and addressed important topics such as

advocacy issues, physician satisfaction and graduate medical education. Special thanks to Tim Stapleton EVP of the Florida Medical Association, Dr Alan Pillersdorf MD, President FMA and Dr Ralph Nobo, Florida Medical Association President elect for their presentations.

(Left to Right): Jack Zeltzer, MD; Michael T.B.

Dennis, MD

(Left to Right): Alan Pillersdorf, MD, FMA

President; Robert M. Wah, MD, AMA

President; Representative David Kerner.

(Left to Right): Shawn Baca, MD; Samathi Raja,

MD; James Goldenberg, MD

Med MemoQuarter One 2015

SAVE THE DATE

March 18th, 2015 6:00pm - 8:00pm Palm Beach County Medical Society Services Annual Recognition DinnerBenvenuto’s, Boynton Beach, FloridaMore info: www.pbcms.org

March 28th, 2015 6:00pm - 9:00pm2015 Doctor’s Day Family CelebrationSouth Florida Science Center and Aquarium Exhibit - Tombs and Treasures of Ancient Egypt April 16th, 2015 11:00am- 2:00pmHeroes in Medicine Awards Ceremony Kravis Center Cohen Pavilion, West Palm Beach, Florida

QUARTER ONE 2015 ON CALL MAGAZINE 25

Chere R. Lucas Anthony, MD Dermatology, Boca Raton

Paolo Coll, MD Family Medicine, Boca Raton

Terestita Casanova, MD Neurology, Atlantis

Jason Scott Cooper, MD Plastic Surgery, Jupiter

Donald William Goodwin, MD Radiology, North Palm Beach

Eric D. Kramer, MD Neurology, Atlantis

Jose LaBault, MD Neurology, Atlantis

David Steven Silvers, MD Neurology, Palm Beach Gardens

Heather Wayland, MD Internal Medicine, Atlantis

Medical Students

Bradford Hastings University of MiamiJessica Holliday University of Miami

Welcome New Members! Quarter One 2015

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EMRBilling Audits

HIPAAHospital Relations

EMRMeaningful UseBilling Audits HIPAA ACO

PCMHReimbursement

ACAMeaningful Use

ACA

Maximize Revenue - Reduce Risk | Free Revenue & Compliance AuditFor over 30 years, physicians have consistently chosen our expert team of practice management consultants and certified coders to increase revenue, maximize profitability, and reduce risk. Revenue and compliance audit available. For more information visit www.rsfha.com or contact John Pappas @ 561-860-6093 or [email protected] Partner of the Palm Beach County Medical Society

Hospital Relations

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SAVE THE DATE!Thursday, April 16, 2015

11:00 am - 2:00 pm at the Kravis Center Cohen Pavilion in West Palm Beach.Individual, Group Tickets and Sponsorships Opportunities are now available.

FOR MORE INFORMATION VISIT www.pbcms.org/events/heroes-in-medicine/

THE REGION’S MONTHLY NEWSPAPER FOR HEALTHCARE PROFESSIONALS & PHYSICIANS

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2015 OnCall Quarter 1

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Transcript of 2015 OnCall Quarter 1