JULY/AUG2010

Volume 40, No. 4

ESCAMBIA COUNTY MEDICAL SOCIETY

President’s MessageThe “New” Medicare Delivery ModelBy Wayne Willis, MD

Dr. Wayne Willis

CME EventTuesday | August 10

Angus Resturant6:00 pm Social Hour

7:00 pm Dinner and

Presentation

Sponsor: Baptist Heath Care

Speaker: Dr. Brett SmithWhat?s In and What?s

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ECMSinfo@bellsouth.net

Founded in 1873

continued on page 3

The Greatest Generation may be the last group of Americans to enjoy the best healthcare system in the world. The wheels haven’t fallen off but they’re start-ing to wobble as doctors and patients face the perfect storm. Rising healthcare costs, increasing national debt and a flood of baby Boomers joining the Medi-care ranks has the policy wonks working overtime. Adding fuel to the fire will be the forty million uninsured added to the system under the new healthcare reform. Rather than look for bottom-up solutions that are con-sumer driven, the policy makers and academics have come up with a new acronym and a top down solu-tion called Accountable Healthcare Organizations- ACO. These organizations are designed to provide cost control to Medicare patients in a fee for service arrangement. Unlike the current Medicare HMO type plans (Advantage Medicare Plans such as Wellcare) Medicare patients would not sign up for a plan but would be enrolled automatically in whatever ACO their Primary Care Physician (PCP) belongs to. The hope is that care coordination can be moved from the insur-ance company down to the level of the PCP working in a Medical Home Model. In the most basic form the in-frastructure necessary to make this work includes so-cial workers, dieticians, home health nurses and other resources provided by the ACO. Electronic Medical Records and other forms of electronic data exchange are the glue that will hold all this together. Some por-tion of money saved in this arrangement would flow back to the providers. Any group thinking about forming an ACO must first figure out how to provide their PCPs with all the necessary pieces required and make the infrastruc-ture profitable. I would also guess that the time re-quired to fill out paperwork- or click through another computer screen- while coordinating all this care, would mean fewer patients seen. Providing the PCP with more nurses to help with all the additional care coordination would help, but drives the cost up. Hope-fully the academics proposing this new model of care will work out the detail before going forward. In the meantime, take a look at this question and answer section on ACOs. If you are intrigued and would like additional information go to our website at

www.escambiacms.org. Q: What is an “account-able care organization”? A: An Accountable Care Organization, also called an “ACO” for short, is an organization of health care providers that agrees to be account-able for the quality, cost, and overall care of Medi-care beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it. For ACO purposes, “assigned” means those beneficiaries for whom the professionals in the ACO provide the bulk of primary care services. Assignment will be invisible to the beneficiary, and will not affect their guaranteed benefits or choice of doctor. A ben-eficiary may continue to seek services from the physi-cians and other providers of their choice, whether or not the physician or provider is a part of an ACO. Q: What forms of organizations may become an ACO? A: The statute specifies the following: 1) Physicians and other professionals in group prac-tices 2) Physicians and other professionals in networks of practices 3) Partnerships or joint venture arrangements between hospitals and physicians/professionals 4) Hospitals employing physicians/professionals 5) Other forms that the Secretary of Health and Human Services may determine appropriate. Q: What are the types of requirements that such an organization will have to meet to participate? A: The statute specifies the following: 1) Have a formal legal structure to receive and distrib-ute shared savings 2) Have a sufficient number of primary care profes-sionals for the number of assigned beneficiaries (to be 5,000 at a minimum) 3) Agree to participate in the program for not less than a 3-year period 4) Have sufficient information regarding participat-ing ACO health care professionals as the Secretary determines necessary to support beneficiary assign-ment and for the determination of payments for shared savings. 5) Have a leadership and management structure that

For more information, contact Shelly Hakes, Director of Society Relations at (800) 741-3742, Ext. 3294.

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Endorsed by

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ECMS BulletinThe Bulletin is a publication for and by the members of the Escambia County Medical Society. The Bulletin publishes six times a year: Jan/ Feb, Mar/Apr, May/Jun, Jul/Aug, Sept/Oct, Nov/Dec. We will consider for publication articles relating to medical science, photos, book reviews, memorials, medical/legal articles, and practice management.

EditorsNorman Vickers, MD

Holly Strickland, Executive Director

AD PLACEMENTContact Holly Strickland 478-0706

Ad RatesFull page: $600 • ½ page: $300 • ¼ page: $150

2010 ECMS OfficersPresident

Wayne Willis, MDPresident-Elect

Michelle Brandhorst, MDVice President

George Smith, MDSecretary /Treasurer

Wendy Wozniak, MD

Page 4 Medical Accounts Receivables

Page 6 & 7 Newest Membership Benefits

Pages 9-12 Vendors of Choice

Vision for the Bulletin:-Appeal to the family of medicine in Escambia and Santa Rosa County and to the world beyond.- Collaborate with the Alliance to bring together Escambia and Santa Rosa County medical families. To know the needs of the community and promote the healthcare needs.- A powerful instrument to attract and induct members to organized medicine. Views and opinions expressed in the Bulletin are those of the authors and are not necessarily those of the directors, staff or advertisers.

Membership

Welcome New Members!Charles Burns, M.D.Medical School: West Virginia University, 1985Residency: University of Kansas School of MedicineBoard Certified: American Board of Pathology The Pathology Group of Northwest Florida4724 North Davis HwyPhone: 438-1154 | Fax: 433-6034 www.pathology-group.com

Herbert Gannon, M.D.Medical School: University of Alabama Medical School, 1972Residency: University of AlabamaBoard Certified: American Board of Obstetrics & GynecologyCovenant Hospice5041 North 12th AvePhone: 202-5814 | Fax: 202-0600 www.covenanthospice.org

Rodney Durham, M.D.Medical School: Medical College of Georgia, 1980Residency: University of Michigan, General SurgeryResidency: University of Texas, Trauma & Critical CareBoard Certified: American Board of General Surgery & Surgical Critical CareSacred Heart Medical Group Department of Trauma5149 North Ninth Ave.Phone: 416-6159 | Fax: 416-7198 www.sacred-heart.org

Reducing Avoidable Readmissions – A New Guide By Donna Jacobi, MD The “Health Care Leader Action Guide to Reduce Avoidable Readmis-sions” was published earlier this year by the Health Research and Educa-tional Trust, an affiliate of the AHA. It lists major strategies and supplies an appendix of interventions that may be utilized. It can be accessed at www.commonwealthfund.org. Search “readmissions” to locate this and other documents.1. During hospitalization:

Risk screen patients and tailor care•Establish communication with the patient’s primary physician, •

family, and home careUse “teach-back” to educate patient/caregiver about diagnosis and •

careUse interdisciplinary/multidisciplinary clinical team•Coordinate patient care across multidisciplinary care team•Discuss end-of-life treatment wishes•

2. At discharge:• Implementcomprehensivedischargeplanning• Educatepatient/caregiverusing“teachback”• Scheduleandprepareforfollow-upappointment• Helppatientmanagemedications• Facilitatedischargetonursinghomeswithdetailedinstructionsandpartnerships with nursing home practitioners

3. Post-discharge:• Promotepatientself-management• Conductpatienthomevisit• Followupwithpatientsviaphone• Usepersonalhealthrecordstomanagepatientinformation• Establishcommunitynetworks• Usetelehealthinpatientcare

Which of these items can YOU influence? Directly or through your in-volvement with your hospital’s medical staff and/or leadership? Are there areas in which the Escambia County Medical Society can provide leader-ship? Let us know the barriers you continue to see to improving this critical aspect of health care for our patients. Thanks!

includes clinical and administrative systems 6) Have defined processes to (a) promote evidenced-based medicine, (b) report the necessary data to evaluate quality and cost measures (this could incorporate requirements of other programs, such as the Physician Qual-ity Reporting Initiative (PQRI), Electronic Prescribing (eRx), and Electronic Health Records (EHR), and (c) coordinate care 7) Demonstrate it meets patient-centeredness criteria, as determined by the Secretary. Additional details will be included in a Notice of Proposed Rulemaking that CMS expects to publish this fall. Q: How would such an organization qualify for shared savings? A: For each 12-month period, participating ACOs that meet specified quality performance standards will be eligible to receive a share (a percentage, and any limits to be determined by the Secretary) of any savings if the actual per capita expenditures of their assigned Medicare beneficiaries are a sufficient percentage below their specified benchmark amount. The benchmark for each ACO will be based on the most recent available three years of per-ben-eficiary expenditures for Parts A and B services for Medicare fee-for-service beneficiaries assigned to the ACO. The benchmark for each ACO will be adjusted for beneficiary characteristics and other factors determined ap-propriate by the Secretary, and updated by the projected absolute amount of growth in national per capita expenditures for Part A and B. Q: What are the quality performance standards? A: While the specifics will be determined by the HHS Secretary and will be promulgated with the program’s regulations, they will include measures in such categories as clinical processes and outcomes of care, patient experi-ence, and utilization (amounts and rates) of services. Q: Will beneficiaries that receive services from a health care profes-sional or provider that is a part of an ACO be required to receive all his/her services from the ACO?

A: No. Medicare beneficiaries will continue to be able to choose their health care professionals and other providers. Q: Will participating ACOs be subject to payment penalties if their sav-ings targets are not achieved? A: No. An ACO will share in savings if program criteria are met but will not incur a payment penalty if savings targets are not achieved. Q: When will this program begin? A: We plan to establish the program by January 1, 2012. Agreements will be-gin for performance periods, to be at least three years, on or after that date. Q: How do I get more specific information? A: CMS plans to hold a listening session to hear stakeholder ideas on ACOs this summer. Further details about this listening session, to be held as a special open door forum, will be posted by June 11 on the following special open door forum website: http://www.cms.gov/OpenDoorForums/05_ODF_SpecialODF.asp#TopOfPage Further details for the shared savings program will be provided in a Notice of Proposed Rulemaking which CMS expects to publish this fall.

Don’t miss our next membership meeting August 10, 2010 at the Angus Restaurant. Dr. Brett Smith will be our guest speaker. Please see the insert to signup for the Pertussis vaccine and meeting. We look forward to seeing you.

The “New” Medicare Delivery Model, continued from page 1

Practice Management

Medical Accounts Receivables“The right medicine for the right symptom”By Doug Hillis and Mark Wilson, Transworld Systems

There is little argument these days that lower reimbursements and

higher costs are putting more emphasis on the unpaid dollars in the “patient

buckets” on your accounts receivables. However, there does seem to be

some question on which approach is best to accomplish this task. The real

answer may come from improved segmenting of your patients based on the

information you already have.

Traditional Approach

Many practices have viewed the patient accounts receivables process

as a two step process that begins with internal billing/follow-up and ends

with third party collections. The real problem with this approach is it forces

the practice or medical facility to do one of two things:

a. Continuous Internal Billing and follow-up OR…

b. Early usage of a third party

Continually billing patients and following up with internal letters and

phone calls can improve the revenue stream somewhat. However, with ris-

ing FTE, administrative and overhead costs; this approach is expensive and

the lift achieved in cash-flow is considerably offset by the associated costs.

More importantly, sending a 3rd, 4th or 5th statement to a patient may actu-

ally be counter-productive. If the patient perceives that the practice will

simply continue to send ANOTHER statement or internal letter, it is easy to

conclude that nothing more will happen. This perception may well have

been reinforced from their past experiences as a patient with many of their

physicians over the years. The patient concludes that waiting it out may

get them off the hook. Complicating matters further is expectation that their

insurance will cover more than it really will cover. To many patients the EOB

is incomprehensible and they think it is the responsibility of the practice to

figure out how to get the insurance to pay. So they wait… for the next state-

ment!

Early usage of a third party also makes sense if the agency is willing

to drop from the typical 33% contingency rate to 30% or even 25%. A

quick call by a collector certainly sends a message to the patient that the

statements were real and that you meant what you said. Getting accounts

to your agency at 60 or 75 days will also increase the recovery rates. The

downside is that most of those patients are not really “collection problems”.

These patients just need a nudge, or motivation to get back on their pay-

ment plan. Furthermore, with the focus on patient care, many doctors won’t

even use an agency (much less use them at 60 days).

Proper Segmentation

To get an idea of the solution, lets first take a new look at the patients and

what we know about them. To do this we will segment your patients with

balances due into 3 catagories:

1. Billing accounts – these are the patients that will get one statement

and pay the bill. If they do not understand the EOB, your staff gets a call

the very next day.

2. Delinquent account Billing – these are “the stubborn payers”. If

they do not understand the Explanation Of Benefits (EOB) , your staff gets

a call the very next day. They may have had previous experiences where

they let medical bills slide without adverse consequences. Most of these

patients are not collection problems, but they do need to know you are seri-

ous about getting paid. Sending another statement could actually send the

WRONG message to this patient. Sometimes they are simply embarrassed

and won’t ask for payments but instead are hoping it will go away. What

they need is a gentle nudge to get them to pay.

3. Collection accounts – these are the patients that may think they

can get out of paying altogether. These patients may not be as numerous

as we have been lead to believe. Those “bad apples” do exist; however,

if some of the patients in the 2nd segment are not managed properly, they

may slip into this 3rd category. If they have not been sent a clear mes-

sage that YOU expect to get paid and that your services are worth EVERY

penny, they could require collection agency attention. If they think that the

statements will continue and that is all, then it may be a savvy decision on

their part to wait and see what happens next. Meanwhile they are making

buying decisions every day. These decisions likely will lead to more debt

and obligations that take precedence over YOUR bill. It is not necessarily

personal or because they don’t like you, but now they have other priorities.

Now they are a COLLECTION PROBLEM.

Recognizing and Managing “Delinquent Billing Accounts”

Regardless of your approach, there will always be patients that can

be identified as “Delinquent Billing Accounts”. The first step is to define

which patients fall into this category. There seems to be a growing consen-

sus that any patient that has not responded after 2 communications(usually

statements) can be identified as a “Delinquent Billing Account”. It is also

important to recognize that a 3rd statement or reminder is NOT the answer.

In fact, it may send the wrong message! These patients need to be man-

aged through a different process.

Transworld Systems has been providing an innovative system to man-

age delinquent accounts as they enter the Delinquent Billing Stage. By

contacting the patient as a third-party we get them to pay attention to YOUR

bill. However, our diplomatic approach is so reasonable that even the most

lenient doctors consider the process to be completely fair and courteous.

We provide the “gentle nudge” that these patients need. Our on-line in-

terface makes it possible for an integrated approach that encourages the

patient to pay the practice directly. The practice can let us know on-line

when payments are made or when a payment plan is implemented. The

patient maintains their honor and integrity while making proper decisions to

keep their obligations to their doctor or hospital. The practice or medical

facility gets the patient engaged before other obligations interfere.

This service is called Profit Recovery and has been offered by Tran-

sworld Systems since 1970. Transworld has been recognized as one of

only 14 Administrative Partners with the Medical Group Management As-

sociation (MGMA). We have also earned the “Peer Review Designation”

from the Healthcare Financial Management Association(HFMA).

For more information on how to manage YOUR “Delinquent Billing Ac-

counts”, contact Doug Hillis at: 251-343-3913 or douglas.hillis@transworld-

systems.com

Practice Management

Liability Concern: School & Sport PhysicalsBy Cliff Rapp, LHRM, Vice President, Risk Management, First Professionals Insurance Company

Physicians that conduct school and sport physicals, such as pre-par-

ticipation physical evaluations, need to be aware of the inherent liability

exposure, particularly in the absence of an existing physician-patient re-

lationship.

The most common types of conditions giving rise to malpractice claims in-

volving pre-participation physician examinations are cardiovascular. Fail-

ing to discover a latent asymptomatic cardiovascular condition is a preva-

lent allegation that in most cases requires proof that the physician deviated

from the standard of care in terms of the pre-participation evaluation. De-

pending on the legal venue, courts may hold that the mere performance

of a pre-participation physical exam serves to create a physician-patient

relationship with the same legal duties as that of an established, private

practice patient. Therefore, it is important to emphasize the precise nature

and limited scope of the physician-patient relationship, delineated solely

to the examination. Generally, physicians that provide medical clearance

for participating in competitive sports are not legally liable per se for in-

jury or death caused by an undisclosed cardiovascular abnormality. Most

courts have recognized that the pre-participation screening standards of

athletes may follow current consensus guidelines in determining cardio-

vascular fitness. Again, this will depend on the legal venue.

Cardiovascular screening is the primary, inherent liability exposure asso-

ciated with school and sports physicals. Congenital aortic valve stenosis

is the most likely condition to be detected reliably during routine screen-

ing.(1) Primarily, differentiating common heart murmurs from potentially

lethal cardiovascular conditions. Of course, other insidious and chronic

underlying medical conditions are also a consideration in terms of the li-

ability exposure inherent to these kinds of physical exams.

High-risk Symptoms

Subjects with a personal or family history of the following may be at high-

risk for cardiovascular conditions (and thus potential claimants for failure

and delay in diagnosis):

• exertionalchestpain/discomfort

• syncope/nearsyncopalepisodes

• excessive,unexpectedshortnessofbreath

• excessive,unexplainedfatiguewithexercise

• historyofheartmurmur

• elevatedsystemicbloodpressure

• familyhistoryofcardiovasculardisease

It is important that the parents or legal guardians not only provide their

consent for the student or child to be evaluated, but in doing so acknowl-

edge the limited nature of the pre-participation evaluation, the fact that no

physician-patient relationship is created or intended, and that the exam

does not replace an annual well-child exam by the students primary care

physician.

Case Summary

Consider the case involving our insured physician and ARNP who were

doing pre-participation sports physicals at an athletic facility on behalf of

the local high school. Both had performed school physicals on a young

male student whose father had died of an MI at a young age. After being

cleared two years in a row by our insureds, the student died while partici-

pating in vigorous physical training while on a treadmill at the school. A

wrongful death action was filed alleging that the student should not have

been cleared for sports activity without further evaluation in light of his

family history. Medical experts could not support a defense in light of the

fact that both of the student’s examination consent forms noted the fam-

ily history of MI. Medical clearance to participate in the sports program

should not have been granted. Our insureds should have either pursued

further diagnostic testing or referred the student to his primary care physi-

cian.

Risk Management Guidelines

• Seekanindemnificationandholdharmlessagreementfromtheschool

or facility requesting the pre-participation evaluation

• Determine if youareentitled to sovereign immunityby theschoolor

recreational entity

• Confirmthatyourexistingprofessionalliabilitycoveragedoesnotex-

clude claims arising from school and sports physicals

• Requirethatparentalconsenttoconducttheevaluationhasbeenpro-

vided and waives creation and expectation of a physician-patient rela-

tionship

• Requirethatinformedconsentisobtainedrelatingtothepurposeand

scope of the evaluation

• Ensurethatdocumentationoftheevaluationismaintainedwhenevalu-

ations are conducted externally to your practice

• Maintainalogidentifyingeverysubjectevaluated

• IncludeabrachialBPmeasurementinthesittingposition,precordialaus-

cultation in both the supine and standing positions, assessment of the fem-

oral artery pulses, recognition of the physical stigmata of Marfan syndrome,

BP >95th percentile, systolic murmur equal to or greater than 3/6 intensity,

any diastolic murmur, any murmur that intensifies with Valsalva. (1)

• Retainacopyofanyevaluationrecordentailingasubjectdiagnosed

with potentially compromising factors

• Communicatepotentialconcernsormedicalconditionstothesubject

of the exam, the subject’s parent or legal guardian, and the subject’s pri-

mary care physician

• Utilizeastudentmedicalhistory form,executedbyboth thestudent

and the student’s parent or legal guardian

• Documentanylimitationswithspecificity

• Document any medical recommendations on the pre-participation

form

• Advisetherequestingpartyandthesubjectoftheevaluationthatsuch

screening should be repeated every 2 years

(1) American Heart Association. Recommendations and Considerations related to Preparticipation Screening for Cardiovascular Abnormalities in Competitive Athletes: 2007 Update. AHA Journals

ECMS would like to highlight our newest benefit. Connect with members on the go IPHONE APP!

I’d like to introduce our new ECMS Mobile application, which we believe is a revolutionary design

to connect with members. Our intention is to create a simple but effective way for our community of

physicians to communicate across hospitals and above physician directories.

ECMS has partnered with DocBook to help keep our community of physicians up-to-date with the

latest physician and pharmacy information. We’ve worked hard to create an electronic directory

that is a living document. This application has a great design which allows physicians the ease to

search for important information on the fly. A quick reference tool located in your pocket every-

where you go.

Membership

By design this app gives our physicians a platform structure to create their own personal com-

munication outcomes. We have loaded the ECMS Mobile app with physician information that

can be tailored to each physician’s communication preference. You may opt to text, email, or

call your fellow physicians.

The app has been planned, designed, tested, and developed with physicians to truly offer

an engaging and convenient resource. The investment involved in this requires us to ask a

small fee in return, and I do believe that our chosen price point of $50 per year for members and $100 per year

for non-members offer great value for the money.

The ECMS Mobile app is currently formatted on an Apple platform. However, there are exciting plans to move this application to the Android in the very

near future.

Our primary goal is to also keep physician information private and secure. Therefore, DocBook uses the highest form of encryption and verification for

safety. The information provided is secure in our database and the information you store on your personal IPhone is limited to your use.

This application is currently a benefit of membership; therefore a physician must apply for membership, receive member number, and sign up for the

application. Only MDs and DOs are eligible for the benefit.

As the emerging technology changes and DocBook implements improvements the cost will not increase. We are excited to see the future of physician

communication reach beyond the yellow pages and hospital directories to the velocity of mobile technology.

Attention Golfers1. Keep Your Back Straight, Knees Bent & Feet Shoulder-Width Appart.2. Form a Loose Grip.3. Keep Your Head Down.4. Stay Out Of The Water5. Try Not To Hit Anyone.

WELL DONE! NOW DO NOT MISS OUR 2ND ANNUAL GOLF TOURNAMENT

October 16, 2010 • 8AM • Scenic Hills Country Club

Sponsorship Opportunities with the Escambia County Medical Society

Escambia County Medical Society (ECMS) gladly welcomes a variety of opportunities for diverse businesses to interact with our physicians. Creating opportunities for physicians to interact with local businesses and services is valuable to our community and our organizational goals.

ECMS Bulletin Published six times a year and mailed to over 500 physicians and community lead-ers, as well as electronically sent to an additional 450 contacts. Visit our website to view our current newsletters. Call ECMS for Ad sizes and contracts.

Dinner Meeting SponsorshipEducational dinners provided to our physicians six times annually. Sponsors can enjoy socializing with members, display before the meeting, and dinner. This in-cludes advertising in our member directory, website, faxes, and emails. Cost of sponsorship: $2,500 solo $500 co-sponsor.

ECMS Pictorial DirectoryPublished annually, this directory is distributed to local physicians, hospitals, community liaisons, and new residents moving to the area with the help of Pensacola Chamber of Commerce. Call Ballinger Publishing for details at 850-433-1166.

Website SponsorshipECMS has a newly renovated website that benefits the public and physician mem-bers visit our site at www.escambiacms.org. Banner space available.

Weekly E-NewsletterECMS has a weekly newsletters that update our physicians on current events and legislative advoca-cy. Add your link to each weekly webcast. Call for details only one vendor for six months webcast.

April Mini Health FairOur April Mini Health Fair is a fun & eventful evening. This event is held in conjunction with the ECMS dinner meeting and space is limited. Sponsorship is $500 which includes a display table and dinner for two.

Annual Golf TournamentJoin the FUN! $40.00 Tee sign sponsor or put a team together.

Membership

MARCH/APRIL2010

Volume 40, No. 2

ESCAMBIA COUNTY MEDICAL SOCIETY

President’s Message

The Road to Reform

By Wayne Willis, MD

Dr. Wayne Willis

General

Membership

Meeting

Tuesday | April 20

Heritage Hall

6:00 pm Social Hour

7:00 pm Dinner

Presentation

Sponsored by:

Merck

RSVP478-0706

ECMSinfo@bellsouth.net

Many of you remember the alphabet soup of

managed care that started in the early 80’s. We had

IPA’s, PPO’s and HMO’s. Now we have a new set

of acronyms that would make a bureaucrat smile.

Welcome to Accountable Healthcare Organizations

–AHCO, consumer directed healthcare –CDHC and

Patient Centered Medical Home –PCMH.

This new form of managed care is an attempt to

transform the health care model in a top down struc-

ture, with the exception of consumer directed health-

care. Hospitals and insurance companies refer to

this as being vertically integrated. The goal theoreti-

cally is to control costs. I remember being told the

same thing when the managed care movement first

started. With a few exceptions, the managed care

movement proved to be a dud as far as controlling

costs.

As a family physician I’d like to talk about the

Patient Centered Medical Home-PCMH by ad-

dressing the strengths and weaknesses. This will

directly involve all primary care doctors but could

indirectly involve specialty physicians also. The

PCMH is the brainchild of the four primary care or-

ganizations: the American Academy of Family Medi-

cine, the American Osteopathic Organization, the

American Academy of Pediatrics, and the American

College of Physicians. These groups recognize that

primary care is on life support and are attempting to

“brand” the essence of what primary care doctors

do.

The American Academy of Family Practice has

developed a National Demonstration Project of 150

members to test the concepts of a PCMH and has

partnered with the National Committee for Quality

Assurance (NCQA) to develop thirty criteria to mea-

sure quality outcomes in practices that adopt the

PCMH model. I have not found a simple definition of

a PCMH, but it involves two categories. First, “Care

principles” the care primary care provides to patients

that encourage an ongoing relationship, develops a

team approach with specialists that coordinate and

integrate care across

the health care system.

Second, “infrastructure”

that supports the patient

care. This will include

electronic medical re-

cords, national and local information technology,

commitment to evidence based medicine, quality

and safety. The core concept of PCMH ultimately in-

cludes access to a primary care health professional

and comprehensive coordinated care.

Strengths:

The concept of the PCMH is altruistic and no-

ble indeed. The gap in health disparities are ever

growing to include the uninsured, underinsured, and

now the “terminally” unemployed. The possibilities

are phenomenal for closing the gaps and providing

better long term patient coverage. It has long been

the goal of Family Medicine to have every patient

maintain a primary care physician. There is better

coordination of care, medication management and

disease prevention.

The structure of the PCMH will heavily rely on

the infrastructure of the practice. The physician

practice will need to navigate the system efficiently,

secure a safe health information exchange, optimize

referrals, and cost effective medication coordination.

Subsequently, restoring the primary care physician

as the center of patient care.

In theory, adopting the principles of the PCMH

will provide not only more cost efficient, higher qual-

ity care, but the entire healthcare system will also

reap the financial benefits of controlling health care

cost inflation.

Weaknesses:

Thus far, the National Demonstration Project

conclusions are receiving mixed reviews from physi-

cians and analysts. It has been an expensive ven-

ture and stressful to physicians and staff that par-

ticipated. It’s also apparent that implementation of Founded in 1873

continued on page 9

Medical/Legal

One patient may stare nervously at his feet,

avoiding eye contact, in hopes that the doctor

will not notice his steadily increasing weight that is dutifully documented

every visit. Another patient may anxiously and tearfully bring up the issue

of a forty pound weight gain while pulling a box of tissue out of her purse.

Either way, a delicate conversation should soon take place.

Some physicians believe they do not have adequate knowledge or train-

ing to address obesity. In studies physicians have reported feeling in-

competent and uncomfortable when the topic comes up. Other factors in

the failure to address issues of weight have been noted. These include,

physician concern that the patient may be hurt or offended, that there is

just not enough time to address the complex issue, and that reimburse-

ment for preventive care has been insufficient. Further, the physician

may perceive that the patient is not ready or motivated to make lifelong

changes.

These factors helps to shed light on a study conducted by the Mayo Clinic

which indicated that the medical charts of only 1 in 5 obese patients listed

them as obese. Documentation of the physician and patient having for-

mulated a weight-management plan is even less likely to be found in the

patient’s records.

The Center for Disease Control (CDC) reports that 30 percent of adults

are obese and another 35 percent are overweight. This translates into

increased risks of heart disease, diabetes, hypertension, and high cho-

lesterol. With increased prevalence and stronger scientific correlations

between risk factors and outcomes, there is potential danger in not having

a frank and informative discussion with the obese or overweight patient.

Although avoidance of liability is probably not the only motivating factor it

may become an important one.

It is easy to imagine the plaintiff’s argument. Mr. Smith, the obese father

of four children does not survive a heart attack. He has been seen by the

same family physician for years and his medical records have no indica-

tion that weight-management or the risks associated with obesity have

ever been discussed. Of course, the information is widely available from

other resources and it is a tenuous argument that the physician’s failure

to warn or develop a treatment plan for obesity was the cause of death.

However, there is never any real certainty for novel issues of liability.

Therefore, the safest approach is to take a deep breath and with gentle-

ness and respect discuss a diagnosis of obesity with the patient. From a

psychological perspective some have advised that the physician refrain

from using the word “obese,” substituting words such as “unhealthy body

weight.” However, from a legal standpoint, if a patient meets the medical

definition of obese it may be advisable to use and define the actual term.

Eat Less, Exercise More: The Dreaded ConversationBy Laurel Hinote Thorpe, Esquire, Bozeman, Jenkins & Matthews P.A.

Next, the physician should outline, in quantifiable terms, the health risks

of being overweight or obese. Assessment and management informa-

tion, including patient questionnaires and handouts, is readily available

through organizations such as the American Medical Association and the

American Academy of Family Physicians.

The physician should then develop a treatment plan in consultation with

the patient and document that plan in the patient’s record. If the patient

refuses to discuss or follow recommendations, a simple documentation of

this fact should go a long way to providing a defense to a legal claim that

may arise in the future.

In addition to the liability issues associated with obesity there are admin-

istrative issues that should be considered in light of recent legislation.

First, under the health care reform law insurance companies will now be

required to cover preventative-health services, which include obesity

screening and nutritional counseling. Careful coding and documentation

should help to alleviate reimbursement concerns and free physicians to

spend the amount of time necessary to adequately address the complex

issues associated with counseling and treating obesity as a primary dis-

ease.

Second, the economic stimulus package provides financial incentives for

physicians to adopt electronic health records. In order to qualify, the phy-

sician must demonstrate a “meaningful use” of electronic health records.

One of the leading factors outlined by Center for Medicare & Medicaid

Services (CMS) is the documentation of BMI at every visit. Over the next

few years the standards for meeting the definition of “meaningful use” will

increase to the point where physicians will have to show that such use

leads to better health outcomes. So not only must physicians document

BMI in the electronic health record, but that information must then be used

in a meaningful way to improve patient health. Eventually, physicians will

face decreased reimbursement if they do not meet the standard.

Now is a good time for physicians to consider their approach to the di-

agnosis and treatment of obese and overweight patients. It may help

to avoid medical liability and ultimately may provide a financial benefit

to the practice. If that is not incentive enough to have the conversation,

consider that a patient is three times more likely to lose weight if advised

to do so by a physician.

Put our team of healthcare banking specialists to work for you and your practice.

Todd O’Brien Darlene Schneider(850) 857-5074 (850) 857-5078

BBVA Compass is a trade name of Compass Bank, Member FDIC.

Hospital News

Alliance News

Sacred Heart NewsCardiac Imaging: The PET/CT Imaging Center of Northwest Florida, lo-

cated at Sacred Heart Hospital in Pensacola, is now offering the area’s

only cardiac PET/CT imaging services to evaluate the health of your heart

by measuring the blood flow it receives. Sacred Heart is one of only two

hospitals in Florida to offer this new technology. For more information,

please call (850) 478-6336.

New COO: Sacred Heart Health System has selected Carol L. Schmidt as

its new chief operating officer. She joins Sacred Heart after serving with

Ascension Health and previously the Daughters of Charity National Health

System for 12 years. “Carol is widely respected across Ascension Health,”

said Laura Kaiser, President and CEO of Sacred Heart Health System.

“She brings to Sacred Heart a passion for quality healthcare. She has a

proven ability in diverse areas, such as operational performance improve-

ment and physician partnering.”

Tobacco-Free Campus: On September 1, all Sacred Heart Health System

facilities will be tobacco-free, inside and outdoors, on all of its campuses.

The goal is to help provide a safer environment for all who visit and work

at our facilities. Our move toward a tobacco-free environment reinforces

our commitment to improving the health of our patients, associates, physi-

cians and community.

In the Community

Baptist Health CareBaptist Health Care Breaks Ground on $29 million Construction Proj-

ect; Seeks Physician Feedback

Baptist Health Care (BHC) continues its passion for growth and employee

satisfaction with new construction efforts, physician satisfaction initiatives

and recent honors for excellence. Following their May 25 ground breaking

at Gulf Breeze Hospital, BHC broke ground at Baptist Hospital on July 7 to

begin their expansion. The construction initiatives across the BHC System

are expected to total $29 million and create many employment opportuni-

ties in our community.

BHC seeks physician feedback and encourages all Baptist affiliated phy-

sicians to take part in our annual physician satisfaction survey going on

now through August 23. This valuable tool gives all physicians the op-

portunity to share insights and opinions so that BHC can further enhance

systems and processes to meet your needs and enhance quality patient

care.

Lastly, thank you for voting BHC as the “Best Place to Work” in the Pensa-

cola News Journal’s 2010 “Best of the Bay” reader survey. The Indepen-

dent News also recognized BHC president and CEO, Al Stubblefield, on

the 2010 “Power List.” The list includes names of 75 area leaders who are

positive ambassadors in the Greater Pensacola area.

Beds for Babies Success!We are blessed with wonderful Alliance Members and ECMS Members. We raised $2,000, with the help of our Members and the Florida Medical So-ciety Alliance, for the Beds for Babies Program in Escambia County. Your donation will provide a safe place for needy babies to sleep. This program works to not only provide a bed, but educational material, parenting education, and coun-seling.

Children’s Health Carnival With the ever growing rates of obesity the Florida Medical Society Alli-ance and the Escambia County Alliance continue to focus on the needs of children. Obesity in children can lead to a lifetime of chronic disease. The ECMS Alliance is sponsoring the 2010 Healthy Carnival for 300 students between the ages of five and fourteen. The event will be located at the Fricker Center, July 30th 10am- 3pm.

Please consider your membership as a viable way to make a difference in our medical community. We encourage all spouses to join! Our Next meet-ing will be Thursday, September 16, 2010 at the Macaroni Grill. Call me if you are interested in membership or leadership 478-0706.

Member AnnouncementDr. Joseph Howard celebrated a momentous event this year, 50 years in Medicine! He Graduated Medical School, July 1, 1960 and he celebrated an Enthusiatic Birthday on July 1, 2010. Thank you Dr. Howard for your

commitment to Medicine and our Community!

Deposit products and services are offered through SunTrust Bank, Member FDIC.

Securities and Insurance Products and Services: Are not FDIC or any other Government Agency Insured · Are not Bank Guaranteed · May Lose ValueSunTrust Private Wealth Management Medical Specialty Group is a marketing name used by

provided by SunTrust Bank. Securities, insurance (including annuities and certain life insurance products) and other investment products and services are offered by SunTrust Investment Services, Inc., an SEC-registered investment adviser and broker/dealer and a member of FINRA and SIPC. Other insurance products and services are offered by SunTrust Insurance Services, Inc., a licensed insurance agency.

©2009 SunTrust Banks, Inc. SunTrust is a federally registered service mark of SunTrust Banks, Inc. Live Solid. Bank Solid. is a service mark of SunTrust Banks, Inc.

Specialized Wealth Management for Practices and Physicians

Your patients look to you for guidance. But when it

you turn? At SunTrust, our advisors can help you stay on

payments received and protecting you against fraud. To

schedule a conversation with a Client Advisor from our

Private Wealth Management Medical Specialty Group,

call 850.435.1204 or visit us at suntrust.com/medicine.

Treasury and Payment Solutions Lending Investments Financial Planning

Strategies for Growth.Healthy Practice Development.

The healthcare specialists at O’Sullivan Creel, LLPhave experience assisting practices with financialand operational issues in this complex industry. In addition to traditional accounting services like bookkeeping and retirement planning, we offer consulting services including:

Personnel AssessmentAccounts Receivable ReviewHospitalist Program ImplementationFinancial AnalysisPhysician AnalysisDaily Practice Operations & Systems OverviewInterim Practice ManagementBenchmarkingStrategic PlanningPolicy and Procedure DevelopmentHealthcare and IT System EvaluationNew Physician Practice Start-up

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Even Better Together.

Florida Doctors Insurance Company is proud to announce it has completed the merger and acquisition of Physicians Preferred Insurance Company. This makes us the fourth-largest admitted writer of physicians’ and surgeons’ medical professional liability insurance in Florida.

The same service, the same quality, the same expertise—now increased by the power of two.

www.fldic.com

(800) FLA-DOCS (352-3627)(904) 296-2887

· 0% Financing and Flexible Payment Plans

· Demotech A, Exceptional Rated Insurance Company

· Extensive Experience and a Strong Focus on Florida

· Claims-Free Discounts up to 25%

· Retroactive and Tail Coverage Available

· Free Online CMEs

RETURN SERVICE REQUESTED

8880 University Pkwy., Suite BPensacola, FL 32514Ph: 850-478-0706 Fx: 850-474-9783Email: ECMSinfo@bellsouth.netExecutive Director: Holly StricklandAdmin. Asst: Ashley Jacobi

PRSRT STDU.S. POSTAGE

PAIDPERMIT #258

PENSACOLA, FL

View and opinions expressed in the Bulletin are those of the authors and are not necessarily those of the board of directors, staff or advertisers. The editorial staff reserves the right to edit or reject any submission.

Visit the ECMS created websites for Dr. Angeli Saith, www.fivepointsfamily.com & Dr. Stephen Kimura, www.allergyasthmamd.net

Save the Date

Upcoming Conferences:

2nd Annual Stroke ConferenceSeptember 10, 2010Sacred Heart Hospital Dudley Greenhut AuditoriumCall MECOP for Details 477-4956

Heart ConferenceSeptember 30, 2010New World LandingCall Dolly Partridge Baptist Hospital 469-7439Or Fran Kahler-Ropp 444-1756

Our Rates are Decreasing by an Average of 5%!*

Call MAG Mutual’s Dennis Wilson toll-free at 1-888-892-5216 or Ray Horn, Fisher-Brown Inc. at 850-994-2620 or visit us at www.magmutual.com.

Physician Ownership and Leadership • Financial Stability

.everthanStronger

everthanStronger

.

*Medical professional liability insurance rate reduction effective June 1, 2010. Actual rate adjustment depends on your medical specialty, location and other factors.**Dividend effective June 1, 2010. Dividend payments are declared at the discretion of the MAG Mutual Insurance Company Board of Directors.

$12.5 Million Dividend Declared in 2010!**