introducing 15yearsofexcellence64.130.39.163/pdfs/summer-2008.pdf2901 okeechobee blvd. west palm...
TRANSCRIPT
Joe DiMaggio Children’s Hospital – One ofthe nation’s leaders in patient satisfaction
Introducing
T H I S I S S U E :
15 Years of ExcellenceJoe DiMaggio Children’s HospitalThe Leading Children’s Hospitalin Broward and Palm Beach Counties
B r o w a r d C o u n t y M e d i c a l A s s o c i a t i o n W W W . B C M A . C O M S U M M E R 2 0 0 8
BCMA | SUMMER 2008
Officers
Nigel A. Spier, M.D.President
Octavio “Tony” Prieto, M.D.President Elect
Alberto Casaretto, M.D.Vice President
Aaron Elkin, M.D.Treasurer
Kutty Chandran, M.D.Secretary
Michael Weston, M.D.Immediate Past President
Linda Cox, M.D.Chair, Board of Trustees
Cynthia S. PetersonExecutive Vice President
Michael Weston, M.D.Editor
Board Members
Wanda Casaretto
Robert Cline, M.D.
Beverley Nelson-Curtis, M.D.
Vincent DeGennaro, M.D.
Alison DeSouza, M.D.
Michael Dolchin, M.D.
Nabil El Sanadi, M.D.
Paul Flaten, M.D.
Michael Funk, MPH, PA-C
Ronald Giffler, M.D.
Mark Grenitz, M.D.
Edwin Hamilton, M.D.
Yusoof Hamuth, M.D.
Julie Long, M.D.
Arthur Palamara, M.D.
Alan Routman, M.D.
Caren Singer, M.D.
Dana Wallace, M.D.
Bruce Zafran, M.D.
AMA Delegates
Robert Cline, M.D.
Ronald Giffler, M.D.
Arthur Palamara, M.D.
3 President’s Statement
7 EVP Message
21 Wage & Hour Issues
25 BCMA NewMembers
26 FDH-Appointment
27 PQRI-Update
33 A Day at Polo
35 The Three Little Pigs
38 Meetings & Events
40 In Memoriam
43 Calendar of Events
44 Announcements
Feature Story
10 The Joe DiMaggioChildren’s Hospital
12 Pediatric Anesthesiology
13 Congenital Heart Defects
14 Craniofacial Program
15 Hematology/Oncology
16 Transport Program
17 Pediatric Sleep Medicine
18 Infectious Diseases
19 Children’s Emergency
C A L E N D A R O F E V E N T S
Mark your calendar
BCMA ANNUALDINNER Nov. 1
THE RECORD is the official publication of Broward CountyMedical Association. Written contributions frommembersare always welcome. Opinions expressed are those of the authors and not necessarily those of the BCMA and BCMAassumes no responsibility for statements made. Advertising does not imply approval or endorsement by the BCMA.All advertising is subject to acceptance. The BCMA reserves the right to edit or reject any material submitted.
The Record: Features & News
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Prescription
B
Someone once said that medicine is the only profession that constantly strives
to make itself unnecessary. But if one were to listen to all the critics and pundits
who claim to know what’s wrong with healthcare today, it would seem that
there is no shortage of groups who would seek to make the title of “M.D.” irrele-
vant. The insurance industry claims we cost too much, trial lawyers say we make
too many mistakes, and so-called consumer groups (many of whom are in fact
just instruments for either one of the former two groups I mentioned) say we
don’t care enough. And it seems everyone wants to propose a solution that
increasingly cuts physicians out of the picture.
Healthcare in the United States is at a crossroads, of that we can be certain.
Mounting costs of healthcare, growing from 14 to 19% of our GDP over the
next 5-10 years at the current rate, an ever increasing number of patients with
insufficient health insurance, and a groundswell of pressure to modernize the
mechanics of how our healthcare system communicates and conducts business,
are all coming to a head to force major change in the delivery of health care in
this country. Not to mention continued expectations, realistic or not, that our
healthcare system be error free.
Some may claim that we as a profession have done little to offer our own
solutions, and that organized medicine remains largely a reactive rather than
proactive effort, driven largely by members of the “old boys club” who spend
too much energy focused on trying to keep things the way they used to be,
rather than putting any challenging or bold new visions forward. My personal
opinion is that there is some truth to that. However, it is equally true that in our
current economic and political climate, there is little attention focused on bold
new ideas. The fact is, the press has limited desire to make healthcare reform
sound sexy in a 30 second sound bite. It just doesn’t get good ratings. And so
all too frequently, it has more to do with the money behind the message, rather
than the message itself.
Physician Heal Thyself!
Nigel A. Spier, M.D., LLC
Obstetrics & Gynecology
President, Broward County
Medical Association
Continued on next page
| 3
But if there is something that has proven true, it is that when our cause
is just, and truly has the best interests of our patients at heart, the message
becomes inescapable and rings loud and clear. Case in point, our recent
battle in the Florida Legislature over our Managed Care Bill. Against seemingly
impossible odds, and just about every insurance carrier in the state, we prevailed
because the logic and fairness behind the effort was inescapable. I was once
told by a very prominent politician that politics has nothing to do with logic.
A seemingly very cynical and jaded view of our current system that, to be sure,
relies too heavily on which special interest group has the most dollars to bring
to the table.
I take a different view. It’s the appetite you bring to the table that counts!
We have heard it before “If you’re not at the table, chances are, you’re on the
menu.” The concept of fair play and parity with regard to insurance plans
recouping payments started out as a very simple concept 3 years ago that I
presented as a resolution entitled “No Take Backs” at the FMA annual meeting.
It passed without much fanfare and quickly became incorporated as part of the
5 year plan of the FMA’s medical economics and managed care committees.
My baby was pretty much out of my hands after that but as a result of one
person speaking out, we finally have some degree of parity with insurance plans
when it comes to claims adjudication. (For those of you who didn’t follow this,
until now Florida was the only state in the entire country where an HMO had
up to 30 months to ask for money back on a claim they had already paid!).
As we draw closer to the FMA annual meeting, it is more important than
ever to focus our efforts and unify around the basic principle that one person,
one voice can make a difference. Since my first days as a delegate to the annual
meeting, I am convinced of this. We have a major election coming up, and
healthcare will feature prominently at the center. We will have an opportunity
like never before to present our ideas and to influence the future of healthcare.
But to do so will take courage, conviction and action. Complaining in the lunch
room will accomplish nothing. If you have something to say, we want to hear it.
If there issomething
that has proventrue, it is whenour cause is
just, and trulyhas the best
interests of ourpatients at heart,
the messagebecomes inescapable
and rings loudand clear.
Continued…
4 |
Signing up as a delegate for the annual meeting is the best way to accomplish
this and let your voice be heard.
I am thrilled and proud to say that we have our voice back. The Record is our
voice, your voice, the voice of healthcare in Broward County. You will notice sev-
eral changes in our layout, content and mission. We have rights as physicians
and we have responsibilities. Our right to be heard only works when we exercise
our responsibly to speak out. Over the next few issues, I will try to present
thoughtful, and perhaps controversial analysis of the various issues facing us
today. I hope that these will spark debate and thoughtful discussion so we can
better sharpen our focus. I challenge anyone reading this to take action and join
the team. For those of you who haven’t yet visited our new and improved web
site, I urge you to do so. You will find many resources there to help you thrive
and run a successful practice. You can also e-mail me with your questions, ideas
and thoughts at [email protected]. This is a new BCMA and revitalized
BCMA! Welcome aboard. I look forward to hearing from you!
NEEDYOUBCMA N E E D S D E L E G A T E S
YouCanMake a Difference!Now is the time to sign up and represent BCMA
by becoming a delegate or alternative for the
August 1-3, 2008 - FMA Annual Meeting
to be held at the Rosen Shingle Creek Resort
Orlando. Submit name and contact information.
Become a delegate
send name, phone
number and email
to Cynthia Peterson
As members of the Broward County Medical Association, you need to call the
BCMA when you have a problem. If we cannot fix it, we will find someone
who can. Really, I promise. We try and most of the time we are successful.
Are you having a problem with MEDICARE, please call or email me. Have
your checks quit coming in the mail? The BCMA has a working relationship with
the people in Jacksonville at
First Coast and can help you
navigate through their long-
term process in solving your
problem. We cannot help if
you do not call. Yes, some of
our members had not been
paid by Medicare for over 6
months just because of a
small mistake in filling out
one of the forms. The NPI
caused a lot of problems.
Many doctors needed two
NPI numbers, and just did
not understand that. When-
ever there is a change to
your information, physicians
today have to fill out the
re-enrollment paperwork,
which is not an easy task.
Always give us your tracking
number, how long you have been dealing with the problem. Are you having a
coding problem? Jean Acevedo and staff are the BCMA’s endorsed experts
when it comes to coding. Jean will answer 5 free questions a year for BCMA
members. So please let us know when you are having a problem. Are you being
You need to call your congress men and
woman and urge them to co-sponsor
and pass S. 2785 (SAVE MEDICARE ACT OF 2008). I know you
are busy so have a staff person make the call for you. This is
very important. We are told that they never hear from the
doctors. So, make your VOICE HEARD. Time is running out to
stop a steep 10.6 percent cut in Medicare physician payments
scheduled for July 1. The AMA is working on your behalf and
has urged Congress to take immediate action to avert looming
cuts that will harm seniors’ access to care. S. 2785 would
prevent the 10.6 percent cuts in Medicare physician payments
planned for July 1, retain current payment levels for the
remainder of 2008 and enact a 1.8 percent increase for 2009.
Cynthia S. Peterson
Executive Vice President
Broward County
Medical Association
To share your ideas
and issues and news
please email at
Who You Gonna Call?
Continued on next page
CallNow
TODAY STAT
�
Sen. Mel Martinez 202-224-3041
Sen. Bill Nelson 202-224-5274
Cong. Lincoln Diaz-Balart 202-225-2778
Cong. Alcee Hastings 202-225-1313
Cong. Ron Klein 202-225-3026
Cong. Kendrick Meek 202-225-4506
Cong. Debbie W-Schultz 202-225-7931
Cong. Robert Wexler 202-225-3001
| 7
audited? Are they asking for more detailed information? Well, we really need
to get to the root of the question. Why are they requesting more information?
SO, who you gonna call? The BCMA!
We are pleased to have the rebirth of The Record, the official journal of the
BCMA, and to announce that this project has been outsourced to the Soldani
Group; Maria Soldani, Pery Canan, and Sheri Dickinson. Thank you to those
of you who had your photos taken. We will be producing a new pictorial
Membership Directory due out October 2008. If you receive an award or know
of someone that has, please let us know. If you would like to advertise or know
of a company that would, please let us know. The information will be available
on the BCMA website. WWW.BCMA.COM Have you checked out the recently
refreshed web site? A very special thank you to our friends at The Quantum
Group, Noel J. Guillama, President & CEO for their support of the web site project.
As time marches on, life does seem to be more and more complicated for
physicians. We are here to help you with your problems and have formed two
new task force groups, the Medical Staff Advocacy Committee, and the MSO to
review managed care contracts. Jeff Cohen and Tim Monaghan, legal counsel
for the BCMA, are active participants in these task force meetings. Stay tuned
for the “Physicians Bill of Rights.”
Please mark November 1, 2008 on your calendar. That is the date for the
BCMA’s Annual Dinner and Installation of Officers. Dr. Tony Prieto and his
spouse, Lynne Prieto will be installed together. He will be BCMA President and
she is the President of the BCMA Alliance. A special evening is being planned
at the Pier 66. So jot that date down now on your calendar. All BCMA Past
Presidents and BCMA Alliance Past Presidents will be invited to attend.
Please see the BCMA Calendar of Events in this magazine with upcoming
events such as the Boat Parade Party (December 13, 2008) and an evening
meeting in September on “Selecting the Best EHR to Fit Your Practice.”
(September 17, 2008).
Until next quarter, don’t forget, Who You Gonna Call? BCMA, 954-714-9772
Continued…
If you have a burning
issue to share with
the members, please
let us know just
send an email
*New FloridaManaged
Care Legislation that
passed the Senate and
House, and awaits
approval by the
Governor. Specifically
the Bills require
managed care companies
to accept a valid
assignment of benefits
and pay in-network
physicians directly when
the services are provided
in-network or part of
a PPO; reduce the
“look back” period where
managed care companies
can demand repayment
from 30 months to 12
months; and expand the
disclosure requirements
of “silent” PPOs.
8 |
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| 19
the employee was doing, but
really was not doing at all.
Regarding the medical office,
the Department of Labor (DOL)
has issued “Fact Sheets” as to
whether nurses are exempt under
the FLSA. There is an exemption
for employees who are employed as a bona fide
executive, administrator, professional, outside
sales and computer employee.
By now everyone is aware that
the minimum wage in Florida has
increased to $6.79 an hour. Along
with this change comes the
responsibility to make sure that
the updated employment posters
are also prominently displayed. It
is not too late. If you need an updated poster go
to www.floridajobs.org/resources/fl_min_wage.
Effective August 23, 2004, the Fair Labor
Standards Act (FLSA) was amended and depend-
ing on your point of view it helped employers or
it just complicated an already confusing federal
law. One of the changes affected the “exempt
status”. It is important to know what each em-
ployee is doing rather than to assign a job title.
Placing all employees on a “salary” is not a good
idea, especially if the employee is really an hourly
non-exempt employee and entitled to overtime.
As a result, it is recommended that a job descrip-
tion be created for each position within the
medical office. The job descriptions should be
reviewed and updated annually. The job descrip-
tion should adequately reflect what the em-
ployee is actually doing as opposed to what the
ideal position entails or worse what you thought
Employment Update:
Wage and Hour IssuesBy Kimberly A. Gilmour, Esq.
Continued on next page
Under the exemption, a nurse may
qualify as a learned professional if
the following criteria are met:
1. The employee must receive a salary
of not less than $455.00 per week;
2. The employee’s primary duty must
be the performance of work which
requires advance knowledge, this
work is mainly intellectual and the
employee exercises discretion and
judgment;
3. The advance knowledge must be
in a field of science or learning; and
4. The advanced knowledge must be
acquired by a prolonged course of
specialized intellectual instruction.
| 21
G i l m o u r ’ s l a w p r a c t i c e i s p r i m a r i l y i n v o l v e d w i t h e m p l o y m e n t l a w c h a l l e n g e s
Registered nurses who are registered by a
state examining board generally meet the crite-
ria listed and are exempt. On the other hand if
you are paying a registered nurse on an hourly
basis, then they would still be entitled to over-
time compensation for every hour over 40 they
worked. It may be that an audit of the hours
worked is in order to determine whether the
R.N.’s in the office should be hourly or salary. If
you find that your R.N.’s rarely, if ever, work more
than 40 hours a week you may want to keep
them as hourly. This would allow a deduction in
their pay in the event they were late, took half a
day off or needed extra days off. When the R.N.
is salaried their pay is the same regardless of the
number of hours they work. In the week the
R.N. works 34 hours or the next week she works
42 hours, the salary is the same and does not
change.
For those medical offices that have licensed
practical nurses, the DOL takes the position that
LPN’s are non-exempt and entitled to overtime.
The DOL’s position is based on the fact that re-
gardless of the work and training, an advanced
academic degree is not required for this position.
Therefore, check to make sure that you have
properly classified the employees in your office.
The last thing an employer, especially a busy
doctor and medical office wants is to have the
DOL conduct an investigation and audit your
payroll and personnel records.
As far as other positions that
may be in your office:
Bookkeeper nonexempt, if they work more
than 40 hours they should be paid overtime.
Clerk nonexempt, if they work more than
40 hours they should be paid overtime.
Office Manager exempt, as long as they
truly are acting in a managerial capacity
and other requirements are met.
Physician Assistant exempt, as long as they
meet the educational qualifications as to years
of study and accredited school.
Registered or Certified Technician exempt, as
long as they have the 4 year degree and have at
least one year in a professional course in a school
of medical technology approved by the AMA.
Receptionist nonexempt, if they work more
than 40 hours they should be paid overtime.
Secretary/Assistant nonexempt, if they
work more than 40 hours they should be
paid overtime.
Supervisor exempt, as long as they truly are
acting in a managerial capacity and other
requirements are met.
It is equally important to make sure that you
have each employee sign a Payroll authorization
deduction form. This document makes it easier
for employers to be able to make deductions
from paychecks for employee expenses. Keep in
mind that it is the employers responsibility to
make sure that paychecks are correct and ready
Employment update continued…
22 |
at the next available pay period. When an
employee is leaving, whether for cause or not,
they are to receive their last paycheck at the next
regularly schedule payday. Employers do not
have to pay employees early. As a side note, the
employee may be of the type that you want out
of the office as soon as possible.
Finally, remember that in the event you do
make an error in the paycheck by not paying the
correct amount or making an unauthorized
deduction, all is not lost as to the exemption
status. According to the DOL, if there is a mistake
as to the overtime calculation, an inadvertent or
isolated deduction will not result in the loss of
the exemption. However, it is necessary for the
employer to pay the employee the back wages.
For more information on this topic or any other employment
related issues please contact Kimberly A. Gilmour, Esq. 4179
Davie Road Suite 101 Davie FL 33314 954-584-6460
| 23
Over the years, VITAS has developed
positive relationships and endorsement
from thousands who have a personal
or professional commitment to quality
end-of-life care, solidifying VITAS’
reputation as the nation’s leading
hospice provider:
Success
Founded in 1978Referrals: 1.800.93.VITASwww.VITAS.com
InnovativeHospice Care
• Since hospices do not compete on cost, success can be measured in large part by anorganization’s reputation throughout the communities it serves for providing great care.VITAS cares for more patients each day than any other hospice in the nation. Thatrecord of success speaks for itself.
• VITAS often offers care that many smaller hospices find it difficult—if not impossible—to provide. For example, VITAS concentrates its significant case management expertiseon providing Intensive Comfort CareSM (Continuous Care), which allows us to managethe patient’s care at home and avoid the inconvenience of a transfer to an inpatient facility.
• VITAS is a preferred provider of hospice services for Sunrise Senior Living, the nation’slargest assisted living company, which allows many seniors to “age in place” by receivingend-of-life care in their assisted living residence.
• VITAS was among the first hospice providers to partner with community-based hospitals(and later skilled nursing facilities and assisted living communities) to open dedicatedinpatient hospice units, with 27 homelike facilities established by January 2008.
WELCOMEAlexander, Timothy A., MDPlastic SurgeryFt. Lauderdale
Allen, Gary S., MDCardiothoracic SurgeryHollywood
Berger, Clayton M., MDOphthalmologyFt. Lauderdale
Blanco, Mercedes Gonzalez, MDPsychiatryMiami
Bonner, Gregory F., MDInternal Medicine/GastroenterologyFt. Lauderdale
Braun, Ronald J., MDAnesthesiologyFt. Lauderdale
Carragher, Barry H., MDAnesthesiologyFt. Lauderdale
Falcone, Steven, MDRadiology/NeuroradiologyBoca Raton
Fernandez Jr., Bernardo B., MDCEO, Cleveland Clinic FLInternal Medicine/Vascular MedWeston
Foster, April EnnisMedical StudentNova SE University
Gayer, Steven I., MDAnesthesiologyDavie
Giraldo, Hernando, MDFamily Practice/GeriatricsHallandale
Gunnlaugsson, KristinaMedical StudentFAU/UM
Hanna, Faris A., MDOB-GYNHollywood
Lerman, Sam, MDInternal Medicine Endocrinology,Diabetes & MetabolismHollywood
Levine, Henry I., MDPediatricsPembroke Pines
Levy, Isaac E., MDInternal MedicineHematology OncologyPembroke Pines
Lim Jr., George T., MDNephrologySunrise
Mao, Lisa Kay, MDOphthalmologyFt. Lauderdale
Martin, Barbara, MDInternal MedicineTamarac
Mejia, Francisco Medina-, MDPediatricsPlantation
Naveira, Jose O., MDAnesthesiologyFt. Lauderdale
Patron, Andres, DOInternal MedicinePembroke Pines
Pevsner, Ramsey K., DOPsychiatryPlantation
Raziano, Joseph V., MDOB-GYNReproductive EndocrinologyPlantation
Reyes, Aurelio R., MDFamily PracticeHollywood
Reyes, Rene A., MDInternal MedicineHollywood
Rubio, Dayana, PAPhysician AssistantHollywood
Sarmiento, Sandra, MDFamily PracticeTamarac
Schneider, Andrew M., MDHematology OncologyLauderhill
Schwimmer, Mark, MDRadiology-DiagnosticHollywood
Seo, Christina J., MDColon & Rectal SurgeryCCF-Weston
Singh, Hari, MDInternal Medicine/GastroenterologyFt. Lauderdale
Steinberg, Jeffrey M., MDNeurologyHollywood
Strogen, Charles P., MDAnesthesiologyFt. Lauderdale
Trainor, Jack M., MDFamily Practice/Sports MedicineFt. Lauderdale
Urwin, Ross W., MDInterventional NeuroradiologyPompano Beach
BCMA N E W M E M B E R S S U M M E R 2 0 0 8
| 25
Paula Thaqi, M.D., M.P.H. selected as new director
TALLAHASSEE – April 15, 2008 The Florida Department of Health (DOH) announcesthe appointment of Paula Thaqi, M.D., M.P.H. as Director of the Broward County HealthDepartment (CHD).
“I am pleased to welcome Paula Thaqi to the Broward County Health Department and toher new role within the Department of Health,” Deputy State Health Officer Tom Arnold said.“Dr. Thaqi’s experience as Director of the Highlands County Health Department and in publichealth organizations will complement the dedicated team at the Broward CHD.”
“I am honored to have the opportunity to work with the Broward County Health Department staff and community partnersin fulfilling our mission to promote, protect and improve the health of the community,” said Dr. Paula Thaqi.
Dr. Thaqi has served as Director of the Highlands County Health Department for the past seven years. She has led the healthdepartment in the Mobilizing for Action through Planning and Partnerships (MAPP) process and worked with community part-ners to meet local needs. Under her leadership, the health department implemented a performance excellence model, achievednational certification as a Public Health Ready health department, expanded children’s dental services, and obtained a newhealth department site for the Avon Park branch.
Previously, Dr. Thaqi has served in international public health with various non-governmental organizations and the UnitedNations World Health Organization in Kosovo. Prior to that, she was a pediatric emergency room attending physician in NewYork.
Dr. Thaqi holds a Doctor of Medicine degree from SUNY Health Science Center at Brooklyn, a Master of Public Health Degreefrom the Columbia University Mailman School of Public Health, and completed her pediatric residency training at ColumbiaPresbyterian Medical Center.
DOH promotes, protects and improves the health of all people in Florida. For more information about DOH programs, visitwww.doh.state.fl.us. To learn more about the Broward CHD, visit www.browardchd.org/.
The Florida Department of Health AnnouncesNew Director of the Broward County Health Department
26 |
doctor gets paid is changing both in
and outside of the Medicare pro-
gram. And, if we look at other types
of health care providers and how the
Medicare program is handling their
“reporting,” physicians are being
treated somewhat better in this one
area at least. Case in point, Ambulatory Surgery
Centers (ASCs) will begin having voluntary reporting
of quality measures in 2009. They’ll be subject to a
2% update penalty if they do not report – no 1.5%
bonus payment for ASCs. As reported in the July/
August 2006 issue of the Journal of Family Practice
Management: “According to a large, national study
conducted in 2005 by Med-Vantage, there are 107
active P4P program sponsors nationwide, covering
more than 53 million Americans…It is estimated
that by 2008 there will be more than 160 P4P pro-
grams covering more than 85 million Americans.
Although primary care physicians continue to be
the key targets for P4P programs, both specialist
and hospital components are growing. For instance,
more than 95 percent of P4P programs include
primary care physicians, whereas 52 percent also
include specialists (with cardiology, orthopedics,
With passage of the Tax Relief and
Health Care Act of 2006, Congress
enabled CMS to reward physicians
for reporting certain clinical measures
under what is called the Physician
Quality Reporting Initiative (PQRI).
The remuneration, while not large, is a
step in the right direction. I think I understand physi-
cian frustration over the shrinking reimbursement
dollar, so it is specifically for this reason that I ask: Do
you really want to forego these additional dollars?
Especially while “reporting” actually should bring in
some additional revenue? I know there are some
physicians who feel PQRI will be burdensome. In
working with several local practices over the last year
since the PQRI program came about, we have found
that once they see what is actually involved, most
physicians react with “That’s all I have to do – circle
another code or two to represent something I’m
documenting anyway? I thought it was muchmore
complicated than that.”
No, the expected bonus check for successfully
reporting won’t pay for your child’s college educa-
tion. However, too many articles have been written
about pay-for-performance, quality reporting, etc.,
for us not to realize that change in how (and if) a
Update on CMS’s
Physician Quality Reporting InitiativeBy Jean Acevedo, LHRM, CPC, CHC
Continued on next page
J e a n A c e v e d o , A c e v e d o C o n s u l t i n g I n c o r p o r a t e d
| 27
obstetrics-gynecology and endocrinology being the
most common) and a full third include hospitals.
Finally, 64 percent of P4P programs nowmeasure
and reward individual physician performance, not
just group performance”
Things to Know About PQRI
You “report” by submitting a CPT
Category II or HCPCS ‘G’ code on the
same claim as your charges when-
ever a measure you have chosen
applies. The “you” includes physi-
cians, nurse practitioners, physician
assistants, physical therapists, among
other Medicare providers.
You must bill with your national
provider identifier (NPI) to participate
in the program. CMS knows you are participating
when any of the PQRI CPT Category II or HCPCS ‘G’
codes appear on a claim submitted to Medicare. The
data reporting will be analyzed by the individual’s
NPI, although the bonus payment will be made to
the holder of the taxpayer identification number
(TIN), the practice.
You must choose at least three applicable
measures to report if three or more measures apply
to your specialty and/or patient base. Measures are
reported using CPT Category II codes and/or HCPCS
‘G’ codes, which often link to the patient’s diagnosis.
Once you pair a CPT Category II code with an
ICD-9 code, the number of times you report that
ICD-9 code for any eligible patient during the report-
ing period will determine the denominator for the
measure (i.e., the number of opportunities you had
to perform and report the measure). For example,
submitting a CPT Category II code for diabetes for
any patient causes all patients with a
diagnosis of diabetes to be included
in the denominator. Once reported,
the CPT Category II code must
be included with the diagnosis
80 percent of the time to be eligible
for the bonus payment.
The bonus will be computed as
1.5% of your total allowed charges
paid off the Medicare Physician Fee
Schedule for the reporting period, not just for claims
in which you reported a measure. The only physician
services that are excluded (because they are not
paid off the Physician Fee Schedule) are clinical
laboratory, DME, and drugs/biologics.
At this time, the only criterion for bonus
payment is the presence or absence of a PQRI code.
These codes must be on the same claim as the
service actually billed for the day (an Evaluation
and Management code or, in the case of reporting
the use of prophylactic antibiotics, a surgical
procedure code).
Wehave foundthatonce they seewhat is actuallyinvolved,mostphysicians reactwith“That’s allI have todo?”
28 |
PQRI continued…
The first 2008 reporting period began January
1, 2008 and ends Dec. 31, 2008. CMS recently
announced a second reporting period; July 1, 2008
through December 31, 2008. So, those of you who
haven’t started yet, you have a couple of months
to get your systems in place
Your total Medicare allowed charges for all of
2008 or the last six months of 2008 (depending on
which of the reporting periods noted above apply
to you) will be used to determine the amount of the
bonus, not just billings that included the selected
measures. There was a cap in 2007, the bonus
payment cap has been eliminated for 2008.
Steps to Take
Once you review the measures that pertain to your
specialty and patient base, the applicable ‘G’ codes
and/or CPT Category II codes will need to be added
to your billing software with a $0 charge. If your
billing software will not allow a code with a $0
charge to appear on a claim, enter the PQRI codes
with a charge of $0.01. There are modifiers to
indicate that a patient meets an exclusion criteria
(the patient with a bleeding disorder who should
not be placed on aspirin for example). So the 1P,
2P and 3Pmodifiers will also need to be added
to your billing software.
CMS has also created a fourth modifier (8P)
which, as unbelievable as this may sound, is to be
used when a patient qualified for a measure yet
there is nothing to support that this was addressed.
Kind of like a Medicare “gimme” to help you win
the game of PQRI. Let’s say you’re a urologist and
you have chosen to report measure # 48 (1090F -
Assessment of Presence or Absence of Urinary
Incontinence in Women Aged 65 Years and Older).
If you see 1000 female patients this year who are
aged 65 or older, you would have to include the
CPT Category II code 1090F along with your visit
code on at least 800 of these patients’ Medicare
claims to qualify for the bonus payment to meet
the benchmark of having successfully reported
80% of the time when a chosenmeasure applies.
You’ve enlisted your billing staff to help ensure
your successful reporting. Today, Sally Biller realizes
as she is doing her data entry that there is nothing
in the charts to show this assessment was
performed for 4 of “today’s” patients. So, she
adds 1090F -8P as a 2nd line item to each of these
patient’s Medicare claims and, voila!, it counts
towards your successful reporting.
I’ve got to give CMS credit for this one, Congress
handed them this program last year and CMS had
very little time to come up with exactly how it
would work. With what they were given, they did a
laudable job, and there is a wealth of resources to
be found at: www.cms.hhs.gov/PQRI. I don’t know
about you, but the hardest part of getting started
Continued on next page
| 29
with anything new is usually
just that, getting started. So,
we’ve provided you with a
sample billing sheet/PQRI
Superbill. This one is for
capturing three of the diabetes
measures. Feel free to take the
format and change it to meet
your needs. There are 134 PQRI
measures to choose from this
year. And, one of them can be
usedmerely because the en-
counter was documented on
an EMR. Regardless of any
hassles you’ve heard about,
this really is a pretty easy pro-
gram to implement and, do
you really want to forego 1.5%
of your Medicare allowed
charges this year? You’ll find
the list of measures, complete descriptions and
instructions as to how and when to report them,
along with other resources and tools at
www.cms.hhs.gov/PQRI.
Please be advised that while every effort has been made to ensure
the accuracy of the informationprovided, noassurance canbe given
by theBrowardCountyMedicalAssociation orAcevedoConsulting
Incorporated (ACI) thatCMS, the FloridaMedicare carrier or any
other payer will agree with ACI’s interpretation of coding and re-
imbursement guidelines. The advice given should be reviewed in
context with the medical necessity of services furnished as docu-
mented in themedical record and other payer-specific policies.
PQRI continued…DOB Date last seen:
Check Measure(s) Documented
Code (See below for modifier indications)
3044F
3045F
3046F
3046F-8P
3048F
3049F
3050F
3048F-8P
3074F
3075F
3077F
3078F
3079F
3080F
2000F-8P
Most recent diastolic blood pressure 80-89 mm Hg
PHYSICIAN'S PQRI DATA COLLECTION SHEET - DIABETESDATE
Measure & result
PHYSICIAN
A1C – Patients aged 18-75. Report with 99201-99215, 99341-99350, 99304-99310, 99324-99337, G0270-71, AND ICD-9 of 250.xx or 648.xx. Report at least once per reporting period.
Check first column to indicate measure(s) to be reported.
Most recent systolic blood pressure 140 mm Hg
Most recent A1C level within 12 months >9%
Most recent LDL-C level within 12 months 130 mg/dL
8P – Performance measure exclusion due to action not performed, reason not otherwise specified.
BP not performed within 12 months, reason not otherwise specified
Performance Measure Modifier Indications
Most recent A1C level <7.0%
Most recent A1C level 7.0% to 9.0%
Most recent diastolic blood pressure 90 mm Hg
Lipid management – Patients aged 18-75 w/most recent LDL-C in control. Report with 99201-99215, 99341-99350, 99304-99310, 99324- 99337, G0270-71 AND ICD-9 of 250.xx or 648.xx. Report at least once per reporting period.
Blood pressure – Patients aged 18-75, BP controlled. Report with 99201-99215, 99241-99245, 99341-99350, 99304-99310, 99324- 99337, G0344. Report at least once per reporting period. Report both systolic and diastolic.
Most recent systolic blood pressure 130-139 mm Hg
Not performed within 12 months, reason not otherwise specified
Most recent LDL-C level 100-129 mg/dL
Most recent systolic blood pressure <130 mm Hg
A1C not performed within 12 months, reason not otherwise specified
Most recent LDL-C level <100 mg/dL
MR#
Most recent diastolic blood pressure <80 mm Hg
PATIENT NAME
Above is an example
of the billing sheet /
PQRI Superbill.
Feel free to take the
format and change it
to meet your needs.
30 |
The Region’s Monthly Newspaper for Healthcare Professionals & Physicians
A Day at PoloThe BCMA and PBCMS were guests of Braman Motorcarsat the International Polo Club in Wellington. A wonderfulChampagne Brunch and Championship Polo was enjoyedby doctors, their spouses, and guests. Special thanks to TheoTarantini and Cathy Idema Tarantini for being wonderful hosts.
Photos (1-7) left to right):
1. Jose Cruz,
Deborah Mulligan, M.D.,
Cristina Pelaez, M.D.
2. Arthur Palamara, M.D.,
Patricia Palamara,
Theo Tarantini
3. Tony Prieto, M.D.,
Nabil El Sanadi, M.D.
4. Pilar Gipps and
Robin Gipps, M.D.
5. Christina Seo, M.D.,
Paula Denoya, M.D.,
Mrs. Bafar,
Bashar Safar, M.D.
6. Mary Hamilton,
Patricia Palamara
7. Med. Students;
Avery Thornhill,
Christina Bergeron,
Gryan Lee, and
Vi Song Tring.
Event sponsored by BramanMotorcars PalmBeach,
Broward CountyMedical Associationand PalmBeach County
Medical Association
| 33
© 2008 Misys Healthcare Systems, L.L.C. All rights reserved. Misys, the Misys Logo, and Misys MyWay™ are either registered trademarks or trademarks of Misys, plc in the United States.
Simple. Affordable. Complete.The new Misys MyWay™ is easy to
solution that can help you increase
how we can help you. Call us toll-free at (800) 334-8534 or
www.misyshealthcare.com.
www.misyshealthcare.com
new revenue sources. They hire
lawyers and other consultants for
things they used to handle on their
own. The scramble to see more
patients and to earn less. They’re
stressed, and so are their families.
Their passion for medicine, for
making a difference is often overshadowed by these
“realities.” Though they often love what they do and
how it changes people’s lives, it isn’t as fun and
energizing as it once was.
In my view, the community of physicians has
never been so fractured. And, sadly, when there is a
connection among them, it is often to focus on their
frustrations, their bruises. The community has be-
come both weakened and focused on the negative.
Their commonality has become draining and disem-
powering. In archetypal terms, they have become
the warrior that does battle and gets beaten up in
the process each day. But there is another way.
Years ago, medical staff meetings were packed.
Departmental meetings were packed. Medical staffs
absolutely controlled the quality of care provided in
their hospitals, and many other things as well. They
walked with respect for themselves and each other.
In the Three Little Pigs story, there
were three pigs who each built a
house of a certain material, each
doing their best to ward off the Big
BadWolf. It is great instruction for
today’s physicians.
Pig #1 (“Ernie”) built his house of
straw, but it was nomatch for the Wolf. Pig #2
(“Bernie”) built his house of sticks and it was no
match for the wolf. Pig #3 (“Deepok”) apparently
attended PU (“Pig University”) where he earned a
degree in mechanical engineering and architecture.
He built his house of bricks and the wolf was
thwarted. The story is used to teach about intelli-
gence, ingenuity, planning and such. But there is
another way to see it.
Each pig alone was unable to deter the wolf.
And the wolf was each pigs’s worst fear, the fear of
being eaten. No single pig alone could deter the
wolf, not even two of them. It was only when they
stood together that victory was possible. Now that’s
a powerful story!
Physicians today feel haunted, some would say
attacked, by many things – managed care, hospital
administration, the government payers. One by one,
they do their best. They shave costs. They look for
Physicians Take A Lesson FromThe Three Little Pigs
By Jeffrey L. Cohen, Esq.
Continued on next page
M r . C o h e n i s b o a r d c e r t i f i e d b y t h e F l o r i d a B a r a s a s p e c i a l i s t i n H e a l t h L a w
| 35
Hospital administration had a respectful and symbi-
otic relationship with themwhich required commu-
nication and cooperation.
Today there are stresses and events that did
not exist years ago. And over time physicians have
begun to tell a different story about themselves and
about their profession, one that casts them as “little
pigs,” as targets, and hospitals
andmanaged care payers as
the big bad wolf. They are “at
war.” They are the beaten war-
rior and their strength being
drained is affecting not only
them, but their patients and
communities. As they lose their
power, their enjoyment, the
quality of medical care is
threatened.
The clear thing about
Ernie, Bernie and Deepok is that there was a com-
plete shift when they stood together. It is not an
easy task, to be sure. Everyone is a little different in
their look, their values, their thinking. And two peo-
ple respecting and valuing each other’s differences is
sometimes hard. It requires an overriding ethic or vi-
sion, a vision of compassion and respect, in essence
“spirituality.” It was easy for the pigs because, well,
they are just pigs. But what we didn’t hear is that
once Ernie called Bernie a bad name, that Deepok
took Bernie’s parking space. In other words, they’ve
had their challenges with one another too. But the
end result is the same: try to survive alone and fail or
work together despite the apparent differences and
live. Taken a step further: Create a new vision that is
energizing and enjoyable and everyone wins.
Physicians have a challenge that is similar to the
pigs. In short, it comes down to vi-
sion, creating a new story, not just
personally but collectively. Everyone
knows the dominant story, the one
that doesn’t work. What story can
physicians tell instead? What inspires
them?What parts of what they do
inspire them? Those are the pieces
that will inform that new vision. They
have to come together to start that
process. And the process can’t be
connected or a reaction to what
they don’t like today, since that’s just another way to
connecting to what doesn’t work. In a sense, they
have to cut the strings that bind them and create a
new vision without those limitations. Work on the vi-
sion first and the particulars will become apparent.
You will knowwhat to do about managed care pay-
ers. You will knowwhat to do about hospital admin-
istration. Once the vision becomes enlivened (as it
once was), physicians will knowwhat to do about
managed care payers. You will knowwhat to do
What story canphysicians tellinstead?Whatinspires them?Thoseare thepieces thatwillinformthatnewvision
36 |
Three Little Pigs continued…
about hospital administration. But focusing on the
particular problems here and there and then react-
ing does not take physicians anywhere. In fact, it
leaves them digging themselves deeper into situa-
tions and problems, with no apparent way out be-
cause there is no greater vision that guides them to
a better, more fulfilling andmore powerful way.
Physicians have to stop looking for quick fixes.
There is no lawyer or consultant that can do it for
them. A lawyer reviewingmedical staff bylaws,
though useful, is valueless if the medical staff mem-
bers will not work together. Physicians have to be
flexible with the way the world is today. They cannot
insist medicine be exactly the way it was. Technol-
ogy is different. People are different. Patients have a
greater need for information and often want to play
a more active role in their care. And they are more
open to things that may be confusing to physicians.
If physicians are to enjoy practicing medicine again,
and if communities will be better off for that, then it
will be because physicians themselves have to-
gether reestablished themselves. And that requires
time, commitment, flexibility, a lot of interaction and
humor. In short, they have to show up…again.
Mr. Cohen worked as Associate General Counsel to the Florida
Medical Association from 1989 to 1993. He is a shareholder in the
DelrayBeach law firmof Strawn,Monaghan&Cohen, P.A. and is
BoardCertified by theFloridaBar as a specialist inHealthLaw.He
was recently selectedbyFloridaTrendas one ofFlorida’s LegalElite.
Mr. Cohenmay be reached by calling 561.278.9400.
Women Physicians MeetingApril 16 - Fort Lauderdale, Tower Club
Sixty women physicians enjoyed networking and visiting with
sponsors including Susie’s Jewelry & Bags with the awesome
view and dinner at the Tower Club.
Photos (1-3 left to right):
1. Gail Woodley, Kameron
Knowlton, Ellen Wong
Representing Ironstone Bank.
2. Shareen Greenbaum, M.D.,
Daniela Botoman, M.D.
3. Tammi Sommerville,
The Photography Company,
Kristina Gunnlaugsson, Med.
Stu, FAU, Gail Woodley.
MergingMedical Practices
O P P O R T U N I T I E S C H A L L E N G E S
April 9 - Sheraton Airport Hotel
Eighty -two physicians and practice administrators
enjoyed an educational evening on the pros and cons
of merging medical practices. Sponsors ranged from
computer software companies to insurance companies.
Photos (7-10 left to right):
7. Dawn Davanzo, M.D. Veronica
Gipps, M.D. 8. Melanie Hecker,
M.D., Christina Bergeron, Med.
Stu., NSU. 9. Jennifer Capezzuti,
D.O., Helen Salsburg, M.D.,
Shery Roth, PA-C, Vladislava
Culina, M.D., Nicole Pearl, M.D.
10. Mariana Martinasevic, M.D.,
Avery Thornhill, Med. Stu., NSU,
Dana Wallace, M.D.
38 |
BCMA AllianceI N S T A L L A T I O N O F O F F I C E R S
May 7 - Lauderdale Yacht ClubPhoto group, left to right: Wanda Casaretto, Lynne Prieto
(New President), Touyen Li, Lori El Sanadi, Joni Routman,
Diana Moll, Anne Grenitz, Marietta Glazer, Susan Flaten, Jane Eberly.
Photos (4-6 left to right):
4. Carmen Miller, Stacey Kroll,
Representing McKinley Finan-
cial Services. 5. Cathy Idema,
Dana Wallace, M.D., Caren
Singer, M.D., Nada Boskovic,
M.D. 6. Christina Bergeron,
Med. Stu., NSU, Hiliary Gerber,
Med. Stu., NSU, Candace White,
Med. Stu., NSU, Nadeen White,
M.D., and Alison DeSouza, M.D.
Photos (1-3 left to right):
1. Will Rideout and Chad
Novitski representing
MISYS. 2. Tom Murphy,
representing Danna-Gracey.
3. Panel Discussion: Lanny
Pauley, Todd Blum, Anne
Tullis, Mark Stern, CPA,
Harold Kaplan, J.D.
| 39
MEMORIAMBCMA I N M E M O R I A M
Extends heartfeltsympathy to the
families on their loss
Henry Cooper, M.D. January 17, 2007
Fernando DeElejalde, M.D. October 19, 2007
William Fanizzi, M.D. May 25, 2007
Joseph Hopen, M.D. February 20, 2007
Sachidanan Mallan M.D. December 21, 2007
Patrick Mulhern, M.D. March 8, 2007
Richard Neubauer, M.D. June 11, 2007
Charles Seymour, M.D. January 17, 2007
Gaetano Lo Presti, M.D. April 9, 2008
Grover McDaniel, M.D. April 16, 2008
Kathleen McGrady, M.D. April 9, 2008
Morton Morris, D.O., J.D. May 2, 2008
“Success always comeswhen preparation
meets opportunity.”- Henry Harmon
S p o n s o r s h i p O p p o r t u n i t i e s :
The Broward County Medical Associationinvites Healthcare organizations andphysician practices to consider thesponsorship of an issue. As a sponsoryou will enjoy the following benefits:
• Customized front cover featuring a photo• 2 - Full page color ads• 8 - editorial pages in color to be used by
BCMA member physicians.
S p o n s o r s h i p $ 5 , 0 0 0 . 0 0
BCMA 5101 NW 21 Avenue, Suite 440, Fort Lauderdale FL 33309 Contact: Pery Canan 954.812.3882 [email protected]
Editorial approval is required. Articles should be 750 words and may include a color photo of the person submitting it. All camera ready pages mustbe submitted 5 weeks prior to the issue date. If writing and design services are required, additional cost will be incurred based on the need..
CALENDARBCMA C A L E N D A R O F E V E N T S
June7 Dade County Medical Association
Annual Dinner, Sofitel Hotel
10 Broward County Pediatric Society,
6:30 p.m., Riverside Hotel
18 AMA Meeting,
Hyatt Regency, Chicago
18 Women Physicians Section
Dinner Meeting, 6:00 p.m.
Arthur Murray Dance Studio,
7:00 p.m., Cantina Laredo Restaurant
26 BCMA Board of Directors, 6:30 p.m.
July10 EMS Committee Meeting, Noon,
BCMA South Florida Caucus Meeting
for All Delegates, 6:30 p.m., place TBA.
31 Thru August 3
FMA ANNUAL MEETING,
Rosen Shingle Creek, Orlando
September17 EHR Best Practice Series-Selecting
the Best EHR (Electronic Health Record)
System to Fit Your Practice, 6:00 p.m.
November1 BCMA ANNUAL DINNER,
PIER 66
December13 BCMA BOAT PARADE PARTY
| 43
CONGRATSBCMA C O N G R A T U L A T I O N S
Linda Cox, M.D.Chair of the Practice and Policy Division
of the American Academy of Allergy
Asthma and Immunology as well as
a member of the Board of Directors.
DanaWallace, M.D.who will be installed Vice President
of the American College of Allergy
Asthma and Immunology.
Joanna L. Greenblatt-Drowas, D.O.a family medicine resident at Broward General
Medical Center and a BCMAMember, was
named as a recipient of the 2008 American
Medical Association Foundation Leadership
Award, which was presented to Dr. Drowas
during the AMA’s National Advocacy Conference
in Washington, D.C. in March.
Please submit announcements
to Cynthia Peterson at:
The Record: Advertisers
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Infectious Diseases Associates 954-772-7773 26
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S. Florida Hospital News 561-368-6950 32 www.hospitalnews.org
MISYS 800-334-8534 34 www.misyshealthcare.com
Avisena 877-284-7362 37 www.avisena.com
All Care Consultants, Inc. 888-369-2224 37 www.allcareconsultants.com
Ober Realty 954-614-8001 40 [email protected]
Med Marketplace 888-502-2800 41 www.medmarketplace.com
First Professionals 800-741-3742 BC www.firstprofessionals.com44 |
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