Newsletter January, February 2015

TICE
OU!
News
January, February 2015
Dr. Carl Foster
2015 BOARD OF TRUSTEES
OFFICERS
Carl Foster, MD - President
Barbara Volk, MD - President Elect
Danielle Kiko, MD - Secretary - Treasurer
Luis Martino, MD - Immediate Past
President
Jack Baker, DO
Jason Bertram, MD
David Bitonte, DO
Anthony Degenhard, DO
Robert Hamilton, MD
Mark Hostettler, MD
JoAnn Krivetzky, MD
Matthew LiCause, MD
Katharine Morrison, DO
Roger Palutsis, MD
Charles Smith, MD
Mark Stachel, MD
s in the
David Utlak, MD
re our
ordable CREDENTIALS COMMITTEE
Todd Meyerhoefer, MD
Mark Vogelgesang, MD
SCMS EXECUTIVE STAFF
Kevin P. Metz, Executive Director
Becky Bors, Admin. Assistant
INSIDE THIS ISSUE:
Lesson on Social Media........................... 3
Night with the Canton Charge!...................4
Locking-Out Lawsuits & Reducing Taxes.... 7
ontgomery
tation
ies
This is my first message as President of the Stark County Medical Society and
I want to begin by expressing my appreciation for the honor and privilege of
serving our membership. The responsibility placed on me is not taken lightly as
we meet the many challenges of the coming year. The coming year will present
developments that will challenge the viability of many physician practices.
How to Manage Exchange Patients............ 9
113th Annual Meeting.............................11
Announcements......................................12
Revolutionizing Healthcare..................... 13
Welcome New Members......................... 19
Reinstated Members.............................. 19
The individual mandate provision of the Affordable Care Act (ACA) requires
that everyone purchase health insurance. Due to the high cost of this coverage
consumers are attracted to plans that have high deductibles. According to a
recent study published by the Kaiser Family Foundation 80% of covered
employees have a deductible and 18% have deductibles of at least $2000.
Furthermore, a bronze plan has an average deductible of $5000 for individuals
and $10,000 for families. These high deductible plans are attractive because of
their lower cost. But patients who have these plans are largely responsible for
the payment for their care. This situation puts the onus of timely collections on
physician practices. Upfront
Dr. Carl Foster
payment
and
partial
payment plans are tried and
We have access to the politicians
true solutions to this problem. A less desirable alternative is
and the state medical association.
the use of collection agencies because, even when successful,
Together, we have a voice that
they only recover a fraction of the amount owed. Practices that
will be heard!
serve price sensitive consumers will be pressured to provide
cost estimates for services as these patients shop around for
Contact us at
the best deals.
The delays in implementation of the International Classification
of Diseases, tenth addition (ICD-10), are expected to
come to an end October 1, 2015. Pluses for the new coding
system include purported greater precision and fewer coding
errors which should result in fewer denials and speedier
reimbursement payments. In addition the system allows for
easier accumulation of acuity data for use in negotiations with
payers for higher reimbursement rates. Critics have expressed
concern that the technology might not work and that it might
result in decreased productivity as clinician notes might
require greater specificity. Regardless, this thing is coming
and practices need to be prepared. A free webinar that helps to
prepare practices for the transition to ICD-10 is available from
the Center for Medicare and Medicaid Services is accessible at
http://www.roadto10.org
New modes of healthcare delivery will continue to compete
with the traditional physician office model. Telemedicine
companies offer patients web-based and mobile-telephone
based consultations with physicians whom they have never
met. Despite the inherent limitations of a lack of familiarity
with their patients, volumes among the leading Telemedicine
organizations had doubled between 2011 and 2013. The
obvious attraction is the convenience of consulting a physician
immediately, without leaving one’s own home. The danger lies
in the obvious limitation inherent in there being no personal
continued on page 15
[email protected]
or call 330-492-3333. We look
forward to hearing from you!
Opinions expressed by the authors
are their own, and not necessarily
those of the Stark County Medical
Society, Trustees or individual members. SCMS News reserves the right
to edit all contributions for clarity
and length, as well as to reject any
material submitted.
www.starkmedical.org
SCMS News
QUALITY INSURANCE SERVICES
The OSMA INSURANCE AGENCY is committed to offering quality insurance services to all OSMA members, their families, and
their staffs. The OSMA’s in-house insurance agency is dedicated to providing useful advice, review and planning on a wide range of
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Data RSecovery estoration
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For a custom quote for all your IT Support needs please
•• Data the•Stark
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• Data Data ack U–p U–p Professional (HIPPA Compliant)
contact Rob Johnston at 330-915-2355.
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• Data Back – Up – Professional Plans (HIPPA Compliant)
Stark County Medical Society Members will receive a
IT Consulting
•• Data Back-­‐Up – Small Business Server Plans – (HIPPA Compliant)20% discount for the first 6 months and 10%
Communications (RingCentral, Meetings, etc…)
•• IT Consulting
thereafter for the other 6 months.
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• Communications (RingCentral, Meetings, etc…)
• 4652
Remote Support (Helpdesk)
Belden Village Street NW, Canton, Ohio 44718 • 330.915.2355 • www.strongbasehc.com
• Network (LAN,WAN) – SBC not run cables in Ceilings or walls.
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- February 2015
DOCTOR’S, HERE’S YOUR LESSON ON SOCIAL MEDIA
By Diane Evans
Understanding social media is easy when you break it down to
things you personally and professionally need to know. If you’re
a physician, platforms such as Healthgrades.com and Vitals.com
matter greatly to you. Why? Because research shows that prospective patients evaluate you by checking ratings sites.
Let’s start with a simple definition of social media: It is word-ofmouth communication empowered by the Internet.
Previously, word-of-mouth spread mainly in person or over the
telephone. But now the Internet enables one person’s voice to
reverberate throughout a community or even around the globe.
For those in healthcare, if you want your message to reach a desired audience, a good exercise is to think about exactly how that
might happen. Here is a possible scenario:
Let’s say your hospital or medical practice has collected email
addresses from patients who agree to receive your e-newsletters.
You now have a subscriber list. Next an email goes out, announcing a new internist on staff. Someone who receives this information forwards the announcement to a friend who needs a physician.
“Hearing” about you, the friend calls for an appointment.
That’s word-of-mouth, spread by one person clicking information
over to another. By sending out the newsletter, you as the healthcare provider created an easy opportunity for patients to share
information about you.
Here are other common ways through which people can learn
about you and your medical specialties online:
1) Your website. This is the space on the Internet that you
control. It’s where you tell your story without distraction from
anyone else. This is the online equivalent of a Yellow Pages
ad and a place where you can convey that which differentiates
you and how patients can benefit.
2) Online directories such as Google+, Heathgrades.com,
Vitals.com and WebMD.com. These listings publicize your
name, phone number, address, and far more, including patient
reviews. Frequently, even basic contact information is in
error. Your best bet: “Claim” your listings and take advantage of the free advertising space available to you. You may
be surprised by the significant volume of information you or
your designee can load onto these sites. Make no mistake.
Prospective patients do rely on these online directories when
evaluating healthcare providers. Consider this finding from a
2014 report titled, Finding Quality Doctors: How Americans
Evaluate Provider Quality in the United States, funded by the
Robert Wood Johnson Foundation:
Provider quality information sources among those who used the information they saw or heard
Sources of Information
% Who saw or heard information
from source
Through friends or family
63
On a ratings website
53
Directly from a doctor
53
Online on a community or advocacy groups’s website
48
Provided by health insurance company
44
In a newspaper or magazine
39
Online on a government website
38
Somewhere else
36
3) Your own use of social media. Keep in mind that whatever
you post online could end up defining your professional reputation.
Let’s say you Tweet. Think about what you’d like to communicate, to whom and why. If you’re calling attention to a new
study you think people should know about, that’s useful coming from a medical professional. However, if you’re Tweeting
that you’ll be attending a wedding today (yes, that’s a real
example), ask if that is what you want to broadcast to the
general public. One way to gauge yourself: When you speak
in public, what are the parameters you set for yourself? At the
very least, it’s a good idea to stay within those same parameters when speaking to others via any widely accessible social
media platform.
ABOUT THE AUTHOR:
Diane Evans is Managing Partner of M.E.D. Media Mart,
an online store offering marketing, education and design
services for health and human services providers. M.E.D.
Media Mart is a sponsor of the Stark County Medical Society and specializes in website development, online identity
control and marketing for doctors, hospitals and nonprofits.
You can email Diane Evans at [email protected]
or call M.E.D. Media Mart at 330-615-6330.
3
Stark County
Medical Society Night
Stark County Medical Society Night
with the Canton
with the Charge!
Canton Charge!
SCMS News
Join fellow members
families
ofand
SCMS
as the
Canton
Charge
Joinand
fellow
members
families
of SCMS
as the
Canton Charge
take
on
the
Reno
Big
Horns!
Sign
up
early
because
the first 30
take on the Reno Big Horns! Sign up early because the first 30
kids will have the opportunity to high five the players as they
kids will have the opportunity
to high five the players as they
come
on thethe
court.Canton Charge!
Stark County Medical Society
Night
with
come on the court.
Join fellow members and families of SCMS as the Canton Charge take on the Reno Big Horns!
Sign up early because the first 30 kids will have the opportunity to high five
the players as they come on the court.
Thursday, February 12, 2015
Join fellow members and families
of SCMS as the Canton Charge
CANTON
v. Reno
Thursday,
FebruarySign
12,
2015
take on the Reno
Big Horns!
up
early
because the first 30
at 7:00
CHARGE
kids will have the opportunity
to TIP-OFF
high five
thep.m.
players as they
CANTON v. Reno
come on the court.
CHARGE TIP-OFF at 7:00 p.m.
Stark County Medical Society Night
with the Canton Charge!
Three Ways to Order
1. MAIL: Complete the form below with payment to:
1101 Market Ave. North Canton, OH 44702 Attn: Mike DeAngelo
2. FAX: Completed Order Form with credit card # to: 330-489-1703
3. ONLINE: https://cantoncharge.formstack.com/forms/scms
Three Ways to Order
1. MAIL: Complete the form below with payment to:
1101 Market Ave.Thursday,
North Canton,Febru
OH 44702
DeAngelo
aryAttn:
12,Mike
2015
2. FAX: Completed Order Form with credit card # to: 330-489-1703
Number of $16.50 tickets
(Discounted from $21.50)
SCMS
3. ONLINE: https://cantoncharge.formstack.com/forms/scms
Upper Centers Rows H-M
THREE WAYS TO ORDER
TOTAL
CANTON v. Reno
1. MAIL: Complete this form with payment to
1101 Market Ave.
North Canton, OH 44702
SCMS
Attention: Mike DeAngelo
Canton vs. Reno
CHARGE TIP-OFF at 7:00 p.m.
PAYMENT OPTIONS:
PURCHASER
Number of $16.50 tickets
(Discounted from $21.50)
Upper Centers Rows H-M
EXP:
TOTAL
Canton
vs. Reno
2. FAX: Completed Order Form
with
credit
Ways
toADDRESS
Order
Three
CITY
STATE
card # to 330-489-1703 1. MAIL: Complete
CHECK:
TO THEwith
CANTON
CHARGE
thePAYABLE
form below
payment
to:
PAYMENT OPTIONS:
$
CHECK: PAYABLE TO THE CANTON CHARGE
CHARGE: VISA/MC/DISC/AMEX
CARD #:
$
ZIP
CHARGE: VISA/MC/DISC/AMEX
PHONE ( Ave.
) North Canton, OH 44702 Attn: Mike DeAngelo
1101 Market
CARD #:
EXP:
3. ONLINE: https://cantonharge.formstack.
Order Form with credit card # to: 330-489-1703
2. FAX: Completed
EMAIL
# OF CHILDREN PARTICIPATING TUNNEL:
com/forms/scms
3. ONLINE: https://cantoncharge.formstack.com/forms/scms
PURCHASER
Questions: Contact Mike DeAngelo Ph: 330-489-5952 Em: [email protected]
ADDRESS
CITY
STATE
ZIP
SENIORS Helping SENIORS®
PHONE
(
)
SCMS
Number of $16.50 tickets
(Discounted from $21.50)
Upper Centers Rows H-M
# OF CHILDREN
PARTICIPATING TUNNEL:
®
Reno
...a wayCanton
tovs.give
and to receive
EMAIL
TOTAL
SUBSCRIBE
AND
$
FOLLOW
OUR NEWS
CHECK: PAYABLE TO THE CANTON CHARGE
Complete these simple steps:
Contact Mike DeAngelo Ph: 330-489-5952 Em: [email protected]
PAYMENT OPTIONS:
CHARGE: VISA/MC/DISC/AMEX
• Friendly Questions:
Compassionate
Care
CARD #:
EXP:
• Quality Service You Can Trust
1. Go to www.starkmedical.org
PURCHASER
• Dependable
Caregivers
ADDRESS
We provide CITY
personal care, companionship
STATE and
assistance with
caregivers
you can rely on.
PHONE (
)
330-499-6015 •
EMAIL
ZIP
3. Click on subscribe
4. You will be notified via email
# OF CHILDREN PARTICIPATING TUNNEL:
seniorcarecantonoh.com
when we post information to
©2014 Seniors Helping Seniors. Each office is independently owned and operated. All trademarks are registered trademarks of Corporate Mutual
Contact Mike DeAngelo Ph: 330-489-5952 Em:
Resources Inc. Not all services are available inQuestions:
all areas.
4
2. At the bottom of the home
page, enter your email address
this section on the website
[email protected]
Stark County Medical Society January
- February 2015
ONLINE STORE FOR
medmediamart THEMEDICAL
PROVIDERS
M A R K E T I N G • E D U C AT I O N • D E S I G N
PHONE: 330.615.6330
EMAIL: [email protected]
Offering resources for patient education, apparel, web design, web hosting, custom print design, and more!
5
SCMS News
We Understand Commitment.
For decades, Edward Jones has been committed to providing
financial solutions and personalized service to individual investors.
You can rely on us for:
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Locations in the community and face-to-face
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6
www.edwardjones.comMember SIPC
Stark County Medical Society January
- February 2015
Program Topics will include:
03/19/15
6:15 pm DATE
Cash Bar & Social
03/19/15
03/19/15
3/19/15
6:45
pm
Dinner
6:15
pm
Bar
6:15
pmCash
Cash
Bar& &Social
Social
TIME
6:15
pm
7:15
pm
Program
03/19/15
6:45
pm
6:45
pmDinner
Dinner
Cash Bar & Social
1.) Maintain the focus of your medical practice on improved patient care
Program
Topics
will
include:
Program
Topics
include:
rather
than will
malpractice
defense
2.) Structure your practices for malpractice protection and prevention
3.) Reduce malpractice insurance costs, as well as, taxes
Maintain
the
focus
your
medical
practice
improved
patient
care
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the
focus
of of
your
medical
practice
on on
improved
patient
care
rather
than
malpractice
defense
rather
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malpractice
defense
2.)2.)Structure
your
practices
forfor
malpractice
protection
andand
prevention
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your
practices
malpractice
protection
prevention
Program
Topics
will include:
Presenter:
3.)3.)Reduce
malpractice
insurance
costs,
as as
well
as,as,
taxes
Reduce
malpractice
insurance
costs,
well
taxes
1.) Maintain the focus of your medical practice on improved patient care
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J. than
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CEO,
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7:15
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8:30
pm
Adjourn
6:45 pm Dinner
6:45 pm Dinner
8:30
8:30pm
pmAdjourn
Adjourn
7:15 pm Program
7:15 pm Program
8:30 pm Adjourn
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PLEASEPMAKE
MY RESERVATION(S):
MY RESERVATION
(S):
PLEASELEASE
MAKEMAKE
MY RESERVATION
(S):
PLEASE MAKE MY RESERVATION(S):
MEMBER NAME:____________________________________________
AME:____________________________________________
MEMBER
NM
AMEN
:____________________________________________
MEMBER
EMBER NAME:____________________________________________
STARK COUNTY
MEDICAL SOCIETY
4942 Higbee Ave., NW
Suite L
Canton, OH 44718
SPOUSE/GUEST NAME:________________________________________
/GSUEST
N
AME
:________________________________________
SPOUSE
/GUEST
NAME
SPOUSE
POUSE
/G
UEST
NAME:________________________________________
:________________________________________
COMPLIMENTARY
OMPLIMENTARY
CC
COMPLIMENTARY
OMPLIMENTARY
This meeting is free for all SCMS Active, Retired, and Resident memThis is
meeting
is free
for all SCMS
Active,
Retired,
and ResidentmemmemThisMember’s
meeting
freeisfor
all for
SCMS
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meeting
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all SCMS
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and
Resident
members.
spouses/staff
members
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welcome
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attend
for
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for
FREE.bers.FREE.
Member’s spouses/staff members are welcome to attend for
FREE.
FREE.
th
Please
RSVP
Advance reservations
are requested
by Friday,
MarchMarch
13th. th13
. Please
RSVP
Advance reservations
are requested
by Friday,
.
Please
RSVP
Advance
reservations
are
requested
by
Friday,
March
13
bythe
returning
the form
attached
formatby330.492.3347
fax at 330.492.3347
or
by calling
th the
by returning
attached
by fax
or byMarch
calling
the
Advance
reservations
are
byrequiring
Friday,
13
. Please RSVP
by returning
the
form
byrequested
fax at
330.492.3347
byplease
calling
the
office
at attached
330.492.3333.
For
reservations
aor
payment,
please
office
at
330.492.3333.
For
reservations
requiring
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payment,
Phone: 330.492.3333
by returning
the
attached
form
byrequiring
fax
at 330.492.3347
orSociety.
by calling the
sendalong
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Fax:County
330.492.3347
avoid
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by
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March
13
office
at
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send this form
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4942 Higbee
NW Suite L
th
4942 Higbee Ave.,
NW Suite
L
send this form along with your check to Stark County Medical Society.
Canton,
Ohio 44718
StarkOhio
County
Medical
Society Cancellations by noon on March 13 avoid a “no-show” fee.
Canton,
44718
[email protected]
4942 Higbee
Ave., NW Suite L
Cancellations by noon on March 13th avoid a “no-show” fee.
Phone: 330.492.3333
Canton, Ohio 44718
4942330.492.3333
HigbeeFax:
Ave.,
NW Suite L
330.492.3347
Phone:
Canton,
Ohio 44718
Fax:
330.492.3347
Phone: 330.492.3333
[email protected]
Fax: 330.492.3347
[email protected]
Phone: 330.492.3333
Fax: 330.492.3347
[email protected]
7
SCMS News
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Stark County Medical Society January
- February 2015
How to Manage Exchange Patients
Scott P. Sandrock & Angela Codougan
Brennan, Manna & Diamond, LLC
In order to help lower the cost of mandatory health insurance
coverage, the Affordable Care Act (“ACA”) includes an advanced premium tax credit which reduces premiums for individuals with a household income from 100-400% of the federal
poverty level. What happens if the patient fails to pay the premiums? The ACA creates a 90-day grace period for nonpayment of
plan premiums. This grace period allows these enrollees to keep
health coverage as long as all premiums owed are paid by the
end of the grace period. The ACA places the burden of paying for
services provided during the first 30 days of the grace period on
insurers. However, physicians may be stuck for services provided
during days 31-90. Therefore, physicians need to be aware of the
new ACA provisions and should take proactive steps
to protect themselves.
Under the ACA, an insurer must continue to pay claims submitted by a health care provider for services provided to an enrollee
during the first 30 days of the grace period as if the enrollee had
paid all premiums. For services performed during days 31-90,
an insurer may “pend” submitted claims. If the enrollee pays all
outstanding premiums before the grace period is over, coverage continues with no lapse, and the insurer is required to pay
claims for that period. However, if the enrollee does not pay all
outstanding premiums before the grace period is over, the insurer
may then terminate coverage retroactively and deny all provider
claims for services provided to the enrollee during days 31-90.
In the alternative, the insurer may pay claims during the grace
period and then later deny the claims and recoup money from
providers should the enrollee fail to pay required premiums.
Insurers are required to notify providers of the possibility of denied claims where enrollees are in the second and third month of
the grace period. At a minimum, the insurers must notify providers who submit claims during this time. Unfortunately, there is
no penalty if the insurers fail to give the notice. Some insurers
have created policies to automatically notify patients’ primary
care providers and any providers that have submitted claims
within a set period of time prior to the start of the grace period as
well. After expiration of the grace period, insurers may terminate
coverage effective day 31 one and deny all claims for services
provided during days 31-90.
Once coverage is terminated due to nonpayment, the physician
may collect any claims due directly from the enrollee and is not
limited to the payer’s maximum allowable charges. However,
practically, a patient that is unable to pay premiums may also
be unable to pay the provider’s charges for services. Even if the
provider is paid directly by the patient, the physician has waited
in excess of 90 days. This waiting and uncertainty is certain to
affect the bottom line for many physicians. Therefore, we recommend that physicians take proactive steps to try to minimize any
negative impact of the 90-day grace period.
FIRST:
Physicians should have their staff check to see if an exchange patient is current with their premiums, or are in the
grace period when they first come for services. You cannot
assume that the patient’s first visit magically falls within the
guaranteed 30 day payment period as opposed to the patient
arriving in your office on day 32, putting the physician at
risk of nonpayment. We have checked with a number of the
Ohio exchange products and it appears most will verify upon
inquiry if the patient is current on their premiums. Despite
what patients may claim, a physician is not required to
provide medical services to a non-paying patient, except for
emergency services which are fairly limited in nature. There
is a cautionary note for that decision, however. If the patient
never pays the premium, the insurance company never has
to pay for the services, but if the patient were to pay the
premium prior to the 90-day grace period, the claims would
be processed. While the insurance company is not at risk in
the second and third month, the physician who declines to
schedule a patient may technically not be meeting the terms
of their provider agreement to see patients who are “covered” by those plans.
SECOND:
Physicians should make sure someone is assigned the role
of reviewing notices related to a grace period and make sure
your staff knows what to do if a notice arrives.
THIRD:
Physician could verify insurance status at the time of providing service. If it is not practical or feasible to verify insurance every visit, providers should verify coverage at least
monthly to reduce the risk of nonpayment. Where patients
are behind on premiums, providers may want to consider
whether to suspend provision of non-emergent services.
FOURTH:
Make sure your staff understands that pre-authorizations are
based on medical necessity only and may not reflect precontinued on page 16
9
SCMS News
w w w. p a n d p m e d i c a l s o l u t i o n s . c o m
PRESCRIPTION MEDICATION HELP
FOR THE UNDERINSURED
You may qualify for prescription medication help if you:
Are a Stark County Resident
Meet our Income Guidelines
Have high medical co-pays and/or high deductibles
Call 330-445-1087 To Make An Appointment
MEDLINE OFFERS THE FOLLOWING RESOURCES
TO SUPPORT SCMS PREFERRED MEMBERS:
Physician Office Catalog - Over 30,000 clinically proven products
and supplies at manufacturer direct pricing
Medline University® - Over 250 FREE online, on-demand courses,
many with CEU credits
Medline.com - Access your account 24/7 for online ordering,
order template guides and reporting analysis
Scrubs123® - Buy scrubs and physician coats direct from the
manufacturer at significant savings compared to retail locations
Contact Medline Account Manager, Candace Bombay at 330-488-7755 or [email protected]
Physician Office Services
Helping You Improve the Health of Your Practice™
©2014 Medline Industries Inc. Medline®, Medline University® and Scrubs123®
are registered trademarks of Medline Industries, Inc. MKT1433936
10
You will be asked to bring the following to your appointment:
Photo ID
Social Security Cards for EVERYONE in the Household
Income Verification for EVERYONE in the Household
Verification of Address
Receipts or Bills for all Household Expenses
Charitable Pharmacy Income Guidelines
One person household.......
Two person household......
Three person household...
Four person household.....
$29,175
$39,325
$49,475
$59,625
This is NEW SERVICE for the underinsured of our community.
It is designed to help those people with high co-pays and/or
those who are having trouble accessing their health care
insurance due to very high deductibles.
408 Ninth St. SW • The Community Campus
Canton, Ohio 44707 • Phone: 330-445-1087
Stark County Medical Society January
SCMS
113
TH
Annual Meeting
October 16, 2014
Stark County Medical Society Honors:
Arnold Rosenblatt, M.D. with Lifetime Achievement Award!
- February 2015
In Recognition of
our 2014
retired Members
Glenn Blankenhorn III, D.O.
Victor Dunham, M.D.
George Vogelgesang, D.O.
In Recognition of
50 Years in
Medicine
Arnold Rosenblatt, M.D.
& Luis Martino, M.D.
This award is in recognition of Dr. Rosenblatt’s enormous contributions that he
has given to our medical community. Born and raised in Boston, Massachusetts,
Dr. Rosenblatt received his Bachelors of Science from Dartmouth College in 1959.
He received his Doctor of Medicine from Tufts University School of Medicine in
1963, and after one year of internship and residency in internal medicine at Boston
City Hospital. He served at Fitzsimmons General Hospital for the U.S. Army and
completed his residency in internal medicine at Metropolitan General Hospital in
Cleveland, Ohio June of 1969.
James Burkholder, M.D.
Luisa Fabella, M.D.
Ricardo Limardo, M.D.
Richard Maioriello, M.D.
Marino Ong, M.D.
Gerald Smith, M.D.
Roger Vincent, D.O.
Professional
Accomplishments include:
• July of 1969 through December 2009 partner at Mansard Medical
Associates and on the medical staff at Aultman Hospital
• 1978 through 1994 clinical associate professor at North Eastern
Ohio University College of Medicine
• 1985 through 1990 chairman of the department of internal
medicine at Aultman Hospital
• 1985 through 1999 steering committee member of the
Canton Medical Education Foundation
• 1989 through 1990 president-elect of the medical staff at
Aultman Hospital
• 1991 through 1992 president of the medical staff at
Aultman Hospital
• 1991 through 1991 board of trustees at Aultman Hospital
• 1993 through 1999 chair of the Canton Medical Education
Foundation
Following his retirement from Mansard Medical Associates, Dr. Rosenblatt went on to volunteer his time at the
free clinic in Massillon to give back to the community that he continues to serve today.
Congratulations Dr. Rosenblatt!
11
SCMS News
Announcements
he
PREFERRED VENDOR PROGRAM
Our Preferred Vendors bring you a variety of services to save time and money. The Society’s preferred
business partnership program is designed to offer special services and discounts to Society members. To
learn more about the discounts offered, contact the representative below or go to www.starkmedical.org
and click on the Preferred Vendor links.
Accu Medical Waste Services
Jim & Doug Parks - 866.696.8379
Aflac: Yen Huhnh - 330.285.2831
Huntington Merchant Services
[email protected] - 330.354.9016
Huntington Bank
Bobbi Richardson - 330.498.5550
Huntington Insurance: Ed Hassay - 330.742.5307
Medline: Candace Bombay-Huelf - 330.488.7755
Sirak Insurance Partners
Sheila Klenner/Barry Riggs - 800.229.5299
Sunlit Communications
Diane Evans – 330.869.5191
SureShred: Timothy Casper - 330.479.7899
REFER A COMPANY
If you know of a company that might be interested in the Society’s Preferred Vendor Program or if you would
like to suggest a service that you think the Society should consider, contact Kevin or Becky at strakmedical@
ameritech.net or 330.492.3333.
SAVE THE DATE
ICD 10 Webinar
Wednesday, January 14, 2015 at AM
“A Cutting Edge Approach to Healthcare Access and Affordability” Webinar
Wednesday, January 28, 2015
Stark County Medical Society Night at the Canton Charge
Reno Big Horns vs Canton Charge
Thursday, February 12, 2015
SPECIAL THANKS
On October 22nd the Society hosted “How Office Staff Can Control Use of a Doctor’s Name Online” We would
like to thank our presenters Diane Evans, SunLit Communications and medmediamart.com, and Karen Lefton,
The Lefton Group, LLC. Special thanks to the our sponsors: Accu Medical Waste Services, Aflac, Edward
Jones, Huntington Bank, Huntington Insurance, Medline, Metlife, Sirak Insurance Partners, StrongBase Consulting, SunLit Communications, SureShred, and The Uniform Place.
STARK COUNTY MEDICAL SOCIETY TO OFFER HEALTH BENEFITS PLAN FOR MEMBERS
The Society has held two information meetings on the formation of a Multiple Employer Welfare Arrangement
also known as a MEWA. What is a MEWA you ask? A MEWA is an arrangement offering health coverage
and other benefits to employees of two or more employers. How would this work for SCMS? In essence, the
members of SCMS would band together to form and fund a medical plan which would provide benefits to their
employees. We have been advised that a MEWA could provide coverage at a cost which is 5 to 10% below a fully
insured plan. Brenda Basso from Business Benefits of Ohio has been working with the Board to develop this
health benefits alternative. Private, onsite informational meetings can be arranged. For more information please
contact Kevin at [email protected] or 330.492.333.
HIPAA
The Federal Office of Civil Rights which is the agency charge with HIPAA compliance and enforcement has
announced that it will be stepping up its HIPAA audits during 2015. They recently reported that based on pilot
audits this year that a high percentage of Covered Entities did not have a current risk assessment in place at the
time of the audit. You may want to review your current HIPAA plans and the OCR Guidance which can be found
at http://www.hhs.gov.
12
lace
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330-492-2826
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PRESENT YOUR MEDICAL BADGE!
*Cannot be combined on any other offers or on previous purchases. Cannot be used on
“Buy Two & Save Pricing” & clearance merchandise. This offer has no cash value
and is not redeemable for cash. Applies only to merchandise purchased from
he
lace
THURSDAY’S PLAZA:
4685 Dressler Rd. NW Canton
330-492-2826
Stark County Medical Society January
- February 2015
Fast, Easy, and Secure.
Stark Medical Society and Huntington Merchant Services – industry leaders –
have teamed up to bring fast, secure, effortless payments to help save you money.
Stark County Medical Society and Huntington Merchant Services
bring you the following benefits:
•
Speciallowpricingforassociationmembers
•
Acceptvirtuallyallcardtransactiontypes
•
Helpimprovecashflow–Receivefundsquicklyfromthebankofyourchoice
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Onlinereportingandaccountinformationincludedvirtuallyanywhere,anytime
•
Receivepersonalizedsupport–24/7customerserviceandtechnicalsupport
For more information, contact
Bobby Greco at 330-354-9016 or [email protected]
Bobbi Richardson at 330-258-4454 or [email protected]
The Huntington National Bank, Member FDIC.
®
and Huntington® are federally registered service marks of Huntington Bancshares Incorporated.
Canton Calvary Mission
Cordially invites you to attend
Presenter:
P & P MEDICAL SOLUTIONS
4791 Munson Street NW, Canton, OH 44718
www.pandpmedicalsolutions.com • 330.494.9969 Office
P&P Medical Solutions helps private practices, aspiring practice owners, hospital
executives and commissions and boards build a stronger, healthier future.
You must register via email:
Send a request email to [email protected]. You will receive your
User ID and Password via email. You need this information the day of the webinar.
Registration deadline is January 26th
Family Living Center
January 28th 11:00 am until 12:00 noon
Topic: “A Cutting Edge Approach to Healthcare
Access and Affordability”
Refuge of Hope
REVOLUTIONIZING HEALTHCARE
The state of healthcare as we know it presents challenges. Even with the world’s best
health system, a growing breed of practitioners feel like things could be measurably
improved. If this sounds like you, then please attend our FREE Webinar.
Thursday, January 29th, 2015
6:00pm - Raffles
Dinner at 7:30pm
Glenmoor Country Club
• Benefiting •
Canton Calvary Mission - Family Living Center
Hope Outreach Ministries - Refuge of Hope
Poverty can affect every area of a person’s life, including
health, school achievement, job security, cognitive ability,
and chronic stress. Together we can make it our Mission to
help alleviate some of these problems.
More than a quarter of Canton’s population lives in poverty.
For more information call Darlene Violet at 330-477-6036.
Tickets are $50.00 per person
Hope Outreach Ministries
13
SCMS News
CH_Golf_SCMS_2014_01b.pdf
1
1/9/14
10:51 AM
Stark County Medical Society
14th Annual
Golf Outing
To score a Hole-In-One
against hunger
C
M
Take Back Control!
Y
CM
The Stark County Medical Society (SCMS) is exploring the idea of starting a Multiple
Employer Welfare Arrangement (MEWA) to provide medical coverage for our
membership. We have heard increasing frustration and concern from our members
regarding the rising cost of medical care, as well as the lack of control over both
employee benefits offered and reimbursement received for medical services rendered. In
this era of uncertainty with the Affordable Care Act (ACA) and rising costs, we believe a
MEWA may be the answer to the employee benefits dilemma.
What is a MEWA you ask? A MEWA is an arrangement offering health coverage and
other benefits to employees of two or more employers. How would this work for SCMS ?
In essence, the members of SCMS would band together to form and fund a medical plan
which would provide benefits to their employees. We have been advised that a MEWA
could provide coverage at a cost which is 5 to 10% below a fully insured plan.
SCMS will be hosting informational meetings in the near future to review this concept in
more detail and to answer questions. Watch for details in our upcoming newsletter, on
our website and through mailers.
MY
CY
CMY
K
Wednesday,
September 16, 2015
Skyland Pines Golf Club
3550 Columbus Road NE
Canton, OH 44705
This year’s outing to benefit:
Stark County Physicians
Graduate from ICD-9
to ICD-10 in Seconds
• Convert your ICD-9 cheat-sheets to ICD-10 codes in seconds
• Get familiar with ICD-10 nuances and CMS guidelines through
visual cues
• Automatic placement of 7th Character where applicable
• Patent Pending SmartSelect™ to help you start dual coding now
• Embedded ICD-10 books – No need to buy
StrongBase Consulting
a Bdewees Consulting Company
330-915-2355
[email protected]
14
Stark County Medical Society January
- February 2015
continued
contact between patient and provider. For instance, strep throat can only be diagnosed by culture and an otitis media can only be diagnosed by looking into the ear
canal. Another mode of caregiving experiencing phenomenal growth is the retail clinic. These facilities are housed in large pharmacy chain stores and utilize nurse
practitioners. These caregivers follow established protocols to treat minor illnesses. They are busiest during off-hours when most doctors’ practices are closed and
they are also less expensive with an average cost per visit of $75. To combat the possible fragmentation of care resulting from a lack of communication about care
received between a retail clinic and an individual’s primary care provider, there is a trend toward the development of reciprocal referral agreements between these
clinics and local health networks.
Another issue effecting primary care physicians is the scheduled expiration of the Enhanced Medicaid Payments in 2015. The result would bring Medicaid reimbursement
back down to about 40% of Medicare reimbursement. This reduction would make it impractical for many physician practices to treat Medicaid patients because the
Medicaid payments are below the cost of providing care. This would cause many practices to necessarily limit the number of Medicaid patients that they serve at a
time when the total number of Medicaid patients is expected to increase due to the ACA. To do so would be a matter of economic survival when one considers that
Commercial payers pay about $119 and Medicare pays $73 for an office visit, while Medicaid pays only $52 which is below the cost of providing care.
The nonpartisan Commonwealth Fund has recently published an Issue
Brief entitled National Trends in the Cost of Employer Health Insurance
Coverage, 2003 – 2013. The findings show an anticipated overall
increase in the cost of health insurance. Premiums for family coverage
were increased by 73% during this period, which outpaced the increase in
median family income. Also during this period, employee contributions
to health insurance premiums increased by 93% while deductibles more
than doubled. Although the rise in premium rates showed steady growth
during this ten year period since the implementation of the ACA, the
rate of growth slowed between 2010 and 2013. These findings suggest
that the combination of higher health care coverage costs and a weak
economy translate into a situation in which families are paying a greater
portion of their incomes for health care premiums and deductibles.
One strategy to partially alleviate the burden of the increased premiums
is the establishment of a Multiple Employee Welfare Agreement
(MEWA). This is an arrangement which provides health coverage
benefits to employees of two or more firms. These are self-funded
organizations which provide a number of coverage products through
one or more third-party administrators (TPA). Participants pay a set
amount for each employee covered and enjoy representation in MEWA
decision-making. The regulatory agencies with jurisdiction require a
minimum enrollment of 300 employees and a minimum cash surplus of
$150,000. The Stark County Medical Society (SCMS) is investigating
the advantages and disadvantages of developing such a program.
Advantages include flexibility in benefit program designing, reduction
in ACA mandates and taxes, increased cash flow, profit retention, lower
costs, better budgeting, and the possibility of developing a network
consisting of our members. The downside includes complicated
administration, the possibility of increased costs with poor claims years,
and the possibility that the MEWA can be sued. The SCMS is presently
undertaking an educational campaign regarding MEWA to evaluate
member interest in forming such an organization. For more information
one can go to http://starkmedical.org.
That recently updated website also has links to the medical societies’
preferred vendors, local medical information, as well as an A to Z listing
of social services agencies in Stark County. Visitors to the webpage are
also encouraged to sign up for e-mail updates of SCMS News. These
are easily subscribed to by submitting your e-mail address in the space
provided at the bottom of the page.
These challenges which I have discussed and many others not mentioned
are formidable indeed. It behooves us to support organized medicine
so as to maximize our ability to influence the healthcare environment
during the coming year. To this end I want to take the opportunity to
encourage present and former members to renew their memberships
and nonmembers to join because there is strength in numbers and at this
time physicians need all the strength that they can muster.
15
SCMS News
BE SURE TO SUPPORT OUR
PREFERRED VENDORS WHO
OFFER OUR MEMBERS
OUTSTANDING SERVICE
AND DISCOUNTS.
ACCU MEDICAL WASTE
SERVICES
Jim & Doug Parks
866.696.8379
AFLAC
Yen Huhnh
330.285.2831
HUNTINGTON MERCHANT
SERVICES
[email protected]
330.354.9016
HUNTINGTON BANK
Bobbi Richardson
330.498.5550
HUNTINGTON INSURANCE
Ed Hassay
330.742.5307
MEDLINE
Candace Bombay-Huelf
330.488.7755
SIRAK INSURANCE
PARTNERS
Sheila Klenner/Barry Riggs
800.229.5299
SUNLIT
COMMUNICATIONS
Diane Evans
330.869.5191
SURESHRED
Timothy Casper
330.479.7899
How to Manage Exchange Patients
continued from page 9
mium payment status. A service could be pre-authorized based on medical necessity,
but later denied due to nonpayment of premiums. If a patient is potentially receiving
a significant amount of services or testing, you may want to make sure your staff
also verifies the status of their premium payment.
FIFTH:
Physician should make sure to verify and collect patients’ cost-sharing amounts
(co-pays, coinsurance, and deductibles) at the time that service is provided. While
this may not be a provider’s normal practice, this practice is allowed by the ACA
and will help to reduce the amount that a provider has to try to collect after a service
has already been provided. Where a patient has a high deductible that has not been
satisfied, the provider may be able to collect the payer’s maximum allowable charge
from the patient at the time of service. If coverage is ultimately terminated, the provider may then go back and collect the difference between the patient’s cost-sharing
amount and the provider’s self-pay charges. Advanced notice of payment policies to
patients may help to encourage patients to stay current on premiums.
SIXTH:
Physicians should require a personal guarantee of payment from each patient prior to
providing services. Providers may also require patients to have a credit card on file
that will automatically be charged for services in the event that claims are not paid
by an insurer. This requires that a patient sign an appropriate authorization. These
measures will help the provider to collect payment in the event that claims are later
denied due to nonpayment of premiums.
SEVENTH:
Although not recommended, there has been commentary in the hospital setting, for
example, that in the case of a large medical charge in a month and where the patient
cannot pay the cost of services otherwise, the provider might consider advancing the
premium on behalf of the patient to assure the bills are paid, thereby reducing the
loss to the provider to collecting the premium. The ACA grace period provisions for
exchange enrollees receiving premium assistance could impose heavy burdens on
unaware physicians. Physicians could be caught providing significant amounts of
services that go uncompensated. However, there are proactive steps that physicians
can take to help to minimize the burden of this relatively new law. Verifying coverage and premium payment up
front, collecting cost-sharing at
If you have any questions on these or other
the time of service, and impletopics, please contact
menting patient payment guarScott Sandrock at 330-253-4367,
antees will help to reduce your
[email protected]
risk of providing uncompensated
or Angela Codougan at 330-374-7475,
services.
[email protected].
Congratulations to Dr. Ryan Drake!
Dr. Drake is this year’s winner in the 2015 dues raffle. Dr. Drake will receive a gift certificate for $150.00.
If you haven’t paid your 2015 dues yet, it’s not too late. If you need another invoice, contact Kevin or Becky at 330.492.3333.
16
Stark County Medical Society January
- February 2015
BRENNAN, MANNA & DIAMOND provides innovative business
strategies and legal solutions to physicians.
Knowledge makes all the difference! Brennan, Manna & Diamond has developed one
of the largest healthcare practices in the region with the experience to solve your
healthcare challenges.
We have developed centers of excellence, physician-joint ventures,
The BMD Healthcare Group
MSOs, ACOs, and other models to enhance physician practices. We
Richard W. Burke
Matthew A. Heinle
represent physicians in contracts, credentialing and payment disputes.
Jason A. Butterworth
Scott P. Sandrock
Jeana M. Singleton
Our experience provides you with the legal profession you need to grow Christopher B. Congeni
John N. Childs
Brendan A. Sorg
your practice and protect your interests.
Jack T. Diamond
Specializing in Healthcare Law
75 E. Market Street, Akron, OH 44308 □ 330.253.5060 □ www.bmdllc.com Amanda L. Waesch
Call Scott Sandrock
Healthcare Group Attorney
at (330) 253-5060
17
SCMS News
YES, I WANT TO HELP MAKE SURE THAT EVERY FAMILY HAS ENOUGH TO EAT.
Please use this generous donation to expand your ability to meet the growing needs of our
community and deliver food for our hungry neighbors. Enclosed is my donation of:
q $50
q $25
Please make checks payable to:
Community Harvest, Inc.
4915 Fulton Drive NW, Suite 7
Canton, OH 44718
(330) 493-0800
q $10
q Other $
Food Rescue Program
,
For your convenience. PayPal on-line donations are also accepted on our website www.communityharveststark.org
18
Stark County Medical Society January
- February 2015
DisabilitY
DisabilitY insurance
insurance
Protect Your Practice and Yourself
With
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Welcome...
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And in
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How
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affect you
you —
— your
your career,
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you at
at work,
work, and
and the
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7337 Caritas Cr. N.W.
Massillon, Oh 44646
330-478-0001
FAX: 330-837-2646
*Internal Medicine,*Hematology
& Oncology
Disability insurance can help you be prepared for the unexpected. Metlife has coverage that can help meet your needs,
Disability insurance can help you be prepared for the unexpected. Metlife has coverage that can help meet your needs,
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JONATHAN CONGENI, M.D.
Gastroenterology
Specialists, Inc.
2726 Fulton Dr. N.W.
Canton. OH 44718
330-455-5011
FAX: 330-588-7127
Internal Medicine
are paid on time.4
ANNA ROSENFELD, M.D., MPH
Anesthesia Associates
of Alliance, LLC
200 East State Street, 2nd Floor
Alliance, OH 44601
330-596-7228
FAX: 330-596-7214
Anesthesia
Reinstated
Members!
DONALD DECOY, M.D.
Mercy Pulmonology,
Critical Care and
Sleep Medicine Physicians
1330 Mercy Drive N.W., Suite 418
Canton, OH 44708
330-489-1454
FAX: 330-430-2772
Pulmonary Diseases,
Critical Care Medicine
And Internal Medicine;
Sleep Medicine
select associations.4
Although
Although you
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be prepared
prepared with
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disability plan
plan
designed
for
you.
For
more
information,
contact
me
today.
designed for you. For more information, contact me today.
Anthony Nicodemo
Anthony Nicodemo
Financial Services Representative
Financial Services Representative
(440)746-8734 or (330)704-2855
(440)746-8734 or (330)704-2855
[email protected]
Although
you can’t avoid
[email protected]
the risk of a disability, you can be prepared with a disability plan
Although
youyou.
can’tFor
avoid
risk of a disability,
can be prepared with a disability plan
designed for
morethe
information,
contact you
me today.
designed for you. For more information, contact me today.
Anthony Nicodemo
Actual benefit amount issued depends on medical specialty, applicant’s income and amount of other disability income insurance in force and applied for. The maximum benefit amount
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benefit amount issued depends on medical specialty, applicant’s income and amount of other disability income insurance in force and applied for. The maximum benefit amount
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issued
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based on the benefit period selected.
(440)746-8734
or
(330)704-2855
3 [email protected]
Like most disability insurance policies, MetLife’s policies contain certain exclusions, waiting periods, reductions, limitations and terms for keeping them in force. Ask
3 Age 65 in some states.
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4
1
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• NotbyFDIC-Insured
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Disability insurance is issued
Metropolitan• Life
on IDI2000-P/NC,
IDI2000-P/NC-ML,
IDI2000-P/GR
and or
IDIP04-1.
September 2012.
• Not FDIC-Insured • Not Insured By Any Federal Government Agency • Not Guaranteed by Any Bank or Credit Union
• Not FDIC-Insured • Not Insured By Any Federal Government Agency • Not Guaranteed by Any Bank or Credit Union
• Not FDIC-Insured • Not Insured By Any Federal Government Agency • Not Guaranteed by Any Bank or Credit Union
Metropolitan life insurance company
Metropolitan
life insurance company
200 Park Avenue
200
NewPark
York,Avenue
NY 10166
Metropolitan
New
York,
NY
10166
metlife.com life insurance company
200
Park Avenue
metlife.com
Metropolitan life insurance company
New York, NY 10166
CLDI22907
L1012284967[1013](xCA)
200 Park Avenue
metlife.com
CLDI22907
L1012284967[1013](xCA)
©
2012York,
METLIFE,
PEANUTS © 2012 Peanuts Worldwide
New
NY INC.
10166
© 2012 METLIFE, INC. PEANUTS © 2012 Peanuts Worldwide
metlife.com
CLDI22907 L1012284967[1013](xCA)
© 2012 METLIFE, INC. PEANUTS © 2012 Peanuts Worldwide
CLDI22907 L1012284967[1013](xCA)
© 2012 METLIFE, INC. PEANUTS © 2012 Peanuts Worldwide
www.starkmedical.org
19
PRSRT STD.
U.S. POSTAGE
PAID
CANTON, OH
PERMIT #50
4942 Higbee Avenue NW, Suite L
Canton, OH 44718
Phone: 330.492.3333
Fax: 330.492.3347
E-mail: [email protected]
MEDICAL MALPRACT
Monitoring EVERY Market
Become a part of this spirited organization. Together we can doTracking
more!
EVERY Rate
www.Starkmedical.org
Fighting for you EVERYDAY
Serving the Physicians
In Stark County
We protect your most valued asset…….YO
MEDICAL MALPRACTICE
Sirak Insurance Partners
For over the past 50 years we have built our
reputation as one of Northeast Ohio’s Leaders
Medical Malpractice Insurance by making sur
4700 Dressler Road N.W., Canton,
OH 44718
clients
have the best coverage at the most affo
Toll Free: 1.800.229.5266 • Fax:
440.835.9614
• www.inspartners.com
rates. You are very
valuable to us.
Monitoring EVERY Market
Tracking EVERY Rate
Fighting for you EVERY DAY!
Serving Physicians
in and beyond Stark County
We protect you and your assets!
Sheila
SheilaKlenner
Klenner
Barry
BarryRiggs
Riggs
David Mo
Call today for a free, no obligation consult
For more than 50 years, we have built our reputation as one of Northeast Ohio’s leaders in Medical
Malpractice Insurance by making sure our clients have the best coverage at the most affordable rates.
You are very valuable to us.
Sirak Financial Compani
4700 Dressler Road N.W.
CALL TODAY FOR A FREE, NO OBLIGATION CONSULTATION.
Phone: 330-493-3211
Toll Free: 1-800-597-8102