May 2016 The Official Publication of the Dade County Medical

May 2016
The Official Publication of the Dade County Medical Association
Dade County Medical Association
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Endorsed by the
Message from your President:
DCMA Legislative
Report 2016
Andrew Nullman, M.D.
President, Dade County Medical Association
T
he 2016 legislative session ended March 11. The DCMA assisted the
FMA in tracking 211 bills and numerous amendments on behalf of our
members. Of the 1,638 bills and proposed constitutional amendments filed
for the 60 day session, the Florida Legislature passed 272 bills.
Here are some of the highlights:
LEGISLATION WE SUPPORTED THAT PASSED
MIAMI DADE INFECTIOUS DISEASE ELIMINATION ACT
(I.D.E.A.) – HB 81/SB 242
As I outlined in my message last month, this key piece of public health
legislation aimed at saving lives and taxpayer dollars passed this year and
was signed into law by Governor Scott on March 23, 2016. This authorizes
the University of Miami to establish a 5 year pilot program to offer free
clean needles and syringes in an exchange – to prevent HIV and other
blood borne diseases among IV drug users. This bill received bipartisan
support and its passing is an accomplishment for our UM medical students
and our Association.
PRIOR AUTHORIZATION – HB 221
Previously, every insurance company used different forms of varying length
that physicians had to complete in order to obtain prior authorization for
procedures or prescription drugs. Insurance companies often made this
process so burdensome that it was difficult to obtain the prior authorizations.
HB 221 includes a provision that now requires a uniform 2 page prior
authorization form. This creates uniformity and will streamline the current
lengthy, complicated process
SURPRISE MEDICAL BILLS IN THE EMERGENCY ROOM –
HB 221/SB 1442
The FMA worked tirelessly on the issue of balance billing and was eventually
able to reach a compromise. Non-contracted physicians will no longer be
able to balance bill PPO patients for ER services, or services provided in
hospitals where patients had no ability to choose the physician. Payment will
be the lesser of 1) physician charges, 2) usual and customary charges,or 3)
mutually agreed upon charge between the physician and insurance company.
There is a detailed dispute resolution process if the physician disagrees with
the payment rate, that is an improvement from previous versions of the bill.
CATASTROPHIC FUND EXEMPTION FOR MEDICAL
MALPRACTICE – HB 651/SB 992
Extends the expiration date to 2019 to exempt medical malpractice
premiums from emergency assessments. This is an important economic
incentives that helps offset escalating costs for physician practices. This
passed unanimously through the House and Senate.
PRESCRIPTION DRUG MONITORING PROGRAM (PDMP) –
HB 313/SB 964
Since the implementation of the PDMP only the pharmacist, prescriber, or
dispenser could access the database. This restriction created inefficiencies,as
physicians could not delegate this task to designees. Now this is corrected.
MIAMI
May 2016
Now the Senate Bill also allows an impaired physician consultant to review
the database information of a consenting participant.
Other bills that passed included:
HOSPITAL OBSTETRIC DEPARTMENT CLOSURE – Provides for 120
days’ notice to physicians with medical staff privileges
ARNP and PA PRESCRIBING – Allows ARNP’s and PA’s to prescribe
controlled substances under a physician protocol. Includes several limitations
and safeguards for prescribing controlled substances (Florida is the last state
in the United States to allow this).
EXPEDITED PARTNER THERAPY – Allows a physician licensed under
Chapter 458 or 459 to provide expedited partner therapy if the patient has
an STD, has engaged in sexual activity before the diagnosis and indicates
that his or her partner is unlikely to seek clinical services. (another positive
legislation that promotes public health)
TELEHEALTH/TELEMEDICINE – We were adamant that telehealth
physicians required to obtain a Florida license. This was the only way to
ensure the safety of Florida patients, as it would give the Board of Medicine
jurisdiction over any disciplinary actions. The passing bill only created a
Telehealth Advisory Committee, and authorized AHCA to conduct a study
on telehealth utilization and insurance coverage. The recommendations of
this committee must be reported by June 2017.
LEGISLATION WE OPPOSED THAT WAS DEFEATED
FOREIGN-TRAINED PHYSICIANS
HB 1277 would have provided an alternative option for graduates of foreign
medical schools to use to meet the educational requirements for licensure by
examination. The DCMA and FMA were concerned that this additional
option was not adequate under current licensing standards. As a result of the
concerns raised, the bill died in committee. DCMA and FMA are committed
to maintaining the highest standards of licensure in the country.
LEGISLATION WE SUPPORTED THAT DID NOT PASS
RETROACTIVE DENIALS
The DCMA and FMA supported legislation that would have prevented
retroactive denials, allowed physicians to override fail first protocols, and
provided a fix to One Beacon.
Fail first and One Beacon were packaged in HB 85 that passed the Senate,
but failed the House. Retroactive denials passed through the Senate on
multiple bills, but was also refused by the House. DCMA and FMA will
continue to fight for legislation to eliminate these burdens.
If you’ve read or perused this entire article, I have engaged your interest.
I once again encourage everyone to BE A PARTICIPANT rather than a
BYSTANDER. Join our Political Action Committee ( PAC). We will be
meeting in the next few months to meet our local representatives and
senators, all who are up for reelection this November. Send me an email to
sign up today – [email protected]
Andrew Nullman, M.D.
President, DCMA 2015-2016
[email protected]
3
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The Healthy Start Coalition of Miami-Dade (HSCMD)
2015 AWARDS CEREMONY
Thanks to all award and recognition recipients, as well as sponsors, consumers, staff, board members, vendors, contracted
providers, professional colleagues and volunteers who attended HSCMD’s 2015 Annual Meeting and Awards Ceremony.
Dedicated staff members from hospitals, health centers and physician practices were honored for their critical role in
improving the lives of pregnant women, newborns and families. With their dedicated efforts, Miami-Dade’s infant mortality
rate stayed well below state and national averages at an extraordinary 4.5 deaths per 1,000 live births.
Honorable Mention in Maternal, Infant and Child Health
for Prenatal Screening Consent Rate between 90–94%
Excellence in Maternal, Infant and Child Health for
Prenatal Screening Consent Rate of 95% or Higher
• Citrus Health Network, Inc.
• Community Health of South Florida, Martin Luther King Clinic
• Alberto Dominguez-Bali, M.D.
• Florida Department of Health in Miami-Dade County Women’s
Health Program-Health District Center
• Florida Department of Health in Miami-Dade County Women’s
Health Program-West Dade
• Florida Department of Health in Miami-Dade County Women’s
Health Program-West Perrine Health Center
• Richard Friefeld, M.D. Obstetrics & Gynecology Associates of
North Miami Beach, LLC.
• Rolando Gonzalez, M.D. Obstetrics & Gynecology
• Faris Hanna, M.D. Obstetrics & Gynecology
• Miami Beach Community Health Centers
• Oscar Morales & James Esserman, M.D., LLC.
•
•
•
•
•
•
•
•
•
•
•
•
•
Excellence in Maternal, Infant and Child Health for
Postnatal Screening Consent Rate 95% or Higher
Baptist Hospital of Miami
Hialeah Hospital
Homestead Hospital
Jackson Memorial Hospital
Jackson North Medical Center
Jackson South Community Hospital
Kendall Regional Medical Center
Mercy Hospital, a Campus of Plantation General Hospital
Mount Sinai Medical Center
North Shore Medical Center
Palmetto General Hospital
South Miami Hospital
West Kendall Baptist Hospital
Breastfeeding Friendly Worksite Recognition 2015
The Breastfeeding Task Force of Miami-Dade, an initiative of
the Healthy Start Coalition of Miami-Dade, recognizes the
support of breastfeeding employees through implementing
worksite lactation support policies.
• Kendall Regional Medical Center
• Mercy Hospital, a Campus of Plantation General Hospital
• North Shore Medical Center
(L-R) HSCMD Board President Mary C. Garcia; presenter Celeste
Philip, M.D., State of Florida Department of Health Interim
Surgeon General, speaker Justin Senior, State of Florida
Department of Health Deputy Secretary for Medicaid and
HSCMD Chief Executive Officer Manuel E. Fermin.
Champions of Change
Evidence Based Maternity Care 2015
The South Florida Hospital and Healthcare Association
(SFHHA) and the Healthy Start Coalition of Miami-Dade
recognize the first designated Baby-Friendly© hospital in
Miami-Dade.
• West Kendall Baptist Hospital
HSCMD and SFHHA also recognizes birthing facilities that
have made significant progress toward Baby-Friendly©
designation.
• Jackson Memorial Hospital - Women’s Hospital & Holtz
Children’s Hospital
• Jackson North Medical Center
• Jackson South Community Hospital
• Mercy Hospital, a Campus of Plantation General Hospital
• Palmetto General Hospital
Ten Years of Service Recognition with Healthy Start
• Niurka Altabaz, Avanti Support & Services
• Sharmila Carlo, Healthy Start Coalition of Miami-Dade
• Betty Charpentier, Jessie Trice Community Health Center
• Darilys Ginebra, Avanti Support & Services
• Grechel Lopez-Hidalgo, The Village South / Westcare
• Doris Nazario, Healthy Start Coalition of Miami-Dade
• Julio Arronte, M.D. Obstetrics & Gynecology-West Kendall OBGYN
• Borinquen Medical Centers of Miami-Dade
• Rachelle Bruno, A.R.N.P Obstetrics & Gynecology
• Community Health of South Florida, Doris Ison Health Center
• Hosain Daee, M.D., Obstetrics & Gynecology
• Florida Department of Health in Miami-Dade County
Women’s Health Program-Little Haiti Clinic
• Florida Department of Health in Miami-Dade County Women’s
Health Program - North Miami Family Planning Clinic
• Louis Gutierrez, M.D. Obstetrics & Gynecology
• Jessie Trice Community Health Center, Flamingo Medical Center
• Christ-Ann Magloire, M.D. Serenity Holistic OB/GYN
• Jaime Nahamias, M.D., Obstetrics & Gynecology
• Patricia Perfetto, M.D. Obstetrics & Gynecology-West Kendall OBGYN
• Luis Roca, M.D. Obstetrics & Gynecology
Recognition & Appreciation of Community
Service in Maternal, Infant and Child Health for
Distribution of Birth/New Parent Gift Packs
• Baptist Hospital of Miami
• Goodwill Industries of South Florida
• Hialeah Hospital
• Homestead Hospital
• Jackson Memorial Hospital
• Jackson North Medical Center
• Jackson South Community Hospital
• Kendall Regional Medical Center
• Mercy Hospital, a Campus of Plantation General Hospital
• Mount Sinai Medical Center
• North Shore Medical Center
• Palmetto General Hospital
• Peace Education Foundation
• South Miami Hospital
• The Children’s Trust
• The Early Childhood Initiative Foundation
• West Kendall Baptist Hospital
Join Us in Thanking our Sponsors!
GOLD
Five Years of Service Recognition with Healthy Start
SILVER
• Pierre Hayeck, The Village South/Westcare
• Carolina Maldonado, Institute for Child and Family Health
• Marie Nelson, Avanti Support & Services
• Claudia Polastri, Borinquen Medical Centers of Miami-Dade EDUCATION/
OUTREACH
Sunshine Health
Miami Beach Community Health Center
Borinquen Medical Centers of Miami-Dade
Jessie Trice Community Health Center
ZipData.net
Moore Stephens Lovelace
Jungle Island
(305) 541-0210 • 7205 NW 19th Street, Suite 500 • Miami, Florida 33126 • www.hscmd.org Follow us:
The Three Options in a Ransomware Attack:
Restore If Possible, Pay, or Lose Patient Information
by Craig Musgrave, Senior Vice President, Information Technology,
The Doctors Company
T
he news made national headlines: Hollywood Presbyterian
Medical Center’s computer systems were down for more than a
week1 as the Southern California hospital became yet another victim
of ransomware—an attack where a business or individual’s computer
system is held hostage by cybercriminals until a ransom is paid.
Hollywood Presbyterian Medical Center ended up paying $17,000 to
restore its systems and administrative functions.
“The quickest and most efficient way to restore our systems and
administrative functions was to pay the ransom and obtain the
decryption key,” said Allen Stefanek, president and CEO of the
medical center. “In the best interest of restoring normal operations,
we did this.”
No healthcare provider wants to be in Mr. Stefanek’s position. Once
ransomware is in your medical practice or hospital system, there are
only three basic options:
1. If you have performed frequent backups, restore your system.
2. If you have not performed frequent backups, pay the ransom.
3. Put your system back to the default setting—and lose
everything.
If before the attack you’ve performed incremental backups, you can
restore the areas affected, with minimal data loss (for example, an
hour). If you have point-in-time backups, you can restore with
increased data loss (for example, a week). If you have no reliable
backups, you can reset the technology back to its “out-of-box,” or
default, state and lose all the data, if no paper records exist. The only
other option would be to pay the ransom.
The key to handling any type of attack is to stop the spread once it’s
identified. For example, Ottawa Hospital in Canada took the right
steps when four of its 9,800 computers were hit by ransomware.2
The hospital was able to find the virus, isolate it before it spread, and
wipe the drives clean on the infected computers. The hospital was
able to prevent loss of any patient information and avoid paying any
ransom because it had saved critical data on servers instead of
desktop computers.
Besides loss of business, inconvenience to patients, and damage to
reputation, a ransomware attack also poses liability risks. The possibility
of adverse events and subsequent claims for professional negligence
increases when computerized systems necessary for various functions
such as CT scans, documentation, lab work, and pharmacy needs are
offline. If hospital systems are down for any significant period of time,
certain patients should be transported to other hospitals.
Adverse events can occur when healthcare workers do not have access
to EHR systems. However, if this type of case was litigated, the
patient would have to prove that something in the records may have
had a bearing on the treatment being provided. In the case of
emergency care, the claimant would have to successfully argue that
the staff should not have undertaken the care until the medical
records could be accessed.
Another risk involves theft of patient records during the attack. If
patients’ personal information such as social security numbers and
addresses are stolen, the physician practice or healthcare facility may
be subject to claims for damages due to identity theft. If a HIPAA
violation occurs because patients’ healthcare information is
compromised, the practice or healthcare facility would face an
MIAMI
May 2016
investigation by the federal
government and could
face fines.
Hospitals, medical
practices, and businesses
should take full precautions
to prevent a hack that
results in ransomware
being installed. Prevention
strategies include:
• P r o v i d e s e c u r i t y
awareness for all
employees. Over 80
percent of attacks are
made possible by
human error or human
involvement. Train staff
members to avoid
downloading, clicking
on links, or running
unknown USB on
computer systems.
• B lock the malware at
the firewall, by using
intelligent firewalls to stop the malware from downloading.
• Install intrusion detection software to monitor illegal activities
on computer networks.
• Stop the malware from executing on desktop computers by
installing application whitelisting software, anti-virus, or antimalware.
• Perform regular system backups.
o Ensure that critical systems and business data are backed up–
even backed up hourly for critical systems.
o Test that the backup restore process works.
• Avoid relying solely on encryption. Encryption does not protect
a business from a ransomware attack. If a cybercriminal has your
login, encryption doesn’t do anything to stop the hacker.
• Perform penetration testing on a regular basis to determine any
existing vulnerabilities that should be patched.
Much of the decision to pay or not to pay the ransom is based on the
circumstances surrounding the attack, the extent to which all or part
of the systems have been compromised, and the degree to which
recovery or restoration of the system can be achieved. Any decision
must be viewed in light of all of the information and made on a caseby-case basis.
Reference
1
angerous escalation in ransomware attacks. CBS News. February 20, 2016. http://www.
D
cbsnews.com/news/ransomware-hollywood-presbyterian-hospital-hacked-for-ransom/.
Accessed March 21, 2016.
2 Ottawa Hospital hit with ransomware, information on four computers locked down. National
Post. March 13, 2016. http://news.nationalpost.com/news/canada/ottawa-hospital-hit-withransomware-information-on-four-computers-locked-down. Accessed March 21, 2016.
Contributed by The Doctors Company. For more patient safety articles
and practice tips, visit www.thedoctors.com/patientsafety.
5
Primary Care Focus Symposium (15th Annual)
Friday-Sunday, June 24-26
Marco Island Marriott Beach Resort,
Golf Club & Spa
Marco Island, Florida (12 CME/CE)
PrimaryCareFocus.BaptistHealth.net
Topics include: healthy living, allergies, endocrinological disorders, heart attack
prevention, mental health update, managing patients with dizziness, headaches,
addiction and more.
Other upcoming symposiums
State of the Science Symposium:
Critical Care Best Practices (Seventh Annual)
Saturday, June 4
South Miami Hospital, Victor E. Clarke Education Building
Auditorium (6 CME/CE) n CriticalCare.BaptistHealth.net
Echocardiography Symposium (35th Annual)
Friday-Saturday, September 23-24
Trump National Doral, Miami (11 CME/CE)
MiamiEcho.BaptistHealth.net
John M. Cassel, M.D.,
Memorial Breast Cancer Symposium (Fourth Annual)
Saturday, September 24
Baptist Hospital Auditorium (4 CME/CE)
BreastCancerSymposium.BaptistHealth.net
More CME opportunities at BaptistHealth.net/CME
Connect with us BaptistCME
Employment or Private Practice;
A Few Considerations – Part 1
By Stephen H. Siegel, Esq., Of Counsel
Florida Board Certified in Health Law; HCCA- Certified in Healthcare Compliance, Broad and Cassel, Miami, Florida
T
he decision to enter private practice (either
alone or as part of a group) or become
employed by a hospital or other healthcare facility
(a “healthcare organization”) is not always clearcut. A physician is trained to make decisions
that are in the best interest of a patient and act
independently, without a “boss” looking over her
shoulder or questioning the cost effectiveness of
his decision. However, with all of the changes in
both the manner in which physicians are being
Stephen H.
reimbursed, as well as the seemingly never-ending
Siegel, Esq.
regulatory burdens imposed by Medicare and
other payers, becoming employed and having less responsibility can
be very attractive. While there may not be a perfect resolution to this
dilemma, here are 6 issues a physician should weigh when deciding
whether to become an employee of a healthcare organization or
maintain a private practice.
1. Independence.
For some physicians the idea of “reporting” to a “boss” is unpalatable.
For others, being held accountable in this manner is not. The question
of whether a particular physician can accept the supervision and
accountability that comes with employment is very personal.
2. Risk Tolerance.
The days when a physician could open an office and have a high
degree of confidence that she would be financially successful are
largely a thing of the past. Today, physicians must “market” themselves
and their practices not only to other physicians (in order to receive
referrals), but also to the public and many third party payers. For many
physicians the idea of having to “sell” themselves, particularly to the
public and third party payers, is a concept they either have no idea how
to accomplish, find somehow distasteful, or simply not within their
skillsets or personalities. For these physicians becoming an employee
may seem the easier route to developing a practice. Warning: Many
employers expect their physicians to “develop business”, which means
doing the same sorts of marketing/selling as their colleagues in private
practice.
3. Back Room Support.
Perhaps the most frustrating part of running a private practice is
making sure the back room support operations are running smoothly.
Hiring, supervising, evaluating and sometimes firing the billing
clerk or receptionist takes time away from treating patients and
generating income. Making sure that the staff performs their functions
in compliance with all relevant coding, HIPAA, FIPA, and other
requirements is necessary because, ultimately, it is the practice’s owner
who is responsible for their mistakes and failures.
As an employee of a large organization, these responsibilities largely
are lifted from the physician’s shoulders. The healthcare organization is
responsible for hiring, firing, and training personnel. The organization
also is responsible for making sure the staff is paid on a regular basis.
The downsides of this arrangement include the fact that the staff is
bound to comply with the organization’s policies and procedures and
the decision to terminate, replace, or add a member of the practice’s
staff may not rest solely with the physician.
4. Exit Strategy.
At some point in time every physician will be leaving their practice.
Many physicians anticipate they will be able to benefit financially from
MIAMI
May 2016
their many years of hard work devoted to building and maintaining
a successful practice. For physicians employed by a healthcare
organization, frequently the only “cashing out” they are able to realize is
the balance of the retirement accounts to which they have contributed
over the years. Sadly, for those physicians in private practice who have
not developed exit strategies well in advance, their ability to reap the
rewards of their efforts also may be limited.
5. Health Insurance.
Large healthcare organizations offer their employees health insurance
with reasonable coverage limits at relatively affordable rates. This is
because, in part, (a) many of them self-insure and/or (b) (i) are able
to analyze their employees’ past health histories, which enables them
to (ii) negotiate rates that cover a large number of individuals, thereby
reducing the cost for each individual employee or family member.
Physicians in private practice usually do not have the ability to take
advantage of the size, resources or sophisticated data analysis. They
are forced to “shop” for health insurance for a much smaller group
of individuals without the ability to exert negotiating leverage. The
result is health insurance coverage that is more expensive/provides
more limited coverage/includes higher deductibles than what many
healthcare organizations can offer their employees.
6. Vacation and Sick Leave.
The ability and flexibility to take time off (for example, to take a
vacation, recover from an illness or injury, or care for an aging parent) is
something that may be overlooked when weighing the advantages and
disadvantages of private practice versus employment by a healthcare
organization. These organizations offer their employed physicians the
same vacation and sick leave benefits as their other employees. Thus, a
physician may have the comfort of knowing that if they take a vacation
or become unable to work for some limited period of time at least a
portion of their income will be protected. Of course, the total amount
of time for compensated vacation/sick leave is likely to be limited. In
addition, there may be an obligation to obtain approval in advance
before taking advantage of this benefit for anything other than illness
or injury.
Private practitioners have a concern that if they are not working, they
will not be generating income. This can be partially addressed, through
disability insurance. Also, limitations on the amount of time and
scheduling of vacation time may be more flexible among the members
of a private practice.
There are additional issues to consider in deciding whether to
remain independent or become a physician-employee of a healthcare
organization. Identifying those issues and trying to get as realistic an
idea of the advantages and disadvantages of each option is critical to
making an informed decision. The goal is to minimize the surprises.
In next month’s issue of Miami Medicine we will review some additional
issues that a physician should consider in deciding which way to take
his or her career.
Stephen H. Siegel is Of Counsel for the statewide law
firm Broad and Cassel’s Fort Lauderdale and Miami offices.
He is a Florida Bar Certified- Health Law Attorney and
can be reached at [email protected] or
305-373-9424.
7
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Connecting Communities through
Health Information Technology
By Carrie Gaudio – PLU Project Manager
C
onnecting health care providers across communities
increases coordinated care and better patient outcomes.
The Agency for Health Care Administration (Agency)
supports these connections by promoting the use of health
information technology (health IT) throughout the state of
Florida. The Agency manages the Florida Health Information
Exchange (Florida HIE), which enables the secure statewide
exchange of health information between health care
providers and administers the Medicaid Electronic Health
Record (EHR) Incentive Program funded by the U.S. Centers
for Medicare and Medicaid Services (CMS).
The Medicaid EHR Incentive Program encourages eligible
providers (EPs) to adopt and meaningfully use certified
electronic health record technology to support the exchange
of health information. This year is the last year that EPs can
begin participation in the program and take advantage of
the incentive payments offered (totaling $63,750 over the
course of six years).
The benefits of EHR utilization are extensive. Patients can
become more engaged in their health care through patient
portals, and providers can more easily document information
and coordinate with one another. This exchange of
information promotes measurable improved care delivery
and performance, leading to improved patient outcomes.
In order to participate in the Medicaid EHR incentive
program, providers must be a non-hospital based
physician, dentist, advanced registered nurse practitioner
(ARNP), certified nurse midwife, or Physician Assistant
(under certain circumstances). Participants must have 30%
Medicaid volume, 20% if they are Pediatricians. Providers
can begin the program by simply adopting, implementing,
or upgrading to certified electronic health record
technology. In years that follow, participants begin
documenting specified measures to demonstrate the
meaningful use of their EHR technology. As part of meeting
these measures, providers must be able to transfer patient
information from their EHR to other providers electronically
when there is a transition of care. One way to achieve this
measure is through use of the Direct Messaging Service
offered by the Florida Health Information Exchange
(Florida HIE).
The Direct Messaging service provides health care
professionals with a secure, encrypted, HIPAA-compliant
way to securely exchange messages and health information
via email. The Florida HIE’s Direct Messaging service is
nationally accredited by Direct Trust. This accreditation
provides the ability for providers, vendors, and
organizations to exchange information across a very large
community of entities meeting these standards. Users of
this service include health care providers, health plans, and
health care agencies. This web-based service has no
software to download and can be integrated with electronic
MIAMI
May 2016
health records and health information or used as a standalone mailbox.
In addition to the Direct Messaging Service, the Florida HIE
promotes exchange through a Patient Look-Up (PLU) query
service. The service enables providers (with patient consent)
in participating health care organizations to query one
another for medical records. PLU provides comprehensive
patient data from many sources, allowing practitioners to
make more informed decisions about patient care. PLU
operates without a centralized database, providing the
security of local control with the utility of statewide
exchange. In addition, PLU provides access to the national
eHealth Exchange gateway. There is currently funding from
the CMS to assist organizations with initial participation
costs. For providers who do not have the technical
infrastructure to directly connect to the PLU network, this
funding can help them join one of the existing partner
organizations - a lighter implementation while still receiving
all of the benefits of the state connections.
Better care coordination is achieved through the inclusion
of every facet of a patient’s health care team. The Event
Notification Service (ENS) provides health plans and
accountable care organizations (ACOs) with timely alerts on
their members’ health care encounters. With over 200
hospitals securely sending admit-discharge-transfer (ADT)
feeds to the service, health plans and ACO subscribers are
able to provide this information to primary care providers to
ensure that patients are receiving the best and most
appropriate follow up care. Supporting the reduction of
hospital readmission and non-urgent use of emergency
departments, ENS works to keep all members of a patient’s
health care team up to date on the patient’s care needs and
health status.
By closing the gaps in information availability, the use of
EHR and HIE systems build a stronger and more
knowledgeable network between all levels of the health
care continuum. Health care professionals are encouraged
to access and utilize Health IT. A number of funding
opportunities are available to help to help providers adopt
EHR technology and communities of care to connect to HIE
services.
To learn more about Florida HIE services, please visit
www.florida-hie.net, or email [email protected].
For more information on EHR incentive program
requirements and how you can participate, visit the website
at www.ahca.myflorida.com/medicaidehr, or email
[email protected] for assistance.
For additional information please go to FLHII@ahca.
myflorida.com or call Pamela King at 850-412-3762 or
Carrie Gaudio at 850-412-3779.
9
Advance Care Planning (ACP)
Coding, Billing, Reimbursement and Documentation
Dear Physicians‚ Below is an excerpt from information provided by Iliana De La Cruz, RMC, Executive Director, Professional Billing
Compliance Office of Billing Compliance Department of Medical Compliance Services Leonard M. Miller School of Medicine/University of
Miami, at the February 27, 2016 End-of-Life Conversations: The Essentials seminar held at the University of Miami Hospital.
The seminar was presented by UHealth, FIU, and the Dade County Medical Association.
DCMA is pleased to share this information with our members. – Patricia
T
wo new codes have been created for advance care planning,
including completion of advance directives. For Medicare
patients who choose to pursue it, advance care planning is a
service that includes early conversations between patients and
their practitioners, both before an illness progresses and during
the course of treatment, to decide on the type of care that is
right for them. It must be documented in the medical record in
order to bill the following codes:
99497: A dvance care planning (ACP), including the
explanation and discussion of advance directives,
such as standard forms (with completion of such
forms, when performed), by the physician or
other qualified healthcare professional; first 30
minutes, face-to-face with the patient, family
member(s), and/or surrogate.
99498: each additional 30 minutes and should be listed
separately and in addition to 99497.
To bill ACP code(s):
• The patient does not need to be present;
• The discussion can be between a physician or qualified
healthcare professional (ARNP, PA, CNS) and a family
member or surrogate.
• Because the purpose of the visit is the discussion, no
active management of the problem(s) is undertaken
during this time period.
Documentation Requirements
• TIME must be documented (start and stop time or total
duration of time spent providing advanced care
planning, including time spent filling out any legal
forms, if performed.)
• Documentation of the discussion of patient’s medical
care preferences. (e.g., CPR, ventilator use, artificial
nutrition, comfort care, hospice care, palliative care.)
Organ or tissue donation, etc.
• No limit on how many times you may bill for ACP
services, because the decisions may change during
certain situations in a patient’s life or if medical
conditions change, as patient gets older or emergencies.
• Can bill Evaluation and Management (E&M) services,
except Critical Care or Neonatal/Pediatric Critical care
codes. (99291, 99292, 99468-99476, and 9947799480), on the same day.
• Not limited to a particular specialty or place of service.
• In the office setting Place of Service (POS 11), if the
ARNP, PA, CNS, provides the ACP service “incident
to” (An integral, although incidental, part of the
physician’s professional service), it may be billed under
MIAMI
May 2016
the Supervising Physician’s name and NPI #. Physician
must be in the office suite (direct supervision), during
the time the qualified non-physician provider is
rendering the ACP service. The qualified non-physician
provider must be employed by the clinical department/
physician group. Cannot be an employee of the hospital.
• If the physician is not in the office suite during the
provision of the service, it must be billed under the
qualified non-physician provider’s name and NPI # and
reimbursement is made at 85% of the Medicare
Physician Fee Schedule (MPFS).
In the inpatient/outpatient/ER hospital setting Place of service
(POS 19/21/22/23), If the clinical department employed
qualified non-physician provider provides the ACP service
instead of the physician, the services would be billed under the
qualified non-physician provider name and NPI #, since the
“incident to” rule does not apply in the hospital setting
• A CP may be billed during the same period as
Transitional Care Management Services (99495,
99496); or
• During the same period as Chronic Care Management
Services (99490); and Within global surgical periods
with modifier -24 (unrelated Evaluation and
Management service by the same physician or other
qualified Healthcare professional during the postoperative period)
• T hey may also be provided on the same day as a
Medicare annual wellness visit (AWV) – initial visit
(G0438) and subsequent visit (G0439) and billed
separately with modifier -33 (preventive services).
• C o-insurance and deductible do not apply to ACP
services when provided on the same day as the AWV.
(waived only once a year)
• Co-insurance and deductibles for ACP service do apply
when provided with other Evaluation and Management
services.
• ACP service is included in the “Welcome to Medicare”
visit (not separately billable)
Medicare Payment for New Codes (MIAMI)
99497
$92.27 Office
$85.61 Inpatient/Outpatient Hospital
99498
$80.92 Office
$80.55 Inpatient/Outpatient Hospital
11
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Topics include: • Law and Ethics of End of Life Decisions • Malpractice • Electronic Records
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Top Five HIPAA Compliance Issues
By Tom Murphy
The Office of Civil Rights (OCR), a division of Health and Human Services
(HHS), is the entity within the federal governments responsible for enforcing
HIPAA. This is the storing, accessing and sharing of personal health
information (PHI). The OCR has provided a list of the top five HIPAA
compliance issues they have seen since 2003.
1.Impermissible Uses and Disclosures of Protected Health
Information
This comes in many forms and can include disclosing patient
information without the proper permission or providing patient
treatment details to an unauthorized party.
2.Lack of safeguards for Protected Health Information
A disgruntled employee of a medical practice in Florida discarded boxes
of patient records in a dumpster near the practice Every medical
practice regardless of size is required to implement safeguards to protect
health information.
3.Lack of Patients Access to Their Health Information
Patients have the right to access their personal health information
within 30 days of a request. The practice can charge the usual and
customary fees associated with copying these records but the practice
must provide them upon the patient or authorized party request.
4.Lack of Administrative Safeguards of Electronic Protected
Health Records
This is the fastest growing area of compliance issues due to the
exploding use of technology in every area of healthcare. You only to
need read the headlines every day to recognize that healthcare
organizations of all sizes are experiencing serious issues with cybercrime
as well as problems within their own organization.
5.Use or Disclosure of More than the Minimum Necessary
Health Information
This is using or providing more than the necessary protected health
information necessary to perform ones job. This can be in the form of
having protected health information visible to all employees of a
medical practice when only certain employees should have this access.
HIPAA Training for Staff
Effective 1/1/2016, the Office for Civil Rights is stepping up its enforcement
of violation of the HIPAA Privacy Rule and even if your practice does not
receive a formal complaint, the OCR is tasked with performing random
audits of medical practices and the business associates of these practices.
We always recommend that any medical practice or business that falls under
the HIPAA guidelines as a “covered entity” should be providing annual
HIPAA compliance training for all employees. This can be accomplished in a
few different ways. The physician or group medical professional liability
insurance company typically has risk management specialists and a wealth of
information on their websites. This is going to be your best option and it is
free of charge.
You can also go to www.hhh.gov/hipaa to get information about the HIPAA
guidelines and compliance training.
Tom Murphy is a medical malpractice insurance and
workers’ compensation specialist with Danna-Gracey.
He can be reached at or (800) 966-2120 or murphy@
dannagracey.com.
If you self-insure, Don’t do it alone.
For many doctors, going bare can seem overwhelming. It doesn’t have to be.
Medical Defense Solutions can help you cost-effectively meet the challenges of self-insuring, with:
• Deeply discounted fees with the best medical malpractice defense
attorneys in Florida
• An experienced claims manager to help manage a lawsuit
• Advice on the best options for financial protection
• Lawsuits prevention hotline, seminars, and newsletters
• Information on state requirements for self-insuring
If you are bare or have dropped your prior
acts coverage by not purchasing a tail,
you should contact Tom Murphy, Matt Gracey,
or Bill Gompers at 800.601.8979.
Physicians will not be eligible for discounted attorney fees on claims open at time of enrollment. All terms, conditions and pricing are subject to change. This is not an
offer of legal, financial services or coverage. Please refer to the Medical Defense Solutions terms and conditions informational pamphlet for full product details.
255 NE Sixth Avenue, Delray Beach, FL 33483 • 6720 SW 88 Terrace, Pinecrest, FL 33156
800.601.8979 • Fax 888.235.5008 • www.defendmd.com
Board of Directors
President Andrew Nullman, M.D.
Tel.: (305) 534-4404
President-Elect Eduardo G. Martinez, M.D.
Tel.: (305) 835-9090
Vice President Eugene Fu, M.D.
Tel.: (305) 585-6970
Secretary Raul Ravelo, M.D.
Tel.: (305) 310-7969
Treasurer Barbara Montford, M.D.
Tel.: (305) 696-0806
Immediate Past Thomas Mesko, M.D.
President Tel.: (305) 674-2397
District One Jorge Marcos, M.D.
Tel.: (305) 443-2626
Term Expires May 2017
Judith Samuels, M.D.
Tel.: (305) 535-3400
Term Expires May 2016
District Two Juan Carlos Verdeja, M.D.
Tel.: (305) 271-9777
Term Expires May 2017
Baptist Health offers more than 200 CME/CE courses each year through its nationally accredited Continuing
Medical Education program. For a complete course listing, go to BaptistHealth.net/CME, or contact the Baptist
Health Continuing Medical Education Department at 786-596-2398, or [email protected].
State of the Science
Symposium: Critical Care
Best Practices (Seventh Annual)
Saturday, June 4, 2016
South Miami Hospital, Auditorium
(6 CME/CE)
CriticalCare.BaptistHealth.net
Beneath the Surface:
In-depth Focus on Wound Care and
Critical Limb Ischemia Symposium
(11th Annual)
Saturday, September 17, 2016
SIM Wars Competition
(Fourth Annual)
Saturday, October 1, 2016
Baptist Hospital, Auditorium
(3.5 CME/CE)
The Ritz-Carlton Coconut Grove,
Miami (6.5 CME/CE)
WoundCLIMiami.BaptistHealth.net
Primary Care Focus
Echocardiography Symposium (35th
Symposium (15th Annual)
Friday-Sunday, June 24-26, 2016 Annual)
Marco Island Marriott Beach Resort,
Friday-Saturday,
Golf Club & Spa, Florida (12 CME/CE) September 23-24, 2016
PrimaryCareFocus.BaptistHealth.net
Foot and Ankle Symposium
(Fourth Annual)
Friday, September 16, 2016
Trump National Doral, Miami
(11 CME/CE)
MiamiEcho.BaptistHealth.net
John M. Cassel, M.D., Memorial Breast
The Ritz-Carlton Coconut Grove, Miami Cancer Symposium (Fourth Annual)
(4 CME/CE)
Saturday, September 24, 2016
MiamiFootandAnkle.BaptistHealth.net Baptist Hospital, Auditorium (4 CME/CE)
BreastCancerSymposium.BaptistHealth.net
Brain Injury Symposium
(22nd Annual)
October 15-16, 2016
JW Marriott Hotel, Miami
(10.25 CME/CE)
Diabetes Symposium
(Fourth Annual)
Saturday, October 15, 2016
Baptist Hospital, Auditorium (4 CME/CE)
DiabetesSymposium.BaptistHealth.net
Archived Lectures and
Relicensure Courses
BaptistHealth.net/CMEOnline
James A. Voglino, M.D.
Tel.: (305) 596-3707
Term Expires May 2016
District Three Carlos Alonso, M.D.
Tel.: (305) 860-6260
Term Expires May 2018
F. Javier Ruiz, M.D.
Tel.: (305) 285-9432
Term Expires May 2017
District Four Misha Denham, D.O.
Tel.: (305) 672-8559
Term Expires May 2018
Milagros G. Huerta, M.D.
Tel.: (305) 935-2441
Term Expires May 2016
District Five Rudy Moise, D.O.
Tel.: (305) 688-0811
Term Expires May 2016
Eloy Roman, M.D.
Tel.: (305) 688-0811
Term Expires May 2018
At Large Eugene Eisner, M.D.
Tel.: (305) 598-2020
Term Expires May 2017
Antonio Mesa, D.O.
Tel.: (305) 670-7650
Term Expires May 2018
Advisory Board Cheryl L. Holder, M.D., FIU
Members Steven Falcone, M.D., UM
Fellows-Residents Vacant
Medical Students Reese Courington, FIU
Alixandra Garic, FIU
Javier Nahmais, FIU
Ben Rich, UM
Executive Vice Patricia C. Handler
President Tel.: (305) 324-8717
Alliance President Sandi Chamyan
Tel.: (305) 720-9488
Legal Counsel Jay A. Ziskind, P.A.
DCMA Staff
Managing Editor Patricia C. Handler
14
SAVE THE DATE
May 13-14, 2016
2016 Florida Brain Tumor
Biomedical Technology Summit
Lois Pope Life Center, University of Miami, FL
Physician Credit: 5.00 AMA PRA Category 1 Credits™
September 16-17, 2016
November 3-6, 2016
Synergy 2016: A Multidisciplinary Approach
to Interventional Oncology
Eden Roc Miami Beach, Miami Beach, FL
South Beach GI Congress 2016
Online CourseS
Physician Credit: 12.00 AMA PRA Category 1 Credits™
Meets Florida Board of Medicine requirements
Eden Roc Miami Beach, Miami Beach, FL
October 6-8, 2016
Miami Valves 2016
Miami Marriott Biscayne Bay, Miami, FL
2 AMA PRA Category 1 Credits™
http://cme.med.miami.edu/online-education
Medical Errors Prevention • Domestic Violence Course
HIV/AIDS Update
To obtain information or to register for upcoming conferences, go to www.cme.med.miami.edu and click on “Conferences” or call the University
of Miami Miller School of Medicine Division of Continuing Medical Education at 305-243-6716 or email [email protected].
Miami Medicine is the official publication of
the Dade County Medical Association
(DCMA).
Advertising in Miami Medicine does not imply approval or
endorsement by the DCMA. Any ads stating approval by the
DCMA have been declared by the DCMA as worthy of
consideration by its members; however, the DCMA shall
have no liability in the event the user is dissatisfied.
The DCMA maintains a sponsorship program which endorses
select vendors and organizations whose products and
services may be beneficial to the membership and/or from
which the DCMA may receive financial support.
Miami Medicine assumes no responsibility for statements
made by its contributors. Opinions expressed by authors are
their own, and not necessarily those of Miami Medicine or
the DCMA. Miami Medicine reserves the right to edit all
contributions for clarity and length, as well as to reject any
material submitted.
Subscription:
$53.50 annually; single issue $5.35
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