May 2016 The Official Publication of the Dade County Medical
Transcription
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 Vendors of Choice dba TR Jones & Company SunTrust Private Wealth Did you receive money back on your workers’ comp premium last year? Many doctors have through the Dade County Medical Association Workers’ Compensation Program. Since the rates for workers’ compensation insurance are set by the state, prices are the same no matter where you secure coverage. But now, you are eligible for this 30% dividend, which effectively reduces the true cost of coverage. AmTrust North America (formerly Comp Options) has been a true partner to the Dade County Medical Association for many years, and now, with the resources of AmTrust - rated “A” (Excellent) by A.M. Best - we are able to provide this exclusive enhanced dividend program that is like no other for Florida physicians and medical practices. To date, these programs have returned a dividend for 12 straight years, with over $5 million over the past five years to Florida medical associations’ members: $600,000 of that went to DCMA members. For more information on the workers’ compensation insurance program, call Bill Gompers at 888.777.7173 or Tom Murphy at 800.966.2120. [email protected] • www.dannagracey.com 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 g n i OUR FUTURE! er v i l e D 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 Looking for the Best EHR? Try DCMA EHR Vendor of Choice that Physicians Say is… Want an EHR that will truly meet your needs? Look at DCMA’s EHR Vendor of Choice: MediTouch®, trusted by 26,000 users nationwide. • Greater accuracy in coding with Medicare Advantage HCC and Chronic Care Management • Recognized by J.D. Power and Associates for “an Outstanding Customer Service Experience” • Designed for full use on the iPad and other tablets via touch, type and dictation • 3-time recipient of the Surescripts White Coat of Quality e-prescribing award “HealthFusion’s MediTouch Medicare Advantage HCC feature helped increase my accuracy in coding, which means more revenue.” - Dr. Jeff Lindenbaum Family Practitioner As a DCMA Vendor of Choice, HealthFusion offers benefits to your practice including: See how MediTouch will meet your specific practice needs in a live demo (855) 342-4407 ehr.healthfusion.com/dcma • Get one month free and pay no enrollment fees • No charge for setup, support, maintenance, software updates or training • Award-winning free Customer Service via phone, email or live chat Give Promo Code: DCMAd15 Your Publication Specialist REQUEST YOUR COPY OF BRYAN J. BOURGEOIS’ US & GLOBAL INVESTMENT OUTLOOK EMAIL: [email protected] CALL: 305-233-9355 Bryan J. Bourgeois, author of US & Global Investment Outlook, is President/CEO of Miami Asset Management, Inc. and serves as a portfolio manager and financial advisor. In this report, he brings clarity and insight to the current economic and investment landscape, focusing on key fundamental and technical analysis, trends and opportunities for US and global equity, fixed-income, real estate, commodities and currencies. Call 305-778-3634 [email protected] www.FranklinDodd.com Compliments of: Bryan J. Bourgeois President/CEO Miami Asset Management, Inc. 1680 Michigan Ave. #700 Miami Beach, FL 33139 www.MiamiAssetManagement.com Securities and advisory services offered through EDI Financial, Member FINRA / SIPC 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 Conferenc e s i u r C e 2 nd A E M nnual C Celebrity Cruises’ Celebrity Silhouette 4-Night Western Caribbean Cruise Conference Round-trip from Fort Lauderdale, FL December 26-30, 2016 Topics include: • Law and Ethics of End of Life Decisions • Malpractice • Electronic Records 10 AMA PRA Category 1 Credit(s)™ 10 Contact Hours Course Fees: Members: $399 | Non-Members: $599 Cruise Rates: start at $659 per person, based on double occupancy and subject to change. Taxes and fees $184.49 per person (additional). Call 1-800-422-0711 or 727-526-1571 or visit www.ContinuingEducation.net 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 N. 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ZISK IND, ESQU IRE DCMA General Counsel General B o ard Ce rt i fiDCMA e d He al t h LCounsel aw ye r Fl o ri da Supre me Co urt Ce rt i fi e d Ci rc uiard t CiCe vi lrtMe diHe at al o rt h L aw ye r i fi e d Bo Fl o ri da Supre me Co urt Ce rt i fi e d Circuit Court Direct ed ui t Ci vi l Me di at o r Ci rcor Privat e Mediat ion 305.753.5990 [email protected] Circuit Court Direct ed or Privat e Mediat ion 305.753.5990 [email protected] Serving physicians insurance needs by the creation and preservation of wealth Specializing in: • Life Insurance • Disability • Hybrid Life • Employee Benefits • Long Term Care • Charitable Giving • Estate Planning • Annuities Call today for more information Tel (305) 893-4488 / Fax (305) 893-1020 12000 Biscayne Boulevard, Suite 506 North Miami, Florida 33181 email: [email protected] Established in 1978 Endorsed by: Jeff D. Hackmeier & Associates, Inc. www.hackmeierinsurance.com MIAMI PRSRT STD U.S. Postage PAID Miami, FL Permit #140 Dade County Medical Association 1501 N.W. North River Drive Miami, Florida 33125 I: www.miamimed.com E: [email protected] T: (305) 324-8717 F: (305) 325-1316 Address Service Requested WE HAVE RETURNED OVER $370 MILLION TO OUR MEMBERS THROUGH OUR DIVIDEND PROGRAM. UNRIVALED GOOD MEDICINE HAS ITS REWARDS—$370 MILLION When our insured physicians in the state of Florida keep patients safe and keep claims low, we all win. The Doctors Company is strong, with 78,000 members and $4.3 billion in assets. This strength allows us to defend, protect, and reward the practice of good medicine like no other. 5% DIVIDEND FOR QUALIFIED FLORIDA MEMBERS JOIN YOUR COLLEAGUES AT THE DOCTORS COMPANY 800.352.0320 WWW.THEDOCTORS.COM REWARDS A5560_ FL_DCMS_UR_Div_May2016_flat_f.indd 1 4/4/16 4:38 PM