April Ebrief 2020

Edition: April 2020

Table of Contents

Letter from the Editor

As we deal with a biological tragedy that has brought the entire world to almost a near complete stop, Radiologists are becoming frontline doctors to diagnose early signs of Covid-19 on Chest CT. – Click Here

ACR has Radiology- specific resources for COVID-19 – Click Here
CDC offers Coronavirus Self-Checker uses ‘Clara’ for people concerned they may have symptoms. – Click Here

Additionally, many hospitals are overloaded and many are short of medical staff. Last month, The Trump administration moved to allow doctors to practice across state lines and recommended that hospitals put off elective surgeries — moves designed to swell the ranks of those treating the coronavirus. Meanwhile, hospitals are straining to find the staff and supplies to care for the overwhelming numbers of seriously ill COVID-19 patients expected in coming weeks. This has resulted in some states already planning to mobilize volunteer doctors. Virginia issued a letter to doctors asking them to sign up for the state’s medical reserve corps to help prepare for the coronavirus. Maryland Governor Larry Hogan on Monday said he was activating his state’s 5,000 medical volunteers.

Due to the COVID-19 outbreak, The ACR will be holding its annual meeting as a virtual meeting this year, May 16-19th.

There is a paradigm shift, during the virus outbreak as more people are selecting for the virtual doctor visits via telehealth. Companies like Bright MD have automated 90% of primary care delivery by increasing the capacity by 15-20x. AI will probably do the same in Radiology in the near future.

Finally, FRS leadership including Drs. Pat Mergo, Mary Swain, Michael Raskin and Charlie Williams, are working with untiring lobbyist Alison Dudley and the FMA to protect all physicians from potential liability due to this crisis. They are drafting/supporting the FMA that includes multiple other medical specialists in sending a letter to Gov. Ron DeSantis. The letter seeks to ensure that Florida’s health care providers are able to make the difficult and necessary decisions for patient management required by Executive order No. 20.72 without fear of future litigation during the COVID-19 crisis.

To view the Governor’s Executive Orders and the State Surgeon General’s Emergency Orders, click here.

“When everything seems to be going against you, remember that the airplane takes off against the wind, not with it.” – Henry Ford

Stay Healthy and Be Well.

Chintan Desai, MD
Secretary, Florida Radiological Society
desai@desairadiology.com

Meet Your 2019 – 2020 FRS Executive Committee

President
Patricia Mergo, MD, FACR

President-Elect
Douglas Hornsby, MD

Treasurer
Rajendra Kedar, MD, FACR

Secretary
Chintan Desai, MD

FRS President’s Message

Things are changing so rapidly that I feel that whatever I write now will be outdated by the time this E-brief is published. I have heard from many members of the FRS over the last several weeks and the overwhelming concern has been for guidance in the interpretation of Executive order 20-72 signed by Governor Ron DeSantis on March 18, 2020. This order prohibits any medically unnecessary, non-urgent or non-emergency procedure or surgery which, if delayed does not contribute to the worsening of a serious or life-threatening medical condition. To date there has been no further clarification of the Executive order. Most of the information that we have received has come through contacts of Alison Dudley with the FMA. We are extremely thankful for the extensive help that Alison has given us in this time, with countless emails and text messages and ultimately direct consultation with Jeff Scott, Legal Counsel for the FMA. Additionally, I am truly thankful for the help and input of the FRS executive committee and all who volunteered to help us find appropriate guidance on this issue. I would also like to thank Dr, Michael Raskin, Dr. Mary Swain and Dr. Charlie Williams, who along with Alison Dudley offered their services as a small group task force to address this issue with officials in Tallahassee. Their guidance and sage advice was outstanding! Thank you all!

FMA General Counsel Jeff Scott met directly with Dr. Scott Rivkees, Florida Surgeon General and with members of the Department of Health. We were hoping that further clarification would follow, but it has not. It remains unclear how the Executive Order applies to outpatient imaging centers and outpatient Radiation Oncology treatment centers. The FRS has taken the position of aligning with the FMA as previously conveyed to our membership through our ACR chapter portal.

Past President
Steven DePrima, MD, FACR

Legal Counsel
Michael M. Raskin, M.D., J.D., FACR

The ACR has provided their guidance for rescheduling Non-urgent care as follows:

The ACR fully supports and recommends compliance with the Centers for Disease Control and Prevention (CDC) guidance that advises medical facilities to “reschedule non-urgentoutpatient visits.” This includes non-urgent imaging and fluoroscopy procedures, including but not limited to: screening mammography, lung cancer screening, non-urgent computed tomography (CT), ultrasound, plain film X-ray exams, magnetic resonance imaging (MRI) and other non-emergent or elective radiologic and radiologically guided exams and procedures. Radiologists should work with their referring physicians to review and reschedule such exams.

As this COVID-19 pandemic continues, I suspect that outpatient imaging centers may play a vital role in providing much needed patient services in an environment that is designed to be optimized for social distancing. If these needs are not met, more patients will be put in the position of needing to seek emergent care in emergency departments and in hospitals that are already maximized to capacity providing care for COVID-19 patients. This further stresses the system and puts everyone at increased risk. At this point in time, regarding outpatient imaging, we are left with interpreting the spirit of the executive order as it best serves each individual patient that comes through our doors. We may approach a scenario in the near future where everyone has been COVID tested and potentially tested for antibody status. We have already seen reports of COVID-18 antibody tests near ready for implementation. This certainly would help us better define the population that would be more suited to imaging in an outpatient setting. I hope that by the time that you see this E-brief in print, we will already have several antibody tests nearing availability to the public across the country.

The media also has started to raise awareness of the issue of addressing ongoing patient medical needs outside of the COVID crisis, as outlined in a CNN Editor’s Note by Dr. Vance Vanier on April 1, 2020: Click Here

On another important note, during this time, CMS has expanded accelerated and advance payment options for Medicare providers to provide additional resources during the COVID-19 crisis. More information on this can be found under this FMA link: Click Here

For those in medicine who are now or will be on the front lines in treating this pandemic and for those who are affected on a personal level by COVID-19 infection, our thoughts, hope and prayers are with you. In normal circumstances radiologists and radiation oncologists are not on the front lines in the ICU’s and emergency rooms. For those of you who may find themselves in this situation and for all who are overwhelmed by the stresses of this pandemic, please reach out to others and find a daily network of support. Sharing daily experiences and discussing with others difficulties encountered along the way will help everyone get through this. As leaders, we need to be mindful of our technologists and support staff and the difficulties that they are faced with and offer support and solutions on a daily basis.

On a note regarding the annual FRS summer meeting, the FRS and FRBMA leadership and the FRS 2020 annual program planning committee are actively engaged in contingency planning in regards to the annual meeting. As soon as information is available, it will be distributed. The safety of all of our members is of the utmost importance.

To finish on a very bright note, we have five physicians in our state chapter who will be recognized in the ACR virtual Convocation Ceremony on May 17, 2020. Following the ceremony, these members will be welcomed as new Fellows of the American College of Radiology. Please join me in congratulating these individuals: Alan Jay Holz, MD, David Bradley Kozlov, MD, Tan-Lucien Hassan Mohammed, MD, John Herbert Rees, MD, and Melvin Stone, MD. Congratulations to you all on this esteemed accomplishment!

Be safe and keep those around you safe!

Patricia Mergo, MD, FACR
President, Florida Radiological Society
Mergo.Patricia@mayo.edu

FRBMA President’s Message

This one may sound simple but, be nice to others. You are more likely to be happy yourself if you show kindness to others on a regular basis. And you will probably cause those around you to also feel more positive. Think of a positive attitude as a survival tool – something you carry with you all the time. Actions that are unprecedented in most of our lifetimes are now being taken to fight COVID-19 (“Coronavirus”). Schools, universities, restaurants, bars, and workplaces are closing; conferences and meetings have been cancelled; and we are being told to shelter in place and avoid gathering together. “Social distancing” and “self-isolation” have become not only a part of our daily lexicon, but a part of our daily lives.

So how do we cope with all these rapid changes that seem to be totally disrupting our daily lives? While no one really understands how or why a positive attitude helps people recover faster from surgery or cope better with serious illnesses such as cancer, we know there is evidence suggesting the effects may be related to the mind’s power over the immune system.
So, can we rely on a positive attitude to bring us through this COVID-19 fight? Studies show that a truly positive attitude can make your view of life seem more-expansive and full of possibilities. And while a positive attitude may not always come naturally, there are some things we can do.

Try surrounding yourself with positive people and connect with people who are inspirational, who like what they do, and who are interested in a myriad of things. Fill your mind with positivity by e.g. listening to inspirational books and your favorite music because, just as you are what you eat, your mind is what you feed it. Think in terms or opportunities rather than tiring and difficult tasks that must be completed, as opportunities are more exciting and ready to be explored.

This one may sound simple but, be nice to others. You are more likely to be happy yourself if you show kindness to others on a regular basis. And you will probably cause those around you to also feel more positive. Think of a positive attitude as a survival tool – something you carry with you all the time.

An easy strategy is to breathe deeply, as this will “trick” your body into calming down. And calm people tend to have better outlooks. Find a place where you can be alone and try some deep breathing exercises. Not only does this reduce stress, but it helps to clear your mind and see situations more objectively.

Set personal goals. Goals give us positive momentum and something to look forward to. Taking a longer-term view of things in crisis situations can remove the emotion and put things into perspective.

And in the words of Harvey Mackay, American businessman, author and syndicated columnist, “Positive thinking is more than just a tagline. It changes the way we behave. And I firmly believe that when I am positive, it not only makes me better, but it also makes those around me better.”

Reference: https://wheniwork.com/blog/18-simple-ways-to-keep-a-positive-attitude-at-work

Barbara Rubel, MBA, FRBMA
President, FRBMA
brubel@msnllc.com

Legislative Update

As I write this, the Governor has issued his executive order that has the entire state sheltering in place effective midnight Thursday April 2nd. The Coronavirus has effected every aspect of our lives and I hope and pray all of you are staying safe and well.

The Florida Legislature was scheduled to end their 60 day session on March 13th. On Tuesday March 10th, the Coronavirus started making its presence known inside the Capitol as the House had to stand in informal recess while the House chambers were sanitized by Dr. Pigman and the cleaning crew in protective suits. A decision had to be made if the five members who had attended a national conference over the weekend had been potentially exposed to the Coronavirus and if they were contagious. Were they putting the rest of the members at risk? Dr. Pigman found them to be fever free and not meeting CDC guidelines for testing so they were allowed to stay, determined not contagious, and they reconvened the Session about an hour later.

Meanwhile, in the Capitol budget talks were stalling as leaders were trying to determine how much to set aside in the rainy day fund for the Coronavirus. It was determined that they would not finish on time and they extended until Thursday March 19th to allow for the mandatory 72 hour clock to run on the budget as mandated by the constitution. They finished their work Friday, met on the budget Saturday and laid it on the members desk Sunday, thus starting the 72-hour clock.

On Wednesday March 11th the Senate came to the House position on HB 607, the ARNP scope expansion bill, and passed it out to the Governor. HB 607 allows qualified nurse practitioners to practice without physician supervision. This bill passed both bodies and was signed by the presiding officers at 4:56pm that day. Dr. Epstein and I were working on our veto message when I received a legislative update which informed me that the Governor had acted at 6:46pm and signed the bill into law. Needless to say we stopped working on our draft letter. On the same day, minutes apart, the legislature passed HB 389, the test and treat bill, which allows pharmacists in collaboration with a doctor to test and treat for the flu and strep throat in addition to several other medical conditions. This bill was on the same time track as the scope expansion bill and the Governor also signed this bill into law that evening.

On Friday March 13th, HB 713, the DOH package passed. On this bill was the language that the FRS self-referral working group had reviewed and agreed to be neutral on. The bill did not contain the language that would have put into statute language that a chiropractor could call themselves a chiropractic radiologist. This bill has not been signed by the presiding officers; so, it has not been received by the Governor to act upon it yet.

The budget has also not been signed by the presiding officers or sent to the Governor.

No bills have been sent to the Governor for action. Once the bills make it to the Governor’s desk, he has 15 days to act where he can sign, veto, or let the bill in question become law without signature.

The Governor has until July 1st to have a new budget in place. Everything seems to be in flux due to the Coronavirus.

Since the Session has ended, there are FRS working groups that have been formed who are working along with the FMA in order to get clarity from the Governor and the Surgeon General on how to interpret nonessential medical procedures and then further work and collaborate in asking the Governor to consider giving protection from lawsuits that could come from the unintended consequences of his executive order on shutting down non-essential medical procedures. As I write there is no response from the Governor.

As you all are very aware, there is constant change on what the population can and cannot do and what businesses can stay open due to the pandemic. It has effected everyone’s daily lives.

Please stay safe and well. Thanks to all for what you do.

Thanks,
Alison Dudley, FRS Lobbyist
AlisonDudley@dudleyandassociates.com

SUBMIT AN ARTICLE

Martin Northup Resident Leadership Award

H. Martin Northup Resident Leadership Award – A scholarship opportunity for Florida Diagnostic Radiology, Radiation Oncology and Medical Physicist 2nd year Residents or graduate students.

Martin Northup was very committed to radiology resident education and advancement. To eternally honor and remember him, the board of the FRS Foundation has established a special award bearing his name, the “H Martin Northup Resident Leadership Award.” Each year, this award will be given to a 2nd year Florida radiology resident who will be a 3rd year at the time of the fellowship to support the cost of accommodations for attending the FRS annual summer meeting. The resident will have an officer mentor and will attend all functions including the board meeting. The goal is to develop future leaders in Radiology and develop promising residents to assume greater roles in the society, such as President of the Resident and Fellow’s Section. The award recipient will be chosen for the 2020 Annual Meeting in Fort Lauderdale, Florida, July 17-19, 2020 by the Scholarships and Grants committee based on a competitive application process.

Please click here to download an application. Return your completed application to lroger@edusymp.com by May 15, 2020 in order to be considered for this award.

Thank you,
Jeffrey Stone, M.D., FACR
President, FRS Educational Foundation

2020 Annual Meeting of the FRS & FRBMA

Please join the Florida Radiological Society and the Florida Radiology Business Management Association for the 2020 Annual Meeting at The Westin Fort Lauderdale Beach Resort, July 17-19, 2020. The meeting will focus on “2020 Vision: Surviving and Thriving” and will feature lectures by faculty who are leaders in the practice of radiology. We look forward to seeing you in Fort Lauderdale, Florida.

Job Board
	Available Positions Lake Medical Imaging

Job Posting Opportunities

Florida Radiological Society is pleased to introduce the opportunity for interested parties to advertise for potential jobs in our monthly FRS Ebrief bulletin.

Advertisement pricing is as follows:

Ebrief Job Posting pricing:
3 months ($100 monthly)
6 months ($90 monthly)
12 months ($80 monthly)

Please contact Lorraine Roger, our Society Administrator for further information on how to advertise in our monthly publication.

ph (813) 806-1070
fx (813) 806-1071
email lroger@flrad.org

We feel that this will provide a valuable service to both our members and our Florida community of Radiology.

Thank you for your interest!
Patricia Mergo, MD
President, FRS

Become a PAC Member Today

Attention FRBMA Members! Please support the cause. We encourage you to be PAC members and supporters; you do not have to belong to the FRS. Donations can be made online through our PAC website www.FLRADPAC.org.

It is critical that we support both our Florida PAC and RADPAC in order to bolster our voice in Tallahassee and Washington, respectively. Please join FRS lobbyist Alison Dudley in her special appeal for all Florida radiologists to become Florida PAC members. If you would like to help FRS defend radiology against untoward legislation and introduce bills that have a positive impact on our practices, we need your financial support to re-elect our friends in the state House and Senate. The FRS can also show you simplified ways on how to sign up your radiology group. Contact Lorraine Roger at lroger@flrad.org or contact Alison Dudley at alisondudley@dudleyandassociates.com for more information.

Telephone (813) 806-1070 • Fax (813) 806-1071
5620 W. Sligh Avenue • Tampa, Florida 33634

The E-Brief is an exclusive member benefit of Florida Radiological Society, delivering monthly member, chapter and industry news. Please do not reply to this automatic e-mail. For comments or questions about the E-Brief, please contact lroger@flrad.org.

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