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Edition: August 2019 |
Table of Contents |
Letter from the Editor | FRS President's Message | FRBMA President's Message | Legislative Update Become a PAC Member |
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Letter from the Editor |
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Radiologist Burnout has been a hot topic of discussion. This was also one of the topics at the 2019 Annual ACR meeting. I decided to think about burnout among the radiologist that I know or work with. Let's start with some facts, ACR 2018 HR Commission Workforce Survey, 78% radiologists and physicists reported burnout being a significant problem in their workplace; only 19% reported having mechanisms for assessing it, and only 21% said they had effective ways of addressing it. The facts indicate that prevalence of burnout is very high within the radiologist and physicist communities. We can probably self-reflect about the practices that we work in and the demands that are placed on all of us to provide continuous optimal performance. Additionally, several studies clearly show the link between physician distress, in terms of burnout and depression, and the effect on patient care, especially medical errors.
One question, is stress related to burnout? The answer is yes. When levels of stress become too high, performance decreases. Stress inversely impact cognitive processes like attention, memory, and problem-solving. That stress increases, a person's ability to function diminishes, ultimately leading to symptoms of anxiety, anger, frustration, disruptive behavior, depression and the syndrome of burnout. Over a longer time period this adversely affects the health and wellness of the individual.
It has shown that burnout can have personal impact that can be devastating and can lead to depression, substance abuse, divorce and even suicide. Burnout may manifest as destructive behavior, including verbal outbursts and physical threats, as well as passive activities such as refusing to perform the same tasks or quietly exhibiting uncooperative attitude.
Maybe it is time for us to integrate and invest in wellness programs into our own practices and institutions. For example, the Canadian Medical Association has a dedicated center for physician health and well-being, and every provincial medical association in Canada has a physician wellness portfolio. Are we ready to commit to including physician wellness and well-being as a quality or key performance indicator?
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Chintan Desai, MD
Secretary, Florida Radiological Society
desai@desairadiology.com
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Meet Your 2019 - 2020 FRS Executive Committee |
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President
Patricia Mergo, MD, FACR |
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President-Elect
Douglas Hornsby, MD |
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Treasurer
Rajendra Kedar, MD, FACR |
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FRS President's Message |
Greetings! Thanks to all who attended the summer FRS/FRBMA annual meeting at the Ritz-Carlton in Naples, Florida. The meeting was a great success and we had a particularly fantastic and notable radiology and radiation oncology resident presence with 66 residents attending! Thanks to Dr. Steven DePrima for his outstanding leadership as the outgoing FRS President. Dr. DePrima’s endless hours of work were evident to all who attended the meeting. Congratulations also to Dr. Juan Batlle, as the program committee chair on putting together an outstanding and flawlessly run program.
For those who were unable to attend this year’s meeting, a few highlights include discussions on the ever-increasing influence of artificial intelligence on our profession, corporatization of radiologic practices and amazing lessons in leadership learned from Dr. Charlie Williams presented by Dr. Larry Muroff. If you could not make it, please consider marking it on your calendar for next year. The meeting next year will be at the Westin Ft. Lauderdale Beach Resort, July 17-19, 2020.
From a legislative standpoint, it is very disappointing to note that Telemedicine licensing legislation in the state of Florida has been signed and put into law. The FRS remains committed to voicing our concerns for quality assurance for radiology practice in the state of Florida with regards to Telemedicine implementation and expansion. We will be discussing these and other legislative highlights in the upcoming FRS/FRBMA Fall 2019 Focus newsletter.
I am excited to take on the role as your FRS President this year. Please feel free to email me with comments or concerns. I am looking forward to serving the FRS and continuing the efforts of our past outstanding leaders.
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Patricia Mergo, MD, FACR
President, Florida Radiological Society
Mergo.Patricia@mayo.edu
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Secretary
Chintan Desai, MD |
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Past President
Steven DePrima, MD, FACR |
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Legal Counsel
Michael M. Raskin, M.D., J.D., FACR |
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FRBMA President's Message |
The RBMA Chapter Webinar Consortium (CWC) consists of 12 RBMA Chapters who provide their members with bi-monthly webinars about timely topics in the radiology space. Participating chapters include California, Delta States (Alabama, Louisiana, Mississippi), Florida, Heartland (Kansas, Missouri), Illinois, Michigan, New England (Maine, Massachusetts, New Hampshire, Vermont), Northeast (Connecticut, Delaware, New Jersey, New York, Pennsylvania), Ohio, Oregon, Rocky Mountain (Idaho, Montana, Utah, Wyoming) and Texas. The most recent Webinar, sponsored by the Oregon Chapter and hosted on July 16th, was titled Update
on Current Legal & Compliance Matters with Paul Pitts, JD as the presenter.
Topics that were covered included Prior Authorization and Improving Seniors’ Timely Access to Care Act of 2019, the Stark Regulations, and Place of Service (POS) and Date of Service (DOS) Billing Rules. The two important laws which address improper referrals are the Stark Law, 42 U.S.C. 1395nn and the Anti-Kickback Statute, 42 U.S.C. 1320a-7b(b). The principle underpinning both is referrals and treatment decisions should be based on what is best for the patient, and not on financial considerations. CMS believes unnecessary referrals are costly to federal healthcare programs and result in unfair competition. This article will focus on the Stark Law and applicable exceptions.
The Stark Law states that if a physician, or immediate family members of that physician, have a financial relationship with an entity, they may not refer to the entity for the furnishing of designated health services for which payment is made under Medicare or Medicaid. The “immediate family member conundrum” is that many radiologists have family members who are physicians and this provision makes investments in technical component joint ventures very difficult. But it also makes referrals for professional component services impossible if the radiologist shareholder has an immediate family member who refers to a group in any setting. There are, however, several exceptions that apply:
The In-Office Ancillary Exception (IOAE) states that a medical practice may make referrals for in-office ancillary services such as laboratory and radiology. The Stark regulations define radiology and certain other imaging services via a list of CPT/HCPS codes. The codes include both the technical and professional components of any diagnostic test or procedure using x-rays, ultrasound, computed tomography, magnetic resonance imaging, and nuclear medicine. Invasive radiology procedures are generally excluded.
The Fair Market Compensation Exception applies when a compensation arrangement is defined in writing, includes a time frame for which the agreement applies, and the agreed-upon compensation.
The Indirect Compensation Exception permits indirect compensation arrangements if the compensation received by a referring physician meets the definition of fair market value, does not consider volume or value of referrals, and the agreement is in writing.
The Non-Monetary Compensation Exception states non-cash items or services will not constitute a financial relationship if the aggregate compensation a) does not exceed the then-current calendar year cap which ($416 per physician for CY 2019) and b) does not consider the volume or value of referrals or other business generated by the referring physician. This compensation may not be solicited by the physician or the physician’s practice (including employees and staff members).
CMS anticipates releasing changes to the Stark Law later this year via an updated regulation which will clarify the definition of volume or value, commercial reasonableness and fair market value. According to Seema Verma, the goal of the update is to address changes in healthcare such as the implementation of electronic health records, cybersecurity, and the shift from volume-based to value-based care.[1]
Paul concluded the Webinar by providing attendees with his seven important “Compliance Guideposts:”
No payment for services without a written, signed agreement with a minimum term of one year and which specifies the services to be performed.
Compensation for services must be demonstrably consistent with Fair Market Value (which is consistent with general market value) and third-party valuations are highly recommended.
Services must be reasonable and necessary for legitimate business purposes, i.e. no “making up” work to justify payments to physicians.
Maintain documentation that contracted services were actually performed.
Compensation must be set in advance and must not be determined in any manner that considers referrals.
Care should be exercised in communications about arrangement with referral sources, most notably emails.
The terms of each agreement must be followed and benefits to the counter party that are not contemplated in the agreement should not be provided.
IN MEMORY: I would like to take a moment to remember Theresa Howell from Tallahassee who sadly passed away last month. Theresa served as a valuable member of the FRBMA Board for many years and was the FRS/FRBMA liaison for Florida Medicaid. She was always willing to help in any way she could and touched many lives, both professional and personally. Theresa will be missed.
[1]
https://www.modernhealthcare.com/law-regulation/stark-law-changes-open-up-value-based-model-participation-verma-says
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Barbara Rubel, MBA, FRBMA
President, FRBMA
brubel@msnllc.com
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Legislative Update |
The FRS Summer Meeting in Naples was a great success, and it was wonderful seeing everyone that attended.
It is the depths of summer, but legislative meetings are around the corner and are starting up in September as this year is a January Session start time.
The Telehealth bill rule making process has commenced but no implementing language is available yet.
Campaign season is in full swing and candidates are busy fundraising. If you have not contributed to the FRS PAC yet, please consider doing so at: https://flradpac.org/
Thanks for your interest and support of the FRS.
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Thanks,
Alison Dudley, FRS Lobbyist
AlisonDudley@dudleyandassociates.com |
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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.
We would like to recognize the following contributors to the FRS PAC in July: Drs. Baran, Bowman, Cibulas, DePrima, Entel, Keller, Pevsner, and Stross.
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.
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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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