May/June 2013 - Travis County Medical Society

TCMS JournalTravis County Medical SocietyMay • June 2013Volume 59 • Number 3

2 May • June TCMS Journal

Sanctuary of Atotonilco, a World Heritage Site, completed 1748, near San Miguel de Allende, Mexico.Photo by Marilyn Vaché, MD.www.capitalprintingco.com512-442-14154 May • June TCMS Journal

TCMSJournalTravis County Medical SocietyMay • June 2013 VOLUME 59 • NUMBER 3FEATURES AND ARTICLES6 FROM THE PRESIDENTThe Gordian Knot of Health Care CostsMichelle A. Berger, MD8 TCMS/TCMA JOINT INSTALLATION10 DELL MEDICAL SCHOOLJim Lindsey, MD12 THE WALTERS PHYSICIAN INCUBATORA Place for DoctorpreneursJacob Childers, MD14 PUBLIC RELATIONS COMMITTEE2013 TCMS/AISD Athletic PhysicalsParviz K. Kavoussi, MDOn the cover.Brain coral off the Florida Keys.Photo by Thomas F. Smith, MD.Stay Connectedwww.tcms.comtcms@tcms.com16 REDUCING RISK THROUGH ROBUSTPERSONNEL SCREENINGSue La Bonté, RHIA, CHP18 DOCBOOKMD CELEBRATESTim Gueramy, MD and Tracey Haas, DO20 LEGISLATIVE UPDATEStephanie Triggs22 TCM ALLIANCELoren Gigliotti24 TAKE 5: LUNG CANCER SCREENING25 CLASSIFIEDSEditorial Staff.Editor, Owen Winsett, MDManaging Editor, Belinda ClareCommunications Coordinator, Shahar GurvitzPublication Coordinator, Ron MizeCONTACT: Travis County Medical Society 4300 N Lamar Blvd.; Austin, Texas 78756; Post Offi ce Box 4679; Austin, Texas 78765Ron Mize email rmize@tcms.com or 512-206-1245.Advertising: Advertising rates and requirements available upon request. Travis County Medical Society Journal assumes noresponsibility for statements made by contributors. Advertising in the Travis County Medical Society Journal does not imply approvalor endorsement by the Travis County Medical Society.SECD #277180: Travis County Medical Society Journal (ISSN 1054-2507) is the offi cial bi-monthly publication of the Travis CountyMedical Society and the Seventh District of Texas. Periodicals Postage Paid at Austin, Texas. Subscription price $2.00 per year to members.Payment of annual membership dues entitles member to a subscription.POSTMASTER: Send change of address notices to the Travis County Medical Society Journal; 4300 North Lamar Blvd.; Austin, Texas 78756.Membership: 3,443TCMS JournalMay • June5

FROM THE PRESIDENTThe Gordian Knot of Health Care CostsMichelle A. Berger, MDPresident, Travis County Medical SocietyRecently, I participatedin the Texas Tribune’s“On the Road,” asymposium on healthcare, in partnershipwith the LBJ School ofPublic Affairs. It wasa day-long program ofpanels covering topicsfrom new technologies on the horizon toour current evolving delivery system andits costs. It was exciting to hear aboutthe potential of new vaccines to helperadicate pandemic diseases anddramatically lower their costs andreplacement limbs that can be controlledby sensors implanted in the brain. Thesedevelopments will have dramatic effectsfor many patients worldwide. The panelon health care technology discussed thepotential future of a personal medicalrecord and advances in communicationthat will make telemedicine andintra-physician communication a largerpart of medical practice.The panel I was on discussed costcontainment. The cost conundrum mustbe solved before any of the advancesdiscussed in the other panels can berealized. There are so many factorscontributing to the increasing cost ofhealth care that there is no easy solutionto the dilemma of how to pay health carebills without creating fiscal problems forother segments of society. It is all tooeasy for physicians to be the target ofcost-cutting. But if that were the correctsolution, the steady erosion of physicianpayments over the last decade-plus wouldhave solved the problem. Clearly, totaldelivery system costs continue to soar.The aging of our society will onlyplace more pressure on health carespending in the near future. Babyboomers have driven our society andeconomy for the past sixty or so yearsand their numbers will cause more healthcare dollars to be spent as they age andretire. To counteract the upward pressureof this demographic force on health carecosts will, at the very least, require a focuson healthy aging and a more humane andless costly approach to dealing with endof life.Another factor that is estimatedto account for up to 70-percent ofhealth care costs is lifestyle choices.Obesity, inactivity, poor diet,smoking and other behaviors cantake 10, 20 or 30 years to manifest indisease. Only by focusing on healthand wellness from early childhood andcontinuing throughout life, will we beable to decrease costs that arise fromlifestyle choices. Society as a whole mustbe responsible for making a healthylifestyle a priority for each individualand for our institutions. I believe ourcountry must take this path into thefuture to have any significant impact onthe rising costs of health care. We mustall be accountable for our lifestyles everyday and no longer shift the total expenseof our choices to third parties.The opacity of health care costshas received increasing focus with Timemagazine recently devoting an entire issueto the subject. No other type of businesswould be expected to solveaccelerating expenses without the abilityto know what its true costs are. I knowwe can do a better job providingcost-effective health care, but physiciansare usually unaware of what the care theyorder costs, or who will ultimately payfor it. In 2009, Johns Hopkins was ableto decrease costs by 9.1 percent withoutcompromising quality by simply adding“charges” to the computer screen forordering tests. While no one suggeststhat care be driven by one factor alone,the time has come for physicians to beaware of what their options cost and addthis to the many factors we use in makingclinical decisions. Physicians must dealwith this reality: the era of the “blankcheck” in medical care is over.Finally, I leave you with this thought:“health care costs” in our country includeso much more than health care. Theyinclude the heavy advertising done by bigpharma, health care providers and eventhe government. They include the profitsthat all public companies in health careneed to generate for their shareholders.Also included are the endless increasingdollars spent by all stakeholders forlobbying and electing public officials atall levels. These expenses are unique tothe United States and are not included inthe “health care cost” equation of othernations, which partially explains whytheir per-capita health system cost iscomparatively lower than that of the US.Please consider what you can doin your daily practice in whatever wayyou can to broaden the focus on healthcare costs to the many factors beyondphysician payments. I believe it willbe the only way to begin to undo theGordian knot of health care costs whichare overwhelming to all of society.6 May • June TCMS Journal

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TCMS/TCMA Joint Installation of OfficersOn March 21, TCMS and TCMA members gathered at the Westin Hotel in the Domain to install the 2013 TCMS PresidentMichelle Berger, MD and the 2013-2014 TCMA President Mrs. Loren Gigliotti.TMA President Michael Speer, MD (center) joined TCMS and TCMA pastpresidents (left) in honoring incoming TCMS and TCMA presidents.TravisCountyMedicalSocietyExecutive BoardMichelle A. Berger, MD, PresidentSarah I. Smiley, DO, President ElectR.Y. Declan Fleming, MD, Immediate Past PresidentRobert K. Cowan, MD, Secretary-TreasurerTony Aventa, MD, Member At LargeLisa L. Ellis, MD Member At LargeIsabel V. Hoverman, MD, Member At LargeJeffrey M. Jekot, MD, Member At LargeAnand Joshi, MD, Member At LargePradeep Kumar, MD, Member At LargeHarish K. Gagneja, MD, Chair, Board of EthicsCatherine L. Scholl, MD, Delegation RepresentativeStephen S. Clark, MD, BTC RepresentativeBoard of EthicsRoberta Braun, MDDawn Buckingham, MDKimberly Avila Edwards, MDHarish Gagneja, MD, ChairGreg Kronberg, MDGhassan Salman, MDTodd Shepler, MDTMA Board of TrusteesDavid C. Fleeger, MDDelegates to AMADavid C. Fleeger, MDC. Bruce Malone, MDAlternate Delegate to AMAMichelle A. Berger, MDAMA Board of TrusteesJoseph P. Annis, MDDelegates to TMATony Aventa, MDIra Bell, MDMichelle A. Berger, MDRobert E. Blais, MDRoberta M. Braun, MDDawn Buckingham, MD*Edward Buckingham, MDWilliam D. Caldwell, MDC. Mark Chassay, MDWilliam J. Deaton, MDLisa C. Ellis, MDJames Eskew, MDNancy Foster, MDJuan Guerrero, MDJames Hicks, MDFelix Hull, MDJeffrey M. Jekot, MD**Greg M. Kronberg, MDDaniel J. Leeman, MDBruce A. Levy, MD, JDJerald A. Mankovsky, MDHillary Miller, MDMelinda Rainey, MDStephanie D. Roth, MDDora L. Salazar, MDCatherine L. Scholl, MDHalsey “Happy” Settle, III, MDEric S. Tiblier, MDEmilio M. Torres, MDZoltan Trizna, MD, PhDBelda Zamora, MDGuadalupe “Pete” Zamora, MD* Chair ** Vice-ChairAlternate Delegates to TMAJeffrey Apple, MDKimberly Avila Edwards, MDTravis Bias, DOMaya Bledsoe, MDNoah Bunker, MDEsther Cheung-Phillips, MDJ. Lauren Crawford, MDOsvaldo Gigliotti, MDErnest Graves, MDAl Gros, MDTracey Haas, DO, MPHKatharina Hathaway, MDJeffrey Kahn, MDThomas Kim, MDMrinalini Kulkarni-Date, MDPradeep Kumar, MDCarlos-Nickolas “Nick” Lee, MDMichelle Markley, MDSamuel Mirrop, MDCelia Neavel, MDJack Pierce, MDGhassan Salman, MDTodd Shepler, MDAnees Siddiqui, MDSarah Smiley, DOTheodore J. “TJ” Spinks, MDXuan Tran, MDAllison Urrutia, MDAlex Valaolka, MDJohn Villacis, MDStanley Wang, MD, JD, MPH8 May • June TCMS Journal

More Residencies, Research Coming with Dell Medical SchoolJim Lindsey, MDChief Medical Officer, Seton Healthcare FamilyThe creation of the Dell Medical Schoolat The University of Texas at Austin is amajor event in the practice of medicinein Travis County. When UT Austin wascreated in 1883, the decision was madeby voters to construct the state’smedical school in Galveston, 185 milesaway from the primary campus but in thestate’s third-largest city.Today, four medical schools and sixhealth institutions carry the Universityof Texas name, and in 2016 therewill be such a school at the flagshipuniversity. Before long, you will for thefirst time practice medicine with youngdoctors who earned their MD here inTravis County.If we were only adding a medicalschool, the impact would be significant.But we are also adding two other elements:a new teaching hospital to be constructedby the Seton Healthcare Family, anda significant increase in local public fundingthough Central Health for innovativemedical care and health education for theunder-insured and uninsured.All of these changes are occurringin an environment of transformationdictated by health care policy changesat the national level. A basic premisebehind the Dell Medical School is thata public-private partnership with UTAustin, UT System, Central Health andSeton Healthcare can navigate this newreality more successfully together thanalone. The collaboration will bring betterlocal health care delivery as it producesworld-class clinicians, researchers andmedical educators.As a member of the Dell MedicalSchool Steering Committee, I receive alot of questions about the school. Howmany physicians will the university bringto the medical school? What will betheir specialties? Who will teach medicalstudents and residents? What willhappen to those currently on faculty atUT Southwestern providing graduatemedical education?While we have answers for some ofthese questions, others will have to wait.As with any venture that has as manyvariables as this does, certainty is difficultto achieve. Here are the things of whichwe are fairly certain:SizeThe school will start fairly small; about50 students will matriculate in 2016(pending approval by the LiaisonCommittee on Medical Education). It willleverage the tremendous strength of UTAustin as a premier research university tomake the most of work in related fieldssuch as pharmacy, social work, nursingand biomedical engineering, as wellas natural sciences, social sciences andbusiness. No other University of Texascampus can do this, as no other schoolhas a four-year medical school as part ofits academic campus. The opportunitiesfor scholar-physicians are tremendous.HospitalA new hospital will be constructed andoperated by Seton Healthcare Familynear the current Brackenridge site. It willbe about the same size as the currenthospital. The land under the hospitalcurrently belongs to UT Austin, butthe UT System Board of Regents hasauthorized negotiations so that a verylong-term lease can be made with CentralHealth. A public agency will continue tocontrol the land under the hospital that isthe safety net for the Austin community,as it has since the 1880s.FacultyFaculty for the Dell Medical Schoolprimarily will include educators, clinicians,researchers and clinician-scientists. Theuniversity is looking first at existing facultywho are engaged in medical and medicallyrelated research. Some of them may in thefuture share appointments to themedical faculty and the departmentsof which they are currently a part. TheDell Medical School will includemedical educators consistent with itscurriculum and accreditation needs.The current medical community willhave opportunities to serve as facultymembers to help provide clinicaleducation and training.Graduate Medical EducationSeton has demonstrated a provencommitment to training residents andplans to add additional graduate medicaleducation positions. Additionally, Setonwill create opportunities for medicalstudents to deliver care under thesupervision of attending physicians. Itcurrently works with UT Southwesternto train residents and fellows. There are213 today and on July 1 there will be 243.There are plans to increase the numberof residents to more than 300 in the next10 years.I would be remiss if I did not notethat members of the Travis CountyMedical Society founded the CentralTexas Medical Foundation (CTMF)in 1972 to sponsor graduate medicaleducation in order to improve care of theindigent population. Physician-leadershave always had an important historicrole in the development of physicianshere. This will continue. The Dell MedicalSchool will be best served by becomingan organic part of a thriving local medicalcommunity, not an added feature.DeanAn advisory committee is looking foran inaugural dean who will have a oncein-a-lifetimeopportunity to begin a10 May • June TCMS Journal

medical school at a major researchuniversity from the ground up. The newdean is expected to begin by the end ofthe year.Community CareCentral Health and Seton are workingtoward an agreement to create aconsortium that is taking shape. Theobject is to become the hub in TravisCounty for patient-centered care thatimproves health outcomes throughexpanded care coordination, types of careand patient management.Impact on PhysiciansThe advent of the Dell Medical Schoolwill not mean an influx of a large numberof clinical physicians in the local area,as most new physicians will likely bescientists, educators and researchers.However, as the number of residenciesincreases, we can expect many doctorswho complete graduate medicaleducation to begin their practice here,so long as Austin has the quality of lifeand economic growth that it has enjoyedin the past. There will be opportunitiesfor physicians who are skilled and loveteaching to contribute to the educationof medical students and young doctors.Finally, there will be a lot morevery bright people in Austin,doing extraordinary research inour hometown, and that should be veryinteresting intellectually.In future articles, I hope to addresssome of the other questions thatmembers of the medical communityhave, including the role of St. David’s andwomen’s health care education.UT Provost Steven Leslie hasestablished a Steering Committeefor the medical school, comprisingrepresentatives from UT, Seton andCentral Health. Committee membersare doing the substantial work ofcreating curriculum, seeking accreditationand building facilities, as well as seekingan inaugural dean. Three engagementgroups have been established withthe goal of providing feedback to theSteering Committee, delivering updatesand receiving input from threekey groups: the community, thewomen’s issues community and themedical community.The Medical Engagement Group has34 members representing a wide numberof specialties and types of medical andnursing practice, including MichelleBerger, MD, president of the TravisCounty Medical Society. We welcomeyour comments and inquiries. Pleasecontact me for a list of members or toarrange a presentation to yourprofessional group. We also plan “townhall” meetings for anyone interested.As a long-time member of the localmedical community, I know that thereis some anxiety about the impact of thenew medical school, faculty and graduateprograms. There is great promise too.Our goal is to ensure that the medicalcommunity has input as plans are madeand that two-way communication isalways in place.You can find information updated atwww.utexas.edu/dell-medical-schooland also on Facebook and Twitter.The TCMS Auto Program Can:Locate the vehicle for you at the best price, with your choice of color and equipment.Arrange for a test drive at your home or offi ce.Arrange all of the paperwork for you.We make the process easy. You just sign.Take advantage of the full benefi ts of the TCMS Auto Program!BMW of Austin7011 McNeil DrFiat of Austin1101 Domain DriveNyle Maxwell GMC3000 N IH35Round RockHowdy Honda5519 E Ben White BlvdLexus of Austin9910 Stonelake Blvd Mercedes-Benzof Austin6757 Airport BlvdTown North Nissan96012A Research BlvdChampion Toyota4800 S IH35John Eagle European12989 Research BlvdNyle Maxwell Super Center13401 N FM 620Contact TCMS Auto Program Director Phil Hornbeakat phornbeak@tcms.com or 512-949-5758.TCMS Auto Program

The Walters Physician Incubator:A Place for “Doctorpreneurs”Jacob Childers, MDExecutive Director, Walters Physician IncubatorThe dual role of a physician entrepreneurcan be very challenging. Most doctorsare creative problem solvers with activeminds, but they may lack the time to seetheir ideas through. The demands of abusy practice can pull physicians in manydirections, leaving little time in their offhours to develop business ideas. Themany years of medical training physiciansundertake restrict early opportunitiesfor meaningful experience in theentrepreneurial world. Further, whilephysicians function within one of thefew authentic meritocracies, the businessworld is heavily dependent onnetworking and connections. TheWalters Physician Incubator was createdto help bridge these issues for physiciansin Austin and surrounding communities.Robert (Bob) M. Walters, MD servedthe Austin community for 27 yearsbefore he passed away in 2010. By allaccounts, Bob was a highly skilled handsurgeon and an even better person. Manyreaders may have known Bob personally,but what most might not know is thathe had worked for years to develop andperfect a device to help patients witharthritic thumb pain. He was in theprocess of applying for a patent when hislife ended unexpectedly.Tim Gueramy, MD, co-founderand CEO of DocbookMD, recallsDr. Walters mentoring him and urginghim to push f orward on his dream ofcreating a software platform to connectbusy physicians. The process oflaunching DocbookMD was aneye-opening experience for Dr.Gueramy and co-founder Tracey Haas,DO. The difficulties of navigatingtheir new venture in addition to theirbusy medical practices demonstratedthe headwind that other physiciansencounter when launching their owncreative ideas. To honor Dr. Walters andto ease the burden for other physicianentrepreneurs, Drs. Gueramy andHaas founded a non-profit physicianincubator to help physicians bring theircreative ideas to life.Today, Dr. Walter’s legacy ofentrepreneurism and encouragementwithin the Austin medical community isalive and well. For eight months now,the Walters Physician Incubator hasprovided a place where aspiring physicianentrepreneurs can come together, learnfrom speakers and interact with theirpeers in a supportive environment. Ideasare generated and tested, problems aresolved and key introductions are made, allin an effort to unlock the entrepreneurialspirit in each participant.If you are an aspiring “doctorpreneur,”but lack the time and experience to moveforward with your concept, or if you aresimply curious about the experiences ofother physician entrepreneurs, the WaltersPhysician Incubator was created for you.It meets monthly in the Texas MedicalAssociation building.For more information, visitphysicianincubator.org.12 May • June TCMS Journal

PUBLIC RELATIONS COMMITTEE REPORT2013 TCMS/AISD Athletic PhysicalsParviz K. Kavoussi, MDPublic Relations Committee ChairRecognized as a Health Care Hero bythe Austin Business Journal, the AthleticPhysicals program, co-sponsored byAISD Student Health Services, providesfree athletic physicals to students who areuninsured or have financial restrictionsand other barriers to health care. Thislong time project is often the onlyopportunity for many of these studentsto see a physician for a well-visit.Over 80 physicians from numerousspecialties were joined by 65 volunteernurses and school health assistants fromChildren’s / Austin ISD at the Burger andDelco Activity Centers over the course offour nights in April and May to examineover 700 students. Volunteers from theLend a Hand program at The Blood andTissue Center of Central Texas alsovolunteered their time as crowd controland chaperones.The Public Relations Committeeappreciates the time TCMS membersgave to the physicals; many volunteeredfor multiple days and/or shifts. Thankyou to the TCMS Friends of the Society:Medical Service Bureau and theUniversity Federal Credit Union for theirfinancial support to provide studentswith healthy snacks. Also, thank you toAustin Radiological Association for theirin-kind donation of bottled water.Without the compassion of TCMSphysicians, nurses, non-medicalvolunteers and corporate sponsors,the Society could not continue tooffer this program.14 May May • June • JuneTCMS Journal

Thank you for your continued support!Micaela Aleman, MD • Mark S. Ambler, MD • Michael L. Armstrong, DO • Tony R. Aventa, MD • Michelle A. Berger, MDBarbara L. Bergin, MD • Nicole Bernard, MD • Jessica A. Best, MD • Robert E. Blais, MD • James R. Brown, MDC. Mark Chassay, MD • Christopher S. Chenault, MD • Lisa K. Clemons, MD • Thomas B. Coopwood, MDRyan D. Cradeur, MD • Steven B. Dobberfuhl, MD • Amy K. Easterling, DO • Lisa C. Ellis, MD • James R. Eskew, MDWesley D. Foreman, MD • Binaca Gaglani, MD • Harish K. Gagneja, MD • Wesley S. Glazener, MDIsabel V. Hoverman, MD • Ellen Elizabeth Howard, MD • Anand Joshi, MD • Deepti G. Kapadia, MDParviz K. Kavoussi, MD • Pradeep Kumar, MD • Asha R. Lall, MD • Daniel J. Leeman, MD • Michael S. Lifshen, MDChristopher R. Manees, MD • Tammy S. McConnell, DO • Catherine B. McCoy, MD • John E. McDonald, Jr., MDRobert Y. Meyerson, MD • Kenneth W. Mitchell, MD • Jurairat Molina, MD • Hector E. Morales, MD • Beth W. Nauert, MDCelia B. Neavel, MD • William R. Otto, MD • Anand D. Patel, MD • Enrique B. Pena, MD • Guadalupe R. Piatt, MDStephen J. Pont, MD, MPH • Anuradha Prabhu, MD • Theresa J. Pugh, MD • Halley Rambally, MD • Raju M. Reddy, MDR. Ashok Reddy, MD • Rhett A. Reed, MD • Paul E. Round, DO • Stuart A. Rowe, MD • Drew G. Sawyer, MDDrew S. Sawyer, MD • Ronald B. Shapiro, MD • Daniel P. Shmorhun, MD • Sheila X. Shung, MD • Sarah I. Smiley, DOThomas F. Smith, MD • J. Brannan Smoot, MD • Allen Sonstein, MD • Paul K. Stansberry, MD • Paula N. Starche, MDClaudia Szych, MD • Daniel R. Terwelp, MD • David N. Tobey, Jr., MD • Elliot J. Trester, MD • John M. Uecker, MDAllison A. Urrutia, MD • Timothy P. Vachris, MD • Vani S. Vallabhaneni, MD • Pooja Varshney, MDChristopher D. Vije, MD • Julie Katherine Wachtel, DO • Eric W. Weidmann, MD • Leslie L. Wells, MDGreg L. Westmoreland, MD • Karen L. Wright, MD • Christopher M. Ziebell, MDTCMS JournalMay • June15

Reducing Risk Through RobustPersonnel ScreeningSue La Bonté, RHIA, CHPDirector, Human Resources and Quality AssuranceFavorite Healthcare Staffi ngEditor’s note:TCMS Staffing Services was recently launchedby the Society as an exclusive member benefitprovided in partnership with Favorite HealthcareStaffing to offer a comprehensive range ofstaffing services. One of the most important,but most overlooked aspects of hiring staff isrisk mitigation and compliance with myriademployment laws and regulations. In this article,Ms. La Bonté addresses those risks and howTCMS Staffing Services can help mitigate themfor medical practices.With the widely publicized episodes ofMedicaid and Medicare fraud in recentyears, there is increasing pressure onhealth care organizations to performmore frequent sanction screenings ofemployees and vendors against federaland state exclusion lists in order to ensurethat they are not billing for the work ofexcluded parties.Protect Yourself from High DollarConsequencesOrganizations that are audited anddiscovered to be billing for servicesrendered by an excluded vendor orindividual will be fined ($11,000 peroccurrence) and will be excluded fromparticipating in federally-funded healthcare programs.The consequences of employing orcontracting with an excluded individualor entity include the following:• Reporting and repayment of allmonies received by the excludedindividual or entity within 60 days;• $5,500 to $11,000 fine for each item/service claimed or “caused to be”claimed;• Extension of the existing exclusionperiod, or a new exclusion imposedby OIG for the individual/entityand• Possible criminal false claim situationunder False Claims Act (FCA), whichis a separate basis for administrativesanctions and exclusions.Federal and State Exclusion ListsThe Office of InspectorGeneral (OIG) and General ServicesAdministration (GSA) search utilizes theUS Department of Health and HumanServices, GSA and OIG databases forindividuals and businesses excludedor sanctioned from participating inMedicare, Medicaid or other federallyfunded programs. If an organizationemploys an individual on these sanctionedlists they may be forced to pay back allfederal funds received via these programsgoing back to the date the person wasemployed. Therefore, the OIG and GSAsearch is vital for health care industries.OIG ListRefers to the List of ExcludedIndividuals/Entities (LEIE) maintainedby the Office of the Inspector General,US Department of Health and HumanServices. Individuals on this list areexcluded from participating in theseprograms: Medicare, Medicaid, Maternaland Child Health Services Block Grants,Block Grants to States of SocialServices and State Children’s HealthInsurance Programs.GSA ListRefers to the Excluded Parties ListSystem (EPLS) maintained by theFederal Government (General ServicesAdministration). Individuals on this listare excluded from participating in federalcontracts. This list also includes data fromthe Department of Treasury’s Office ofForeign Assets Control (OFAC) list.Favorite Healthcare Staffing hasbeen providing per diem, contract,temp-to-perm and direct hire personnelto health care organizations for over31 years and understands the riskassociated with improperly screenedhealth care personnel.As the exclusive provider forTCMS Staffing Services, Favoritehelps physician offices andclinics mitigate their compliance risk.Trained Favorite recruiting professionalsconduct comprehensive, pre-employmentscreenings that include OIG-GSAreviews on all health care job applicantsin addition to reference checks,background checks, drug screens andcomprehensive interviews.Utilizing an external organization toperform these critical screening functionsallows physicians and their staff to keeptheir priority and focus on patient care.For more information, visit www.tcms.com.For inquiries, email tcmsstaffi ng@tcms.comor call 512-215-5194 to speak with a medicalstaffi ng expert.16 May • June TCMS Journal

TCMS JournalMay • June17

MEMBER BENEFITDocbookMD Celebrates Four YearsTim Gueramy, MD and Tracey Haas, DOCo-Founders of DocbookMDDocbookMD is excited to celebrateits fourth year of helping physicianstransform medical collaboration throughsecure mobile communication. If youhaven’t used it in a while, DocbookMDhas expanded significantly in the past yearand is now working with medicalsocieties in 33 states - and continuesto grow, all to the exclusive benefit ofmedical society members.Originally known as the app thatprovided a free, mobile medicalsociety directory to the greater Austinarea, DocbookMD has added manyfeatures along with regional coverageto make it a vital companion to yourmedical practice. With DocbookMD,Central Texas physicians now haveeasy direct access not only to TCMSmembers, all of whom are listed in theDocbookMD directory, but also tophysicians in 20 surrounding counties inthe region.In addition to a mobile membershipdirectory, DocbookMD is a HIPAAsecure, user friendly messaging tool –working much like texting, but safer. Youcan now tell at a glance if a physician hasregistered to receive secure messagingbecause a speech bubble will appear nextto their name in the directory listing. Ifthis icon does not appear, you can invitethem to join you in secure messagingdirectly through the app.The latest and most exciting featurenow allows physicians to invite membersof their care team into their securecommunication circle. Now, your nurseor medical assistant can immediatelyand securely send you an EKG, a copyof a lab report or even a snapshot ofan X-ray – wherever you are.Physicians are not limited tothe number or type of teammembers they can add totheir secure communicationcircle. It’s easy to build yourown team within the app –just go to “Care Team” in themenu, and start inviting – it’ssimple and free. As always,DocbookMD can be used to sharepatient information whether ornot you use an EMR.DocbookMD is now partnering withlocal answering services to allow you toreceive your messages securely throughDocbookMD, if you choose. In the nearfuture, DocbookMD is planning to workwith your hospital to allow stat reports tobe sent directly to you through the app ifyou opt in for this feature.To sign up for DocbookMD today,go to iTunes or Google Play anddownload the app. You will need yourTCMS member number and the emailaddress that is on file with TCMS whenyou register.HOUSE - HOLDButlers“Weekly. Monthly., or Yearly”….Expediter, Concierge & Restaurant Assist Management & Residential.● Professional personality, broad knowledge of household cleaning and their care.● Prep Souf’ Chef ć mature, social skills, excellent communication in personal mgt● Business technology capability in computer software & residential home system.● kitchen, bed quarters, bathroom maintenance to vehicle, lawn and landscaping.● Multi-lingual for easy communication in speaking ć contractors, Or other staff.Multiple Duties: W/Out the Expense(512) 206- 6111For questions regarding registrationor help retrieving your TCMS number,contact TCMS Membership DirectorMegan Janicke at mjanicke@tcms.comor 512-206-1252 or DocbookMD at1-888-930-2048.18 May • June TCMS Journal

Ashwin Gowda, MDMedical Director - Texas Sleep MedicineBoard Certifi ed in Sleep MedicineAustin’s Premier ComprehensivePhysician Based Sleep Practice.Convenient North, Central and South locationsproviding both clinical consultations and the full range ofsleep diagnostic and treatment services.New Central Location1301 W. 38th St. Ste. 605Seton Medical Park TowerAccepting Appointmentsstarting on May 20, 2013.1221 W. Ben White Blvd., Ste. A-100Austin, TX 7870411675 Jollyville Rd., Ste. 101Austin, TX 78759ServicesOur Care Team• Case Management oriented consultationswith extended hours at Ben White andSeton locations.• In-lab sleep studies (PSG, CPAP titration, MSLT andMWT) at Ben White and Jollyville locations.• Home based sleep studies (HST and AutoPAP) studiesarranged from all three locations.• CPAP DME services available from allthree locations.Monique Mulvany, NP-CShane Concepcion, CNS• Clinical Sleep Educators scheduling appointments atall three locations with appointment times into theevening.Email agowda@txsleepmedicine.comwww.txsleepmedicine.com512-440-5757 Fax 512-440-5858

LEGISLATIVE ADVOCACYStephanie TriggsTCMS Senior Director Community and Government RelationsMay 7, 2013, was the last First Tuesdaylobby day of the 83rd Legislative Session.TCMS and Alliance members lobbied StateSenators and Representatives on severalimportant pieces of legislation throughoutthe day.Senate Bill 303 expands patient rightsin end-of-life care and provides protectionfrom forcing physicians to violate theirreligious beliefs, moral conscience andprofessional ethics. SB 303 has passedthe Senate and is now pending in HousePublic Health.Senate Bill 406 relates to thedelegation and supervision of advancedpractice registered nurses and physicianassistants allowing them to practice tothe level of their training. The billstrengthens the physician-led medicalteam model and establishes a morecollaborative, delegated practice. It’san agreed to bill by the Texas MedicalAssociation, Texas Academy of FamilyPhysicians, Texas Academy of PhysicianAssistants and Texas Nurses Association.The bill is now on its way to GovernorPerry.House Bill 620/Senate Bill 822– known as the “Silent PPO” bills –will decrease the silent PPO problemconsiderably. The bills require entitiesthat enter into a direct contract witha physician to register with the TexasDepartment of Insurance. In addition,they would require the contracting entityto notify and receive expressed authorityfrom the provider if the entities wantto sell, lease or otherwise transferinformation regarding payment orreimbursement terms of the contract.SB 822 became the ultimate bill for finalpassage. The bill is now on its way tothe Governor.In 2012, Celia Neavel, MD, inconjunction with the Travis CountyMedical Society delegation, brought aresolution to the TMAHouse of Delegatesnoting that a minorparent could consent toimmunizations for theirchild, but not for themselves.The resolutionrequested that TMAbring the issue before theTexas Legislature askingthat minor parents beable to consent toimmunizations for themselves whichwould better protect their child frompreventable diseases, such as pertussisand influenza. Senate Bill 63, which is onits way to the Governor, does just that.In addition to meetings with ourlegislators, physicians and Alliancemembers were also spectators asTMA members provided testimony incommittee hearings. In particular,TMA President Michael Speer, MDtestified in the Senate Health andHuman Services Committee in supportof House Bill 740, which would addscreening for congenital heart disease tothe panel of screenings conducted onall newborns in Texas. The bill has beenapproved and is on its way to the Governor.While the 83rd session is almostover, it does not mean that physiciansand Alliance members can rest on theirlaurels. Now is the time to becomeinvolved in the election process.Fundraising for the next election cyclewill begin soon. It’s more important thanever to elect medicine friendly candidatesto state and federal offices. To do this,support of the Texas Medical AssociationPolitical Action Committee (TEXPAC)is needed. A bipartisan PAC,TEXPAC allows the work of the TCMSand TMA lobby teams to continue theirefforts to pass legislation that improveshealth care and to squash legislationthat does not. Find out more aboutTEXPAC and contribute today byvisiting www.texpac.org.20 May • June TCMS Journal

TCM ALLIANCELoren GigliottiPresident-Elect, Travis County Medical Alliance2012-2013 Volunteer of the YearCindy Nelson was named the TCMAVolunteer of the Year at the AnnualAwards and Grant Recipient Meeting onApril 16. Cindy has been a member ofthe Alliance since 1994, and she certainlybelongs on this list of prestigiousvolunteers in both the organizationand community. Cindy loves that theAlliance has something for everyone, agreat combination of community servicemixed with fun. “The members areintellectually challenging and alwaysinspire me to be my best self,” shesaid. Cindy has served in almost everyimaginable role. This year, she completelyrevamped the TCMA website byinputting data, helping with transactionsand keeping information current.Lydia Soldano and Volunteer of the Year Cindy Nelson.Membership in TCMA is open to TravisCounty Physicians and their partners.We have monthly community service,legislative or social events. For moreinformation, see our website or contactElaine Agatston at agatston@aol.com.2012-2013 Grant Recipient AwardsRepresentatives from local area charities:Lifeworks, The Volunteer HealthcareClinic, Family Eldercare, Hospice Austin/Camp Braveheart and St. Louise Housewere on hand at the Annual Awardsand Grant Recipient Meeting to receivetheir grant awards. They also educatedmembers about the impact thesecontributions make on their organizationsand did not leave a dry eye in the house.TCMA is proud to support these worthycauses. If you know a charity that servesthe health care needs of Central Texasand could benefit from a financial award,fill out the application on the TCMAwebsite, www.tcmalliance.org.Spring PicnicThe 2nd Annual TCMS/TCMASpring Picnic was held on April21 at Mayfield Park. Everyone hada wonderful time at this familyevent which featured musicalentertainment from Mr. Will,Patti’s face painting and peacockwatching. We hope to continuethe tradition and see everyonenext year!Alliance leadership honors grant recipients.Project GraduationThe TCMA continued its long reachingsupport of Project Graduation, and wasable to expand financial contributions to13 local high schools this year. ProjectGraduation is an adult supervised all-night,drug and alcohol free evening of fun-filledactivities for graduating senior classes.The event is organized by parents withfinancial donations and sponsorshipsfrom local businesses and communityorganizations. If you know a schoolthat would like our support, contact JeniLowry at jenimlowry@gmail.com.22 May • June TCMS Journal

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TAKE FIVEfor yourHEALTHLUNG CANCER SCREENINGLUNG CANCER SCREENINGLung cancer is the international leading cause of cancer deaths. Tobacco use is the principal risk factor for lung cancer andaccounts for at least 85 percent of all lung cancers. Until recently, no screening test had been shown to be effective in reducingdeaths associated with this disease.SCREENING TESTS FOR LUNG CANCERScreening tests detect cancer before symptoms develop, with the goal of decreasingthe risk of dying of cancer. Detecting cancers earlier may provide a better chance ofa cure. Low-dose computed tomography (CT) scans of the chest are used for lungcancer screening. Low-dose means that lower radiation doses are used compared witha regular diagnostic CT scan.DOES SCREENING FOR LUNG CANCER WORK?• A large study of patients at high risk of lung cancer (the National LungScreening Trial [NLST]) showed that CT screening reduced lung cancer deaths by20 percent (1.33 percent in those screened compared with 1.67 percent in thosenot screened).• People at high risk of lung cancer are aged 55 years to 74 years, have at least a30-pack-year smoking history and are currently smokers or have quit within thepast 15 years.• In the NLST, CT screening had a high false-positive rate and used ionizingradiation. A false-positive result means that a positive screening result is laterfound to not represent lung cancer. In the NLST, false-positive resultsoccurred in about one of every four baseline and first-year annual CTscreening examinations.• The NLST found that 320 people at high risk of lung cancer needed to bescreened to prevent one death from lung cancer.• False-positive results may cause unnecessary testing and follow-up. Mostfalse-positive test results are resolved by performing a regular CT scan. Otherslead to more invasive testing, such as biopsies or surgical intervention.• Potential harms of CT screening include radiation exposure and the need foradditional tests, some of which require invasive procedures and cancreate anxiety.• The most effective frequency and duration of lung cancer screening is unknown.WHERE TO STARTIf you believe that you meet the criteria for a high risk of lung cancer, make anappointment to visit your primary care physician. She or he can conduct an evaluationand assist in helping you decide whether lung cancer screening with low-dose CT isappropriate for you.FOR MORE INFORMATION• National Cancer Institutewww.cancer.gov• American Cancer Societywww.cancer.orgMake copies of this article toshare with your patients.24 May • June TCMS Journal

Classifieds Call 512-206-1245.OPPORTUNITIESUrgent Care: MedSpring Urgent Care,Austin seeking staff physicians for six newurgent care locations in Austin.Gorgeous, centrally located centers feature12-hour shifts, no nights, no call and no overhead.MedSpring is dedicated to getting patients ‘backto better,’ and we are looking for doctors whoseek to provide outstanding service to everypatient. MedSpring is poised to become anindustry leader in urgent care, and we are lookingfor doctors to grow with our company.Excellent compensation, annual bonus, benefitpackage, licensure and CME reimbursement,paid medmal insurance and excellentopportunities for leadership.Contact Director of Recruiting JulianneSherrod at julianne.sherrod@medspring.com or512-861-6362.Primary Care: MedSpring is anexciting health care company with six Austinlocations. Determined to have a positive impactin health care, MedSpring is building areputation for the quality and caliber of itspeople and the great service theydeliver. MedSpring will now offer primary careservices, in addition to the excellent urgent carewe already provide. We have both part-timeand full-time opportunities for board certifiedor board eligible family medicine or internalmedicine physicians. We seek physicians withan outstanding bedside manner, a positive andenergetic attitude and a team orientation absentof hubris. Together, we will build a newstandard for primary care in the communitieswe serve.Contact Director of Recruiting JulianneSherrod at julianne.sherrod@medspring.com or512-861-6362.OPPORTUNITIESOccupational Medicine: Director ofOccupational Medicine, Austin. MedSpring isthe new leader in urgent care, and we are rapidlyexpanding into occupational medicine. We areseeking a medical director for our occupationalmedicine overseeing our occ med program inAustin and beyond. This position will developour program, train our physicians in occ medand meet with occ health clients to convey thebenefits of working with our company.MedSpring is dedicated to getting patients ‘backto better,’ and we are looking for doctors whoseek to provide outstanding service to everypatient. We offer gorgeous, centrally locatedcenters featuring 12-hour shifts, no nights andno overhead and generous compensation andbenefits. Our comp package includes salary,bi-annual bonus, benefit package, licensure andCME reimbursement and paid medmalinsurance as well as a director stipend.Contact Director of Recruiting JulianneSherrod at julianne.sherrod@medspring.com or512-861-6362.SERVICESJoe Kasson Painting: Residentialspecialist in quick, neat, clean professionalinterior/exterior painting. References available.512-312-1035.EQUIPMENTFor Sale: Ortho/sports medicine supplies.Stryker cast saw and spreaders, casting, braceand splint supplies, hard sole shoes. Contact512-413-1903.Wanted to Buy: Old, vintage and antiquemedical equipment, supplies, models, charts,etc. Email cecimd@sbcglobal.net or call512-249-6119.OFFICE SPACEMedical Office: Shared office space inMedical Arts Square complex (central Austin).Perfect for part-time specialist. Privatephysician office with separate reception/frontoffice, shared waiting and exam rooms.Convenient patient parking. Availableimmediately. For additional information emailrmehta@hotcaustin.com or call 512-474-5551.Medical Office: 4207 James Casey#302, across from St. David’s South AustinMedical Center, 1240 sq.ft. three exam rooms,office, lab, restroom, reception office andwaiting room. Contact broker/owner atmpsifuentes@austin.rr.com or 512-797-4977.Lakeway: Office space for lease for FT orsatellite office near LRMC. Six fully equippedexam rooms + two office spaces + X-ray and lab.2400 sq/ft free standing bldg. w / parking. Greatvisibility w/signage on RR 620. 1411 RR 620South, Lakeway. Email dorisrobitaille@att.netor call 512-413-1903.PROPERTYInvestment Ranch: Lake Travis areaappreciating 39-53% per year! 10-76 acres.$29,900.00/acre. Contact Chris at 512-923-8701.For Lease: Beautiful custom Westlakehome for long-term lease, semi-furnished orunfurnished, summer 2013. Eanes schools,3br/2 1/2 ba, with extra loft space andsoundproof music/recreation room. Emailddgjr.501@gmail.com.Sleep 360 Sleep Diagnostic CenterVani Vallabhaneni, MDBoard Certifi ed in Sleep MedicineBoard Certifi ed in Internal MedicinePecan Park Professional Plaza10601 Pecan Park Blvd. Suite 203Austin, 78750Our Services• Physician Consultation• Physician supervised sleep studies withquick turn around time for results• CPAP/BPAP compliance clinic• Cognitive Behavorial Therapy (CBT) forinsomnia management.AASM & JACHO Accredited 4 - Bed Sleep CenterPH: 810-036 • Fax: 918-0361 • www.sleep360md.comThe Park at Eanes CreekRajat Gupta, MD4407 Bee Caves Rd, Bld. 2, Suite 211Austin, TX 78746512 330-0961, 330-0962 FAXOffering: Medical Evaluation & Treatment, Physical Therapy,Massage Therapy, Biofeedback, Acupuncture, and other services.Dr. Gupta is a board certifi ed neurologist and pain specialist, and formerInstructor of Pain Management at Johns Hopkins University.TCMS JournalMay • June25

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