The Florida Internist - Fall 2002
From the Governor:
A Foul Wind Blows Florida's Civil Liability Crisis
Bob Dylan said it well: "You don't have to be a weatherman to know which way the wind blows." Florida has a serious civil liability crisis. Here are the three key facts needed to understand the problem:
- The average Florida doctor has an approximate 10-15 % chance of being sued every year.
- If you are that average doctor and you are sued, you have a 46-48% chance of walking away from the situation without paying a settlement of some amount.
- If you are that average doctor and you are sued and you do not prevail in your defense, you (or your insurance company) will pay an average indemnity of $247,000.
The number of malpractice actions brought against Florida doctors each year is roughly stable - about 800 to 900 suits are filed each year. There are two things making the situation worse here in Florida. First, if you are the average Florida doctor you are 20% more likely to lose your case than is the average doctor elsewhere in the US. Second, the amount of money squeezed out of you during the course of your defense is far higher here than in the rest of the country. There is no question about it. The civil liability crisis in Florida is caused by a tort system run amok. It is not the result of bad doctors as the legal community would have the public believe.
Given these stark facts, what can be done about the problem? In 1975 the state of California reacted to a similar tort crisis by passing the Medical Injury Compensation Reform Act (MICRA). The salient points of this reform package are:
- A cap is placed on non-economic damage awards of $250,000.
- A sliding scale limit is placed on attorney contingency fees so that injured persons receive most of the money, not the lawyer.
- Juries are informed of compensation already received by plaintiffs for the same injury.
- Payments of future damages are made in periodic payments to ensure funds are available for victims.
With initiation of this reform California's then astronomical malpractice settlement amounts stabilized. Now the California doctors medical malpractice premiums at or below the median for the country.
If MICRA is the solution, why doesn't Florida initiate the same sort of reform? There are at least three reasons. First, the trial bar is making a fortune. The current system allows lawyers to maneuver juries into enormous verdict amounts - sums of money that never make it to the injured party. Second, the fear of losing the big case is motivating doctors to settle rather than fight. Third, The Florida Supreme Court has preemptively ruled that any cap on pain and suffering would be an infringement of Floridians basic rights. That means that any real change to the civil liability system would require an amendment to the state constitution.
A campaign to pass a constitutional amendment is a complicated and expensive thing to wage. It was tried in 1988 (Amendment 10) and we narrowly lost. It is estimated that a successful effort to change the Florida Constitution will cost from twenty to twenty-five million dollars and over a year of hard work. Nonetheless, if we are going to pass meaningful tort reform, we must be prepared to contribute the necessary money and walk the required miles to pass a constitutional amendment. There is just not another way.
The natural outcome of this civil liability crisis will be a crisis of access. If doctors cannot get affordable
malpractice insurance, they will cease to practice or limit the type of practice they pursue. And that is what really counts. If physicians cannot write prescriptions, perform procedures and attend to Florida's sick and injured then we will all suffer.
What can you do?
- Know and be confident of the facts: doctors are not at fault; lawyers and the tort system they control are.
- Help present a united front to our opponents. The Florida Chapter ACP-ASIM will be working in concert with the Florida Medical Association and other specialty organizations to enact tort reform. Support all these organizations.
- Join efforts to pass a change in the Florida Constitution. Call the FMA at 1-800-762-0233 and contribute to the Citizens for Tort Reform. This group will collect money and eventually wage the constitutional amendment campaign.
Thank you. If you have questions or would like to be more deeply involved call the chapter office at 800-542-8461-1-2 or write me at email@example.com.
Congratulations to new Fellows elected in July, 2002 !
Anteneh M. Addisu, MD, FACP - Ocala
Yeshitila Agzew, MD, FACP - Pinellas Park
Syed W. Ali, MD, FACP - Brooksville
Elias N. Amador, MD, FACP - Wellington
John A. Baker, MD, FACP - Jacksonville
Gregory F. Bonner, MD, FACP - Weston
MaryPat L. Clements, MD, FACP - Boca Raton
Herbert E. Cohen, MD, FACP - Weston
William Steven Dalton, MD, FACP - Tampa
Sara M. Garrido, MD, FACP - Miami
Jose M. Gaviria, MD, FACP - Miami
Phillip George, MD, FACP - Fort Lauderdale
Kevin K. Hunger, MD, FACP - Jacksonville
Ghosn A. Issa, MD, FACP - Gulf Breeze
Daniel T. Layish, MD, FACP - Maitland
Owen Linder, MD, FACP - Safety Harbor
Jose A. Montero, MD, FACP - Riverview
Yallappa Nadiminti, MD, FACP - Bradenton
Seema Nishat, MD, FACP - Spring Hill
Zoraida Rivera-Hidalgo, MD, FACP - Hollywood
Frank Sorhage, MD, FACP - Fort Lauderdale
Shou-Ching Tang, MD, FACP - Miami
Douglas M. Whitmore, MD, FACP - Fort Lauderdale
Aristides Zacharoudis, MD, FACP - Fort Lauderdale
Awards Presented at the 2002 Regional Meeting
Samir Habashi, MD, UF Health Science Center, Jacksonville
Galo Garces, MD, ACP Associate, University of Miami
Gilberto Lopes,MD., ACP Associate, University of Miami
Perri Young, MD, ACP Associate, University of Miami
Joshua Harris, MD, ACP Associate, University of Miami
P. James Abraham, MD, ACP Associate, Mayo Clinic, Jacksonville
Miguel A. Park, MD, ACP Associate, Mayo Clinic, Jacksonville
Carris McInnis, MD, ACP Associate, University of Florida
Robert M. DuBose, MD, ACP Associate, University of Florida
Carolyn Stalvey, MD, ACP Associate, University of Florida
Joseph Creevy, MD, ACP Associate, Orlando Regional Medical Center
Jorge Lamarche, MD, ACP Associate, Orlando Regional Medical Center
Karen Echevierra-Beltran, MD, ACP Associate, Orlando Regional Med Ctr
Daniel Farray, MD, ACP Associate, Cleveland Clinic Florida
Yoram Padeh, MD, ACP Associate, Mount Sinai Medical Center
Chief Residents attending the Awards Dinner received plaques from the Governor in recognition of their contribution to medical education. (Left to right) Drs. Joseph Creevy (ORMC), Carolyn Stalvey and Carrie McInnis (UF), Miguel Park and James Abraham (Mayo Clinic Jax), Samir Habashi (UF Health Science Cneter Jax), Gilberto Lopes and Galo Garces (UM).)
Key Contact Award
Michael A. Zimmer, MD, FACP
Dr. Michael Zimmer (left) accepts the Key Contact Award from Dr. Fred Turton.
Community Based Teacher Award
David Perloff, MD, FACP
Internist of the Year Award
N. H. "Bo" Tucker, MD, FACP
Drs. Fred Turton (left) and John Langdon (center) congratulate Dr. N.H. Tucker, III upon receiving the Internist of the Year Award.
Charles E. Donegan Volunteerism Award
H. Frank Farmer, MD
H. Frank Farmer, MD (left) Immediate Past President of the Florida Medical Association, receives the Charles K. Donegan Memorial Award for Volunteerism from Cecil B. Wilson, MD, FACP, Chair of the ACP-ASIM Board of Regents.
Outstanding Teacher Award
Jorge Trejo-Gutierrez, MD, FACP
Bryan A. Bognar, MD, FACP
Alan R Morrison,,D.O., FACP
The Florida Governors, Dr. Frederick E. Turton (center) and Dr. Craig Kitchens (right), presenting the Outstanding Teachers of the Year Awards. Recipients were (left to right) Drs. Jorge Trejo-Gutierrez , Bryan Bognar, and Alan Morrison.
Yank D. Coble, Jr, MD, MACP
Kenneth R. Ratzan, MD, FACP
Dr. Frederick E. Turton presented the 2002 Laureate Award to Yank D. Coble Jr., MD, MACP, current AMA President.
Dr. Frederick E. Turton presented the 2002 Laureate Award to Kenneth R. Ratzan, MD, FACP, Immediate Past Governor, Florida Chapter.
Florida Chapter ACP-ASIM
Dr. Andy Hedberg, ACP-ASIM Regent, presents Drs. Frederick E. Turton, Kenneth R. Ratzan and Craig S. Kitchens with the 2002 Evergreen Award. The Florida Chapter received this Award for the educational program "In Defense of Dr. X." Watch for this at Annual Session 2003.
ACP-ASIM Florida Regional Meeting Associate Awards
The Florida Regional Scientific meeting was held at the PGA National Resort & Spa on September 20-22. The local Council of Associates under the leadership of Dr. Todd Heimowitz met on Saturday afternoon to review membership activities at each of the internal medicine training programs in the state. Dr. Joseph Creevy of the Orlando program will join in the advocacy related activities of the Chapter including participation in next spring's Leadership Day. The Council of Associates also discussed the freestanding Associates Meeting which will be held March 8 and 9 at the Sheraton Ft. Lauderdale Airport hotel.
Dr. Keith Swanson of the Mayo Clinic Jacksonville program and Dr. Victor A. Diaz of the Mount Sinai Medical Center program shared top honors in the Regional Meeting poster competition.
First place in the Associate oral presentations was taken by Dr. Jyoti Patel . Dr. Patel received her medical degree at the Southern Illinois University School of Medicine in Springfield and is currently a 3rd year resident at the University of South Florida in Tampa.
Another exciting "Doctors Dilemma" Competition was won by the University of Miami team: Drs. Galo Garces, Gilberto Lopes and Andres Soriano. This means that the 'traveling trophy" will be housed at the University of Miami this year and the Chapter will make a grant available for Dr. Patel and the UM team to travel to Annual Session in San Diego.
Congratulations to all! Keep your eyes peeled for those interesting cases you feel compelled to write up. We are looking forward to more of your excellent work at the Associates meeting in the spring.
Dr. Elena Oberstein, Council of Associates Representative from the University of Miami (center) seems to know the answer but is not telling!
The Mayo Clinic Jacksonville was well represented at the Poster Competition. (Left to right) Drs. Keith Swanson, Amit Shah, Michelle Biewend, Edgar Martorell, and Alan Elliot.
Dr. Craig Kitchens seems to indicate that this "Medical Jeopardy stuff" is a serious educational experience.
Having Problems Getting Paid?
The Florida Chapter actively brings common payment problems to the attention of third party payors and the Department of Insurance. If you are having a problem, chances are that somebody else is, too. Let us know about it by contacting the Chapter office, either by fax at (904) 771-0603 or e-mail at firstname.lastname@example.org.
Business Plans for Physicians
Corey L. Howard, MD, FACP
Marketing Your Practice
This installment of business plans will concentrate on marketing. Before we can actually talk about marketing we need to do some homework. In other words we need to perform a market analysis. At this point in time most, if not all of you, have started your practices. In light of this what we really need is a market-penetration strategy. This is when you try to get great dominance and penetration in the market that you are already in. The analysis that is required to get you to the next level is not often easily obtained. The first thing to do is define your target market. Often we are tempted to set a 'net' to attract all patients but this may not be the best use of resources and time. By defining the type of patients you desire in your practice you can develop a strategy that can predict which patients will have a high likelihood of utilizing your services. The main areas to focus on include the following: Demographics-what kind of patients are you looking to reach? Geographic's-where do you want your patients to come from? Finally, find out where your new target market shops, lives, eats and spends time relaxing. From that information you can derive a plan that will target your 'new' market.
Well, now that you have defined a target market for your practice you need to get the patients. Before you start buying expensive ads in magazines and newspapers you need to do one more thing. That is an analysis of your strengths, weaknesses, opportunities and threats (or competition) also know as a SWOT analysis. I would suggest you make a table and outline each of these areas. Putting things on paper has a way of making you think of things in a different way. This is sometimes called a paradigm shift. This shift is a very important tool for us since we tend to be creatures of habit.
When you have finished the SWOT analysis you are ready to spend some money on the actual advertising portion of marketing. Ads in country club magazines, information handouts to be left at shops where your patient might go, free lectures, and internet advertising are all possible mechanisms to get your word out. Word of mouth advertising is also highly effective but, takes a long time to develop.
Do a good job for all of your patients. Be a good listener and show compassion. That will gain you more satisfaction and success than any ad you can purchase.
The Financial Plan
In this section, we are going to deal with financial planning. For the most part, we will discuss the two main tools to monitor your practices: Profit and loss (P&L) statements and the Balance sheet. The third tool to utilize is a cash-flow projection sheet (proforma statement). This tool is mainly used when starting a practice or when you are going to make changes in your business that will include new income or expense items. It is similar to your P and L except it is the tool to help predict the future.
The profit and loss statement is also known as your income statement. Simply put this analysis of your business shows whether you are making a profit or not. It is made up of two simple parts income and expenses. Both of these areas have their own subsections and can be further subdivided to give you as detailed information as you might want.
The income is mainly from your services and can be noted as "patient fees." You may have a nurse practioner who provides services independent of what you bill and you want to track that. In this instance, create another category "NP patient fees." Other income items may include honoraria, refunds from vendors, lab fees or products you may sell so you create income categories to note where you get your money. It is imperative to be accurate in all of your accounting so that you can pay your taxes correctly but more importantly pay yourself. If you have partners, you can track how much each brings into the practice and this may be linked to bonuses or salary. It is important here to mention that medical practices typically use cash-basis accounting. That is when you track cash on hand for accounting purposes and do not use accounts due to you as income as you might do if an accrual-basis form of accounting is used. The main thing is that we do not track bad debt or charity care because we will not get any tax break as some business can when they lose money because of bad debt.
The other side of the coin is expenses. This category is subdivided many times to track where you spend your money. It is important to have enough detail so that you can identify areas to potentially have improvement or areas that you are doing well. The bottom line will be net income at the end of each month and certainly at the end of each year. We want to see profitability increase not decrease. This is particularly tough because of decreasing reimbursement and rising costs. Due to this alone, it is imperative that we track income and expenses carefully. In addition, by keeping detailed books the partners or the solo practioner can carefully monitor problems. Remember, it is your business. You need to keep a keen watch over the store because no one else cares as much as you do.
The balance sheet is harder to understand. It is a snapshot, usually up to date, on what your business is worth. The balance sheet looks at your assets and liabilities: what you have and what you owe. The assets are broken down into current assets (cash on hand, inventory) and fixed assets (land, buildings, equipment, furniture etc…). Liabilities are broken down into current liabilities (what you owe currently-bills and the like) and long-term liabilities (loans). The difference between* assets and liabilities is your businesses net worth. The balance sheet does not change dramatically day to day but is an essential tool for the end of year analysis and for accounting purposes.
In a nutshell, you have learned about profit and loss and balance sheets. Throughout the series, I have tried to simplify the information and make it directly cogent to the practice of medicine. If you would like to learn more about any one particular area, I would be happy to guide you in the right direction. Good luck!
- Save the Date! FL Chapter Meeting
October 4-6, 2013
- First Issue of "News & Notes" from Florida's Internal Medicine Residency Programs
- December 2012 Governors' Newsletter
- New Governor-elect
- 2013 Florida Chapter Legislative Agenda
- FL Grassroots Advocacy Center
- View presentations from 2012 Florida Chapter Meeting
- Florida Chapter Wins Permanent Injunction Against Physician Gag Law
- Florida Chapter receives 2013 John Tooker Evergreen Award
- Member Accomplishments