FSPMR - Florida Society of Physical Medicine & Rehabilitation
FSPMR - Florida Society of Physical Medicine & Rehabilitation
FSPMR - Florida Society of Physical Medicine & Rehabilitation
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President's Message
Mark Rubenstein MD

As we reached the turn of the century in 1999, the world was in fear of a bug. It was the “Y2K” bug, or what some called the “millennium bug.” The reality was the world recognized that we had permanently crossed the threshold into a computerized society. Alarmists feared that all of our personal information could be “lost” when the clock struck midnight on 12/31/99. Fortunately, that fear was unfounded, and there were minimal glitches as we entered year 2000. Technically we hadn’t even reached the 21st century (that began on 1/1/01).

Technology was improving connectivity, efficiency, and information gathering/dissemination. Yet technology was our biggest fear as we turned the clocks from 1999-2000. How many of us remember staying up till midnight to “watch the ball drop” from NYC on that particular New Year’s Eve? Most were waiting to see if their computers would fail. (My wife would tell you that I had likely fallen asleep on the couch waiting for the countdown, and she would probably have been correct).

Fast forward twenty years. Who was worried about technological failure when we entered the year 2020? More importantly, who was worried that 2020 would turn out to be the most challenging year on our Earth in our lifetimes? Who feared that a corona virus would alter the way we greet each other? The way we socialize? The way we open a door? The way we shop? The way we are educated?

Sure, we had the usual challenges in medicine before 2020. We also had the ongoing and additional responsibility of maintenance of certification, and all the resource dedication that it requires. We are privileged to be able to practice medicine, but with that comes responsibility, commitment, effort, and sacrifice. We talked about protecting our future as a specialty, and we talked about how to most appropriately provide a forum to advance the premises of our chosen field (Physical Medicine & Rehabilitation).

With the Covid-19 era, we are faced with immeasurable challenges. There are ways in which the specialty of medicine in general has adapted already to the immediate threats. For example, telemedicine became instantly invaluable to connect with our patients and has allowed us to evaluate and intervene in ways that were not accepted previously. The electronic record has its deficiencies (if you ask me, I will argue that it has more deficiencies than proven benefits), yet mandated e-prescribing by 7/1/21, or your next license renewal, whichever is earlier, in Florida may be a useful tool (of course, I digress when I point out that companies that provide government approved e-prescribing software have raised their prices substantially to take advantage of the state requirement). Currently telemedicine is allowed with a variety of means, and reimbursement is supposed to be similar to non-telemedicine visits of same complexity. Stay tuned closely to the legislation, however, as the rules governing telemedicine change rapidly. And if you don’t already e-prescribe, I would refer you to the AHCA website for more information about rules and regulations, providers, etc. The following link should be helpful: https://ahca.myflorida.com/SCHS/ePrescribing/index.shtml

And while I’m still digressing, there is yet another major obstacle in our near future. The 2021 Medicare Physician Fee Schedule and Quality Payment Program will make substantial changes to the way we currently code patient encounters. The Centers for Medicare and Medicaid Services (CMS) recently released a proposed rule. Controversy has already erupted with regard to the changes proposed for Evaluation and Management (EM) service valuations. There is likely to be a substantial overhaul in the codes and methods used unless the rule is deferred.

The 21st century has changed the practice of medicine substantially. Hospitals have employed more physicians than ever. Corporate America has ventured into practice purchases. Mergers of groups and practices have occurred based on the principles of microeconomics (economies of scale). Insurance companies have been successful at delaying or denying authorization for care through methods such as prior authorizations or use of clinical guidelines that are not universally accepted. Paperwork (or computerwork) responsibilities take us away from what we should do best: provide care for our patients.

The last legislative session in Tallahassee was one of the most challenging for the field of medicine that I can remember. Politicians misled us, and in some cases blatantly lied. Each year the Florida Medical Association spends extensive capital and time to follow its mission: Helping Physicians Practice Medicine. As a member of the Executive Committee and Board of Governors of the FMA, I will do my best to keep the FSPMR informed and engaged in issues that affect us all. 2020 was expected to be a trying year as we navigate continued scope of practice challenges, rising liability insurance rates, and third party interference in healthcare. Who knew that we would have even more significant challenges related to an invisible contagion that has created hysteria, shortages of supplies, and a reset as to how we can even interact with each other?

It is with a sense of commitment to our specialty, and a career of dedication to my colleagues and our patients, that I humbly assume the Presidency of the Florida Society of Physical Medicine and Rehabilitation. The average physiatrist in our state has little idea of how many capable and responsible leaders have served in this role over the last few decades. I have respect for all who have volunteered their time and effort to preserve our field. We have a committed group of Board members, and an experienced, qualified, and committed Executive (Lorry Davis). Like many other societies, we face new dilemmas. All organizations are faced with the issues of member benefit. Practice expenses continue to rise, and physicians have been reducing their organizational involvement rather than increasing it when we need them most. In the coming year, our Board will seek to increase our membership base. There are many fundamental reasons for this. There is truth to the theory that there is “strength in numbers.” One of the most vital member benefits is ADVOCACY. This includes patient advocacy as well as physician and practice advocacy. The legislative system in Florida dictates administrative codes, rules, and statutes that we must follow. To remain engaged and have a voice, we need to have the ability to discuss issues with those that make the rules. Even a non-active member in FSPMR has value, since we need a capital base to sustain the organization. On that note, we must all thank the out-going President of FSPMR, Dr. Craig Lichtblau.

Dr. Lichtblau is extremely passionate about the field of PM&R. He has a career that has spanned 30 years and has watched the field grow from relative infancy to the levels we have now. If you speak with him, you will know that he fears we will become relatively obscure if we don’t unite and act to protect our careers and our patients. It has been thru Dr. Lichtblau’s personal generosity that we have managed to remain afloat financially in an era when many specialties and organizations are simply shutting its doors. As testament to his commitment, he has already personally committed to financially underwrite our largest organizational expense for the next two years. We applaud him for his commitment, his dedication, his passion, and his generosity. Job well done, Craig!!

It is now up to us to decide what becomes of the FSPMR. There will always be financial challenges, and we have to prove member value. But we also have to prove that PM&R is a fundamental requirement in the healthcare arena. It’s up to us. Because if we don’t, no one else will…..

I look forward to working with all of you in the coming years, and welcome your input as we all navigate 2020 and beyond together.

FSPM&R Presidents Message September 2020


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