St. Augustine neurosurgeon represents 135^th FMA president

ST. AUGUSTINE—Miguel Machado, MD, a native of Matanzas, Cuba, started a one-year term as president of the Florida Medical Association (FMA) during FMA’s annual meeting, held in Orlando in late summer. The St. Augustine neurosurgeon represents the statewide association’s 135^th president.

Machado and outgoing FMA president Madelyn E. Butler, MD, of Tampa, share a Cuban heritage. Butler’s family immigrated to the United States via Georgia when she was four; Machado was 14 when the family found a home in Miami.

After earning a medical degree from the University of Zaragoza in Spain, Machado completed a surgical internship at Franklin Square Hospital in Baltimore, then his neurosurgical residency at the University of Maryland hospital in the same city before building a practice in St. Augustine and working with Flagler Hospital.

Florida Medical News asked Machado about priority member issues he faces during his leadership term.

At your annual meeting, what overall medical industry concerns emerged from the FMA membership?

During this year’s annual meeting, we saw more resolutions than usual in the House of Delegates, which indicates an increased level of concern among our 20,000 members. This is why the FMA’s strong advocacy on behalf of Florida’s physicians is so crucial. An effective association makes Florida a better place to practice medicine, and that ensures the highest quality of care for our patients. 

Some of the main topics we covered were workforce issues, such as the physician shortage and Florida’s aging doctor population. We also discussed the reorganization of the Florida Department of Health and reiterated that a physician direct the DOH. The governor must have a direct line of communication with a physician during disasters and epidemics.

We talked about ways to combat the mounting administrative burdens being placed on physicians, which interfere with maintaining a focus on our patients. Also of concern is the continuing decline in access to care for patients, which is due to many factors: managed care networks that are not inclusive; decreasing reimbursements for all healthcare providers; and ongoing Medicare funding problems.

What impact will the new state dispensing law have on your members?

Since this law hasn’t taken effect, we can’t comment on what problems dispensers will face. However, the FMA has kept its members informed regarding the new law’s requirements, and we have posted detailed information on the FMA website, www.flmedical.org. Doctors who regularly dispense haven’t yet expressed any concerns about the new requirements. 

At the ACO summit FMA hosted earlier this year, what were members discussing?

When the concept of ACOs was first introduced in the federal health reform legislation, there were many more questions than answers. The FMA quickly responded by holding an ACO summit to address those questions. The FMA Task Force on Accountable Care Organizations studied the issue in depth and concluded that the proposed rules, as currently drafted, are worrisome. We advised our members that they should be very careful before forming or joining an ACO, and other large, reputable medical groups have said that they would not form ACOs under the proposed rule. 

Our message to physicians is that even if they don’t intend to participate in an ACO, it’s important that they understand these regulations. There’s a good chance that the concepts being developed as part of the rulemaking process could find their way into the private market. 

Above all, we must insist upon preserving physician choice and independence, and prevent our doctors from being forced into participating in ACOs and other experimental payment models. 

With EHR implementation hitting snags, what is the FMA doing to help physicians comply with this new mandate? 

Large groups have had little trouble incorporating EHRs into their practice settings, but smaller practices—those with one to five physicians—have had more difficulty. There are a number of reasons: the aggressive timeline set forth in the federal legislation, the cost, and the workflow issues involved in selecting and implementing a system. The FMA conducted 18 seminars throughout the state to help members with these issues. We’ve since received a great deal of positive feedback. The Regional Extension Centers (RECs), which were created by the federal HITECH legislation, are gearing up, and the FMA is partnering with them to help primary care physicians become eligible for the HITECH incentive funding. The FMA will continue to assist members with this complex issue.

Are your members satisfied with tort reform changes that state lawmakers made recently?

The FMA passed its number-one priority during the 2011 session: medical liability reform with expert witness provision. We’ve been pushing for reform for over a decade, so this legislation, which Gov. Rick Scott signed into law, is one of the biggest victories for Florida doctors in many years. The law holds expert witnesses accountable for their testimony and contains a number of provisions that will greatly improve Florida's medical liability environment.

We’re confident the law will make the state much more attractive to doctors who have previously avoided practicing in Florida because of medical liability concerns. The FMA is grateful to the bill sponsors—Rep. Mike Horner and Sen. Alan Hays—and to Gov. Scott and all of the lawmakers who supported this landmark legislation.

It’s important to note that the FMA also defeated many harmful bills, including all attempts by non-physicians to inappropriately expand their scope of practice. We fight these battles every year to protect our patients. And unlike other states, the FMA has succeeded in keeping these proposals from passing.

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