January 5, 2018

DEAR FRIENDS:

As many of you know, I write an annual letter to my patients to discuss what has happened in our practice and in the field of dermatology over the past 12 months. I also give details about our Patient Appreciation Party. This year, the letter is going to be a little bit different.

This past year has been professionally one of the most difficult, yet rewarding years since I have been in practice.

So, while this letter is longer than usual, I hope you take the time to read it.

First things first though: I want to give the details of our Patient Appreciation Party. We have been hosting this party
for almost 20 years. Every year, we have food, music, and the local K-9 police demonstrate the skills of their incredible canines. We appreciate the community’s support and participation in this. One problem we’ve had in the past is that there have been many party crashers. Last year, we seemed to have controlled this problem better than ever, but I would ask that you keep the details of the party private, so that we can continue to have a successful event.

Another topic I discuss is my family. My daughter, Cammy (her nickname is “C.C.”), is now 6 years old. She is in kindergarten and doing well. She reads to me almost every night, likes to swim, and is in gymnastics. I am very proud of her and how hard she is working at school. She is not only a great daughter, but she is also a wonderful sister to her little brother.

My son, George, is now 4½ years old. As I mentioned in previous letters, my son has a speech impediment, and might have a component of autism. We are not sure the full extent of these issues at this time, but he has made remarkable progress just over the past several months. We are proud of his bravery and strength, and we try to match it with our love and patience. Despite his speech difficulty, George is a happy boy. He plays with his pre-kindergarten classmates, and loves to run and play like any other kid his age. I have spoken about this openly to several patients and I appreciate everyone’s support and prayers.

My wife, Cammy, and I are in our twelfth year of marriage. Every day, I try to be a better husband for her. I know I have said this before, but I do not know what I did to deserve such a loving and kind wife. She has been patient and supportive throughout our entire marriage, even with all my faults.

As many of you are aware, Dr. Golomb, who was with our
practice for more than a decade, has left this year. You might also have known that she had another practice in Miami, and her husband’s business is in South Florida. Traveling back and forth became more and more difficult, and ultimately, she and her husband chose to stay down south. She has told me many times that she did not find it easy leaving the Treasure Coast and her patients here, but I think we are all thankful that we have had a chance to know her.

Now for the professional part. As I said earlier, this year has been one of the most professionally rewarding and professionally difficult years of my life. First, the good part. We have been in discussions with The University of Miami School of Medicine Department of Dermatology about the possibility of them establishing a clinic on the Treasure Coast.

There are many reasons for doing so, but with the growth of the population here, there is certainly a demand for a tertiary care center. Right now, if I have a patient with a difficult medical problem, I must send the patient out of town to University of Miami, Cleveland Clinic or Mayo Clinic. You can imagine what a difficult trip that is, especially for someone who might be critically ill.

But hopefully soon, in our own community, we may have academic physicians that are professors treating not only patients with hard-to-treat problems, but also patients with routine dermatologic issues like skin cancer and other skin diseases.

This would be a huge advancement for the Treasure Coast. As far as I know, this would be the first clinic from a tertiary care center that would open in dermatology on the Treasure Coast. As you might imagine, some of the medical community have not been happy about this. They see it as “competition,” but I have always felt there is always room in the community for another good group of doctors. Having a University clinic on the Treasure Coast would not only spare patients from long trips to other facilities, but would also provide access to cutting-edge treatments for both common and rare diseases.

I can see no downside to this for all of us, both doctors and patients.

These talks with the University are ongoing so we don’t have any firm details yet. Because we are dealing with an academic institution decisions sometimes take a while. We’ll keep you posted.

The next professional good news event is that I was senior author on a paper published in the Journal of the American Medical Association Dermatology, a major medical journal. Our paper is titled “Association of Human Papillomavirus Vaccine With the Development of Keratinocyte Carcinomas”. I can’t tell you how excited I am to be part of this, especially as senior author. We will have a copy of the paper on our website, if you want to read it.

Basically, we have found a vaccine that seems to prevent skin cancer in many patients.

In the next year, I believe we will have published three additional papers that not only show that this vaccine prevents skin cancer, but it will also, when used appropriately, resolve difficult – if not impossible-to-treat tumors. To be honest, if I was not involved in the treatment, I would not believe both the pictures and the results that we have achieved. University of Miami has opened a clinic in Miami to treat patients with this vaccine protocol. It is becoming standard of care for some groups of people, even now at the University. I think in many ways this will change the practice of dermatology, and make life much better for many of our patients.

Saying that, we should still wear our sunscreen, but I think there will be a lot less skin cancer once this vaccine is more generally used. I am proud to be part of this.

Hopefully by the time I write my letter to you next year, I will have more information about this to tell you.

Now for the difficult part of this letter, which I wanted to address publicly, though many of you might not ever hear about this.

A little over two years ago, a complaint was made by a patient, with the help of lawyers who were associated with a competitor of mine.

Because of this complaint, “government” lawyers started looking into my practice. As many of you know, I have one of the top-rated practices by Medicare in the country. I am humbled by the success of the practice, but it has also made me a target.

Over the years, I have had many audits and as anyone who does business with the government knows, audits are frequent, cumbersome, and very bureaucratic. I have at times been struck by the incompetence and thoughtlessness of both the auditors and the bureaucracy that they represent.

But so be it. I think we all know that our government does not run efficiently.

This one was different though, as the impetus of this was from outside lawyers. I had heard of these witch-hunt type of investigations before, but being in the middle of one was like a made-for-television movie. I met with the government twice, and even had other physicians who worked in this practice speak to them refuting their accusations.

I knew that the “government” lawyers did not know what they were doing. In a recent court trial, it was stated that…“the government’s error merely underscores that Medicare’s supervision rules are extraordinarily complex and confusing, even for trained healthcare lawyers, let alone for practicing physicians.”

Where I come from, if you are in a profession and you don’t understand the rules, we call that incompetent. I initially thought that this was just a misunderstanding. But after they started accusing me of doing procedures that I have never done, billed for, or performed in any way, I realized that I was in a no-win situation.

In this case, it was like arguing with a wall.

I am not the only one who has had to deal with this. A recent similar case has even had judges saying that they were ’appalled’, ‘embarrassed’ and ‘ashamed that the government would rely on this kind of nonsense.’ (This case happened to be the government going after a large cooperation that had millions of dollars to spend on legal fees.)

In addition, a well-known and respected local doctor in Vero had similar issues with an investigation. After spending a considerable amount of money on legal fees and having that investigation consume years of his life, the physician ended up retiring from practice.

My case was interesting too, because here is what happened. After these “government” lawyers threw all this mud at me, we settled with the agreement that I would pay some monies, but I would still be allowed to practice exactly as I had before they began their investigation.

This does not make any sense to me.

If I was doing something wrong, they should have restricted my practice.

Many of you might have heard this story about my grandfather who was a barber in Miami. What I mean to say is this: he had a barber shop and cut hair, but he was really a bookie.

I would often spend weekends in his barber shop. One day, my grandfather came out of the back room looking a little scared, and I asked him what happened. He said that what just happened was a shakedown.

Basically, he had to pay off someone, in order to keep his bookie operation going.

Unlike my grandfather, I am not doing anything illegal, but the shakedown comparison still applies.

I mentioned the other physician that went through a similar investigation, and he appeared to be, in many ways, spent. I, myself, have paid a substantial amount on legal fees and spent many hours just to get to the point where I am now.

It has consumed hundreds of hours of my life over the past 18 months.

But I will say this: though I settled this case, I am not broken. It is beyond my comprehension that one would have to pay some monies but still be allowed to continue to practice in the same way I did previously.

I understand some of you might have this romantic notion that you should always fight, and in many ways, I wanted to.

But as my wife said, many times, there often is no justice in our world. When you have lawyers who are just looking to score a dime, and are willing to make up false accusations in order to support their case, one has to make a choice.

I am not the type of person who backs away from a fight. But I was not going to bang my head against a wall for another three to four years, when I saw the utter disregard that these “government” lawyers had for the truth, and were so incompetent that they could not even understand basic medical standards.

It is also suspicious to me that the lawyers involved were associated with my competitors. At one point, the government even used a competitor of mine to perform one of my past audits. This isn’t a fair way to look at things. For the process to remain impartial the government should not employ competitors or those associated with my competitors.

Further, an insurance policy from my malpractice carrier is contributing towards these monies. A large part of the monies that is being paid out is not even coming from my pocket.

These people were not looking to punish me; rather, they were looking for the big payday. This is how our government keeps score now, not by whether they are doing right or wrong, but how much money they can collect.

I would not have believed situations like this would occur, if I had not gone through it myself.

I understand how this might appear to some people. Some people think that no one settles something unless they are a little bit guilty.

I am sharing this with you even though I could have let it go unmentioned. I have nothing to be ashamed of.

I have nothing to hide.

To the patients and friends who stand by me and continue to support me I appreciate it every day. I have said this before, that it is an honor when someone allows you to take care of them; you should rise to that honor.

I believe that I have.

Thank you for taking your time to read this letter.

Thank you for your faith in me.

I look forward to seeing you at the party.

Sincerely,
TIM IOANNIDES, MD