December 7, 2023

Governor DeSantis’ Focus on Florida’s Future Budget Supports Continued Improvements to Public Health and Health Care for Floridians

Governor DeSantis announced his Focus on Florida’s Future Budget, which includes critical investments that support the health of Florida’s communities. The Focus on Florida’s Future Budget demonstrates Governor and First Lady DeSantis’ continued commitment to public health and health care innovation.


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Source: Florida Department of Health

Grappling with Florida's Physician Shortage and the Effect on Health Care Access

A House panel hears a presentation that reported the shortage could affect access to health care if current trends persist, as the supply of physicians could meet only 77% of the projected demand by 2035.


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Source: Health News Florida

Proposal Would Ban Non-Compete Agreement for Doctors

State lawmakers are expected to make health care a top priority when they return to Tallahassee in January for the 2024 legislative session. One proposal would address Florida’s doctor shortage by getting rid of restrictions on where they can practice.


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Source: WCTV.tv

Student-Led Program Bridges Gap Between Homeless and Healthcare

A student-run initiative at Florida State University is making a positive difference in the lives of Tallahassee’s homeless population.


It’s called the Homeless Outreach Medicine and Education (HOME) program and it seeks to provide potentially life-saving medical care and bridge the gap between people experiencing homelessness and healthcare professionals.


READ MORE


Source: FSU College of Medicine/Tallahassee Democrat

Money vs. Principle: Supreme Court Sends Mixed Signals in OxyContin Maker's Bankruptcy

The justices of the U.S. Supreme Court sent mixed signals Monday as they struggled to decide whether to give a thumbs up or thumbs down to the multi-billion dollar Purdue Pharma bankruptcy deal--a deal meant to compensate victims of the highly addictive pain killer OxyContin.


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Source: Health News Florida

Big City Mosquitoes are a Big Problem — and Now a Big Target

About a decade ago, a new kind of mosquito began showing up in African cities. Native to Asia, Anopheles stephensi prefers crowded urban environments over rural ones. That spelled trouble: These mosquitoes transmit malaria.


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Source: Health News Florida

Florida's Physician Workforce in 2023

The Florida Department of Health recently released the 2023 Physician Workforce Annual Report. This report provides information about the state of the physician workforce in Florida, including practice patterns, geographical distributions, Medicare acceptance rates and more. A full copy of the report can be found here. Key findings, taken from the report, are presented below.

 

Key findings include: 

 

Of the physicians renewing their licenses and responding to the survey, 71.82% (56,769) said they were providing direct patient care in Florida. With respect to those physicians:

 

·    Statewide, 35.82% of Florida’s 67 counties have a per capita rate of 10 or fewer physicians per 10,000 population. 

·    Physicians providing direct patient care are generally concentrated in populous counties and within large, urban population centers. Survey results indicated that 98.11% of physicians work in urban counties while 1.89% work in Florida’s 31 rural counties. In all of the rural counties, at least 20% of physicians are primary care providers. 

·    Among physicians, 34.17% (19,396) are age 60 and older (page 10). 

·    For physicians under age 40, the percentage of female physicians is 46.21%. 

·    The top three specialty groups for physicians providing direct patient care in Florida are internal medicine at 28.11% (15,724), family medicine at 14.64% (8,191), and pediatrics at 7.89% (4,413).

·    Primary care physicians account for 31.63% of physicians providing direct patient care. 

·    In Florida, 77.45%(40,132) of physicians practice in an office setting and 20.17%(10,451) practice in a hospital (page 18). 

·    Survey results indicate 75.28% of physicians report they accept patients with Medicare (page 30) and 64.13% report they accept patients with Medicaid. 

·    A total of 9.56% (5,429) of physicians providing direct patient care plan to retire in the next five years.

Just over 2% (1,181) of physicians practice in Florida’s rural counties. Over the last ten years, the number of physicians who have indicated, through the survey, that they provide direct patient care in Florida has increased. However, there was a slight decrease between 2022 and 2023.


Source: Jarrod Fowler, MHA, FMA Director of Healthcare Policy and Innovation

Health Insurers Face Scrutiny Over Claims Denials

UnitedHealthcare (UHC) is facing a class-action lawsuit, which claims the company used artificial intelligence in lieu of medical reviewers to inappropriately deny Medicare Advantage patients access to post-acute treatment. The suit alleges that the AI model has an error rate of around 90%, given that 90% of such denials that are challenged internally or through a judge are reversed. The suit further alleges that UHC utilized this technology knowing that only a small minority of policyholders would appeal their denied claims due to their impaired condition, lack of knowledge, or lack of resources. This story has been covered in detail by multiple outlets, including Ars Technica and StatNews

 

Meanwhile, according to an article published in Fierce Healthcare, the Minnesota attorney general is asking that the Centers for Medicare & Medicaid Services investigate Humana’s Medicare Advantage program for wrongfully denying claims and overcharging subscribers on numerous occasions. 

 

As these stories are unfolding, Politico reports that a bipartisan group of lawmakers is expressing concern that some Medicare Advantage plans may be engaged in unscrupulous practices, such as denying care that traditional Medicare would have covered. Medicare Advantage plans have already come under scrutiny in recent years for having burdensome and potentially problematic prior authorization practices, which many policymakers have been seeking to reform through more oversight, transparency, and guardrails. 

 

The Politico article cites multiple bodies of research that illustrate the problems patients and caregivers can encounter as a result of the prior authorization process. While it remains to be seen whether new regulatory or legislative actions will be taken, momentum for change appears to be building. That said, cost concerns and fierce lobbying by health insurers may influence the scope of any reforms that are enacted.


Source: Jarrod Fowler, MHA, FMA Director of Healthcare Policy and Innovation

UF Health Central Florida Celebrates Major Milestone in Treatment of Atrial Fibrillation

UF Health Central Florida is celebrating the 100th procedure using the latest-generation WATCHMAN FLX™ left atrial appendage closure device. The procedure was performed at UF Health Leesburg Hospital by interventional cardiologist Maria Baldasare, MD.

 

“The WATCHMAN procedure is a way in which we can take people off blood thinners and still protect them from stroke,” Baldasare said. “Patients get a similar benefit as if they were taking an anticoagulant, Eliquis or warfarin for example, but without that bleeding complication that may occur.”

 

UF Health Leesburg Hospital was the first in Lake County to offer the device designed to treat patients who develop a potentially dangerous heart rhythm condition known as atrial fibrillation, or AF. An estimated 7 million Americans are affected by AF — an irregular heartbeat that can feel like a quivering heart. People with AF have a greater risk of stroke than those with normal heart rhythms. 

 

Dr. Baldasare’s patient, Philip Martin, 82, of Summerfield, Fla, received the 100th WATCHMAN device. Martin is a cancer survivor and his own father died from a massive stroke. He was diagnosed with AF last year, at the same time he was diagnosed with cancer and was prescribed a daily blood thinner.

 

UF Health Central Florida interventional cardiologist Maria Baldasare, MD, and her patient, Philip Martin, of Summerfield, Fla. Under Dr. Baldasare’s care, Martin became the 100th UF Health Central Florida patient to receive the WATCHMAN FLXTM left atrial appendage closure device. This safe, minimally invasive implant reduces patients’ risk of stroke, ultimately providing an alternative to lifelong use of blood thinners.“When they mentioned there is something to catch the block clots, that perked my ears up a bit,” said Martin. “I never know when I’m in AF. I asked Dr. Baldasare when am I in AF, and she said, ‘You’re in it right now.’ ”

 

He learned about the WATCHMAN procedure a few months ago and the benefit it provides in not having to take a daily blood thinner.

 

“A lot of our patients, especially those who live in The Villages, are very active,” Dr. Baldasare explained. “They play pickle ball and other activities, and it can be quite hazardous if they’re on a blood thinner. So, from a physician satisfaction standpoint, it is actually gratifying to see them do what they like and not be in fear of falling or having a head bleed for example. For the patient, it’s the ultimate return to their quality of life, especially for Mr. Martin. We don’t have to worry about him bleeding and having to come into the hospital all the time.”

 

The WATCHMAN FLX™ device, built upon the most studied and implanted left atrial appendage closure device in the world, is an alternative to the lifelong use of blood thinners for people with atrial fibrillation that is not caused by a structural heart valve problem (also known as nonvalvular AF). Several UF Health Central Florida cardiologists use the WATCHMAN device, including:

 

·    Sujata Balulad, MD

·    Maria Baldasare, MD

·    Christopher Jones, MD

·    David Lew, MD

·    Satish Goel, MD

·    Srinivas Attanti, MD

 

“UF Health Central Florida is proud to offer a world-class heart and vascular program, which provides immediate access to highly sophisticated treatment options and exceptional care to our patients,” says Heather Long, MSN, chief executive officer at UF Health Central Florida. “We strive to be this region’s premier destination for advanced cardiovascular services and the WATCHMAN FLX™ device provides potentially life-changing stroke risk treatment.” 

 

The device closes off an area of the heart called the left atrial appendage to keep harmful blood clots from entering the bloodstream and potentially causing a stroke. By closing off this area of the heart, the risk of stroke may be reduced and, over time, patients may be able to stop taking blood-thinning medication. The latest-generation technology has a new design aimed at helping to treat patients even more effectively to ensure the best possible long-term outcomes. 

 

“With the WATCHMAN procedure, it won’t change the fact Martin has AF,” said Kathy Hough, RN, structural heart coordinator at UF Health Leesburg Hospital. “He’ll still have AF and the device doesn’t control the heart rhythm, but it will put him at a lower risk for having a stroke. It gives patients the freedom of not having to take an anticoagulant so that they can enjoy life.”

 

The WATCHMAN is a permanent device that does not have to be replaced and can’t be seen outside the body. The procedure to place it is performed under general anesthesia and takes about an hour. Some patients leave the hospital the same day of the procedure. Others spend one or two nights in the hospital. For Martin, the WATCHMAN has improved his quality of life in a short amount of time.

 

“I feel good about it,” said Martin. “A lot of these meds are hard on your kidneys. I feel good anytime you don’t have to take a medication — and I take a lot of medication. But I won’t have to take a blood thinner now. That’s a huge positive for me.”


Source: Special to the FMA from UF Health

Thank You to Our Sponsors of the 2023 CMS Foundation Holiday Auction

Florida CHW Advocacy Day at the Florida Capitol - Tuesday, December 12

CEs that can be used for certification and credential renewal. Join us for an educational day of advocacy! Please share within your networks. Sign up below.

 

If you’re interested, fill out our interest form, by clicking the link: Register HERE and select the informational training session you would like to attend.


To view the policy brief, click here.


For any additional information, please contact flchwcoalition@gmail.com or 850-296-3481.


Source: Florida Community Health Worker Coalition

Doctor of the Day Program for the 2024 Regular Legislative Session

To: All Physicians and Interested Parties,


In anticipation for the 2024 Regular Legislative Session, preparations for this program are underway.

 

You can find information regarding the Doctor of the Day program, as well as the Doctor of the Day application HERE.


Please contact me regarding any questions or concerns.

 

Thank you,

 

Kelly Welborn

Office of Legislative Services

Claude Pepper Building, Room 874

111 West Madison Street

Tallahassee, Florida 32399-1400

(850) 717-0301

welborn.kelly@leg.state.fl.us

DEA Requirement CME Available

The Florida Medical Association (FMA) has announced they will be providing the 8-hour, required DEA continuing education requirement through their CME portal: www.flmedical.org.

 

Here is the clickable link to the FMA site for further information and courses. Sign in is required, membership is not required.

 

Course fees apply: Member $200 / Non-Member $300 for the one-time requirement.

DEA-Registered Practitioners' Training Requirement
On December 29, 2022, the Consolidated Appropriations Act of 2023 enacted a new one-time, eight-hour training requirement for all Drug Enforcement Administration (DEA)-registered practitioners on the treatment and management of patients with opioid or other substance use disorders. Below is information on this new requirement.
 
Who is responsible for satisfying this new training requirement?
 
• All DEA-registered practitioners, with the exception of practitioners that are solely veterinarians.
How will practitioners be asked to report satisfying this new training requirement?
• Beginning on June 27, 2023, practitioners will be required to check a box on their online DEA registration form—regardless of whether a registrant is completing their initial registration application or renewing their registration—affirming that they have completed the new training requirement.
What is the deadline for satisfying this new training requirement?

·    The deadline for satisfying this new training requirement is the date of a practitioner’s next scheduled DEA registration submission—regardless of whether it is an initial registration or a renewal registration—on or after June 27, 2023.
·    This one-time training requirement affirmation will not be a part of future registration renewals.
·    How can practitioners satisfy this new training requirement?
·    There are multiple ways that practitioners can satisfy this new training requirement.
 
• First, the following groups of practitioners are deemed to have satisfied this training:
 
1.Group 1: All practitioners that are board certified in addiction medicine or addiction psychiatry from the American Board of Medical Specialties, the American Board of Addiction Medicine, or the American Osteopathic Association.
2.Group 2: All practitioners that graduated in good standing from a medical (allopathic or osteopathic), dental, physician assistant, or advanced practice nursing school in the United States within five years of June 27, 2023, and successfully completed a comprehensive curriculum that included at least eight hours of training on:
 
·    Treating and managing patients with opioid or other substance use disorders, including the appropriate clinical use of all drugs approved by the Food and Drug Administration for the treatment of a substance use disorder; or
·    Safe pharmacological management of dental pain and screening, brief intervention, and referral for appropriate treatment of patients with or at risk of developing opioid and other substance use disorders.
 
• Second, practitioners can satisfy this training by engaging in a total of eight hours of training on treatment and management of patients with opioid or other substance use disorders from the groups listed below. A few key points related to this training:
 
1.The training does not have to occur in one session. It can be cumulative across multiple sessions that equal eight hours of training.
2.Past trainings on the treatment and management of patients with opioid or other substance use disorders can count towards a practitioner meeting this requirement. In other words, if you received a relevant training from one of the groups listed below— prior to the enactment of this new training obligation on December 29, 2022—that training counts towards the eight-hour requirement.
3.Past DATA-Waived trainings count towards a DEA registrant’s 8-hour training requirement.
4.Trainings can occur in a variety of formats, including classroom settings, seminars at professional society meetings, or virtual offerings.
5. What accredited groups may provide trainings that meet this new requirement?
 
·    The American Society of Addiction Medicine (ASAM)
·    The American Academy of Addiction Psychiatry (AAAP)
·    American Medical Association (AMA)
·    The American Osteopathic Association (AOA), or any organizations accredited by the AOA to provide continuing medical education
·    The American Dental Association (ADA)
·    The American Association of Oral and Maxillofacial Surgeons (AAOMS)
·    The American Psychiatric Association (APA)
·    The American Association of Nurse Practitioners (AANP)
·    The American Academy of Physician Associates (AAPA)
·    The American Nurses Credentialing Center (ANCC)
·    Any other organization accredited by the Accreditation Council for Continuing Medical
Education (AACCME) or the Commission for Continuing Education Provider Recognition (CCEPR), whether directly or through an organization accredited by a State medical society that is recognized by the ACCME or CCEPR
·    Any other organization approved or accredited by the Assistant Secretary for Mental Health and Substance Use, the ACCME, or the CCEPR
 
We hope this information is helpful. For information regarding the DEA Diversion Control Division, please visit www.DEAdiversion.usdoj.gov. If you have any additional questions on this issue, please contact the Diversion Control Division Policy Section at (571) 362-3260.

Sincerely,
Thomas W. Prevoznik
Acting Assistant Administrator Diversion Control Division

Source: U.S Department of Justice Drug Enforcement Administration (DEA)
CMS Foundation Physician Wellness Program is Here for Physicians and TMH Residents

Overloaded? Stressed? You're Not Alone.


Does your workday start before dawn and end well after dusk? Do you go to bed tired and wake up the same way? Maybe it’s time you talk to someone who can help you make positive changes for a healthier, happier life and lifestyle. The CMS has five professional counselors who are available to you - free of charge - free of worry. This program remains one of the few in the state that serves all local practicing physicians and TMH Residents, without cost, without question. Six sessions annually are completely confidential and autonomous. 

 

WELLNESS COACHES: 

Paul Deitchman, Ph.D.
313 Williams St., #5
Tallahassee, FL 32303
850-878-3571
UNIVERSITY: FLORIDA STATE UNIVERSITY
Tracey Morse, Ph.D.
1114 E. Tennessee St.
Tallahassee, FL 32308
850-556-7944 
UNIVERSITY: SOUTHERN ILLINOIS UNIVERSITY – CARBONDALE
Stephen Wright, Ph.D.
313 Williams St., #7
Tallahassee, FL 32303
850-222-3045
UNIVERSITY: FLORIDA STATE UNIVERSITY
SPECIALTY AREA WELLNESS COACHES:
Jane Marks, LFMT, LMHC
3325-C Thomasville Road
Tallahassee, FL 32308
850-385-8222
 UNIVERSITY: FLORIDA STATE UNIVERSITY

For five decades, Jane Marks has helped countless families navigate the challenges in life. As a Licensed Family & Marriage Therapist, she will bring a thoughtful approach to wellness for those seeking individual, family or marriage coaching through the CMS Foundation’s Physician Wellness Program.
Brenda Rabalais, Ph.D.
216 Lake Ella Drive
Tallahassee, FL  32303
850-841-7733 
UNIVERSITY: FLORIDA STATE UNIVERSITY

Brenda Rabalais, Ph.D., specializes in providing counseling services to those who are struggling with a loss or a trauma. Examples include; divorce, abandonment (foster care, adoption, service families), abuse, suicide, homicide, crime, loss of functionality, loss of home or job, long-term illnesses, other life transitions, as well as death. Brenda founded Lee's Place, a grief, loss and trauma counseling center, in 2000 and has been a practicing therapist as well as the Executive Director for those 21 years.
Special thanks to the MagMutual Foundation and the TMH Medical Staff for helping the CMS fund this program.
African-American Alzheimer's Caregivers Training and Support (ACTS 2) Project
Informational Correspondence with the Capital Medical Society
In this digital era, we strive to keep you updated with the latest in information. Please let us know when your emails and contact information change. We want you to be part of this Society and be active in your practice networking. Patients seeking provider referrals and providers seeking provider referrals keep your practice flourishing. If your membership information is old and you would like to contact us about relocating, new staff changes, or if you haven’t heard from us in a while, your information may not be current. Your personal contact information is kept confidential but is our way of reaching out to you about meetings, medical updates, license requirements, legalities in medicine and patient privacy and care, Journals, newsletters and more.
Pam Irwin, Executive Director, 850-559-8611, pirwin@capmed.org
Are You One of our Members on the Move?
If you can answer "yes" to any of these questions, we want to know more!
·    Is your practice expanding? Are you adding staff members?
·    Do you have a new practice administrator/office manager?
·    Have you changed or added locations?
·    Have you changed your email/phone/fax?
·    Have you added a new specialty or passed your Board Certification(s)?
·    Have you retired within the last six months?
 
Send your updates to rcarlin@capmed.org.
Subject line: Member Updates
Updated Physician Headshots
The CMS website is your link to our physician member database. The CMS has been actively working on each provider search. Please take the time to search the listing. If you find there is any inaccurate information or an outdated headshot, please reach out to CMS to update your information. Let us know as soon as possible to make sure your information is current.
CMS | (850) 877-9018 | rcarlin@capmed.org
Advertise in CapMed Today

Electronic Version of December 2023 Cap Scan

Click here to view the December 2023 Cap Scan.

Free Monthly Webinars: "The Business Side of Medicine"
Each webinar is on the third Tuesday of every month at 6:30 PM.

For more information and to register, click here.

Source: MIRZA, Healthcare Law Partners
Medicare Revalidations
Medicare Revalidations are back in full force after a brief pause during the height of the COVID-19 Pandemic. All healthcare providers and suppliers are required to revalidate their Medicare enrollment every 3-5 years per CMS’ request. Medicare has implemented new revalidation screening criteria that you will need to be aware of. Missing this important deadline will have significant financial consequences on your medical practice! This link is to a tool to a searchable database that allows you to look up the revalidation due date for Medicare providers who must revalidate their enrollment record information every three or five years.

Your Dose of Medical Humor

Save the Date for Upcoming CMS Meetings/Events

Friday, December 8, 2023


CMS Foundation Holiday Auction


6:00 pm


Dunlap Champions Club at FSU

Here's Another Connection for CMS Members: Healthcare Lawyer On Call
The CMS has had a long-standing relationship with Jeff Cohen and The Florida Healthcare Law Firm. Did you know that you can tap into a program called Healthcare Lawyer On Call through Jeff and his firm? That's right! On-Call is different than what you may be used to and doesn't mean that you'll find an attorney at 3 AM to answer a question, but what it does mean is that you can call and speak with someone at The Florida Healthcare Law Firm for 15 minutes at no charge! Please remember that any purely verbal discussion on legal matters is simply the lawyer’s best (and unconfirmed) understanding. Another benefit of being a CMS member!
CME Resources

Accredited Education Courses to Meet DEA Training Requirement

The Doctors Company offers 6.75 hrs. that meet the DEA requirement for free. These hours can be combined with previous opioid education the physician may have completed to achieve the 8 hr. requirement. This, and all The Doctors Company CME, is available for free to any physician. They do not have to be a The Doctors Company insured.

https://www.thedoctors.com/patient-safety/education-and-cme/accredited-education-courses-to-meet-dea-training-requirement/


FreeCME.com 

Easy to use web portal makes it easy to find courses and track credits. Accredited activities for over 30 medical specialties; Over 100 active courses at any given time; Activity accreditations include ACCME, ANCC, AANP, ACPE, and more; Content is always current, and always free.


CME - From Brain Disorders to Brain Health

Free 1-hour online CME opportunity!

University of Florida's Department of Epidemiology

Raising awareness for Alzheimer's disease and increasing screening for cognitive impairment. This CME has a focus on primary care physicians but is applicable to all physicians who may encounter patients with cognitive impairments.


On-Demand CME by The Doctors Company

Prevention of Diagnostic Error in Primary Care

Diagnostic error continues to be a top patient safety concern, a global burden, and cause patient harm from treatment delay, testing, or misdiagnosis. “Prevention of Diagnostic Error in Primary Care” is an on-demand CME activity that features patient safety expert Jeffrey A. Gold, MD, professor of medicine, vice chair for quality and safety, for the department of medicine at the Oregon Health and Science University. This program highlights major contributing factors of diagnostic error along with the diagnostic process of care framework with additional focus on strategies to mitigate risk of patient harm in the primary care setting.


On-Demand CME by The Doctors Company

Telemedicine to Telehealth: Trends and Emerging Risks

1.25 AMA PRA Category 1 Credits™

Explore the challenges and risks associated with telehealth. Concerns regarding privacy, security, licensure, and technology that might instigate a malpractice claim are discussed.


On-Demand CME by The Doctors Company

Safe Opioid Prescribing for Physicians and Dentists

2.5 AMA PRA Category 1 Credits or 2.5 ADA CE Credits

Opioids play an important role in pain management—both in acute and chronic care settings—but overuse, misuse, and diversion have contributed to an opioid-related epidemic leading to addiction and death. Our on-demand program provides a useful and informative examination of the epidemic’s prevalence and effects.

National Human Trafficking Hotline
If you suspect human trafficking, please call:
  
National Human Trafficking Hotline
1 (888) 373-7888
Suicide Prevention Hotline
Reach the National Suicide Prevention Lifeline and Veterans Crisis Line by Phone and Text

By Phone:
Call 1-800-273-8255 to reach the National Suicide Prevention Lifeline today. 988 is not a nationwide calling code right now.
Veterans should Press 1 to be connected with the Veterans Crisis Line.

By Text:
The National Suicide Prevention Lifeline is also available today through online chats. 988 is not a nationwide texting code right now.
Service members, Veterans, and their families can reach the Veterans Crisis Line by texting 838255, and through online chats at veteranscrisisline.net.


Source: Federal Communications Commission
PAP Machine Donations Needed!
A PAP (Positive Airway Pressure) machine is an electronic respiratory ventilation device used to treat obstructive sleep apnea. Capital Medical Society Foundation, Inc.'s We Care Network program assists low-income, uninsured adults, whose income is at or below 150% of the Federal Poverty Level, with obtaining these potentially life-saving medical devices, when prescribed by a pulmonologist. Thanks to our partners at Desloge Home Oxygen and Medical Equipment, Inc., we are able to provide refurbished CPAP, AutoPAP, and BPAP machines for eligible We Care Network patients in Leon, Gadsden, Jefferson, and Wakulla Counties. We Care Network also accepts unused, unopened supplies for PAP machines, such as masks, nasal cannulas, and tubing. We Care Network coordinates over $5,000,000 in donated specialty medical and dental care annually.
 
Machine donations can be dropped off at Capital Medical Society Foundation's office at 1204 Miccosukee Road, Tallahassee, FL 32308. Donations to Capital Medical Society Foundation are tax-deductible within IRS guidelines Federal Tax I.D. #: 59-2104510. For additional information, please call 850-942-5215 or email dbixler@capmed.org.
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