Doctor's Life Magazine Vol. 4 Issue 2, 2016

Look Who’s Joined BayCare Medical Group Mahesh Amin, MD Cardiology 1107 S. Myrtle Ave. Clearwater (727) 441-8663

Jay Harvey, MD Pediatrics 3012 Starkey Blvd.

Trinity (727) 645-6941

Rafael Quinones, MD General Surgery 4729 U.S. Highway 98 S. Suite 101 Lakeland (863) 701-2053

Thomas Applegate, MD Hospitalist 6901 Simmons Loop Riverview (813) 302-8388

Carlos Lamoutte, MD Obstetrics and Gynecology 1601 W. Timberlane Drive, Suite 400 Plant City (813) 321-6677

Saihari Sadanandan, MD Cardiology 2814 W. Virginia Ave. Tampa (813) 875-9000

Roxann Cook, DO Family Medicine 619 Midflorida Drive Suite 1 Lakeland (863) 701-7188

Karl Metzger, MD Hospitalist 6600 Madison St. New Port Richey (727) 815-7207

Rakesh Sharma, MD Cardiology 455 Pinellas St. Suite 330 Clearwater (727) 724-8611

Hassan Ebrahim, MD Hematology and Oncology 200 Ave. F N.E. Winter Haven (863) 292-4670

Latha Pillai, MD Internal Medicine 4211 Van Dyke Road Suite 101B Lutz (813) 960-4026

Stanley Shrom, MD Urology 4729 U.S. Highway 98 S. Suite 101 Lakeland (863) 646-5789

Svetlana Enman, DO Internal Medicine 400 Pinellas St. Suite 350 Clearwater (727) 462-3696

Eugenio Quinones, MD Obstetrics and Gynecology 1601 W. Timberlane Drive, Suite 400 Plant City (813) 321-6677

Ana M. Verdeja, MD Obstetrics and Gynecology 1601 W. Timberlane Drive, Suite 400 Plant City (813) 321-6677

Learn about employment opportunities with BayCare Medical Group. Contact a recruiter: (813) 636-2009

BC1601824-0416

BayCareMedicalGroup.org

“ My patients need help.

I see them struggling with losing weight and trying to change a lifetime of habits. I’d like to provide them with medical nutrition therapy, but my office is stretched to its limits. I have to find someone who can help them achieve their health goals.”

PUBLIX DIETITIAN SERVICES Help is here. Medical nutrition therapy services from licensed, registered dietitian nutritionists are now available at four convenient Publix locations across the Tampa Bay area.

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Visit publix.com/dietitianservices today for details about how Publix can serve as a valuable extension of your healthcare team.

Publix dietitian in Palm Harbor Anastasia Kyriakopoulos, RDN, LDN (727) 785-1526 Dietitian.1341@publix.com

Publix dietitian in St. Petersburg Megan Rose, RDN, LDN (727) 821-7568 Dietitian.0640@publix.com

Publix dietitian in Wesley Chapel Holly Long, RDN, LDN (813) 973-4295 Dietitian.0006@publix.com

Publix dietitian in Riverview Jamie Stolarz, MS, RDN, LDN (813) 684-3039 Dietitian.0890@publix.com

Contents

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Okyanos Stem Cell Therapy The challenges of today’s healthcare model precipitate a discussion on how we move beyond on drugs and devices.

Integrative Holistic Medicine Treating the patient not just the symptom.

4

From the Publisher

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Feature Integrative Holistic Medicine

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Feature Understanding You...

Before the Numbers

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Feature Okyanos Stem Cell Therapy is Making a Difference

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Feature David & Goliath

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Feature 4 Considerations Before Implementing Telemedicine

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Food for Thought Backyard bounty: Vegetables are nature's original nutritional powerhouses

Advertisers BayCare Medical Group 2 The Meridian Club 21 JW Marriott 23 Okyanos Cell Therapy 5 PNC Bank 24 Point Grace 11 Publix 3 Suncoast Advisory Group 7 Tampa Bay Radiation Oncology 13

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4 Considerations Before Implementing Telemedicine

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20

Food for Thought Doctor’s Life Tampa Bay

Issue 2, 2016

The future of medicine is an option, today.

Cell Therapy has emerged as a promising new option for the millions of patients who live with debilitating symptoms of chronic, degenerative conditions.

Okyanos Cell Therapy utilizes adult stem cells from

CELL THERAPY

patients’ own body fat which have the ability to decrease inflammation and pain, repair damaged tissue, improve blood flow and modulate abnormal immune response.

Our facility is built to and operated in accordance with U.S. Surgical Center standards, located in Freeport on Grand Bahama Island where we are

Request a complimentary consultation, or contact us to learn more about opportunities for physician collaboration.

855-OKYANOS (659-2667)

www.okyanos.com

fully licensed and regulated by the National Stem Cell Ethics Committee (NSEC) of The Bahamas.

www.okyanos.com | 855-OKYANOS (659-2667) | info@okyanos.com First Commercial Centre | East Mall Drive | PO Box F42476 | Freeport, GB, The Bahamas | 242.352.6520

From the Publisher

S

www.doctorslifetampabay.com

tem cells have the ability to develop into many different cell types in the body during early life and growth. In many tissues, they act as an internal repair system.

They are the core building blocks of organs, tissue, blood and the immune system. The history of stem cell research dates back to the 1950s. Since then researchers from around the world have pursued the science and opened the discussion of using them to repair damaged tissue or create new organs, but such medical applications have also attracted controversy.

The FDA has released specific guidelines on stem cell-based therapies. In the United States, cell therapy must be with an approved study under Investigational New Drug (IND) approval.

In this issue of Doctor's Life, we met with the physicians, leadership and patients behind Okyanos Cell Therapy and discovered remarkable outcomes. On August 7, 2013, The Bahamian Parliament passed legislation allowing and regulating the use of patients’ own stem cells for treatment.

Okyanos is fully licensed to operate by the National Stem Cell Ethics Committee (NSEC) of The Bahamas, and regulated under the Stem Cell Research and Therapy Act of 2013.

Dr. Deepa Verma, double board certified in family medicine and integrative holistic medicine, author and guest physician on the NBC Daytime show and Bay News 9, provides her opinion and facts regarding integrative medicine and why it is the standard in her practice. Rick Helbing CFP, ChFC is back and breaking down the truth behind our DNA behavior and how it affects our financial future and strategy. Additionally, DLM explores the considerations before implementing telemedicine and why physicians are teaming up, joining forces or better known as IPA's and no they are not starting beer distilleries.

Independent Practice Associations (IPA) are becoming a method to survive the modern healthcare market.

I hope you enjoy this issue as much as the DLM team did in creating it. As always, thank you for your readership and have a great summer.

TAMPA BAY

Tampa Headquarters 1208 East Kennedy Blvd.

Tampa Fl, 33602 813-419-7788 Group Publisher Ed Suyak publisher@doctorslifetampabay.com Creative Director Rob Stainback Editorial Director Danielle Topper Associate Publisher CJ Cooper Advertising Account Executive Ryan O’Neil Contributing Writers Dr. Deepa Verma MD, ABIHM Nick Hernandez Rick O. Helbing CFP, ChFC

Be well,

-Ed Ed Suyak Group Publisher publisher@doctorslifetampabay.com

™

Doctor’s Life Magazine, Tampa Bay is always seeking events, stories and remarkable physicians. Please email the publisher if you have an event, an editorial idea or you know of a doctor or dentist who may have done something extraordinary. We want your suggestions and feedback. publisher@doctorslifetampabay.com Doctor’s Life Magazine, Tampa Bay does not assume responsibility for the advertisements, nor any representation made therein, nor the quality or deliverability of the products themselves. Reproduction of articles and photographs, in whole or in part, contained herein is prohibited without expressed written consent of the publisher, with the exception of reprinting for news media use. Printed in the United States of America.

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Issue 2, 2016

Serving PhySicianS for over 25 years and named among

THE BEsT Financial advisErs For docTors by medical economicS magazine for *

FivE yEars in a row, Rick O. Helbing cFP, chFc 941.375.7320

www.suncoastadvisorygroup.com *based on credentials, educational background, experience, size of the firm, minimum portfolio requirements and noteworthy professional achievements. See www.medicaleconomics.com.

Investment advice and advisory services offered through Suncoast Advisory Group, a Registered Investment Advisor

c i t s i l o H

Integrative Treating the patient not just the symptom

Medicine H

By Deepa Verma, MD, ABIHM

ealthcare in America is indeed changing. While Americans feel pressured to carry insurance to have services and pharmaceuticals covered, insurance sadly does not support preventative health. In other words, healthcare these days seems to be more reactive than proactive, unfortunately. And that is not a good thing. Essentially, people are not told to take control of their health and made to believe to only go to the doctor only when there is something wrong.

The paradigm in healthcare is slowly shifting. What we see now is more of a new age medicine. But alas, this new age medicine is actually centuries old. Whether we call it holistic medicine, a term derived from the Greek word halos, which means whole OR integrative functional medicine which has its roots in arguably the most ancient and intricate medicinal system in the world, Ayurveda, translated to Science of Life....this is the wave of the future.

For the purpose of this article and to make it simple, I will refer to preventative/holistic medicine as integrative medicine. And I will refer to Westernized/conventional medicine as traditional medicine.

Integrative medicine stresses the synergy of mind, body, and spirit, where everything in the body is dependent upon each other. All the symptoms, whether it be a mental manifestation or physical one, are intricately tied to other imbalances in the body, anywhere in the body. Traditional medicine tends to separate each body system and not emphasize that everything in the body is connected at all levels, from micro to macrocellular.

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When patients are sick and tired of feeling tired and sick, they search for more answers. Unfortunately, traditional medicine has shortcomings and restraints whether it be insurance or just the general philosophy of treating the disease and numbers, and not the patient. The principles of integrative medicine are as follows: • recognition that good medicine should be based on good science, inquiry driven and open to new paradigms • use of natural and effective and less invasive interventions WHENEVER possible • a partnership between the patient and physician or practitioner before, during and after the healing process • consideration of all factors that influence health, wellness and disease • emphasis on the mind, body, spirit connection • a philosophy that neither rejects traditional medicine nor uncritically accepts alternative/non-pharma therapies • use of broader concepts for the promotion of health and the prevention of illness as well as the treatment of existing disease • training of physicians/practitioners to be models of health and healing committed to the process of selfexploration and self-discovery • appropriate use of traditional AND integrative methods to facilitate the body's innate healing response While traditional medicine not only overlooks how all body systems function and intermingles with one another, it also focuses merely on the elimination of symptoms.

Integrative medicine promotes optimal health, and if disease, including cancer, exists, it strives to treat the root cause of the disease process. It is quite simple. The body likes to be at peace. Any unrest will cause it to retaliate.

When it does so, different mental and physical issues become apparent.

There are a time and place for pharma drugs and surgical intervention of course, and integrative medicine recognizes that. But what integrative medicine strives to do is to empower patients to be proactive about their mental and physical wellness while teaching them to address the various causes of their disease(s) as they are facilitating lifestyle Issue 2, 2016

changes which can include detoxification, weight loss, dietary changes, implementation of exercise, stress reduction, etc. And all these lifestyle changes will be successful when the proper testing is completed, and the root issues are identified and worked upon. ny disease, cancer, mental or physical ailment, can be addressed through integrative medicine and nutraceuticals. Nutraceuticals are the natural supplements such as vitamins, minerals, adaptogens, herbs, bioidentical hormones. Pharmaceuticals are man-made, synthetic chemical substances that are prescribed for various diseases. They tend to have several adverse effects, whether they are short-term or long-term. While pharmaceuticals are certainly justified in certain conditions, they should not be relied upon chronically as they create sick customers, not cures. For example, recent research has shown that proton pump inhibitors (PPIs) are implicated in kidney disease. These include medications such as Prilosec or Nexium. Instead of taking a pill to "cure" heartburn, which is a fallacy, investigate the root cause of the heartburn.

There could be several problems which need to be evaluated and narrowed down. Because what's the real answer? Starting the PPI and developing some adverse side effects from that and then taking another pharma drug to treat those adverse side effects which then cause additional negative effects...get the gist?

America, unfortunately, has diseases that are generally completely preventable with a healthy lifestyle. America, in fact, ranks as one of the top most obese countries in the world with some of the unhealthiest population in the world. Metabolic diseases such as obesity, diabetes, heart disease are skyrocketing.

Cancer rates and diagnoses are rising faster than we have seen. For a country that loves its dairy consumption, how is that we have one of the highest rates in osteoporosis? I always recommend patients to watch health documentaries and one of the best to date is Forks Over Knives. The message is clear and straightforward. The documentary outlines why America has the highest rates of the aforementioned disease processes, and the results are enlightening.

What are common issues patients present with to integrative/functional doctors? First of all, their initial complaint is that they are at their wits end with traditional doctors and treatment. Ironically, I am a traditional MD by training, right here in the States. And definitely proud to be one! What started bothering me as

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Doctor’s Life Tampa Bay

a family physician was that I only saw patients getting sicker as I wrote more pharma Rx, and I could not deal with not having enough time to spend with them at the office visit, as 1520 minutes is not sufficient. Sorry, insurance companies, news flash! I also do not live my life that way. I am proactive and always strive to better than I have ever been, creating a healthier and happier version of my existence day by day.

As a single mother of three boys, I live my life to the fullest, and health & wellness are on top of the list. Being of Eastern-Indian origin, Ayurveda flows through my veins. Ironically, I was born and raised in America and am very Americanized. But I think that Ayurveda was innate, and I relish that. I can quickly grasp how to use nature and the healing propensity of the body to promote optimal wellness and fitness. A few years ago, I opened up a cashbased private integrative practice and fulfilled my passion for helping people who continue to struggle with disease processes and even cancer. As an integrative doctor, I put on my traditional hat when need be.

Apologies for the sidebar. Getting back to the issues that patients present with to integrative physicians, they include weight gain, fatigue, leaky gut, hormonal imbalance, insomnia, adrenal fatigue, loss of libido, depression, diabetes, elevated cholesterol, joint pains, cancer, promotion of existing wellness and the list goes on. Through innovative and indepth testing, IV therapies, nutraceuticals, hormone balancing, a hypobaric chamber, issues that patients never knew they had are finally brought to light. While addressing adrenal fatigue, gut disorders, micronutrient deficiencies, autoimmune diseases, metabolic diseases, and showing patients how all these are intertwined, a regimen can be set forth. I always tell my patients that the road to optimal health and aging is slow and gradual. It is a perpetual evolution, to always become better, so patience is required. No instant gratification expectations allowed, as those type of results are unhealthy and more importantly nonsustainable.

My opinion is that Integrative Medicine is on the forefront and is here to stay and propagate. Patients, people, everyone just wants to feel better. It is never too early or too late to start on the journey to health, wellness and fitness. It is not about being or feeling better than someone else; it is about being and feeling better than YOU have ever been. For more information visit www. drdeepaverma.com.

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Understanding You… Before the Numbers

By Rick O. Helbing, CFP, ChFC

Are you Sabotaging your Decision Making Process?

A

ccording to Hugh Massie, founder of DNA Behavior International, his research and experience shows that the best means of creating wealth is to understand yourself and behavioral biases and then create a financial and life strategy suited to your complete financial personality-or your Behavioral DNA. Discovering your Behavioral DNA will assist in guiding you to more confidently make committed life and financial choices by improving and enhancing relationships, quality of life and financial performance.

Behavioral DNA is based on the belief that your financial advisor should “understand you before numbers.” There are four profiles you complete to gain insight into your learned versus natural behavior, your strengths and struggles based on behavioral biases and your true core drivers that will assist in improving your decision making process.

The four profiles are Communication DNA, Natural Behavior DNA, Quality of Life Discovery and Financial Personality DNA. Why do some physicians repeatedly lose wealth and others continue to accumulate

wealth? When the markets decline, the economy is weak, your practice may be losing patients, your revenues are declining, you naturally become stressed and your decision making process will be driven by your Behavioral DNA and biases. Understanding these biases and the four profiles of your Behavioral DNA will assist you in managing your emotions and improve your decision making process and quality of life.

Behavioral psychologists have long understood that people are not entirely rational. We are influenced by a range of factors, from emotion to cognitive biases, which make a less rational choice seem more appealing. You probably have experienced a patient who is overweight, with high blood pressure, and other potential chronic issues. You provide excellent medical advice with a strategy to lose weight, exercise, and eat healthy. On their next visit to your office, this same patient expresses displeasure because their back constantly hurts, their knees are sore, and they’re having breathing issues when climbing stairs. Sound familiar? The less rational choice seems more appealing.

WHILE SAVING YOU 15 HOURS A WEEK

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Doctor’s Life Tampa Bay

Issue 2, 2016

Ad

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One Heart Magazine

www.heartbeatsaveslives.org

Discovering your Behavioral DNA will assist in rational choices by helping you discover: • Your natural behavior under stress and how to uniquely respond to life and financial events.

• A strategy for wealth creation through managing your emotional responses to events you cannot control.

• How to build the quality of life you have always dreamed about through self- awareness and improved confidence.

According to the Leavey School of Business at Santa Clara University, 94.6% of wealth creation comes from your behavior and personal decision making and 5.4% from investment return.

“Money cannot buy peace of mind. It cannot heal ruptured relationships or build meaning into a life that has none.”

Rick O. Helbing, CFP®, ChFC® is a financial life advisor for Suncoast Advisory Group. Recognized by Medical Economics Magazine The 150 Best Financial Advisors for Doctors in 20092010-2011-2012-2013* Suncoast Advisory Group is located in Sarasota, Florida. Mr. Helbing can be reached by email at rick@ suncoastadvisorygroup.com or phone at 941-375-7320.

Investment advisory services provided through Partnervest Advisory Services, LLC, Registered Investment Advisor, with Financial Life Planning and Insurance services offered through Suncoast Advisory Group. *Based on credentials, educational background, experience, size of the firm, minimum portfolio requirements and noteworthy professional achievements. See www.medicaleconomics.com. Third-party recognition from publications does not guarantee future investment success. Working with a highly-rated adviser does not ensure that a client or prospective client will experience a higher level of performance. This recognition should not be construed as an endorsement of the adviser by any client nor is it representative of any one client’s evaluation.

– Richard M. DeVos

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Issue 2, 2016

OKYANOS Y

ou may have heard the phrase and likely see it in your practice— patients today are living longer, but not necessarily better lives.

In fact, research estimates that 75% of today’s American population over the age of 65 is living with two or more chronic conditions. Although medical pioneers before us have innovated life-saving surgeries, drugs, and devices for those patients who otherwise would have died, a significant number of patients today are living with debilitating pain or loss of function even after receiving the available standard(s) of care.

The challenges of today’s healthcare model precipitate a discussion on how we move beyond a dependence on drugs and devices to fix issues the body natively understands how to repair on a cellular level.

The Cycle of Disease— Complications of the Pharmaceutical Model The importance of a multi-faceted strategy in managing the cycle of disease becomes unmistakably clear when you understand first how early inflammation and abnormal 14

Stem Cell Therapy is Making a Difference immune response can lead to ischemia, tissue degeneration, and cell death.

“Despite the many complex factors we deal with in treating chronic, degenerative conditions, it is routine to resort to the pharmaceutical model: one chemical, molecule or cell type with a single dominant mechanism to address the primary factor in a disease,” says Moira T. Dolan, MD Internist and Patient Consultant at Okyanos Cell Therapy, an adult stem cell treatment facility located in Freeport, Grand Bahama.

“It’s not a sustainable methodology and doesn’t account for the inevitable coDoctor’s Life Tampa Bay

morbidities, adverse drug effects, drugdrug interactions and other complications.”

Take for example a patient such as Patsy, who at age 72 was diagnosed with congestive heart failure (CHF). Following a regimen of medication, an implanted device, and invasive bypass surgery, she soon found herself facing heart transplant—a treacherous prospect at her age.

“You lose hope. The drugs aren’t helping, and you think—what am I going to do?” says Patsy, who sought the expertise of 12 different cardiologists, followed the standard cardiac intervention protocols Issue 2, 2016

and watched her condition steadily worsen.

Having been told that her only option would be a full heart transplant and yet being too old by some transplant candidacy standards, she felt hopeless.

Patsy’s heart health continued to deteriorate until she had an ejection fraction* of 19% and even the most basic day-to-day tasks were becoming impossible. “You get to a point with a body where you push and push and run out of energy. That’s not really life to me,” she adds. *Ejection Fraction refers to the percentage of blood which leaves the heart each time it pumps. It is a measure of how effectively your heart is functioning as a pump. EF numbers in healthy adults can range from 50-70%.

Patsy then contacted Okyanos to see if she was a candidate for adult stem cell therapy—a procedure which would isolate the reparative stem and regenerative cells from her own adipose (fat) tissue for reinfusion directly into and around areas of dead or damaged heart muscle. She opted to move forward with the minimally invasive procedure, which offers patients like Patsy and the millions of others with chronic, degenerative cardiac, orthopedic, neurologic or autoimmune conditions the hope of a more normal life. Today Patsy has resumed a full work schedule; her blood pressure has improved, and her ejection fraction is now at 32%.

The Proven Mechanisms of Stem Cells: Separating the Potential from the Panacea Published research including clinical trials which focus on stem cells number more than 250,000. More specifically, recent research has honed in on the safety and efficacy of using adipose-derived stem and regenerative cells (ADRCs) to treat a variety of complex, unmet healthcare needs.

Dr. Eric Duckers, MD, PhD, FESC, FACC works to advance the science behind treatments done at Okyanos as the center’s Medical Advisory Council Chairman, having served as an investigator in multiple clinical trials observing the reparative mechanisms of ADRCs. “Our observations in both clinical and research settings have repeatedly shown the ability of these cells to reverse scar, restore blood flow and address immune response on a systemic level as well as repair or replace damaged tissue in the heart and elsewhere in the body,” says Issue 2, 2016

Dr. Duckers. “These multi-potent cells are unique to each patient and open the door to treatment opportunities where patients currently have none.”

In truth, not all patients are like Patsy— rather, they may not have exhausted all their options or be facing death. Some are simply are not comfortable with the prospect of joint replacement or other invasive options which could compromise quality of the life which remains for them.

For example, Jake’s mobility was limited by severe knee pain as a result of osteoarthritis (OA) even after knee surgery to repair his meniscus. A lover of Olympic weightlifting, skiing and playing pickleball, at 72 Jake decided to take a proactive approach to preserving his active lifestyle by researching non-surgical alternatives to knee replacement surgery.

“I’m at the age where a lot of people get knee replacements and if I was going to continue to play I wanted to make sure that didn’t happen.” Jake traveled to Okyanos for direct stem cell injection into his knee as well as a systemic infusion to target other underlying inflammatory factors associated with OA. "After eight weeks I felt very comfortable walking around—I felt like I was walking on velvet. That to me was when I felt it was really working," recalls Jake, who now is more than 1-year post-op and has resumed his full exercise regimen and active lifestyle.

“Adipose derived stem cells have a fascinating ability to differentiate into, bone and cartilage just like bone marrow-derived stem cells do,” comments Dr. Dolan. “The advantage of working with the patient’s body fat is that we are able to obtain a much greater number of cells in a higher concentration than can be obtained if we were working with bone marrow.”

“As advocates for patient health, the most important job we have as medical professionals is to responsibly advise what options truly exist for the condition at hand,” she adds. “While cell therapy is not appropriate for every condition, factually patients who come to us with multiple comorbidities tend to do very well with the treatment because of capitalization on the multiple mechanisms of stem cells. Many of the patients I talk to are facing grave health concerns for which they have been told there are no more options. I am overjoyed when I can tell a patient, ‘This is an option for you.' We are not in the business of Doctor’s Life Tampa Bay

FDA Position on Stem Cell-Based Therapies According to explicit FDA guidance: 1.

Liposuctioned fat which has gone through a cell-separating machine is “more than minimally manipulated,” and thus it is categorized it as a regulated biologic drug.

2.

Any substance put to nonhomologous use is a regulated biologic drug (i.e. cells from fat used to treat a lung condition.)

The only exception is cell therapy within an approved study under an (IND) approval.

The defense offered for disregarding these rules is that cell therapy physicians are exercising their right to practice medicine, something they feel the FDA is not authorized to interfere with.

However, the authority of the FDA to regulate therapeutic substances is well established by Federal law.

One could argue that the FDA is in the wrong to deprive Americans of these treatments. Given that the FDA is the country’s regulatory authority, one must wonder what else a clinic is willing to do besides practice in frank violation of these rules.

accepting patients who we do not feel we can help, however, or for whom we cannot provide a scientific rationale that stem cell treatment could produce a benefit.”

The Future of Medicine, Today What clinicians struggle with today is experienced by patients in an amplified way: A lack of options and certainly no shortage of healthcare needs, particularly for those with co-morbidities. Yet stem cell therapy takes advantage of the remarkably potent reservoir of untapped potential within the most unlikely of places: body fat.

Tapping into the body’s natural repair mechanisms, a new phase in the evolution of medicine is upon us, wherein patients have options not previously thought possible.

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&

David

Goliath

Individual Physicians are Teaming Up I to Survive in the Modern Healthcare Market

n today’s medical market, natural selection is at an all time high. The demands and costs for physicians in private practice have skyrocketed since the 2010 signing of the Affordable Care Act. They are being pressured to use information technology, such as new electronic health record systems, and other new resources to improve patients’ wellbeing. However beneficial these resources may be, they are extremely costly. Because of this, more and more doctors are choosing to band together in Independent Practice Associations, better known as IPAs. Essentially, an IPA is a network of physicians who remain independent, but agree to work together to contract with HMO’s or other managed care plans to improve the quality of care they provide.

These collaborations can be advantageous for physicians, patients and the community at large. However, they also have their drawbacks.

Perhaps most importantly, IPAs allow physicians to retain both their autonomy and their independence. Through IPA membership, physicians can avoid selling their practices to hospitals or larger groups.

Instead, the physicians are essentially investing in their own futures. By joining an IPA, physicians can still keep their

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independent practice, but put the focus back on patients and away from regulatory business and insurance paperwork.

Working as a team provides IPA members with access to insurance contracts and enables them to meet government mandates, which may not be possible on their own. Through collaboration, IPA members pool their financial resources, which enables them to purchase and utilize better practice management systems as well as electronic health records. This allows members to reduce risk while also engaging in opportunities available to larger groups.

Further, IPAs have the financial means to hire a more adept staff, with specialized Issue 2, 2016

By trimming administration costs, physicians have more time and resources to focus on patient care.

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skills in practice management. This can improve the quality of reporting, ease the burden of call and increase appointment availability.

Physicians also find that IPA’s can help them negotiate tough insurance contracts, and receive payment for services that they would otherwise not be reimbursed for. Insurance companies often give more credence to a claim when they already have a relationship with the IPA. It can be a strength in numbers situation.

Patients can also stand to benefit when individual physicians join together. By trimming administration costs, physicians have more time and resources to focus on patient care. It often means better health Doctor’s Doctor’s Life Life Tampa Tampa Bay Bay

record systems, more qualified staff and also shorter wait times. By cultivating an environment of alliance, everyone ends up working for a common goal, and patient care can truly be the primary focus.

“Our physician network is committed to providing high quality, cost effective care to our patients to achieve improved results and patient satisfaction,” said Mona Boghdadi, M.D., president of TBIH and president of University Community Independent Practice Association (UCIPA). “Our goal is to reduce hospital readmissions, eliminate unnecessary emergency room visits, and eliminate duplication of services. Our team is committed to support our patients towards better health and we will strive to minimize costs by sharing information and meeting superior targets.”

While they are certainly gaining traction, not all IPAs are created equal, and not all physicians find IPAs to be a good fit. There are many things to consider before joining, and they are not without their drawbacks.

A majority of IPA’s, for example, encompass all specialties. Because of this, some specialists may find difficulty in getting the full support they require.

“Sometimes hospital systems don’t see the benefit of an individual practice area for the entire hospital system. This leaves those specialties with minimal control and autonomy. When the IPA is specialtyspecific, you are better able to focus on contracting, investing into equipment and finding the necessary resources for your practice because you are all focusing on the same specialty,” said Miguel Rivera, M.D., of Select Physicians Alliance.

Another notable concern is whether the IPA has a sufficient and experienced management team in place. Experienced leaders, a sound Board of Directors and a well-equipped staff are vital to IPA success.

Information technology is an ever-changing and complex territory and IPA membership does not negate the requirement of administrative tasks.

For those reasons, experts suggest that physicians use due diligence prior to signing up for an IPA. It is important to understand how the IPA is representing the physician. What is the IPA’s relationship with local hospitals? How are they meeting solvency standards? Who is in charge?

Physicians cannot be shy about asking these questions.

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4

Considerations

By Rick O. Helbing, CFP, ChFC

There is no such thing as a standard telemedicine program.

Consequently, it is extremely important to develop a strategic plan first.

M

any practices are hearing about telemedicine and becoming increasingly interested in how such a program could be implemented in their operations. Physicians want to start a telemedicine program quickly. Practice managers don't want to learn by trial and error.

The biggest issue I see by far is that practices immediately focus on the technology.

This often leads to two problems: they either become overwhelmed by the plethora of options available and end up not pursuing telemedicine, or they choose poorly and the technology quickly becomes unused. Consequently, I tell clients to ignore the technology that is available for starters. There are many more important things to consider in order to have a successful telemedicine program, and you will then be less likely to overspend or purchase equipment you don't need or can't use. Here are four items practices should carefully weigh before jumping into telemedicine by purchasing technology first.

1. Legal requirements Because of the way telemedicine adoption is currently happening in the United States, practices must look into a host of legal requirements, especially as the requirements pertain to applicable state law. Although there are some exceptions, physicians usually must be licensed in the state where the treatment or diagnosis is being provided. Many malpractice insurers will now cover telemedicine, but that conversation must be had with

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Before Implementing Telemedicine your particular carrier so they can look at the various risks involved. As with other areas of healthcare, privacy, consent, and regulatory compliance must be thoroughly evaluated by a healthcare attorney.

Additionally, I would strongly suggest that your proposed telemedicine program be reviewed by a telemedicine consultant and healthcare attorney to ensure it is vetted for potential fraud and abuse.

2. Reimbursement assessment Currently, reimbursement (governmental and commercial) continues to be a barrier to telemedicine adoption in some (but not all) states. The type of telemedicine services you are proposing as well as the type of setting needs to be examined through the lens of the state(s) where services will be rendered, as well as the Issue 2, 2016

portfolio of applicable payers. Even though there may be restrictions that affect billing practices (and thus reimbursement), there are ways to get "paid" (e.g. subscriptions, etc.) for telemedicine services in lieu of reimbursement.

3. Market analysis Telemedicine has many applications and uses, so a first task is to determine what the needs of your patients are and how telemedicine could address them. This step is a very detail-oriented process which will help identify potential telemedicine opportunities. A qualified consultant will help educate you about telemedicine technology applications which may apply to your potential goals, as well as educate you about predictors of success and best practices.

Doctor’s Life Tampa Bay

4. Feasibility study The implementation of telemedicine services to your existing practice will certainly impact your operations. Some items to consider are the time you could save by implementing telemedicine, how you expect the telemedicine program to tie into your regular in-person practice, and what type of clinic hours you will devote to telemedicine.

There is no such thing as a standard telemedicine program. Consequently, it is extremely important to take the time to develop a telemedicine strategic plan first, as there are many nuances to consider as they relate to your particular practice. Hiring a consultant to help guide you in the right direction will be money well spent, especially given that such an endeavor will change your practice operations, including your marketing and financial operations.

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Food for Thought

Backyard bounty:

Vegetables are nature's original nutritional powerhouses

You've probably heard the chatter around how a handful of unusual foods are must-eat nutritional powerhouses - and wondered how you'll ever get your kids to try kale or chia seeds. But you don't have to stress over how to incorporate the latest health food fads into your family's diet in order to get powerful nutrition.

T

he truth is, those headline-grabbers aren't the only nutritional powerhouses. Most vegetables are packed with vitamins and minerals, so quit worrying about how to pronounce acai or where to find seaweed in the supermarket. Instead, improve your family's diet and save some money by growing nutrition-packed vegetables right in your own backyard.

Keep these 5 tips in mind: 1. Growing squash is easier than finding chia seeds. Many vegetables are easy to grow in any home environment, whether it's a large garden plot or pots on your patio. Leafy greens like lettuce, spinach, arugula and kale are full of nutrients and simple to grow, even for beginners. Transplants, like those offered by Bonnie Plants, make it even easier by helping you bypass the work of starting from seed. Plus, you'll harvest six weeks sooner.

2. Healthy benefits go far beyond nutrition. Growing your own vegetables and herbs means you'll always have a CONTINUED ON PAGE 22

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Doctor’s Life Tampa Bay

Issue 2, 2016

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Food for Thought fresh supply of nutrient-rich food at home. But gardening also delivers healthful exercise, time in the fresh air, and it's a relaxing and satisfying activity.

3. Gardens are good for Mother Nature. The more food you grow at home, the fewer natural resources will be needed to grow veggies in far off places and ship them to your local supermarket. Your garden is also a great opportunity to recycle household food waste as compost.

Plus, when you choose Bonnie Plants in biodegradable pots, you're saving millions of pounds of plastic from landfills. The pots decompose, add nutrients to the soil and help prevent transplant shock.

4. Gardening could get your kids excited about veggies really! When kids participate in gardening, they take ownership of the plants they help grow. And with their hands in the dirt, they're not on their cellphones or playing video games. Kids who grow veggies are much more likely to eat them, and make gardening an ongoing, healthy habit.

5. Save money at the supermarket. Growing your own food means you'll spend much less money in the produce aisle. Plus, you can grow a wide variety of vegetables and herbs, even expensive, restaurant-style "foodie" greens you may not have tried otherwise.

The plant pros at Bonnie recommend these nutrient powerhouses to jumpstart your garden: • Strawberries Just one cup of berries contains 3 grams of fiber and more than a full day's recommended allowance of vitamin C. Phenols are potent antioxidants that work to protect the heart, fight cancer, block inflammation, and they give strawberries their red color.

• Sweet potatoes Alpha and beta carotene give sweet potatoes their bright orange color, and your body converts these compounds into vitamin A, which is good for your eyes, bones and immune system. A half cup of sweet potato provides nearly four times the daily recommended allowance of vitamin A, plus vitamins C, B6, potassium and manganese.

• Broccoli This green nutritional giant delivers vitamins C, A and K (associated with bone health), folate and sulforaphane that helps stimulate the body's detoxifying enzymes.

• Tomatoes Tomatoes provide vitamins A, C and B, potassium and lycopene - an important phytonutrient thought to help fight various cancers and lower cholesterol.

• Spinach Spinach contains more than a dozen phytonutrients, and twice the daily recommended allowance of vitamin K. These nutrients contribute to cardiovascular and colon health, better brain function, eyesight and increased energy.

• Kale Kale contains vitamins A, C and K. A cup of cooked kale gives you more than 1,000 percent of the daily value for vitamin K. It's also high in manganese, which promotes bone density.

• Cauliflower Low in calories and carbohydrates, cauliflower is packed with a long list of nutrients, including phytonutrients. They say cauliflower is the new kale!

For more information on growing nutritional powerhouse vegetables, visit www.bonnieplants.com. Bonnie Plants is the largest producer and supplier of vegetable and herb plants in North America. You'll find their plants at Home Depot, Walmart, Lowes and 4,700 independent garden retailers.

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Doctor’s Life Tampa Bay

Issue 2, 2016

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