Florida MD October 2020 by FloridaMD

OCTOBER 2020 â&#x20AC;¢ COVERING THE I-4 CORRIDOR

The Meisenheimer Clinic Dermatology and Mohs Surgery Combating Skin Cancer in the Times of COVID 19

GIFT CERTIFICATES ARE AVAILABLE

The Natural Way to Solve your Allergy, Sinus and Respiratory Discomfort. ANTI-BACTERIAL | SIDE EFFECT FREE | ANTI-INFLAMMATORY

Relieve Symptoms of: • Acne • Allergies • Asthma • Cold & Flu • Cystic Fibrosis • Dermatitis • Ear Infections • Eczema • Sinusitis ::

DRUG FREE

FUSION OF

SCIENCE & NATURE

100%

NATURAL TREATMENT

Kerri and Clay: “My son’s allergy medicines were causing terrible side effects. Now that we have been coming to The Salt Room we have been able to control his symptoms with salt therapy.” Jessica L.: “My son looked and felt better after just one session. His cough wasn’t as bad. I felt he could breathe so much better.”

Joseph Cannizzaro, MD: “I have been recommending The Salt Room for years. It has helped my patients with respiratory nuisances and skin problems, reducing symptoms while we address the root cause to improve their long-term quality of life.” 407.862.1163 l 357 Wekiva Springs Rd., Longwood l www.SaltRoomLongwood.com

................

Located inside Cannizzaro Integrative Pediatric Center. Offering relief to all ages.

contents 4

OCTOBER 2020 COVERING THE I-4 CORRIDOR

 COVER STORY

John “Lucky” Meisenheimer M.D. has been the director of the Meisenheimer Clinic Dermatology and Mohs surgery the last 33 years. Located in Southwest Orlando, his clinic is in the Medplex Building adjacent to Dr. Phillips Hospital. You may recognize him and his son John Meisenheimer, VII, a medical student at USF, from their monthly dermatology column in FloridaMD Magazine. PHOTO:PROVIDEDD BY

Doctor Meisenheimer is an assistant clinical professor in the Division of Dermatology and was the division chief of dermatology at ORHS from 2003 to 2015. He has built a solid reputation for his approach and treatment of skin cancer over the last three decades, having successfully treated over 30,000 cases.

ON THE COVER: John Meisenheimer, VII and John “Lucky” Meisenheimer, MD

MEDICAL MARIJUANAROUTES OF ADMINISTRATION

PHOTO:PROVIDEDD BY

DEPARTMENTS 2

FROM THE PUBLISHER

8 HEALTHCARE LAW 9 MARKETING YOUR PRACTICE 10 PHARMACY UPDATE

FLORIDA MD - OCTOBER 2020

FROM THE PUBLISHER

am pleased to bring you another issue of Florida MD. I can only imagine the emotional and physical trauma that a woman goes through when she has a mastectomy. The procedure affects not only her body, but her mind and her self-esteem. Now add in the inability to not be able to reconstruct her breasts and give that part of her life back, because she’s uninsured or under insured, and it becomes an unthinkable crushing blow. Fortunately there is My Hope Chest to help women who are unable to afford reconstructive surgery. I asked them to tell us about their organization and how you, as physicians, can help. Please join me in supporting this truly wonderful organization. Best regards,

Donald B. Rauhofer Publisher

MY HOPE CHEST — Making Women Whole Again In 2010, more than 22,000 uninsured women lost their breasts to cancer and were left disfigured, deformed and feeling “less than whole.” How many years has this figure been growing? Many organizations raise funds for research, education and “awareness” of breast cancer. Most have no idea there lies a huge gap in assistance for delayed reconstruction and co-pays for survivors wanting this surgery. My Hope Chest is the ONLY national 501c3 non-profit organization focused on funding breast reconstruction for the uninsured and under insured survivors. Our services “pick up” where other breast cancer organizations leave off… providing the “final step in breast cancer treatment. ” My Hope Chest is about addressing the needs of survivors now. Through wonderful surgeon partnerships we are able to transform the lives of breast cancer survivors who otherwise have no hope of reconstruction. We hope to hear from you to learn how we can work together to eliminate our wait list and take action to help every woman who desires reconstruction after mastectomy and feel restored in body, mind and spirit. Wish List • Surgeons to create awareness for My Hope Chest and to identify new clients • Doctors of Distinction- Surgeon partners nationwide to join our program. • Corporate partners, interested in Win-Win, Commercial- coventure marketing campaigns promoting their product or service by sharing our vision to make sure there is always coverage for reconstruction surgery. For additional information on how you can help or refer a patient please go to www.MyHopeChest.org.

ADVERTISE IN FLORIDA MD

PREMIUM REPRINTS

For more information on advertising in Florida MD, call Publisher Donald Rauhofer at (407) 417-7400, fax (407) 977-7773 or info@floridamd www.floridamd.com

Reprints of cover articles or feature stories in Florida MD are ideal for promoting your company, practice, services and medical products. Increase your brand exposure with high quality, 4-color reprints to use as brochure inserts, promotional flyers, direct mail pieces, and trade show handouts. Call Florida MD for printing estimates.

Email press releases and all other related information to: info@floridamd.com

2 FLORIDA MD - OCTOBER 2020

Publisher: Donald Rauhofer Photographer: Donald Rauhofer / Florida MD Contributing Writers: John “Lucky” Meisenheimer, MD, Sonda Eunus, MHA, Julie Tyk, JD, Michael Patterson NHA, OTR/L, CEAS, Juan Lopez, Pharm D, John Meisenheimer, VII Art Director/Designer: Ana Espinosa Florida MD is published by Sea Notes Media,LLC, P.O. Box 621856, Oviedo, FL 32762. Call (407) 417-7400 for more information. Advertising rates upon request. Postmaster: Please send notices on Form 3579 to P.O. Box 621856, Oviedo, FL 32762. Although every precaution is taken to ensure accuracy of published materials, Florida MD cannot be held responsible for opinions expressed or facts expressed by its authors. Copyright 2020, Sea Notes Media. All rights reserved. Reproduction in whole or in part without written permission is prohibited. Annual subscription rate $45.

Medical Marijuana-Routes of Administration By Michael Patterson, NHA, OTR/L, CEAS With marijuana flower (also known as “bud” or “plant material”) now legal in Florida for Medical Marijuana (MMJ) patients, and rules for implementing marijuana edibles coming any day, it will give MMJ patients more choice in the route of administration of the cannabis plant. As more patients begin asking physicians about these new routes of administration (regardless if the MD writes MMJ recommendations), it is beneficial to know the different effects each administration route has on the human body. 1) Vapor- This is the most common method of ingestion of MMJ currently in Florida. Cannabis oil or flower is heated to a vapor, via a portable battery or stand-alone device, and inhaled. According to Researcher Dr. Kari Franson at the University of Colorado Skaggs School of Pharmacy, the bioavailability of vaporizing cannabis is between 5%-20% with peak concentrations affecting the patient within minutes. These effects last 1-3 hours depending on the patient and tolerance to cannabis. Vapor allows patients to inhale cannabis without combusting the medicine. 2) Smoking- Has a bioavailability of 10%-25% with peak effects occurring within minutes and lasting 1-3 hours depending on the patient and tolerance to cannabis. Smoking MMJ will increase now that cannabis flower is legal and available at MMJ dispensaries. 3) Oil/Tinctures- Has a bioavailability of 50%-75% which requires less product to get the desired effect. Oils and Tinctures offer a more reliable dose of cannabis, without the need to smoke or inhale the medicine. Oils and tinctures have a delayed effect compared to smoking or vaping. Peak effects can take up to one hour to appear and can last up to 5 hours. 4) Edibles- Edibles are any food product that contains cannabis (cookies, gummies, brownies, pretzels, chocolate products, drinks, coffee, etc.) The regulation will only allow the maximum dose of 10 mg of THC per each item. For example, if you buy a package of 10 MMJ cookies which contain 100mg of THC, each cookie would have 10mg of THC. This standardization of dosing for edible products at 10mg per item will decrease the risk of ingesting too many cannabis products.

With the bioavailability between 50%-75%, edibles allow users to experience the desired effect with MMJ from less product compared to smoking or vaping. However, edibles have even a more delayed effect (peak effects can take 30 min-2 hours to appear), which can lead to patients taking too many edibles due to lack of education of the delayed effect of ingestion.

5) Concentrates- Concentrates are a potent consolidation of cannabinoids that are made by dissolving cannabis in its plant form into a solvent. The resulting product has high THC levels and can produce multiple products from thick sticky oils (BHO), to

moldable goo (budder/wax). The classification of concentrates is dependent on the manufacturing method and consistency of the final product. 6) Lotions/Balms- Lotions and balms work by interacting with the CB1 and CB2 receptors which are present in muscles, skin, bones, peripheral nerves and synovial fluid within joints. There have not been any major studies on bioavailability of cannabis lotions and balms at this time. 7) Transdermal Patches- Since cannabis transdermal patches are relatively new, there is little research on bioavailability. Transdermal patches have been known to provide a steady dose of cannabis medicine up to 48 hours while applied. However, it is not well known how much of the medicine penetrates the dermal layer of skin and provides adequate amounts of medicine to the body to get the desired effect. Other delivery methods that are developing, but still not widespread are: a) Inhalers with Medical Cannabis (similar to an asthma inhaler) b) Water Soluble cannabis- This will be added to all types of drinks (including water) to deliver cannabis without any odor of a typical marijuana plant. c) Powdered Cannabis- Imagine taking a small individual pack of powdered cannabis (similar to Sugar, Equal, or Stevia) and mixing it into any beverage. Powdered cannabis will provide convenience, discretion, and proper dosing of the medicine. Michael Patterson NHA, OTR/L, CEAS is CEO of US Cannabis Pharmaceutical Research and Development LLC. (uscprd.com). Mr. Patterson is a healthcare executive with over 25 years experience in the following areas: Cannabis-Hemp investment, Law, Regulation, Compliance, Operations, and Management, Skilled Nursing, Pharmacy, Laboratory, Assisted Living, Home Healthcare, and Healthcare Analytics. Michael is a subject matter expert in the Global Cannabis and Hemp Industry with Gerson Lehrman Group (glg.it) and Guidepoint. Mr. Patterson is an editorial board member of the American Journal of Medical Cannabis, licensed Nursing Home Administrator, and licensed Occupational Therapist in 4 states.. 

www.floridamd.com FLORIDA MD - OCTOBER 2020

COVER STORY

The Meisenheimer Clinic - Dermatology and Mohs Surgery Combating Skin Cancer in the Times of COVID 19 By Staff Writer John “Lucky” Meisenheimer M.D. has been the director of the Meisenheimer Clinic Dermatology and Mohs surgery the last 33 years. Located in Southwest Orlando, his clinic is in the Medplex Building adjacent to Dr. Phillips Hospital. You may recognize him and his son John Meisenheimer, VII, a medical student at USF, from their monthly dermatology column in FloridaMD Magazine.

CHALLENGES OF TREATING SKIN CANCER DURING THE COVID 19 It is a requirement for Mohs surgery that the surgeon and the pathologist examining the PANDEMIC.

PHOTO: DONALD RAUHOFER / FLORIDA MD

histology are the same individual. Dr. Lucky Meisenheimer is shown here microscopically evaluating a Mohs surgery case.

4 FLORIDA MD - OCTOBER 2020

One of the biggest challenges to physicians during 2020 has been the impact of COVID-19, not only the actual cases of COVID-19, but the unintended consequences of societal changes adopted to lessen the impact of the pandemic. “If there is one important message I could get out to patients, it would be, if you have medical issues, do not delay seeing your physician out of fear of COVID 19. Numerous patients fear contracting COVID-19 they have or are delaying evaluations and treatments of many important conditions. This trend is ubiquitous across all specialties. Virtually every physician I have spoken to have a patient or case negatively impacted due to fears created by the pandemic.” Dr. Meisenheimer has many concerns related to patients delaying evaluation for suspicious skin lesions. He speaks with a passion for patients, not delaying treatment, and gives practical advice for those needing encouragement. “Florida is a great state when it comes to dermatological care. Our community is blessed with some of the sharpest, smartest dermatologists. I would feel safe seeing any boardcertified dermatologist in Central Florida. I tell patients and medical providers not to fear the dermatologist’s office; everyone uses safety precautions during the pandemic. This biggest risk is not contracting COVID 19 in the doctor’s office, but delaying a diagnosis that might be much more lethal.” Most skin cancers are treatable and curable if diagnosed early. This phrase is the mantra of The American Academy of Dermatology and

COVER STORY

“I can’t say enough about the importance of early detection. I emphasize to medical students and residents all the time if you think a lesion is suspicious, don’t follow it, biopsy it, or refer the patient to a dermatologist. You should only “follow” lesions that you are sure are benign. And remember, lesions can evolve with time just because it was fine on an exam four weeks previously, change can happen, and sudden transformation may be a clue to something more ominous.”

THE MEISENHEIMER CLINIC SPECIALIZES IN MOHS MICROGRAPHIC SURGERY Dr. Meisenheimer is a board-certified dermatologist and a Mohs surgeon. Mohs surgery, also known as Mohs micrographic surgery, is a precise, tissue-sparing, microscopically controlled surgical technique for removing skin cancer. This specialized procedure was developed in the 1930s by Dr. Fredrick Mohs and is now well accepted by the medical community worldwide. Mohs surgery is a two-step process: First, the tumor is removed in stages, followed by immediate histologic evaluation of the margins of the specimen; Second, additional excisions and assessments are performed until all margins are clear. It is important to understand that the dermatologist performing MMS serves both as surgeon and pathologist, performing the excision and the histologic evaluation of the specimen.

PHOTO: JOHN MEISENHEIMER, VII

the American Society of Dermatologic Surgery. These organizations spend hundreds of thousands of dollars annually promoting the importance of self-exam and early detection of skin cancer. These patient education campaigns have saved thousands of lives. Symptoms suggesting a lesion may be a problem include a rapidly growing lesion, bleeding, color changes, itching, or tenderness. For melanomas, the deadliest form of skin cancer, there is an acronym to help physicians and patients achieve better awareness of the physical characteristics suggestive of malignancy. ABCDE represents Asymmetry, Border irregularity, Color variations, Diameter greater than 6mm, and Evolution (the lesion changes in size, color, or shape). Regardless of the algorithm, if a physician or patient believes there is even a remote possibility that a skin lesion is a problem, a dermatologist’s evaluation is best even in the times of COVID 19, don’t delay.

Keratoacanthomas are a rapidly growing subtype of squamous cell carcinoma. This keratoacanthoma on the arm grew from nothing to this size in three weeks.

patients ask me before a Mohs procedure. Unfortunately, lacking a crystal ball, I cannot predict the final defect’s size because we will not know this until all margins are free from the tumor. Upon clearing of the cancer, I will know what to do as far as the reconstruction. This knowledge comes from the experience of having completed thousands of repairs.” Treatment of skin cancer is not limited only to the Mohs surgery technique. The Meisenheimer Clinic closely follows the Appropriate Use Criteria for Mohs surgery guidelines endorsed by the AAD/ACMS/ASDSA/ASMS. Dr. Meisenheimer strongly believes that each cancer is evaluated based on its particular circumstance and features, and individually developed treatment plans are essential. One specific This patient delayed having this lesion evaluated for many months due to the COVID 19 pandemic- a nodular malignant melanoma with a Breslow’s thickness of greater than 3mm.

PHOTO: JOHN MEISENHEIMER, VII

The method employed to examine the tissue allows for better elimination of cancer roots with maximum preservation of normal tissue. Currently recognized as the skin cancer treatment with the highest cure rate, Mohs surgery has a success rate of approximately 99 percent. Because less tissue has to be removed compared to traditional surgery, Mohs can allow for better final cosmetic results. At the Meisenheimer clinic, the doctor has treated over fifteen thousand cases by the Mohs technique. The majority of defects are repaired immediately following the surgery by Dr. Meisenheimer. “I always tell my patients my first concern, and the initial focus is removing and obtaining clear margins of the skin cancer. Once I have determined the margins are clear, my focus immediately switches to giving the patient the best cosmetic results. Patients are anxious regarding the size of the defect and the reconstructive repair plan. This concern is the number one question FLORIDA MD - OCTOBER 2020

treatment is not right for all skin cancers. Dr. Meisenheimer chooses from several different modalities to treat skin cancer based on what he believes will combine a high cure rate and the best cosmetic result. Most physicians are aware of the aggressive and feared malignant melanoma and the common non-melanoma cancers such as basal cell carcinomas and squamous cell carcinomas. But there are many other forms of skin cancer physicians may not be familiar with, such as Merkel cell carcinoma, sebaceous carcinoma, cutaneous T cell lymphomas, Moh’s surgery clinics require a laboratory and Mohs technician. Dr. Meisenheimer, in his lab with his Mohs malignant glomus tumors, technician preparing slides for microscopic evaluation. angiosarcomas, and others. they come in for surgery when I have had a chance to speak with Even with the most common non-Melanoma skin cancer, the them.” basal cell carcinoma, there are many cancer variations based on histologic growth patterns. Each cancer is different, and features MENTORING OF NEW MEDICAL such as tumor type, histologic growth pattern, location, age of PROFESSIONALS IS IMPORTANT TO the patient, immunologic status are all considered in the develMEISENHEIMER AND HAS BEEN A DECADESopment of the treatment plan. When treating skin cancer, one LONG COMMITMENT. treatment does not fit all. Dr. Meisenheimer addresses each cancer individually and tries to establish the treatment plan decision From the beginning of his career, Dr. Meisenheimer has on cure rate, cosmesis, function, and cost. In addition to treating opened his office to mentoring medical students and residents. skin cancer by the Mohs technique, other management modaliScores of young medical professionals have spent time learning ties are available at the Meisenheimer clinic. These treatments about the field of dermatology in his clinic. Meisenheimer beinclude traditional excision with or without frozen sections, eleclieves one of the best ways to give back to medicine is providing trodesiccation and curettage, intralesional chemotherapy, topical guidance to those entering the medical profession. chemotherapy, and laser therapy. “I would not be a dermatologist today if it was not for the The best description of the Meisenheimer Clinic would be a kindness of my hometown dermatologist, allowing me to do a traditional solo medical practice where the doctor sees all the parotation in his office. It was a life-changing experience for me. tients himself. The clinic does not use non-physician extenders, I view it as a debt that I am trying to repay 100 times over. and Dr. Meisenheimer performs all exams and surgical proceMentoring is a win-win. I cannot think of a student or young dures. The office is also unique because it does not use a computphysician I have not learned from as they spent time in my oferized phone tree to answer the phone. This feature is of benefit fice. Regardless of what specialty a new physician enters, they for both referring physicians and patients alike, saving them time will find overlap at some point with dermatology. All physicians and effort. When a physician or patient calls, they will immedineed to recognize common skin conditions and potential signs of ately speak with a human. Although the office is computerized, cancer and know when it is appropriate to refer to a dermatolothe clinic, due to ransomware and hacker risks, protects patient gist. Not only is it important to mentor young professionals, but records by keeping paper medical charts on all patients. I feel an obligation to communicate and share information with colleagues.” “Some colleagues consider me old fashion because I don’t use In addition to writing the dermatology column for Florida computerization in some select tasks. For instance, I call all paMD magazine with his son John, a medical student at USF, tients personally when I get biopsy results showing skin cancer, Meisenheimer has several scientific research publications. He whether it’s their first skin cancer or their 50th. I strongly believe has published in such journals as the Journal of the American it’s important for patients to receive cancer results from the phyAcademy of Dermatology, Annals of Emergency Medicine, and sician themselves, not from a computerized text/email/portal or Journal of Drugs in Dermatology. Meisenheimer was the first to a staff member. Patients are less anxious and better rested when 6 FLORIDA MD - OCTOBER 2020

PHOTO: DONALD RAUHOFER / FLORIDA MD

COVER STORY

COVER STORY publish a CD30+ Lymphoproliferative nodule’s successful treatment using a 308-nm excimer laser. He was the first physician in North America to report cutaneous T cell lymphoma treatment utilizing an excimer laser. His writing skills are not limited to dermatology; his novel The Immune won the 2012 international Book Awards for science fiction. His first book on the subject of history and collecting yo-yos is in the Smithsonian Institution.

GIVING BACK TO THE COMMUNITY BEYOND MEDICINE. Although well known within the medical community he is perhaps better known for his activities outside the medical world. He Is a former National Masters swimming champion and world record holder. His daily lake swim “Lucky’s Lake Swim is free and open to the community, and many local physicians and medical personnel are some of the thousands from around the world that have joined him in the mornings for an open water swim. Lucky’s Lake Swim was proclaimed a historic Central Florida event by the Central Florida Historical Society in 2015. The swim is ranked as one of the top 100 open water swims in the United States by the World Open Water Swimming Association. Meisenheimer also coached the Orange County Special Olympics swim team for 25 years and will be hosting the national open water swimming and paddle boarding Special Olympics championships at his home in 2022. Perhaps his most unique attribute is his love for the history of the yo-yo. He has the Guinness World Record for the most extensive yo-yo collection, and hosts a weekly live talk show on Facebook called Doc Lucky’s Yo-Yo talk. Dr. Meisenheimer welcomes new referrals from area physicians for patients that need treatment of skin cancers by the Mohs technique. Visit OrlandoSkinDoc.com to learn more or contact his office at 407-352-2444.

Dr. Meisenheimer examining a skin lesion with a dermatoscope connected to an iPad.

John Meisenheimer, VII is a medical student at USF, and his father, Dr. John “Lucky” Meisenheimer, the Meisenheimer clinic director – Dermatology and Mohs Surgery.Together they write the Dermatology columns for this magazine. In this issue, they give warning to delaying diagnosis and skin cancer treatment due to the fear of COVID 19. The senior Meisenheimer specializes in the treatment of skin cancer by Mohs surgery. What is Mohs surgery, also known as Mohs micrographic surgery (MMS)? It is a precise, tissue-sparing,

microscopically

controlled

surgical technique for removing skin cancer. Mohs surgery is a two-step process: First, the tumor is removed in stages, followed by immediate histologic evaluation of the margins PHOTO: DONALD RAUHOFER / FLORIDA MD

of the specimen; Second, additional excisions and assessments are performed until all margins are clear. It is important to understand that the dermatologist performing MMS serves both as surgeon and pathologist, performing the excision and the histologic evaluation of the specimen. 

FLORIDA MD - OCTOBER 2020

HEALTHCARE LAW

Anatomy of a Florida Department of Health Complaint By David Doyle and Julie Tyk Department of Health (Department) Complaints are common and originate from a wide variety of sources. Complaints come from patients, family members, Notices of Intent in medical malpractice claims and Code 15 Reports hospitals are required to submit to the Department. Typically, a physician receives a letter from the Department including a copy of the complaint. The physician has 45 days to submit a written response to the complaint. Upon receipt of the letter, a physician should contact their professional liability carrier as insurance policies often provide coverage for administrative actions. Under no circumstances should a physician submit a response to the Department or speak with its investigator without seeking legal advice. A physician, with the assistance of counsel, should submit a written response to the complaint. This initial response, if done properly and thoroughly, is the physician’s best chance to, in the immortal words of Deputy Barney Fife, “nip it in the bud.” The response should provide all relevant information and records for the Department in an easily understandable manner since investigators usually have no medical training. Counsel can also submit a summary of the physician’s defense, as well as an expert affidavit in support of the physician’s treatment. During the investigation, the investigator may request an inter-

view. Physicians under investigation are not required to submit to an interview. However, if a physician agrees to an interview, he should only do so with counsel present. Once the initial investigation is complete, the investigator prepares a report for The Probable Cause Panel (the Panel). The Panel reviews the investigator’s report and any information the physician submitted to determine if probable cause exists that the physician violated any Florida Statute or rules. If the Panel finds no probable cause, the case is dismissed, and the matter is not a public record. The Panel may also elect to issue a Letter of Guidance, which is neither public record nor considered formal discipline. The case will be dismissed after the Letter of Guidance is issued. If the Panel finds probable cause, a formal Administrative Complaint is prepared by the Department. The Administrative Complaint outlines the charges against the physician. A physician typically has three options: 1) dispute the charges and request a formal hearing; 2) stipulate to the Department’s proposed settlement; or 3) attempt to negotiate a settlement with the Department’s attorney. If a physician elects a formal administrative hearing, an administrative judge will hear the case. Both sides can call witnesses, experts and submit evidence. The judge will prepare a written decision called a recommended order. The order is submitted to the Board of Medicine where a final order is entered. The final order may be appealed. A Department Complaint can have far reaching implications on a physician’s medical license. The Health Care Practice Group at Pearson Doyle Mohre & Pastis, LLP are committed to assisting Clients in navigating and defending Department Complaints. For more information and assistance, please contact David Doyle and Julie Tyk at Pearson Doyle Mohre & Pastis, LLP.

David O. Doyle, Jr., is a Partner and civil trial lawyer, concentrating his practice in medical malpractice defense litigation, insurance defense litigation and health care law. He can be reached at ddoyle@pdmplaw.com or 407-636-3880. Julie A. Tyk, is a Partner with Pearson Doyle Mohre & Pastis, LLP. Julie concentrates her practice in medical practice defense litigation, insurance defense litigation and health care law. She has represented physicians, hospitals, ambulatory surgical centers, nurses and other health care providers across the state of Florida. She may be contacted by calling (407) 951-8523; jtyk@pdmplaw.com. 

8 FLORIDA MD - OCTOBER 2020

MARKETING YOUR PRACTICE

Is Your Online Reputation Costing You Patients? By Sonda Eunus, MHA, CMPE What does your online reputation say about your practice? If you have a negative online reputation, you are missing out on new patients every day. Most medical practices now get the majority of their new patients through Google and other search engine queries, such as “Pediatrician in Orlando”. If your practice appears in these searches, the most common next step for a potential new patient would be to check out your reviews – what are other patients saying about your practice? It has been reported that 90% of consumers read online reviews before visiting a business and that online reviews influence 67% of purchasing decisions (Bright Local). For this reason, it is incredibly important to pay attention to the rating and reviews that your practice has on search engines, social media platforms, and local online business directories. However, despite the importance of cultivating a positive online reputation, only 33% of businesses report actively collecting and asking for reviews (1). One great process to set in place at your practice is asking for patient reviews after each patient visit. It can be as simple as training your front office staff to ask each patient how their visit went while checking them out, and if they receive favorable feedback then they can ask the patient to please leave a review on Google or Facebook about their experience. If they receive negative feedback, this feedback should be taken very seriously, and management should be notified as soon as possible so that the issue can be mitigated before the patient decides to post a negative review. Setting up an automated text or email campaign that asks each patient for their feedback after their appointment is also a great way to improve your online reputation as well as to correct any issues that may be occurring at your practice. When you receive feedback from patients, you are then able to prompt them to leave a public review on Facebook, Google, Yelp, Healthgrades, or other applicable review platforms. However, you must be aware that legally, you are not allowed to only direct people with favorable feedback to leave reviews, which is known as review-gating – so if you are implementing an automated system like this, just make sure that you are aware of this limitation. There are online reputation management platforms which allow you to customize the messages that people see when they leave negative feedback as opposed to positive feedback, but both of those messages must still offer the option to leave a public review. However, if you create your message in such a way as to communicate to the patient who may leave negative feedback that you are working hard on resolving the issue and that someone will be in touch shortly, that may prevent them from leaving a public negative review. When you receive a public review on Google, Facebook, or other review sites, make sure that you respond to it – either by thanking them for a good review or by asking them to contact you to discuss how you can improve their experience. Do not argue or try to defend yourself online – try to speak about it with them privately, fix the issue, and ask them to remove the review if possible. When you receive great reviews, make sure to cross-share them on

your various social media platforms. You should also create a “Reviews” page on your website and add all great reviews to this page. This instantly adds credibility to your website. Finally, make sure that when you look over the feedback and reviews that you receive, you are paying attention to what the negative reviews are saying – this is a great opportunity to identify current process challenges and improve your patients’ experience at your practice. Need help managing your practice’s online reputation? Visit www.lms-plus.com to see how Leading Marketing Solutions can help. Sonda Eunus is the CEO of Leading Marketing Solutions, a Marketing Agency working with Medical Practices and other Businesses to help them identify the best marketing strategies for their business, create a strong online presence, and automate their marketing processes for a better return on their Marketing budget. Learn more about Leading Marketing Solutions at www.lms-plus.com.



Check out our newly redesigned website at www.floridamd.com!

Sea Notes Photography Donald Rauhofer – Photographer Head Shots • Brochures • Meetings Events • Portraits • Arcitectural

4O7-417-74OO FLORIDA MD - OCTOBER 2020

PHARMACY UPDATE

New Approaches to Personalized Skin Care By Juan Lopez, PharmD, FAPC

INNOVATIVE SKIN CARE WITHOUT A PRESCRIPTION! Our pharmacy team is always trying something new to see if it would be of benefit to our patients. This year, the COVID-19 pandemic has increased the use of masks, hand sanitizer, hand washing and gloves in our everyday lives. This can be hard on the skin. Pharmacy team members and patients alike are dealing with dry, irritated skin, as well as the dreaded “MASKne,” or mask acne, a new term describing acne and physical trauma to the skin caused by the combination of oil, sweat, heat, bacteria and friction. In our quest to address some of these issues we came across Skin Repair Dermatological Moisturizing Lotion. Skin Repair is a fantastic moisturizer that has been used to repair clinically dry, damaged skin using innovative natural ingredients. The pharmacy team has personally used Skin Repair for a number of issues that we have experienced over the last year and have had a number of positive responses. My family has used Skin Repair to help prevent peeling after sun exposure and sunburn, to calm down our children’s itchy and irritated skin after outdoor play and to help soothe rough feet after a day at the beach. Additionally,

team members report using Skin Repair to help with cracked heels, sore and irritated hands after a day of wearing gloves in the lab, moisturizing the face after gentle cleansing as a preventative regimen against “MASKne” and even using it for facial recovery after cosmetic procedures. Diabetic skin, eczema, psoriasis, orthopedic, oncology and dialysis patients have used Skin Repair to address many of the skin challenges they face, including itchiness, redness, cracking, peeling, and scaling. All these positive responses from a lotion that is available without a prescription! Skin Repair Dermatological Moisturizing Lotion is a fast absorbing, non-greasy, hypoallergenic formula that provides hydration to very dry, flaky or clinically damaged skin. Skin Repair was developed by a team of doctors, dermatologists and cosmetic chemists to moisturize, repair and protect the skin. Skin Repair delivers soothing and hydrating ingredients that promotes cell renewal and restores the skin’s pH balance. The lotion is non-comedogenic (doesn’t clog pores) and free of parabens, dyes, drying alcohols and is available fragrance-free for those with sensitive skin. Skin Repair contains several natural hydrating ingredients – kalaya (Emu) oil, shea butter, Aloe vera and glycerin (vegetable derived), as well as antioxidant vitamins A, E and C. Kalaya oil is able to deeply penetrate the layers of the skin and repair skin cell damage. Kalaya oil and shea butter help to increase circulation while nourishing the skin. The vitamin E found in shea butter increases microcirculation, which results in increased blood supply to and from the skin. Kalaya oil boosts the transfer of oxygen to the skin, which enables blood to flow more easily and helps repair and rehydrate the skin. Kalaya oil is made up of essential fatty acids, such as omega-3’s and, along with Aloe vera, can help reduce inflammation.

PERSONALIZED SKIN CARE When it comes to dermatology patients, there are many health concerns that are as unique as each patient’s skin, and a standardized, one-size-fits-all approach may not adequately address these specific needs. A compounding pharmacy has the ability to customize medication therapy to meet a wide variety of demands. While pharmacists do not prescribe medications, they can educate patients and collaborate with providers to recommend therapies and specific dosage forms that can optimize patient compliance and outcomes. Formulations that can take advantage of the benefits of Skin Repair Dermatological Moisturizing Lotion and provide additional targeted therapy include, but are not limited to:

10 FLORIDA MD - OCTOBER 2020

•

Zinc Pyrithione in Skin Repair Lotion

• • •

Naltrexone in Skin Repair Lotion Clobetasol in Skin Repair Lotion Lidocaine in Skin Repair Lotion

•

Ketotifen in Skin Repair Lotion

COVERPHARMACY STORY UPDATE INNOVATION IN TOPICAL DERMATOLOGY MICRO-DOSING Medications applied to the face often times only need to be put on as a thin, uniform layer to targeted areas. Micro-dosing allows patients to easily apply medication to desired areas without impacting healthy skin while avoiding creating a mess or contaminating the medication jar. The Topi-CLICK Micro® device is a revolutionary way to provide accurate, targeted micro-dosing. The device provides a patient-friendly, pen-shaped device pre-loaded with medication that allows patients to simply “click” out their prescribed dose of medication. Patients can choose from 3 applicator styles (rounded, soft angled or pin-point applicator tips) for customized application to the skin. Compared to traditional dosing methods, like jars and ointment tubes, the Topi-CLICK Micro® device provides patients with a uniquely enhanced experience.

Prescribe topical medications in Topi-CLICK Micro®

NEW Colors Available

The pen-like device has a triangular shaped barrel that allows for a secure grip and precision handling during application. Each “click” dispenses 0.05ml of topical medication for a consistent dosing throughout treatment and results in significantly less residual medication waste. Little to no mess is generated and the risk of hand transference to other people or surfaces is reduced. To prevent exposure to humidity and air, and the tip of the applicator is sealed by a screw-on cap. The device protects the stability of custom formulated medication with UV-blocking, plastic free of BPA, latex, phthalates, and PVC.

0.05 mL Per CLICK

• Accurate metered micro-dosing of transdermal medications • Choice of 3 applicator styles for customized dosing Universal Rounded Applicator™

Soft Angled Applicator™

Pin Point Applicator™

Request FREE samples for Patient Trials at: www.DoseLogix.com | 877.870.8448 | info.TopiCLICK@teamtech.com

Commonly requested formulations that can be dispensed in the Topi-CLICK Micro® dispensing device include: • • • • •

Clindamycin topical spot therapy Niacinamide topical spot therapy Wart formulations Customized fading creams Anti-aging facial creams

As personalized medicine pharmacists, our goal is to meet the individual needs and circumstances of patients and physicians. Pharmacists can further enhance medication therapies by including agents that work together for a desired outcome. A delivery base, such as Skin Repair Lotion can be utilized to help moisturize dry, damaged skin while delivering targeted pharmaceutical therapy. Medications can be formulated to be hypo-allergenic and free of undesirable ingredients that patients might be sensitive to. The pharmacist will be more than happy to discuss with you personalized options for skin care and can help determine if it is appropriate to transition your current prescription device to the Topi-CLICK Micro®. * The formulas and/or statements listed are provided for educational purposes only. They are compounding ideas that have commonly been requested by physicians and have not been evaluated by the Food and Drug Administration. Formulas and/or material listed are not to be interpreted as a promise, guarantee or claim of therapeutic efficacy or safety. The information contained herein is not intended to replace or substitute conventional medical care, or encourage its abandonment. Every patient is unique and formulas should be adjusted to meet their individual needs.

Juan Lopez, PharmD, FAPC, is a personalized medicine pharmacist with Pharmacy Specialists Compounding Pharmacy in Altamonte Springs, FL. For more information on how personalized medicine can help you, please call (407) 260-7002, or email us at Info@MakeRx.com.



Check out our newly redesigned website at www.floridamd.com! FLORIDA MD - OCTOBER 2020 11

Your Skin is Your Body’s First Line of Defense

KEY BENEFITS • hypo-allergenic • non-comedogenic • non-greasy • anti-inflammatory • rehydrates clinically dry skin • repairs cell damage at its core • alleviates skin irritations • ideal for post procedure skin PLUS Omega-3, 6, & 9 Vitamins A, C, E & F

Dermatological moisturizer that contains super hydrators emu oil, shea butter and aloe vera Provides long-lasting hydration to very dry or clinically damaged skin Ideal lotion for those who suffer from arthritis, muscle or joint pains Great for sensitive skin and beneficial for serious skin conditions such as eczema and diabetic skin

www.aligonusa.com 12 FLORIDA MD - OCTOBER 2020

+1 (205)-663-0521

2020

EDITORIAL CALENDAR

Florida MD is a four-color monthly medical/business magazine for physicians in the Central Florida market. Florida MD goes to physicians at their offices, in the thirteen-county area of Orange, Seminole, Volusia, Osceola, Polk, Flagler, Lake, Marion, Sumter, Hardee, Highlands, Hillsborough and Pasco counties. Cover stories spotlight extraordinary physicians affiliated with local clinics and hospitals. Special feature stories focus on new hospital programs or facilities, and other professional and healthcare related business topics. Local physician specialists and other professionals, affiliated with local businesses and organizations, write all other columns or articles about their respective specialty or profession. This local informative and interesting format is the main reason physicians take the time to read Florida MD. It is hard to be aware of everything happening in the rapidly changing medical profession and doctors want to know more about new medical developments and technology, procedures, techniques, case studies, research, etc. in the different specialties. Especially when the information comes from a local physician specialist who they can call and discuss the column with or refer a patient. They also want to read about wealth management, financial issues, healthcare law, insurance issues and real estate opportunities. Again, they prefer it when that information comes from a local professional they can call and do business with. All advertisers have the opportunity to have a column or article related to their specialty or profession.

JANUARY –

Digestive Disorders Diabetes

FEBRUARY –

Cardiology Heart Disease & Stroke

MARCH –

Orthopaedics Men’s Health

APRIL –

Surgery Scoliosis

MAY –

Women’s Health Advances in Cosmetic Surgery

JUNE –

Allergies Pulmonary & Sleep Disorders

JULY –

Neurology / Neuroscience Advances in Rehabilitation

AUGUST –

Sports Medicine Robotic Surgery

SEPTEMBER – Pediatrics & Advances in NICUs Autism OCTOBER –

Cancer Dermatology

NOVEMBER – Urology Geriatric Medicine / Glaucoma DECEMBER – Pain Management Occupational Therapy

Please call 407.417.7400 for additional materials or information. FLORIDA MD - OCTOBER 2020 13

Our results set us apart

The Joint Commission Disease-Specific Care Certification in Stroke Rehabilitation

We offer superior care and results for patients when compared to nursing homes. Research* tells the story. Connect with a higher level of care at Encompass Health Rehabilitation Hospital of Altamonte Springs. Learn more at ehc.rehab/floridamd

831 South State Road 434 Altamonte Springs, FL 32714 407.587.8600

*Dobson | DaVanzo analysis of research identifiable 20% sample of Medicare beneficiaries, 2005-2009

ÂŠ2020:Encompass Health Corporation:1514451RPPE