Florida MD February 2021 by FloridaMD

FEBRUARY 2021 • COVERING THE I-4 CORRIDOR

Encompass Health Hospital Rehabilitation of Altamonte Springs

Providing Superior Outcomes Through Connected Care

TO TAKE CHARGE. At Orlando Health Heart & Vascular Institute, cardiology is a highly trained, team effort. Our experts in more than 40 specialties and subspecialties — including leading cardiovascular surgery techniques and atrial ﬁbrillation treatments — work in sync to craft a personalized care plan for each and every patient. Offering 24 convenient locations, as well as an environment designed with our patients’ needs in mind, Orlando Health is revolutionizing heart and vascular care in Central Florida, so our patients can take charge of their heart and their health.

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contents 4

FEBRUARY 2021 COVERING THE I-4 CORRIDOR

 COVER STORY

PHOTO: DONALD RAUHOFER / FLORIDA MD

As a nationwide leader in rehabilitation services, Encompass Health Corp., formerly HealthSouth Corp., has been known in the medical community for over three decades. In 2015, the company, already present in the state of Florida, expanded to Central Florida, bringing an exemplary level of post-acute care to the region with the opening of Encompass Health Rehabilitation Hospital of Altamonte Springs in 2014. The hospital is part of a nationwide network of 130 inpatient rehabilitation hospitals and 220 home health locations and 58 hospice locations. As Encompass Health, the hospital and its staff remain dedicated to guiding each patient through recovery and are committed to helping patients regain their independence. By building a solid reputation for its comprehensive approach to rehabilitation of patients, including those dealing with traumatic injuries that require extensive rehabilitation services, Encompass Health Altamonte Springs provides options that benefit patients with acute care needs and their families committed to getting them back home, getting them back their independence and living life to its fullest. ON THE COVER: Encompass Rehabilitation Center of Altamonte Springs

CANNABIS DEMONSTRATES IMPROVEMENT IN OPIOID ADDICTION OUTCOMES

PHOTO: ENCOMPASS HEALTH

10 LEADING TECHNOLOGIES IN HEART AND VASCULAR CARE

DEPARTMENTS 2

FROM THE PUBLISHER

8 DERMATOLOGY 9 MARKETING YOUR PRACTICE 11 HEALTHCARE LAW 12 PHARMACY UPDATE

FLORIDA MD - FEBRUARY 2021

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.

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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, Farhan J. Khawaja, MD, 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 2021, Sea Notes Media. All rights reserved. Reproduction in whole or in part without written permission is prohibited. Annual subscription rate $45.

Cannabis Demonstrates Improvement in Opioid Addiction Outcomes By Michael Patterson, NHA, OTR/L, CEAS Cannabis demonstrates improved treatment outcomes for people suffering from opioid addiction and reduced risk from accidental fentanyl exposure, according to research published in the December 2020 issue of the Drug and Alcoholic Dependence Journal. The link to the article is below. Cannabis use is associated with reduced risk of exposure to fentanyl among people on opioid agonist therapy during a community-wide overdose crisis - ScienceDirect The study was performed by University of British Columbia and BC Center on Substance Abuse (BCCSU). The study included 819 participants, with 53 percent either intentionally or accidentally using fentanyl despite being treated for opioid addiction with treatments like methadone or buprenorphine/naloxone. The researchers found that participants who had urine tests positive for THC were about 10% less likely to have fentanyl-positive urine which puts them at a lower risk for overdoing on the opioid. Dr. Eugenia Socías, the study’s lead author and clinician-scientist at BCCSU, said the “findings suggest that cannabis could have a stabilizing impact for many patients on treatment, while also reducing the risk of overdose.” Previous BCCSU research found that individuals on opioid agonist treatments, such as methadone, who reported using cannabis on a daily basis were 21% more likely to continue addiction treatment at six months than non-cannabis users, the report says. BCCSU is set to work with the Canadian Institutes of Health Research on further evaluating the role of cannabis as a potential adjunct therapy to opioid agonist treatments. Canadian researchers have found that without access to and rapid expansion of take-home naloxone, overdose prevention services, and opioid analog treatments, the number of overdose deaths in B.C. would be 2.5 times higher than current levels; but patient retention on these medications remains a challenge despite more individuals with opioid-use disorder being connected to treatments, the report says.

ANALYSIS This study provides positive data linking cannabis use with decreased effect of opiates. It helps validate cannabis as a viable treatment for opiate dependence. This is extremely important because the US opioid crisis has picked up momentum under the distraction of the Coronavirus pandemic. Eighteen states and Washington, D.C. have reported a 10% increase in opioid related deaths from 2019 to 2020. According to Addictioncenter.com, drug overdoses rose 4.6% in 2020 to 70,890 cases in the USA.

In the US, more individual states are adding qualifying conditions for medical cannabis related to opiate dependency. Cannabis has never killed anyone in human history, and therefore safer than many prescription medications, including opiates. The more data we collect on the benefits of cannabis for opiate addiction, the more momentum is gained to push to recognize cannabis as a legal medicine under US federal law. 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.. 

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COVER STORY

Encompass Health Hospital Rehabilitation of Altamonte Springs – Providing Superior Outcomes Through Connected Care By Staff Writer As a nationwide leader in rehabilitation services, Encompass Health Corp., formerly HealthSouth Corp., has been known in the medical community for over three decades. In 2015, the company, already present in the state of Florida, expanded to Central Florida, bringing an exemplary level of post-acute care to the region with the opening of Encompass Health Rehabilitation Hospital of Altamonte Springs in 2014. The hospital is part of a nationwide network of 130 inpatient rehabilitation hospitals and 220 home health locations and 58 hospice locations.

cated to guiding each patient through recovery and are committed to helping patients regain their independence. By building a solid reputation for its comprehensive approach to rehabilitation of patients, including those dealing with traumatic injuries that require extensive rehabilitation services, Encompass Health Altamonte Springs provides options that benefit patients with acute care needs and their families committed to getting them back home, getting them back their independence and living life to its fullest.

Based on 2016 data, Encompass Health accounts for 22 percent of licensed beds in the nation and provides rehabilitation services for 29 percent of Medicare Dedicated physical therapists are key to providing focused care to patients. patients. In November 2018, Encompass Health Altamonte Springs expanded its services to reach even more patients. The hospital added 20 new beds, giving it a total of 70. It also recently opened a new dialysis unit with four beds, allowing those in need of dialysis to continue their therapy and work toward their individual goals. The hospital has seen over 1,800 patients since it opened its doors in the fall of 2015 and received a reaccreditation by The Joint Commission as a facility of care. As Encompass Health, the hospital and its staff remain dedi-

For Dr. Eliam Fuentes, medical director of Encompass Health Altamonte Springs, it was not surprising; “Since our opening we have helped so many patients providing excellent rehabilitation care for many strokes, Parkinson’s, and other catastrophic injuries.”

PHOTO: ENCOMPASS HEALTH

Dr. Fuentes, began seeing patients at HealthSouth Altamonte Springs in 2014, after doing his residency in Cleveland, Ohio. He was drawn to the endless possibilities that would result in bringing an established hospital system to a growing and aging community. “Being such a large corporation, Encompass Health has rehab down to a science, we have resources and each hospital can function and operate and focus on specialties needed in our patient population.”

“THE UPSWING OF MEDICINE” Encompass Health Altamonte Springs employs a staff of more than 100 who are quick to point out what sets their teams and their services apart. First is clearing up the misconception, that because “rehabilitation” is in the hospital name, 4 FLORIDA MD - FEBRUARY 2021

COVER STORY

“At a skilled nursing facility a patient’s stay is a lot longer and they have approximately three to five hours of rehabilitation a week. At Encompass Health Altamonte Springs, we are a hospital and as such we are regulated to do three hours of therapy a day for five days each week,” explains Dr. Kuriakose. The secret to the hospital’s success, he added, is its staff and the fact that it is 100 percent dedicated to rehabilitation. The therapy is intentional, focused, Patients participate in a variety of exercises which help strengthen motor skills. multi-disciplinary and effective. With an average length of stay of about 12 days, compared to 38.5 days at a skilled nursing pital current holds disease-specific care certification from The home, Dr. Fuentes said Encompass Health can also get patients Joint Commission for its stroke rehabilitation program. back to their home, which is better for the patient and more For all patients though, regardless of their injury, there is a cost-efficient. For 2017, the company had a 79.4% discharge common denominator. Patients and their families must be comrate back to the community outperforming the Uniform Data mitted and able to handle the intense rehabilitation they will System for Medical Rehabilitation average of 75.9%. undergo at Encompass Health Altamonte Springs. The therapy gym, located in the center of the hospital, is a fo“If you have a complex patient with many medical comorcal point of a patient’s time at the hospital and boasts the most bidities, it is a challenge to do therapies outpatient or at home,” advanced equipment. Patients can move easily from one modalexplains Dr. Fuentes. “Most patients cannot endure home theraity to the next during their multiple visits to the gym each day. pies and some think they can’t tolerate three hours of therapy, Modalities include partial weight bearing equipment, to gate but many can and they do.” training, to IREX, a new modality that is a virtual reality therapy Before a patient is admitted, he or she undergoes pre-admissystem which uses immersive video gesture control. sion screening. Nurses do a CMS guideline screening, patients “The biggest thing to educate our patients about is that they’re are then evaluated by a physiatrist and physical and occupational not going to spend all day in bed. The goal here is to be out of therapists. bed, in the gym and working toward independence. For some “Every patient is exposed to multiple therapies. Patients enthat is terrifying and for some that is a welcome change,” says Dr. gage in physical therapy and we see how they perform. If they Kuriakose. “We almost take a second seat as a physician, because can tolerate it, it’s a good predictor of their success in an inpathe real goal is to get their therapies and ultimately transition tient rehabilitation facility,” says Dr. Fuentes. them home.”

THE ENCOMPASS HEALTH PATIENT

PLANNING DISCHARGE AT ADMITTING

Most Encompass Health Altamonte Springs patients are admitted from local acute care hospitals, although some are referred from home or other long-term care facilities. Patients admitted to Encompass Health Altamonte Springs face complex situations resulting from stroke, spinal cord injuries, amputations, traumatic brain injuries, ALS and neurologic cases. The hospital is also one of the few facilities in Central Florida certified in LSVT programs designed for Parkinson’s disease. In addition, the hos-

For Encompass Health Altamonte Springs patients, discharge planning begins at admission and includes patients and their families and caregivers every step of the way. “We work as a team. From day one, we establish realistic goals that involve patients, family, and the whole team. The whole idea is to set up a rehabilitation plan that includes the patient, and an interdisciplinary team aimed to guarantee a safe discharge home,” says Dr. Fuentes. FLORIDA MD - FEBRUARY 2021

PHOTO: ENCOMPASS HEALTH

that it is the same as a skilled nursing facility. The hospital also provides access to independent physicians specialized in rehabilitative medicine including Dr. Fuentes, and Dr. Dana Kuriakose.

COVER STORY This includes case managers planning ahead for everything from durable medical equipment to dialysis treatments, so that when patients can return home they have everything that they need to sustain their rehabilitation success. And if further care is needed after discharge, patients can choose to continue that high level of care they received in the hospital at home. In addition to inpatient rehabilitation, Encompass Health also has a home health and hospice segment available after discharge if needed.

“This is exceptional, especially considering we are working with post-surgical patients,” says Dr. Fuentes. “It is not only about function. As physiatrists we are trained in wound care, and our hospital is blessed to have a great wound care program that handle complex wounds on a regular basis.”

THE “TEAM CONFERENCE”

At Encompass Health Altamonte Springs, the multi-disciplinary team is charged with executing a road map that will get paPATIENT OUTCOMES tients out of their hospital bed and return home. The hospital For patients, being part of an acute care facility means that has all the specialties of an acute hospital including infectious they will move around and benefit from it. Encompass Health disease and cardiology to name a few. These specialists, comprisAltamonte Springs prides itself on extremely low infection rates, ing the team, meet two to three days per week in what is called half the benchmark for national rehabilitation hospitals. the “team conference.” Working cohesively as a group in these “team conferences” they ensure that patients are The goal at Encompass Health is to get patients out of bed and working toward their independence. getting all of the services they need to get them home faster, healthy and infection free. At the table you will find the entire team including the physician, a pharmacist, physical therapist, occupational therapist, speech therapist, registered dietitian, nurse and a case manager. The first team conference takes place within the first week of admission after the patient has fully been assessed. Together the 15-20 members of the team come up with one solidified idea to make a patient more functional with the ultimate goal is to start addressing a patients needs early on. “These meetings help us to coordinate patients’ needs better,” says Dr. Fuentes. “Every portion is so valuable and will help the patient turn the corner.”

PHYSIATRISTS - THE QUALITY OF LIFE SPECIALISTS Physiatry is a specialty that began during war time, caring for the military during the first and second World Wars. The physiatrists at Encompass Health Altamonte Springs point out that, while not as well known in the United States as in other countries, it is a specialty that is growing exponentially.

PHOTO: ENCOMPASS HEALTH

“As a specialty, physical medicine & rehabilitation focuses on function. We treat neurological and musculoskeletal conditions which can limit independence” says Dr. Fuentes. For those who have made their careers in physiatry, such as Drs. Fuentes and Kuriakose, it is a specialty of the heart. Each has a unique path that led them to this field. Dr. Fuentes did his residency at Case Western Reserve University at the MetroHealth Rehabili6 FLORIDA MD - FEBRUARY 2021

COVER STORY tation Institute of Ohio, where spent part of his residency at the trauma hospital and at the Veterans’ Hospital in Cleveland treating traumatic brain injuries and spinal cord injuries. For him, overseeing a patient’s rehabilitation from a devastating injury and observing their strength, and the strength of their families recommitted him to the specialty.

“I changed my career goals after that. Other specialties don’t have the ability to see the direct results of treating complex issues. My daughter was completely dependent when she became a patient at Encompass Health Puerto Rico. And now, here we are years later, she is a normal teenager and has recovered completely. I often share this story with my patients. It helps us create a rapport. I don’t presume to know what ever patient is feeling, but I’ve been there in a hospital, crying and I have been in their shoes.” For Dr. Kuriakose, the specialty is incredibly rewarding because she can oversee a patient’s progress. “We get to see patients over a long period of time, their progression and as they move back into the community.”

PHOTO: ENCOMPASS HEALTH

Dr. Fuentes understands firsthand the life changing effects of rehabilitation. At the age of two, his daughter suffered a stroke and became a patient at the Encompass Health hospital in Puerto Rico.

Therapists review multi-disciplinary patient treatment plans.

“I would advise them to trust our care and providers. We have the best therapy teams, we have the best nursing teams and we have an excellent team of doctors dedicated to our patients.” With the commitment of its staff, therapists and physicians, Encompass Health Altamonte Springs continues to spread its wings, and reach those with acute rehabilitation needs, providing patients with a road to recovery in order to return home, to a new normal and regain a level of independence despite their injuries. 

It was while in residency at Harvard that she treated Boston Marathon bombing victims and witnessed firsthand the strong sense of support within the rehabilitation community. “This support is invaluable for patients. I consider it a privilege to be a part of the team that gives them the physical and emotional tools to regain their independence.”

WHY ENCOMPASS HEALTH? At Encompass Health Altamonte Springs, the physiatrists and therapy teams work in tandem, providing an acute rehabilitation facility that offers patients the ability to be monitored and have their therapy directed from all angles. This aids in overall positive outcomes and patients return to an independent, albeit perhaps new normal, life. For Dr. Fuentes and his colleagues, time spent at the inpatient rehabilitation hospital is a critical component to a patient making important strides in his or her recovery.

ENCOMPASS HEALTH REHABILITATION HOSPITAL OF ALTAMONTE SPRINGS 831 SOUTH STATE ROAD 434 ALTAMONTE SPRINGS, FL 32714 PHONE NUMBER: 407.587.8600

FLORIDA MD - FEBRUARY 2021

DERMATOLOGY

Not All Basal Cell Carcinomas Are Created Equal

Lucky Meisenheimer, M.D. is a board-certified dermatologist specializing in Mohs Surgery. He is the director of the Meisenheimer Clinic – Dermatology and Mohs Surgery. John Meisenheimer, VII is a medical student at USF.  8 FLORIDA MD - FEBRUARY 2021

Nodular basal cell carcinoma.

PHOTO: JOHN MEISENHEIMER, VII PHOTO: JOHN MEISENHEIMER, VII PHOTO: JOHN MEISENHEIMER, VII PHOTO: JOHN MEISENHEIMER, VII

Occasionally a patient will tell me their “doctor friend” recommended that they don’t need treatment for a basal cell carcinoma because it will never hurt you. “Doc, he said it’s only a basal cell carcinoma.” Dermatologists fully recognize this as a genuinely cringe-worthy statement. You don’t need to see too many people missing various parts of their facial anatomy to know this advice is blatantly wrong. Even in this modern time of medical miracles, people still die from neglected basal cell carcinomas. When pressed for the name of their “doctor friend,” it usually comes up as I don’t remember their name, or it ends up being “Doctor Google.” It is true a superficial basal cell carcinoma on the torso probably would take years and years for it to cause any sort of significant morbidity to a patient. But, on the other hand, even a small basal cell on the torso will continue to grow if left untreated slowly. What might have been a simple, inexpensive procedure now, a decade later, has turned into a monster of aggravation, discomfort, and cost. Although metastatic disease risk is low with basal cell carcinomas, it is certainly not zero. Several people die each year from basal cell carcinoma. Even more, patients can have disfiguring bouts with cancer losing various parts of anatomy such as nose, ears, eyes, etc. What a lot of patients and even some physicians are not aware of is that not all basal cell carcinomas are created equal. There are several different histologic growth patterns. These varying histologic types can each behave Infiltrative Basal Cell carcinoma of the forehead. differently and require different treatment plans. As mentioned before, a superficial basal cell carcinoma is probably not going to cause a great deal of physical damage unless neglected for long periods. There are other types of basal cell carcinomas; morpheaform and sclerosing basal cell carcinomas with infiltrating growth patterns. These cancers left untreated can cause a significant amount of morbidity in shorter periods measured in months, not years. Aggressive basal cell cancers can also become neurotropic, meaning that they “wrap” around a nerve and can track down its length. Neurotropism can be particularly dangerous, especially if this is on the face and affecting a nerve that happens to pass through a foramen into the brain. Clearly, not a good scenario. Basal cell carcinomas, limited to the skin, tend to be very amePathology of an infiltrative Superficial Multifocal BCC. basal cell carcinoma. nable to treatment in a variety of different ways. Even as a Mohs surgeon I can think of at least half a dozen different ways that I have treated basal cell carcinomas. Not all basal cell carcinomas need Mohs surgery. Each case of basal cell carcinoma should be evaluated individually and in consideration as to the best method of treatment based on its histologic growth pattern, location, and physical condition of the patient. The great news about basal cell carcinoma, even though it is the most common type of skin cancer and millions are treated each year, only a tiny percentage of these end up causing death in patients. When someone says I would much rather have a basal cell Neurotropic basal cell carcinoma. carcinoma than a melanoma, there is a caveat; if you die from a basal cell carcinoma, you are just as dead as if you were to die from melaSclerosing basal cell noma. Happily, most of the time, with early diagnosis and treatcarcinoma. ment, you don’t have to die from either. Basal cell carcinoma is called cancer for a reason. Give it its respect that it is due, or otherwise, you may regret saying, “oh, you don’t have to worry about it, it’s only a basal cell carcinoma.”

PHOTO: JOHN MEISENHEIMER, VII

By John “Lucky” Meisenheimer, MD and John Meisenheimer, VII

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.

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. 

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 FLORIDA MD - FEBRUARY 2021

Leading Technologies in Heart and Vascular Care By Farhan J. Khawaja, MD According to data published by the Centers for Disease Control and Prevention, cardiovascular disease is the leading cause of death in the United States, accounting for 1 in every 4 deaths. Included among these cardiovascular disease-related deaths are coronary heart disease, stroke, heart failure and diseases of the arteries. While this is a sobering statistic, it must be tethered to the new technologies that continue to advance the fight against heart disease. We know many of the risk factors that contribute to cardiovascular disease, whether lifestyle or genetic, including smoking, physical inactivity, poor diet, obesity, high cholesterol, high blood pressure and diabetes. But medical intervention is often critical in providing an improved quality of life and lifesaving care for many individuals facing cardiovascular disease. Based on a collaborative model of care, unique in our state, Orlando Health Heart & Vascular Institute offers multidisciplinary care where cardiologists, vascular surgeons, and cardiac surgeons work together to deliver optimal care to the patient. This collaborative approach is coupled with the latest technology to drive high-quality patient care and the best possible outcomes. The following looks at some of the cutting-edge programs and technologies used to bring hope and healing to heart patients. Diagnostic imaging is often one of the first steps in developing a plan of care for cardiovascular conditions. Orlando Health Heart & Vascular Institute is one of a few sites that offers HeartFlow® FFR CT (fractional flow reserve) Analysis, a noninvasive technology that creates a 3D image of the coronary arteries. This tool allows physicians to determine if the blockages seen on a CT scan warrant revascularization, stent placement or bypass without having to do an invasive angiogram. Conditions involving a defect or abnormality in the heart valves or chambers fall under the structural heart disease umbrella. These disorders are either congenital or acquired later in life due to aging, infection or a related underlying condition. Orlando Health Heart & Vascular Institute’s Interventional Cardiology Program focuses on the utilization of minimally invasive approaches in both diagnosis and treatment. By navigating catheters through veins and arteries, interventional cardiologists can locate and clear blocked arteries and repair heart defects. Innovative treatments like the transcatheter aortic valve replacement (TAVR) procedure allow for effective repair and replacement of heart valves. Since 2012, Orlando Health Heart & Vascular Institute’s interventional cardiologists have performed more than 500 minimally invasive TAVR procedures, replacing a damaged aortic valve with a collapsible valve made from medical-grade plastics and bovine heart tissue. Heart disease and heart patients do not follow a one-size-fits-all approach, so both cardiologists and surgeons evaluate patients to determine the best treatment option. In the realm of the advanced electrophysiology, the Electrophysiology and Arrhythmia Center at Orlando Health Heart & Vascular Institute offers a number of therapies to treat an irregular heartbeat — a major risk factor for stroke. Atrial fibrillation ablation and ventricular tachycardia ablation are procedures that 10 FLORIDA MD - FEBRUARY 2021

eliminate the areas of the heart causing the arrhythmia, using radiofrequency or cryoenergy. Offered at only a select number of facilities, hybrid-convergent ablation is a unique procedure in which both the surgeon and cardiologist evaluate patients to determine how best to complete the procedure. The minimally invasive Watchman® procedure can help prevent strokes for qualifying patients by implanting a device that closes the left atrial appendage in the heart to keep harmful blood clots from traveling out of the heart and potentially causing a stroke. By offering treatment options from an electrophysiological and a surgical standpoint, we can look at each patient individually to determine the best course of therapy. One of the institute’s marquee collaborations is between our highly trained vascular surgeons and interventional cardiologists. For all vascular conditions, be it carotid disease, aortic disease, venous, or lower extremity peripheral arterial disease, there is a team approach to provide comprehensive care. With the cardiologist and vascular surgeon working side by side, the patient is ensured the best available therapies. Orlando Health Heart & Vascular Institute offers a multitude of highly specialized programs that address specific needs. One of these areas is pulmonary hypertension, which is elevated pressure on the right side of the heart. This can be a very dangerous condition, and there are a limited number of physicians who can treat it. Orlando Health Heart & Vascular Institute has a pulmonary hypertension clinic, with specialists who know how to treat the disease and prescribe the correct treatment regimen for it. A robust cardio-oncology program is an area that also is an example of multidisciplinary collaboration, where cardiologists work with their oncology colleagues to monitor patients undergoing chemotherapy for any toxic side effects to the heart. A cardio-obstetrics program was created to provide specialized, multidisciplinary care for pregnant women with heart disease for a successful outcome for both mother and baby. There are limited facilities able to offer this specialized care. President of Orlando Health Heart & Vascular Institute, Farhan J. Khawaja, MD, is a practicing interventional cardiologist. He holds several board certifications in internal medicine, cardiovascular diseases, interventional cardiology and nuclear cardiology. Dr. Khawaja earned his medical degree from Albany Medical College in New York. He completed his internal medicine residency and cardiovascular diseases fellowship at the Mayo Clinic, followed by fellowships in interventional cardiology, and vascular and endovascular medicine at Columbia University Medical Center, where he also was an instructor of medicine. He is a fellow of both the American College of Cardiology and the Society for Cardiovascular Angiography Interventions. 

HEALTHCARE LAW

Social Media – Five Things Physicians Should Never Post By Julie A. Tyk, JD Last year, Alaska dentist, Seth Lookhart, made national headlines for filming a video of himself riding a hoverboard while extracting a patient’s tooth. Dr. Lookhart filmed the procedure on a sedated patient without authorization and forwarded the video to several people. A lawsuit was filed by the State of Alaska in 2017 charging Dr. Lookhart with “unlawful dental acts”, saying his patient care did not meet professional standards. The lawsuit goes on to further allege Dr. Lookhart joked that performing oral surgery on a hoverboard was a “new standard of care,” citing phone records that were obtained. Dr. Lookhart has also been charged with medical assistance fraud for billing Medicaid for procedures that were not justified, unnecessary, and theft of $25,000 or more by diverting funds from Alaska Dental Arts. On Friday, January 17, 2020, Dr. Lookhart was convicted on 46 counts of felony medical assistance fraud, scheming to defraud, misdemeanor counts of illegally practicing dentistry and reckless endangerment. Dr. Lookhart is expected to be sentenced on April 30, 2020. He faces the possibility of up to 10 years in prison. A doctor in Rhode Island was fired from a hospital and reprimanded by the state medical board. The hospital took away her privileges to work in the emergency room for posting information online about a trauma patient. The doctor’s post did not include the patient’s name, but she wrote enough that others in the community could identify the patient, according to a board filing. The popularity of social media has exploded in recent years. According to a recent PEW report, 70% of Americans use social media. Before jumping on the bandwagon, healthcare professionals are advised to be mindful of the possible ramifications of posting information on social media sites. There are numerous legal issues that can arise when healthcare providers use social media, including issues related to patient privacy, fraud and abuse, tax-exempt status, and physician licensing. The Federation of State Medical Boards has issued the Model Guidelines for the Appropriate Use of Social Media and Social Networking in Medical Practice, which contains the “industry standards” for cyber security, online behavior, and patient privacy. Physicians should familiarize themselves with these guidelines. Five things which physicians should never post to social media. 1. Inaccurate Medical Information: Medical professionals should avoid republishing, sharing, “liking,” or “retweeting” news stories about medical treatments unless they have completely read the story and have verified its accuracy. If a user finds inaccurate medical information through your social media channel, it can reflect very poorly upon you and your practice. Healthcare professionals also need to be careful about providing medical advice to patients using social media. If a patient receiving the medical advice from a doctor through social media is located in a state in which the doctor is not licensed, the doctor giving the advice risks liability under state licensing laws. 2. Do Not Post Anything that Violates Patient Confidentiality: Friending patients on social media sites may pose risks under Health Insurance Portability and Accountability Act (HIPAA) and state privacy laws. The fact that an individual is a patient of a healthcare provider falls within the types of health information that these laws

are designed to protect. As a rule, healthcare providers should not use social media to share any health information that could be linked to an individual patient, such as names, pictures, and physical descriptions, without the patient’s consent. The American College of Physicians recommends that doctors be especially aware of the implications for patient confidentiality when using social media. There have been cases of physicians losing their medical license after posting an image on social media that violated patient confidentiality. Always obtain permission from the patient in writing if you intend to use an image featuring any body part. Avoid talking about specific patients at all on social media unless you have permission to do so. Even if there is no chance that a patient could be identified by what you write on social media, it is considered unprofessional to discuss the specifics of their condition. Also be careful when taking photographs of yourself while in your practice. There have been cases where medical professionals have accidentally included the image of the patient behind them while taking a ‘selfie’. Make sure there are no patient health records on display when taking photos in the medical practice and no patients are included in photographs unless they want to be. 3. Your Personal Information: The American College of Physicians (ACP) and the Federation of State Medical Boards (FSMB) recommend that doctors create separate social media accounts for their professional and personal lives. They also suggest that the professional profile be more visible than any personal one. 4. Opinions on Controversial Issues: Any controversial topic or “hot button” topic should be avoided as much as possible, including anything to do with religion, politics, racism, abortion, and gun control. Moreover, healthcare providers that are exempt from taxation under Section 501(c)(3) of the Internal Revenue Code are prohibited from intervening in political campaigns and from seeking to influence legislation as a substantial part of their activities. This restriction may extend to advertising on or sponsoring social media sites that support a political candidate or particular pieces of legislation. 5. Complaints or Rants: It is unprofessional to use social media platforms to complain or rant about your professional situation. Everything you write on social media may one day come back to haunt you. A patient might realize that you were complaining about them on social media. A medical malpractice claim can have far reaching implications. The Health Care Practice Group at Pearson Doyle Mohre and Pastis, LLP, is committed to assisting Clients in navigating and defending medical malpractice claims. For more information and assistance, please contact David Doyle and Julie Tyk at Pearson Doyle Mohre & Pastis, LLP. Julie A. Tyk, JD, 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, and may be contacted by calling (407) 951-8523; jtyk@pdmplaw.com.  FLORIDA MD - FEBRUARY 2021 11

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: • 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 12 FLORIDA MD - FEBRUARY 2021

PHARMACY 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.

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Check out our newly redesigned website at www.floridamd.com! FLORIDA MD - FEBRUARY 2021 13

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 14 FLORIDA MD - FEBRUARY 2021

+1 (205)-663-0521

2021

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 - FEBRUARY 2021 15

Connected care. Superior outcomes. HealthSouth Corporation and Encompass Home Health & Hospice have combined our post-acute strengths into Encompass Health. As part of a nationwide network, we are redefining expectations for how providers work together to create better patient experiences and deliver unparalleled outcomes. As a coordinated care team, we set the standard for the future of rehabilitation. ENCOMPASSHEALTH.COM/ALTAMONTESPRINGSREHAB 18

Rehabilitation Hospital of Altamonte Springs