Florida md september 2016 by FloridaMD

SEPTEMBER 2016 â&#x20AC;¢ COVERING THE I-4 CORRIDOR

Florida Hospital Leads Changes in Digestive Health Dr. Monson, Colorectal Surgeon, Focused on Overseeing Expansion and Growth

LIFE. SAVED. “One night after work, I was riding my bike home when a car hit me at 50 mph. The collision threw me 100 feet and left me with a traumatic head injury, broken ribs and severely injured knees. Thankfully, I was rushed to Osceola Regional Medical Center, where they just opened a new trauma center. For 22 days, I got incredible help from an amazing team of doctors, nurses and therapists – people who literally saved my life. Now I’m on the road to a complete recovery!” – David

TAKING CARE TO THE NEXT LEVEL. Osceola Regional Medical Center’s Level II Trauma Center has transformed care for critically injured patients in Osceola County and beyond. Our experts are here 24/7, saving time and saving lives, giving patients like David a second chance at life.

See David’s full story and learn more about our Level II Trauma Center at Osceola Regional.com/trauma

FLORIDA MD - SEPTEMBER 2016 1

FROM THE PUBLISHER

am pleased to bring you another issue of Florida MD. The 2016 Olympics in Rio have come and gone, but the Special Olympics Florida, a biennial event, continues on. Their Healthy Athletes program is designed to help meet the health needs of individuals with intellectual or developmental disabilities. I hope some of you can take the time to learn about this program and howe you can help these very special athletes. Best regards,

Donald B. Rauhofer Publisher

COMING NEXT MONTH: The cover story focuses on Florida Hospital Cancer Institute. Editorial focus is on Cancer and Dermatology.

Many people are surprised to learn that Special Olympics is much more than a single biennial event. Here at Special Olympics Florida, we provide year-round sports training, competition, and health services to children and adults with intellectual disabilities, all at no cost to the athletes or their caregivers. As part of our wellness initiative, Healthy Athletes, we seek to create a culture of health throughout our organization, communities, and state. Healthy Athletes is designed to help meet the health needs of individuals with intellectual or developmental disabilities (ID/DD) and was started by Special Olympics in 1997. We currently offer free health exams to individuals with ID/DD in Florida in the following seven areas: Fit Feet (podiatry), FUNfitness (physical therapy), Health Promotion (health and well-being), Healthy Hearing (audiology), MedFest (sports physical/medical exam), Opening eyes (vision), and Special Smiles (dentistry). In 2015, we conducted nearly 9,000 exams across the state. We are committed to assisting our athletes with finding the services and resources that they require based on exam results. We educate families about programs and services that are available to them in the community. Special Olympics Florida Healthy Athletes refers athletes to carefully selected providers from our database. This is an opportunity for you to become a health provider to an under-served, yet very deserving population. If you are interested in being included as one of our preferred providers, please contact Jennifer Miller at 352-243-9536 ext. 503 or JenniferMiller@sofl.org. Being one of our preferred providers does not require you to offer free or reduced services or add anything to your normal services. It is simply a way for us to include you in our database. Far too often, our athletes and families struggle to find providers who are willing to give them the assistance they seek. Thank you for your consideration!

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Publisher: Donald Rauhofer Photographer: Donald Rauhofer / Florida MD Contributing Writers: Katie Dagenais, Daniel Layish, MD, Scott R. Wehrly, MD, Scot C. Holman, MD, Vinay Gutti, MD, Sajeve S. Thomas, MD, Steven Rosenberg, MD, Jeff Holt, CMPE, VP, Jennifer Thompson, Corey Gehrold, Marni Jameson Carey 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 2012, Sea Notes Media. All rights reserved. Reproduction in whole or in part without written permission is prohibited. Annual subscription rate $45.

contents

ON THE COVER: DR. MONSON, COLORECTAL SURGEON

COVERING THE I-4 CORRIDOR

 COVER STORY

When John Monson, MD, first visited Florida Hospital as a guest lecturer in colon and rectal surgery in 2013, he was impressed by what he saw; a comprehensive program led by internationally renowned physicians and surgeons, delivering care across five hospitals in the Central region, and a range of clinics around Central Florida. He returned annually to teach an international course at the Orlando campus location, but when he was first approached about leading the colorectal group, he originally declined. He wanted to do more than lead a colorectal surgery group, for him this was a larger, more expansive mission encompassing a broader vision to redefine patient delivery beyond one subspecialty. His vision aligned with leaders at Florida Hospital, who recognized that developing their colorectal surgery program was indeed a bigger undertaking. The bigger project would need to include a focus on overall digestive health and also a focus on the patient experience and building a program based on specific patient needs of this specialty area. When Dr. Monson joined the team in April of 2016 as Executive Director of Colorectal Surgery for the Florida Hospital System, he began immediately on a multi-phase plan to expand upon the health system’s mission of quality and service excellence and expanding the fields of training, education and research to navigate and be a part of the changing healthcare landscape.

PHOTO: DONALD RAUHOFER / FLORIDA MD

SEPTEMBER 2016

17 NEXT-GENERATION IOL OFFERS “MOST NATURAL” EYESIGHT CORRECTION TO CATARACTS PATIENTS 19 FAST-GROWING INDEPENDENT DOCTORS’ GROUP – NOW IN OVER HALF OF NATION

DEPARTMENTS 2

FROM THE PUBLISHER

PULMONARY & SLEEP DISORDERS

MARKETING YOUR PRACTICE

10 HEALTHCARE BANKING, FINANCE AND WEALTH 11 ORTHOPAEDIC UPDATE 12 CANCER 15 ALLERGIES

FLORIDA MD - SEPTEMBER 2016 3

COVER STORY

Florida Hospital Leads Changes in Digestive Health Dr. Monson, Colorectal Surgeon, Focused on Overseeing Expansion and Growth By Katie Dagenais When John Monson, MD, first visited Florida Hospital as a guest lecturer in colon and rectal surgery in 2013, he was impressed by what he saw; a comprehensive program led by internationally renowned physicians and surgeons, delivering care across five hospitals in the Central region, and a range of clinics around Central Florida. He returned annually to teach an international course at the Orlando campus location, but when he was first approached about leading the colorectal group, he originally declined. He wanted to do more than lead a colorectal surgery group, for him this was a larger, more expansive mission encompassing a broader vision to redefine patient delivery beyond one subspecialty. His vision aligned with leaders at Florida Hospital, who recognized that developing their colorectal surgery program was indeed a bigger undertaking. The bigger project would need to include a focus on overall digestive health and also a focus on John R.T. Monson, MD, Executive Director of Colorectal Surgery for the Florida Hospital System.

the patient experience and building a program based on specific patient needs of this specialty area. When Dr. Monson joined the team in April of 2016 as Executive Director of Colorectal Surgery for the Florida Hospital System, he began immediately on a multi-phase plan to expand upon the health system’s mission of quality and service excellence and expanding the fields of training, education and research to navigate and be a part of the changing healthcare landscape. Credited with leading the development of laparoscopic colorectal surgery in the United Kingdom, Dr. Monson brings to Florida Hospital a fellowship-trained background in colon and rectal surgery, surgical oncology, and vascular surgery. His areas of expertise include the use of minimally invasive technologies in colorectal cancer treatment, including Transanal Endoscopic Microsurgery (TEMS) and Transanal Total Mesorectal Excision (TME), laparoscopy, and robotic surgery. On the research side, his work includes investigation of a broader range of cancer-related areas including development of national standards of cancer care and qualitative assessments of decision-making in cancer care. His research into how cancer care is delivered is a building block for his dual role at Florida Hospital.

TAKING A HIGH-LEVEL VIEW

PHOTO: DONALD RAUHOFER / FLORIDA MD

In addition to heading up the development of the specialty colorectal practice, he is also taking a broader, higher level view of delivery of digestive health services across the Florida Hospital system and the development of the emerging Digestive Health Institute. As a first step this requires growing and implementing changes in the colorectal surgery program to accommodate the needs of patients at multiple locations, further streamlining and developing the clinical practice and skills across the system and expanding and building new office areas. He is also tasked with beginning a comprehensive research program focused on delivery of care and developing a much-needed national accreditation program in the care for patients with rectal cancer. As he embarks on this work and successful implementation of these projects across the Florida Hospital system, Monson keeps his focus on the basics.

TREATING THE WHOLE PERSON “The most basic level is to deliver care in a patient and family centered way, recognize that the patient is more than an organ, they are human beings who have a lot going on in their lives. Consultations are about more than just surgery. How are families going to cope with this issue? What can we do to help them with this process? It’s about providing care in a seamless way, not driving hours for a 15 minute X-ray, for example - patients need someone leading coordination of care,” says Monson. 4 FLORIDA MD - SEPTEMBER 2016

COVER STORY He also believes that when it comes to meeting the needs of patients, its about knowing what you are up against. That will include concentrating much-needed attention on an area in healthcare that is lagging here in the United States - colorectal cancer care. The research that Monson led at the University of Rochester, where he spent eight years prior to coming to Florida Hospital, found that nationally, one in four colorectal cancer patients did not get the care they should have received simply based on where they lived and what facility they went to. PHOTO: DONALD RAUHOFER / FLORIDA MD

“Despite well-established guidelines, not all patients were getting the care they needed,” says Monson. Enter in The Digestive Health Institute, a collaboration of Florida Hospital specialists including gastroenterologists, pancreatic surgeons, liver surgeons and colorectal surgeons focused on coordination of care. Florida Hospital is putting resources behind the Digestive Health Institute and The Center for Colon and Rectal surgery, to lead what Dr. Monson calls a major re-design of digestive care in central Florida. “The goal of the Digestive Health Institute is to focus not just on a single organ, but on the whole person and to have the physicians, surgeons, and other care providers work it all out as a seamless process for patients in one package,” says Monson.

SETTING THE STANDARD OF EXCELLENCE Monson and other researchers also saw the need for a National Accreditation Program for Rectal Cancer care. The NAPRC is being developed by the American College of Surgeons and the Commission on Cancer along with the OSTRiCh Consortium, a group of healthcare institutions dedicated to providing access to high-quality rectal cancer care for all Americans. Florida Hospital was one of six sites chosen to launch the new accreditation program, joining Baylor University Medical Center in Texas, The Cleveland Clinic in Ohio and Florida, The John Muir Medical Center in California, and The University of Rochester Medical Center in New York to serve as a model and test site for how colorectal cancer care should be delivered and best practiced. According to Monson, whose research has spanned both sides of the Atlantic, the United States needs to look to Europe, where leaders in the field have completely changed how colorectal cancer care is delivered. Subsequently, it has changed the way other cancer care is delivered in Europe.

DELIVERING CARE WHERE IT’S NEEDED According to the American Cancer Society more than 131,000 new cases of colon and rectal cancers will be diagnosed in 2016. Colorectal cancer is expected to cause more than 49,000 deaths making it the second leading cause of cancer-related deaths among men and women combined. While the death rate has been dropping for decades, due in part to screenings and early diagnosis, Monson points out a concerning disparity among colorectal cancer survival based on a person’s zip code and the access they have to life saving screenings and specialists.

Discussing the function of the colon.

“It’s referred to as the zip code lottery, where a person lives directly translates into outcomes,” says Monson. Florida Hospital continues to make enormous investments in brick and mortar, technology, and equipment to further the focus on colorectal surgery and digestive issues, and to bring services to the patients, rather than requiring them to travel for care. Monson and his team are tasked with organizing and overseeing the program and overcoming the challenges faced by healthcare systems. Monson calls it the 30,000 foot view. “How do you navigate an efficient, seamless, high-quality, trouble-free, patient-friendly journey? That’s what all medical centers around the world are now trying to work out. Our job is to say to the patient ‘We will look after you, whatever you need. You don’t have to worry. The right hand will talk to the left hand. You just have to focus on being a well person. Our job is to figure everything else out for you and to listen to your needs.’” To further meet the needs of its patients managing digestive and colorectal health issues, Florida Hospital is beginning with aggressive recruitment of additional colorectal surgeons. The colorectal surgery practice is expected to grow from six surgeons to at least nine, adding services at Florida Hospital campuses in Apopka, Celebration and Winter Garden over the next two to three years. Florida Hospital will also increase its presence at the downtown Orlando campus and at campuses in Altamonte Springs, East Orlando, Kissimmee and Winter Park. “Our communities are in need of this coverage,” says Monson. “They know our services are very high quality. They want more of this. We are not there all the time. They want more.” In addition to improving patient access across its hospitals and facilities, Florida Hospital is also taking on one of the biggest FLORIDA MD - SEPTEMBER 2016

COVER STORY

PHOTO: DONALD RAUHOFER / FLORIDA MD

“Any sensible individual attempting to redefine healthcare delivery programs looks at examples of best practices around the world. Because of my background, I do that all the time. No one has the patent on excellence across the board, but partnering with national consortiums and developing a true Center of Excellence, we will continue to build on the training and research that we have access to here in the Florida Hospital system and we will make great strides in the delivery of care for our patients,” says Monson.

Preparing to use an electrosurgical device.

challenges faced by health care systems: delivering patient-and family-centered care. “In most countries in the world, it is a human characteristic that we want the best quality care on our doorstep and we don’t want to have to travel,” says Monson. “In the past decade, healthcare systems are pressing the reset button, becoming more familycentric, having specialists travel to regional and satellite centers. These coordinated approaches are complex dynamics to resolve, but worthy of resolving.” Committed to pioneering how healthcare is delivered, Florida Hospital is building a brand new research facility on the Orlando campus dedicated solely to health services research. “We will research the way we deliver care to patients,” says Monson. “What drives successes in clinical care, what drives obstacles, why is there such a spectacular level of diversity of care provided to people around this country?” Research will also look at everything from managing electronic medical records, to connecting care to address geographical challenges. For Monson, Florida Hospital is the perfect location to investigate these issues and implement new ideas. “In the last 15 years most of my research has been focused on analyzing delivery of care, developing new treatments with clinical trials. One of the most attractive qualities I saw here was the fact that the colorectal group, specifically, was very active from a research and education standpoint. They are, by a comfortable margin, the most prolific and productive colorectal group in Central and Northern Florida. They are a very well-known group with an exceptional reputation both nationally and internationally, and are among the most productive group in the entire Florida Hospital system.” Monson recognizes that implementing new ideas to benefit the patient care experience, especially in a system such as Florida Hospital, which has its origins in private practice, is a big project. But with population growth and the demand for highly specialized practices, the leadership of Florida Hospital is well poised to meet those needs and develop a Digestive Health Institute by laying the foundation in education, training, and research. 6 FLORIDA MD - SEPTEMBER 2016

Monson knows this success depends on a group of people focused on the broader, balcony-level view of healthcare. And, he believes that from the overseas observers and the fellows that come to Florida Hospital for the specialized training, to the new surgeons joining the team, to research outcomes, that Florida Hospital is well-positioned to change the way healthcare is provided for patients in need of digestive health and colorectal surgery specialists. John R.T. Monson, MD practices at The Center for Colon & Rectal Surgery which offers comprehensive treatments and minimally-invasive surgery for colorectal disorders, conditions and cancers. The multi-disciplinary practice consists of six highly-trained physicians and board-certified colon and rectal surgeons. To learn more visit www.CenterColon.com or call 407.303.2615. 

CONDITIONS TREATED AT CENTER FOR COLON AND RECTAL SURGERY • Anal Abscess/Fistula • Anal Cancer • Anal Fissure • Bowel Incontinence • Colon cancer • Colorectal Cancer • Constipation • Colostomy Avoidance • Crohn’s Disease • Diarrhea • Diverticular Disease • Hemorrhoids • J-Pouch surgery • Pelvic Floor Dysfunction • Polyps of the Colon and Rectum • Rectal Cancer • Rectal Prolapse • Rectovaginal Fistula • Ulcerative Colitis

PULMONARY AND SLEEP DISORDERS

Idiopathic Pulmonary Fibrosis – Current Approach to Therapy By Daniel T. Layish, MD Idiopathic pulmonary fibrosis (IPF) is also known as usual interstitial pneumonitis (UIP). There are estimated to be 48,000 new diagnoses of IPF per year in the United States, with 40,000 deaths per year. About two thirds of patients with IPF pass away within five years of diagnosis. For many years, combination therapy with prednisone and azathioprine had been used. However, the PANTHER trial revealed convincingly that combination therapy with prednisone and Imuran actually resulted in greater mortality, more hospitalizations, and more serious adverse events than placebo. Therefore, combination therapy with azathioprine and prednisone is no longer recommended. For a while, treatment of IPF had been essentially supportive including supplemental oxygen, pulmonary rehabilitation and vaccination against Streptococcus pneumoniae and influenza. Lung transplant can also be considered when appropriate. Pirfenidone (Esbriet) is an antifibrotic agent, which has now been shown in several clinical trials to reduce disease progression and improve progression free survival in patients with IPF. Pirfenidone inhibits the synthesis of transforming growth factor Beta, which plays a role in cell proliferation and differentiation. There have been two previous phase III trials of Pirfenidone that seem to have conflicting results. One study (published in 2010) showed that Pirfenidone slows disease progression while another study (published in 2011) did not meet its end point. However, this last study did have some trends that were in a positive direction; this resulted in the FDA requesting the “ Assessment of Pirfenidone to Confirm Efficacy and Safety in Idiopathic Pulmonary Fibrosis Study” (ASCEND). The result of this study was published in the New England Journal of Medicine. In the ASCEND study, 278 patients with IPF were randomized to receive Pirfenidone 2403 mg per day for 52 weeks. 277 patients were randomized to receive Placebo. The primary endpoint was forced vital capacity and secondary end points included 6-minute walk test distance, progression free survival, dyspnea, overall mortality and disease specific mortality.The proportion of patients who had an absolute reduction of at least 10% in predicted forced vital capacity (FVC) or who died was 47.9% less in the Pirfenidone group as compared to the Placebo group. In addition, the average decrease in FVC from baseline was lower in the Pirfenidone group versus the Placebo group (235 versus 428 mL). Furthermore, the proportion of patients who had no decline in FVC was 132% higher in the Pirfenidone group than in the Placebo group and there was also less decline in the 6-minute walk distance in the Pirfenidone group compared to the Placebo group as well as better progression free survival. However, there was no significant difference in dyspnea score and all cause mortality or disease specific mortality between the two groups. There has been a pooled analysis of data from all three Pirfenidone trials, which revealed that the overall risk for death at 52 weeks was lower in the Pirfenidone group versus the placebo

group with a hazard ratio of 0.52. In this pooled analysis Pirfenidone improved both all cause mortality and disease specific mortality. The most common side effects included gastrointestinal and skin related adverse effects, but these rarely led to treatment discontinuation. Unfortunately, patients on Pirfenidone do not necessarily perceive improvement and Pirfenidone is certainly not a cure for this serious illness. Nevertheless, it appears to be a good option for slowing down the progression of this serious condition. Another new option for treating UIP/IPF is Nintedanib (OFEV®) This is a tyrosine kinase inhibitor that targets growth factors including the vascular endothelial growth factor receptor, fibroblast growth factor receptor and platelet derived growth factor receptor. In May 2014, Luca Richeldi et al published the results of two 52 week randomized, double blind phase 3 studies of nintedanib (150 mg twice/day) versus placebo in the New England Journal of Medicine. 1066 patients were enrolled in a 3:2 randomization. The adjusted annual rate of change in FVC was negative 115 ml with Nintedanib versus negative 240 ml with placebo. Diarrhea occurred in over 60 percent of patients on Nintedanib but led to discontinuation in less than five percent. The most frequent serious adverse reactions reported in patients treated with OFEV® (more than placebo), were bronchitis (1.2% vs. 0.8%) and myocardial infarction (1.5% vs. 0.4%). However, in the predefined category of major adverse cardiovascular events (MACE) including myocardial infarction, fatal events were reported in 0.6% of OFEV® treated patients and 1.8% of placebo-treated patients. Therefore, the clinician must weigh the risk/benefit ratio of using this medication in a patient with known coronary artery disease (or cardiovascular risk factors) carefully. In conclusion, IPF/UIP is a relatively common and progressive pulmonary disorder. Pirfenidone and Nintedanib are two new agents that appear to slow down the progression of this disease. Further research needs to be done to identify agents that can reverse pulmonary fibrosis. Since Nintedanib and Pirfenidone seem to have similar efficacy, most clinicians choose one over the other based on side effect profile and dosing considerations. References available upon request

Daniel Layish, MD, graduated magna cum laude from Boston University Medical School in 1990. He then completed an Internal Medicine Residency at Barnes Hospital (Washington University) in St.Louis, Missouri and a Pulmonary/Critical Care/Sleep Medicine Fellowship at Duke University in Durham, North Carolina. Since 1997, he has been a member of the Central Florida Pulmonary Group in Orlando. He serves as Co-director of the Adult Cystic Fibrosis Program in Orlando. He may be contacted at 407-841-1100 or by visiting www.cfpulmonary.com.  FLORIDA MD - SEPTEMBER 2016

MARKETING YOUR PRACTICE

3 Essential Medical Office Employee Training Initiatives By Jennifer Thompson Does your office conduct training for new hires? Not just the “here’s what you’ll be doing and how to do it” training; but the “here’s how we expect you to act and thrive in our culture” training? Nothing can be harder than getting thrown into a new role without fully understanding expectations. Properly training employees helps: • Manage expectations • Increase efficiency • Improve outcomes Training shouldn’t be reserved for new hires exclusively. The doctor and clinical staff are often pursuing additional training like CME credits throughout the year, but your administrative and support staff are sometimes overlooked. Here’s 3 essential medical office employee training initiatives that are low-cost and will pay off big:

• Like and share photos (another boom, that gave us tons of brand reach) • Share ideas (ideas can be hard to come by, so this was very helpful) The point is, employee engagement was the game changer. Plus, it created a positive energy throughout the practice and engaged everybody in the process.

3. SALES TRAINING Your employees don’t sell anything, so why offer them sales training? Because training employees in sales will help you become profitable.

1. CUSTOMER SERVICE TRAINING

Overall patient experience is one of the most critical factors contributing to your practice’s bottom line. More than 75% of your patient interactions are with support staff and not one-onone with a clinician or physician. Establishing regular customer service training for your staff can be the difference between satisfied patients and dissatisfied ones. And, properly training your staff as to why and how the patient experience effects your practice will help lead to necessary buy-in by employees. Training doesn’t need to be formal and boring. • Make it fun • Intertwine it with day-to-day operations • Create a contest • Recognize exceptional customer service

2. SOCIAL MEDIA TRAINING

Although most practices don’t allow employees to have access to social media on their computers (heck, some don’t even provide email to employees), more often than not, your employees are still looking at their social accounts on their mobile phone (we know, this couldnever be the case in your office). Rather than fight it, consider embracing it. A few years back, we had an orthopaedic client who decided to enter a local social media contest. It was called ‘Social Media Madness’. And yes, it was madness. Our client won the local contest (they’re in a major local media market so it was no small feat) and we went on to place 8th nationally. We learned a ton about social engagement including what worked and what didn’t. During the heat of the contest when it was neck to neck with some big players, one thing was extremely clear: Employee engagement was our differentiator. The practice has over 150 employees and their reach on social media and their buy-in and highly competitive enthusiasm for winning this contest gave us the extra momentum we needed to win. Every day, we would encourage employees to: • Check-in on their smart phone (boom, that gave us huge reach socially) 8 FLORIDA MD - SEPTEMBER 2016

Sure, we’d all like to think that our practice doesn’t ‘sell’ anything but with the squeeze on healthcare profitability, that’s just not the case. Ancillary services and products are now a part of every smart practice and your employees need to fully understand how to sell them. • An ortho practice might offer in-house MRI and physical therapy, DME products and even items like orthopaedic flip-flops • We work with a board certified ophthalmologist who also offers laser hair removal, injectables, medical grade skin peels and full spa services • Chiropractors sometimes offer monthly wellness plans, spa services and even skin care products. • An ENT practice might offer adult and pediatric services and even facial cosmetic and reconstruction The fact is, everybody is selling something and it’s important that your staff understand this and have the necessary training (not just how to sell, but you should train them on what you offer and how the products work as well). Jennifer Thompson is co-founder and chief strategist for DrMarketingTips.com, a website designed to help medical marketing professionals market their practice easier, faster and better.



LEADING THE WAY IN SUPERIOR CATARACT SURGERY With Breakthrough Technologies that Restore Vision From Every Distance. As the first local practice to offer the industry’s most accurate laser cataract surgery and the only FDA-approved extended depth-of-focus lenses for crisp multi-range vision, Lake Eye remains at the forefront of advanced cataract treatment. Drs. Scot Holman, Scott Wehrly and Vinay Gutti combine world-class surgical experience and breakthrough technologies to restore healthy vision - and better lives - to countless satisfied patients.

Lake Eye – the clear choice for clear vision.

Board-certified ophthalmologists (from left to right):

352-750-2020 • LakeEye.com •

VINAY GUTTI, MD, SCOTT R. WEHRLY, MD and SCOT C. HOLMAN, MD FLORIDA MD - SEPTEMBER 2016

HEALTHCARE BANKING, FINANCE AND WEALTH

The Foundation of Practice Profitability! Attracting and Keeping a Great Team

By Jeff Holt, CMPE, VP, Senior Healthcare Business Banker with PNC Bank What are the key assets of a practice, which has the greatest impact on financial success? Many feel that the largest asset you have is your team who you count on each day. I tell my clients at times - “If you want to go to the championship, then finding, hiring, and keeping the best teammates gives you the best chance for success!”. In Florida that can be a great challenge these days, so let’s focus on the first step… As someone who works with people every day, you know how important it is to hire the right team members. But how do you find them? One way is to create an effective job listing. Here are some rules for writing a job description that works.

RULE 1: FIGURE OUT THE TYPE OF WORKER YOU WANT. Think about your practice and what sort of person would work best there—specifically, not just generally. What makes the people in your practice different? Whether it’s that they’re ready for anything or are compassionate and caring, the clearer your listing is about the right person, the easier it is to find him or her. (1)

RULE 2: TALK WITH YOUR CURRENT EMPLOYEES. Ask them how they would describe what they do— especially if you’re looking to attract someone similar. Find out what they feel the job’s responsibilities are, and ask them what they’d search for if they were looking. They might have a clearer sense of what someone looking for a position like theirs might want or need to know.(2)

to cover the same duties, so use both terms in your job description. If you’re looking for particular areas of expertise, put them in the description, as someone skilled in those areas might be searching using those words.(5) Hiring the right person—the one who will fit well and stay—is crucial to making your practice run smoothly so you can focus on your own work. Put time into getting the listing right, and you’ll have an easier time finding the person you need. References: 1. http://profitable-practice. softwareadvice.com/optimize-joblistings-to-attract-candidates-0214/ 2. Ibid. 3. (3) http://hiring.monster.com/hr/hr-bestpractices/recruiting-hiringadvice/jobdescriptions/sample-job-descriptions. aspx 4. Ibid. 5. (5) http://profitable-practice. softwareadvice.com/optimize-joblistings-to-attract-candidates-0214/ The third-party trademarks referenced in these articles are owned by and are the registered trademarks of their respective third-party owners. There is no affiliation, sponsorship or endorsement relationship between PNC or its affiliates and any such third party. PNC is a registered mark of The PNC Financial Services Group, Inc. (‘‘PNC’’)

Jeff Holt is a Senior Healthcare Business Banker and V.P. with PNC Bank’s Healthcare Business Banking and is a Certified Medical Practice Executive. He can be reached at (352) 385-3800 or Jeffrey.Holt@pnc.com. 

RULE 3: BE COMPREHENSIVE. When you have a sense of who you want and what makes your practice special, write your job listing, which should include the job’s title, purpose, scope and duties. List the responsibilities and the job’s relation to other positions in your practice. The clearer you are at the outset, the easier it is to get worthwhile candidates. (3)

RULE 4: BE SPECIFIC. Note exactly what the job entails. It’s a waste of your time and job seekers’ time to call them in for an interview, only to find they’re not qualified or interested in the position once they know more about it. Your listing should do some of the culling for you.(4)

RULE 5: MAKE YOUR POST SEARCHABLE. That means using keywords to cover the different ways a candidate might search, including variations on the job title itself. For example, “office assistant” and “administrative assistant” tend 10 FLORIDA MD - SEPTEMBER 2016

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ORTHOPAEDIC UPDATE

Do Stem Cells Work? Surgeon Injects Himself to Find Out By Corey Gehrold To avoid surgery and continue doing the activities he loves, Matthew R. Willey, M.D., a board certified physician, specializing in physical medicine, rehabilitation and sports medicine at Orlando Orthopaedic Center, found himself asking, “Do stem cells work?”

normally found in our blood. Stem cells can turn into virtually any cell in the body, so when they are injected into an Matthew R. Willey, MD area in need of healing, they can often promote rapid recovery wherever they are utilized.

Dr. Willey was experiencing nagging pain in his hip and ankle, especially when working out, so he decided to use himself as a test to determine if stem cells work, injecting his hip and ankle with the alternative medicine therapy and recording the results.

HOW DOES STEM CELL THERAPY WORK?

When Dr. Willey underwent diagnostic tests to ascertain the state of his hip and ankle, it was determined he had a labral tear in his hip, as well as some mild arthritis combined with a stress fracture in his ankle. “I’m pretty aware of various treatment options, and I’ve been utilizing these as needed at home,” Dr. Willey says. “Occasionally using anti-inflammatories, ice, and certainly I’ve done a significant amount of physical therapeutics and different types of exercise.” Despite these efforts, Dr. Willey was looking for another nonsurgical option to help get his hip and ankle to the next level. That’s when he turned to stem cell therapy.

WHAT IS STEM CELL THERAPY? Garnering increased attention in recent years is the use of stem cell therapy or platelet-rich plasma (PRP) injections, to help people with knee, hip, ankle and other joint pain and disease. “New in the news are treatments such as stem cells and platelet rich plasma,” says Dr. Willey. “You may be hearing more and more about them; the idea behind these treatments is that we hasten the body’s own abilities to heal and regenerate, and we use it to target various painful and pathological joints.” A PRP injection contains a very high concentration of platelets, making its potency five to 10 times stronger than what is Dr. Willey injected his hip and ankle using stem cell therapy to see if the treatment would provide relief without surgery.

A stem cell injection is prepared by drawing a patient’s blood and then separating the platelets from the rest of the blood cells. A procedure called centrifugation concentrates the platelets and growth factors, which are then injected directly into the injured tissue and mixed with the patient’s remaining blood. An ultrasound device is used to help the physician pinpoint the best area to insert the needle, which is what Dr. Willey used to inject himself. Although it’s not known exactly how PRP injections work, the theory is that the concentration of platelets and growth factors will enhance the healing process and increase the tissue’s inherent ability to heal itself. “Today, I’m going to be using amniotic suspension (stem cells), to see if I can have some improvement in both my ankle and my hip,” Dr. Willey says. “I’m going to perform ultrasound guided injections on my ankle and my hip, and we’ll see where we get.”

WHAT TO EXPECT AFTER A STEM CELL INJECTION After a PRP injection, patients may experience a few days of discomfort, and may be prescribed pain medication to use as needed. The physician will also suggest patients rest for a few days after treatment and avoid anti-inflammatory medication. “Afterwards I might have a little bit of soreness in my ankle and my hip,” says Dr. Willey. “It’s important to avoid anti-inflammatories; we want to actually use the inflammatory process to stimulate healing, and taking anti-inflammatory (medication) can sometimes limit that process. So we’re going to try and avoid anti-inflammatories for a period of two to four weeks.” Three months after his stem cell injections, Dr. Willey is feeling much better and has been able to resume his normal activities without any limitations. Patients normally start to see their pain levels drop within three to four weeks after their injection. Recovery times vary with each individual and the injury being treated. The doctor will most likely recommend that patients keep intense physical activity to a minimum for a few weeks after your injection, so as not to strain the injected area. To view the full video of Dr. Willey’s stem cell treatment, visit OrlandoOrtho.com,  FLORIDA MD - SEPTEMBER 2016 11

CANCER

Immunotherapy: The Oncology Game Changer By Sajeve S. Thomas, MD Sometimes the body’s most powerful weapon in fighting against disease is the body itself. In recent decades, immunotherapy, which uses the body’s own immune system to attack cancer cells, has become a viable treatment option. There will be an estimated 1.6 million new cancer cases in the U.S. this year, but immunotherapy may increase survivorship for many patients with late-stage disease. At UF Health Cancer Center — Orlando Health, we started using immunotherapy primarily in clinical trials to treat metastatic melanoma patients prior to the FDA approval of the first checkpoint inhibitor ipilimumab (Yervoy) in 2011. Prior to 2011, if a patient had Stage IV metastatic melanoma, the median survival rate was six months and twoyear survival on average was less than 5 to 10 percent. The only treatment options available prior to these new drugs were chemotherapy or a very old immunotherapy drug called Interleukin-2 (IL-2), which was very toxic and only cured a few patients. However, we’ve seen cure rates increase with new immunotherapy treatments like ipilimumab, pembrolizumab, nivolumab, and a new first-in-class oncolytic viral therapy called talimogene laherparepvec, now allowing us to treat patients who previously had very few options.

HOW CANCER IMMUNOTHERAPY WORKS The basic fundamentals of how our immune system works first requires an antigen to be picked up and recognized by the dendritic cells. The antigen is typically specific to the foreign invader like a bacteria or virus but cancer can also express antigens that are uniquely different to the normal cells of our body. Dendritic cells present the cancer-specific antigen to a T cell which has receptors at its surface that specifically recognize the cancer-specific antigen. Once these T-cells are activated, they proliferate and go on a seek-and-destroy mission. Understanding how the immune system works allows for novel immunotherapeutic helping boost or take down barriers to an immune response. There are several types of cancer immunotherapy including checkpoint inhibitors, cytokines, vaccines, cellular based therapies and oncolytic viral therapy. Cytokines, like IL-2, rapidly increase the number of T-cells in the body, stimulating an immune response that helps the body fight cancer. Vaccines can be endogenous or exogenous release of a cancer specific antigen. Monoclonal antibodies target a specific antigen and block the signaling pathways that aid in the growth of tumor cells. Cellular based methods involved harvesting the patient’s own T-cells from a resected tumor, growing these cells by the billions, and then infusing these cells back to the patient. These are older immunotherapy methods associated with modest responses with some responses being durable. Newer approaches 12 FLORIDA MD - SEPTEMBER 2016

include checkpoint inhibitors such CTLA4/PD1/PDL1 inhibitors and oncolytic viral therapy. TVEC or talimogene laherparepvec is the first oncolytic viral therapy approved in the US for the treatment of patients with unresectable melanoma. TVEC is a genetically engineered herpes virus that selectively kills the cancer cells without significantly

harming the normal cells nearby. The overall response rate is about 30 percent to the injected lesion but what’s most impressive is that about 16 percent of patients will have long-term durable response beyond six months to both local and distant tumors. Patients come in every 2-3 weeks for an injection directly to a palpable skin or nodal tumor and it is very well tolerated with perhaps limited flu-like symptoms in some patients. Other clinical trials in which we’ve been involved have pricontinued on page 14

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FLORIDA MD - SEPTEMBER 2016 13

CANCER marily used these new and exciting checkpoint pathways such as the PD-1 (pembrolizumab, nivolumab) and CTLA4 (ipilimumab) inhibitors. CTLA4 inhibitors reactivate the T-cells, allow T-cells to proliferate and migrate into the circulatory system and ultimately into tumor microenvironment to hopefully recognize the cancer and kill it. The disease control rate long-term beyond five years goes up 20-25 percent. This is better than the historical 5-10 percent rate with older treatment options and these patients look like they are cured. Patient with metastatic HCC previously treated with multiple chemoembolization, Around 2012, we started using PD-1 inhibiradioembolization, and sorafenib. Treated with PD1 inhibitors when the AFP was tors in clinical trials. This antibody inhibits an greater than 100,000 with a dramatic biochemical response. interaction between PD-1 and PD-L1, two proteins (one on the T-cell surface and the other on the cancer cell THE FUTURE OF IMMUNOTHERAPY surface) that bind together and inhibit the T-cells from attacking What about those patients that do not respond with these the cancer cells. Sort of a biochemical shield to the cancer cells. drugs? I would highly encourage clinical trials. We currently have PD-1 inhibitors help take down this shield and unleash an imseveral clinical trials that offer different combinational theramune attack. pies. Many of our trials are coming PD1 inhibitors with TVEC, PD-1 inhibitors, which are far better tolerated and have much BRAF/MEK inhibitors, IDO inhibitors, and even newer viral fewer side effects compared to other drugs, improve upon the therapies. We may also find interesting durable responses when results we’ve seen with ipilimumab. The response rate increased combined with other older modalities such as stereotactic radioto 30-40 percent and again the majority were very durable. What therapy, chemotherapy, or liver directed therapy such as embohappens if we combine both a CTLA4 and PD1 inhibitors? In lization. Also, we will need reliable biomarkers to select which the Checkmate 067 study, patients were randomized to PD1 patients will benefit the most with immunotherapy. alone, CTL4 alone or the combination of the two drugs together, What about other advanced malignancies? Hopefully we’ll the response rate increased to 50 to 60 percent in the combinastart to see the paradigm shift in the next 5-10 years and we’ll tion group which was superior to either drug alone. This is now use a lot more immunotherapy agents for various cancers. Right every other patient I treat. now, the paradigm is still using chemotherapy or targeted drugs Immunotherapy does come with certain adverse effects, the that have a clear track record, but we’re already slowly moving in most common of which is itchy skin, rash, and diarrhea. Other this direction. uncommon serious adverse effects include hepatitis, colitis, pneuImmunotherapy is the ultimate holistic approach to treating monitis, thyroid and adrenal dysfunction. These adverse effects patients and by using combinational approaches, we may attain can be well managed with holding treatment, early institution even higher responses. Here at the UFHealth Cancer Center – of steroids and other immunosuppressing agents. Physicians will Orlando Health, it has been humbly exciting to be involved in need to be aware of these “new” oncologic emergencies no differthe multidisciplinary care and the dramatically evolving treatent than recognizing the neutropenic fevers or cytopenias related ment landscape for patients dealing with advanced malignancy. to chemotherapy.

INDICATIONS FOR DIFFERENT CANCERS In the last two years, immunotherapy drugs have also been approved for lung cancer, kidney cancer, head/neck cancer and Hodgkin’s lymphoma with many newer indications coming along in the pipeline. Most recently, a new PD-L1 inhibitor was approved for bladder cancer. We currently have a Merck “bucket” clinical trial offering PD1 inhibitors to various malignancies such as cervical, endometrial, anal, hepatobiliary, neuroendocrine, salivary gland tumors, and small-cell cancers. For the majority of colon, small bowel, and pancreatic cancers that are microsatellite stable, we’re finding that checkpoint inhibitors alone do not work at all. However, there is a small subgroup within these tumor types — those that have tumors with microsatellite instability – may make the cancer more sensitive to the immune system. The response rate was significant in this group and appears to be very promising. 14 FLORIDA MD - SEPTEMBER 2016

Sajeve Samuel Thomas, MD, is board-certified in Medical Oncology and Hematology and serves as a medical oncologist with specific interest in melanoma, sarcoma and GI malignancies. Dr. Thomas has a genuine interest in medical education by providing didactics periodically to the fellows, residents and medical students. He serves as an associate professor for the University Of Central Florida College of Medicine. As a computer engineering graduate from the USF, Dr. Thomas went on to receive his medical degree from the UF. He completed his internal medicine residency at the USF. Dr. Thomas is currently a very active primary investigator on multiple cooperative groups and industry-supported clinical trials. 

ALLERGIES

Anaphylaxis: The Allergic Emergency By Steven Rosenberg, MD, FAAP, FAAAAI Anaphylaxis is one of the most feared conditions seen and treated by the Allergist. It is a medical emergency in which the individual experiences a generalized, potentially, life-threatening allergic reaction. In the majority of cases anaphylaxis is mediated by the allergic (IgE) antibody. However in certain instances, it may occur independent of this antibody; in which case it is defined as an anaphylactoid on Non-IgE Dependent Reaction Examples of anaphylactoid reactions are those caused by radiocontrast materials, aspirin, as well as opiates.

Anaphylaxis can occur as one episode (Single Phase), as two distinct episodes separated by several hours (Biphasic), or by a prolonged episode that can last well over one day.

Without prompt and aggressive intervention anaphylaxis can result in significant morbidity and even death. Unfortunately despite the seriousness of this condition, there are many misconceptions held by both the general public and the medical community, as to what anaphylaxis is, what causes it, and of most importance, how to treat this serious condition.

Agents, which can cause Anaphylactic reactions, will include the following:

Instances of anaphylaxis have been recorded for well over 3,000 years. In 2641 B.C. the Egyptian Pharaoh Menes died after being stung by an insect, possibly a Wasp, Hornet, or Honeybee. At the start of the 20th century it was observed that certain individuals experienced life-threatening reactions after receiving anti-toxins derived from animals such as horses. In 1913 Charles Ricet received the Nobel Prize in Medicine for his and his partner’s, Paul Porter’s, work in describing the mechanism of anaphylaxis. With the introduction of Penicillin in the 1940’s physicians began to observe patients who would experience a severe allergic reaction after receiving this antibiotic. Similar reactions were observed after the administration of Aspirin. Even today many antibiotics, agents used in chemotherapy and radiology, and the new class of “Biologic Drugs” such as Omalizumab, carry the risk of causing anaphylaxis in a small subset of patients who receive these drugs. Anaphylaxis is under diagnosed, so that the true incidence of its occurrence is hard to determine. It is estimated that the incidence of anaphylaxis ranges between 0.05%-2% of the general population. It is also estimated that there are over 1500 fatalities/year secondary to anaphylaxis. Foods can be one of the most common causes of anaphylaxis, and in a report issued by the Center for Disease Control in 2013; it was estimated that between the years 1997-2011, the incidence of food allergy in children increased by 50%. There are more than 200,000 emergency department visits/year secondary to food allergy reactions. The Food Allergy Research & Education (FARE) has estimated that over 15 million Americans have food allergy. Anaphylaxis is defined as a serious, possibly life-threatening allergic reaction, which is rapid in onset. It will involve two or more organ system. This may include both the skin and mucosal membranes resulting in generalized pruritus, hives and swelling. In addition anaphylaxis can cause severe respiratory distress (bronchospasm and laryngeal edema), hypotension, and multi-organ dysfunction that may involve the heart.

Death can occur from anaphylaxis. Causes of death can include respiratory failure secondary to bronchospasm or laryngeal edema, severe hypotension secondary to third spacing of fluids, as well as from cardiac arrhythmias and myocardial ischemia.

a) Stinging insects such as the Wasp, Hornet, Honeybee, Yellow Jacket and the Fire Ant. Fire Ants are a major cause of insect sting reactions in the Southeast, especially Florida. b) Foods, including milk, eggs, seafood, peanuts and tree nuts. Reactions from foods, especially peanuts and tree nuts can be quite severe and are seen in young children. c) Medications such as penicillin, opiates, sulfonamides, aspirin (NSAID’s), agents used in chemotherapy, radiocontrast materials, and monoclonal antibodies. Immunotherapy (allergy injections) can also in rare cases trigger an anaphylactic event. d) Latex. Latex reactions are of particular concern to the individuals engaged in health care such as nurses. e) Exercise f ) Extremes in temperature g) Idiopathic. No etiology or cause can be identified. Clinical manifestations of anaphylaxis can vary. Often the individual, who is experiencing an anaphylactic reaction, reports the sensation of an impending sense of doom. The most common clinical manifestation is generalized pruritus, hives, and swelling (angioedema). In fact, if one does not observe cutaneous symptoms, one should question if anaphylaxis is the correct diagnosis. Colic or abdominal cramps may occur and be severe. Respiratory distress and failure caused by bronchospasm and/or laryngeal edema can be life threatening. Hypotension or shock can be a serious consequence of anaphylaxis and can result in death. The individual may experience cardiac manifestations such as an irregular heart rate and cardiac ischemia. Syncope is also observed and is often confused with a vasovagal reaction. All too often, rather than seeking emergency medical care; the individual who is experiencing an anaphylactic reaction will elect to self-treat with an antihistamine. In fact, in many instances, even in the emergency room, treatment of anaphylaxis will consist of the administration of only an antihistamine, and possibly corticosteroids. It should be stressed that the drug of choice for the treatment of an individual experiencing anaphylaxis is epinephrine. Epinephrine is the only drug that is effective for the combination of events that occur in anaphylaxis including hives, bronchospasm, and laryngeal edema. In fact it is thought that FLORIDA MD - SEPTEMBER 2016 15

ALLERGIES epinephrine can also inhibit the third spacing of fluids leading to hypotension that is a serious complication of anaphylaxis. In the past it was suggested that epinephrine be administered by subcutaneous injection, but it is generally thought that administration by the intramuscular route (the lateral deltoid muscle is the most preferred site) is superior. Studies have indicated that delay in the administration of epinephrine can increase the likelihood of a poor outcome in the individual experiencing anaphylaxis. Epinephrine is available in selfinjectable form (Epi-Pen, Adrenaclick) that is safe and easy to use by the individual if he/she is alone without nearby medical assistance. Other medications that can add to the effectiveness of epinephrine, but not replace it, would include H1 histamine antagonists such as diphenhydramine. Antihistamines may be administered orally, by injection and intravenously. It is thought that the combination of an H2 and H1 histamine antagonist may be more effective than the use of an H1 agent alone. We suggest that ranitidine or cimetidine be administered to an individual experiencing an anaphylactic event. Corticosteroids may be of benefit in inhibiting the late phase reaction often seen in anaphylaxis and we do strongly advocate their use. Since hypotensive events such as shock may lead to fatalities the aggressive use of intravenous fluids such as Normal Saline or Lactated Ringers may be of benefit, especially if the patient becomes hypotensive. Dopamine may also be utilized in conjunction with intravenous fluids for severe, unresponsive hypotension. The use of bronchodilators such as albuterol as well as oxygen may be effective if the individual is experiencing bronchoconstriction of the airways. Glucagon should be considered if the individual has been taking beta-blockers that may potentiate the anaphylactic event. Of utmost importance is to maintain a patent airway in the patient. A thorough history is of utmost importance to try to elicit the specific cause of the anaphylactic event. This can aid in treatment, and will enable the physician and patient to modify therapy in the future to avoid further exposure to agents such as foods or medications, which may precipitate an anaphylactic event. Laboratory tests may also be of importance for the diagnosis and treatment of anaphylaxis. If there is doubt if the individual is experiencing an anaphylactic event, a serum trypase level may of benefit. Tryptase is elevated for up to 6 hours after the anaphylactic episode. A thorough allergy evaluation, including skin and/or RAST testing may of benefit in trying to identify specific triggering factors. If a drug reaction is thought to be a possible triggering event, RAST and/or skin testing is of value to determining sensitivity to antibiotics such as Penicillin and local anesthetics such as the ‘caines. Anaphylaxis is a much-feared event. However with aggressive therapy the physician can prevent such an event from leading to serious consequences. The Allergist is specialty trained in the diagnosis, management, and treatment of the individual at risk for anaphylaxis. Steven Rosenberg, MD, FAAP, FAAAAI, has been practicing medicine in the Central Florida area for over 20 years, specializing in the area of Allergy, Asthma, and Immunology. He received the Doctor of Medicine from the State University of New York, Downstate Medical Center. Dr. Rosenberg completed a residency in Pediatrics at the State University of New York at Buffalo and a Fellowship in Allergy, Asthma, and Immunology at the UniORTHOPAEDIC versity of Pittsburgh. Dr. Rosenberg has SUBSPECIALTIES held positions as President of the Central • SPINE Florida Pediatric Society, at the Florida • ELBOW Allergy, Asthma, and Immunology Soci• FOOT & ANKLE ety, and on the medical staff at Florida • HAND & WRIST • HIP Hospital. In addition, Dr. Rosenberg has • KNEE held the position of Chairman, Depart• ONCOLOGY ment of Pediatrics at Florida Hospital • PEDIATRICS and is a member of many local and na• SHOULDER tional societies which include the Ameri• SPORTS MEDICINE can Academy of Allergy & Immunology, • PAIN MANAGEMENT the Florida Allergy and Immunology So• PHYSICAL THERAPY ciety, Florida Hospital Kid’s Docs and the Central Florida Pediatric Society. He holds faculty appointments at the University of Central Florida Medical School SAME DAY, NEXT DAY APPOINTMENTS AVAILABLE and the Florida State University School OVIEDO SATURDAY WALK-IN CLINIC of Medicine. For additional information NO APPOINTMENT NECESSARY | 9AM - 1PM please contact him at 407.678.4040 or Downtown Orlando | Winter Park | Sand Lake | Lake Mary | Oviedo | Lake Nona aaaofcf@gmail.com. 

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Next-Generation IOL Offers “Most Natural” Eyesight Correction to Cataracts Patients By Scott R. Wehrly, MD, Scot C. Holman, MD, Vinay Gutti, MD

CM RE E CEI CR VE ED IT S

According to the American Academy of Ophthalmology, nearly 22 millions Americans age 40 and older have cataracts, a clouding of the natural lens of the eye. Since the first cataract extraction surgery in the mid 1700s, cataract surgery has become the most frequently performed and, with a 98% success rate, the most effective, operation in the United States. Cataract surgery involves removing the damaged natural lens and most commonly replacing it with a corrective lens called an intraocular lens implant, or IOL. Though the first lens implant was done back in 1949, IOLs didn’t become the norm until the 1970s. Now Americans receive more than a million IOLs annually. Naturally, IOLs have progressed through the decades, and today there is a wealth of choices, including lenses that address astigmatism and even provide multifocal vision correction. Now comes the latest advance in IOL technology, the first and only FDA-approved extended depth-of-focus lens, the Tecnis® Symfony. Unlike other multifocal lenses, the Symfony uses diffractive technology to extend the focal point and create a unique “defocus curve,” for continuous, seamless vision correction at all distances, much like a normal healthy lens. “Extended depth-of-focus lenses provide the closest approximation to natural sharp eyesight,” says Board Certified ophthalmologist and eye surgeon Scot Holman, MD, from Central Florida’s Lake Eye Associates. “Research demonstrates that 85% of patients can achieve 20/20 distance, intermediate and near vision with the Symfony IOL, meaning most can get rid of glasses entirely or use them only occasionally for detailed, up-close tasks. That’s remarkable.” Lake Eye Associates is the first practice in Central Florida to offer the lens and to perform this procedure, which fellow eye surgeon Scott Wehrly, MD, describes as “the greatest advance in intraocular lens implants in the past decade.” Available in Extended Range for patients with no or mild astigmaWalt Disney World tism and Extended Range TORIC for those Swan & Dolphin Resort, Orlando, FL with moderate to severe astigmatism, the Saturday, Nov. 5, 2016 Symfony lens provides unparalleled correction of presbyopia, or deterioration of near vision, a common problem among middleaged and senior populations. “The Symfony also shows a low incidence of halo and glare, which is a huge advance in IOL quality and performance,” says Lake Eye cataract surgeon Vinay Gutti, MD. For patients undergoing cataract surgery, the Tecnis® Symfony offers those whose conditions qualify for the new lens the chance *This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical education through the joint providership of the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) and the Association of Independent Doctors (AID). ABQAURP is accredited by the ACCME to provide continuing medical education for physicians. The American Board of Quality Assurance and Utilization Review Physicians, Inc. designates this live activity for a maximum of 6 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

FLORIDA MD - SEPTEMBER 2016 17

to enjoy exceptionally crisp, clear vision, some for the first time in their lives. Says Dr. Wehrly, “This is an exciting development in IOLs and Lake Eye is proud to be the premier provider of this amazing technology.”

For more information, visit our website at www.LakeEye.com, contact Lake Eye Associates at 352-750-2020 or stop by one of our four locations in Tavares, Lady Lake, The Villages and Leesburg, FL.  Lake Eye Associates’ Board Certified ophthalmologists and experienced cataract surgeons are some of the first in the state of Florida to perform cataract surgery with the revolutionary Tecnis® Symfony IOL. Pictured from left to right: Scot Holman, MD, Scott Wehrly, MD and Vinay Gutti, MD.

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Dr. Scot Holman performing the very first Tecnis® Symfony IOL cataract procedure in Central Florida.

To learn more, call 407 587-8600. A Higher Level of Care®

18 FLORIDA MD - SEPTEMBER 2016

Closeup during Tecnis® Symfony IOL procedure.

Fast-Growing Independent Doctors’ Group Now in Over Half of Nation AID Adds 26th Member State By Marni Jameson Careythr ee and a half years ago, 100 frustrated independent doctors with the Federal Trade Commission to and two certified public accountants got together in the lobby of fight hospital consolidations, and has a cardiology practice in Winter Park, Fla., and formed an associabeen a resource to many media outlets. tion to help doctors nationwide fend off the advances of hospitals Meanwhile, the association’s goals – to stop the trend of hoslooking to acquire them. pitals buying up medical practices, to educate consumers about Since that night in April 2013, the Association of Independent Doctors has grown rapidly, and this week added its 26th member state with the addition of Ohio, announced Marni Jameson Carey, AID executive director. “We are officially in over half the counServing Central Florida Since 1982 try,” said Carey. “Word is getting out.” The national nonprofit now has 1,000 members Our physicians are Board Certified in Internal Medicine, coast to coast, with chapters in four states: Pulmonary Disease, Critical Care Medicine, and Sleep Medicine Florida, California, Maine and South Carolina. Specializing in: “Independent doctors are telling others • Asthma/COPD about the association, which is devoted to • Sleep Disorders • Pulmonary Hypertension helping doctors stay independent, and they • Pulmonary Fibrosis are joining the cause,” said Carey. • Shortness of Breath This month the association saw its biggest • Cough surge of members in new states since AID • Lung Cancer began, with the addition of seven states: • Lung Nodules Michigan, Missouri, Ohio, Pennsylvania, • Low Dose CT - On Site Tennessee, Virginia and Utah, she said. • Clinical Research In the past 10 years, hospitals have been Daniel Haim, M.D., F.C.C.P. aggressively buying up independent doctors Daniel T. Layish, M.D., F.A.C.P., F.C.C.P. and turning them into employed physicians. Francisco J. Calimano, M.D., F.C.C.P. In 2000, 57 percent of the nation’s doctors Francisco J. Remy, M.D., F.C.C.P. were independent; today only one in three Ahmed Masood, M.D., F.C.C.P. are, or 33 percent, according the Accenture. Syed Mobin, M.D., F.C.C.P. “That trend is not good for patients, docEugene Go, M.D., F.C.C.P. tors or communities,” said AID co-founder Mahmood Ali, M.D., F.C.C.P. Tom Thomas, CPA. “We founded the AsSteven Vu, M.D., F.C.C.P. sociation of Independent Doctors because Ruel B. Garcia, M.D., F.C.C.P. we recognized that as the number of indeTabarak Qureshi, M.D., F.C.C.P. pendent doctors shrinks, unfavorable market Kevin De Boer, D.O., F.C.C.P. dynamics, including higher health-care costs Jorge E. Guerrero, M.D., F.C.C.P. and less competition, grow.” Roberto Santos, M.D., F.C.C.P. Hadi Chohan, M.D. In the past three years, the association has Jean Go, M.D. landed a role on the national stage providing Guillermo Arias, M.D. a collective voice for independent doctors Erick Lu, D.O. who, before AID was formed, had little to no voice. Downtown Orlando East Orlando Altamonte Springs AID representatives have spoken on Capi1115 East Ridgewood Street 10916 Dylan Loren Circle 610 Jasmine Road tol Hill in Washington four times, addressed 407.841.1100 | www.cfpulmonary.com | Most Insurance Plans Accepted national health-care associations, partnered

Central Florida Pulmonary Group, P.A.

FLORIDA MD - SEPTEMBER 2016 19

how this consolidation increases costs and lowers quality and access, to increase price transparency so consumers can know what health-care costs before they get their bills, to expose and stop nonprofit hospitals’ abuse of their tax-exempt status, and to inform lawmakers about why independent doctors are critical to America’s health – have not wavered. Marking another milestone, the association is hosting its first conference for independent doctors, Independence in Action 2016, on Nov. 5, in Orlando. A one-year membership in the association costs $500, and is tax deductible. For more information about the conference or AID go to www.aid-us.org or call (407) 571-9316. About the Association of Independent Doctors: Founded in 2013, the

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Association of Independent Doctors is a national nonprofit dedicated to helping reduce health-care costs by helping consumers, businesses and lawmakers understand the value of keeping America’s doctors independent. A fastgrowing trade association with 1,000 members in 26 states coast to coast, AID is a 501(c)(6) based in Winter Park, Fla. For information, visit www. aid-us.org.

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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.

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Please call 407.417.7400 for additional materials or information. FLORIDA MD - SEPTEMBER 2016 25

If I can

SAVE ONE LIFE WITH MY STORY, I’LL BE PROUD TO CALL MYSELF A

CANCERVIVOR. As a firefighter, Hector helps save lives every day. But it was his own life on the line when a routine colonoscopy discovered a mass that turned out to be Stage-3 colon cancer. Now five years cancer-free, Hector is a strong advocate for early detection through colorectal cancer screening. Colorectal cancer is the second leading cause of cancer-related death in the U.S. If caught early, it’s 90 percent curable. Get screened today.

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