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Making Informed Decisions on Medical Marijuana Orlando symposium to educate healthcare providers on research, proper dosing and legal ramifications ON ROUNDS PHYSICIAN SPOTLIGHT PAGE 3 Delicia M. Haynes, MD

By PL JETER

Whether the Florida Legislature agrees to a medical marijuana program or punts the decisions to the Florida Department of Health, July 3 will see the implementation of some form of program

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marijuana. To prepare for the unprecedented demand, Canna Holdings is hosting a day-long symposium 30 days before the law goes into effect. Space is available for up to 300 participants – physicians, nurse practitioners, (CONTINUED ON PAGE 4)

HEALTHCARELEADER

A Few Questions with Daryl Tol By PL JETER

HEALTH INNOVATORS

affecting nearly a half million qualified patients in the state. Fewer than 700 of some 50,000 Florida-licensed physicians are registered with the state Office of Compassionate Use (OCU) to recommend or order medical

The worldview held by Daryl Tol began in the small town of Dunlap, Tennessee, and by kindergarten age, he had spent most of his life halfway around the world in Borneo, Indonesia surrounded by role models who approached life with a servant’s heart. By the time he reached school age, his missionary parents Bill, a pastor and mother Darla had returned the family to the United States to live in the picturesque Northern California coastline city of Eureka where he began to witness a life of

caring for others. “(Mom) was a home health nurse for years and would become very close to her patients,” he recalled. “I remember visiting many of them as she would develop a personal connection with each. I appreciated the emphasis my parents put on meaningful work versus work for a paycheck. Both worked hard, but had very satisfying careers that made a difference to the people they worked with. I remember my folks routinely sending me on my way each day with the reminder to ‘make it a good day,’ rather than the more

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passive ‘have a good day.’ That important difference has stuck with me.” Tol earned a business administration degree with a focus in accounting and finance from Walla Walla University in College Place, Wash., where he was elected president of the American College of Healthcare Executives (ACHE) chapter. He then earned a master’s degree in healthcare administration from Loma Linda University in Loma Linda, Calif. After leaving the California coast, (CONTINUED ON PAGE 8)

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DAYTONA BEACH – When Delicia Haynes, MD, was 12 years old, she felt a lump in her breast while showering. At first, she hoped her adolescent breasts were simply budding. Maybe a lump on the other side would even it out? Two months passed before fear prompted Haynes to confess this unwelcomed discovery to her mother. “Off we went to see a doctor,” said Haynes, recalling hours spent waiting to see a physician. Even without a doctor in the family, helping others via medicine held great appeal to Haynes, and she’d been searching for a mentor. Perhaps this doctor could be her guide? Unfortunately, her daydream fizzled when the doctor barged into the room and unceremoniously ordered her to take off her top. “For a moment, I sat in stunned silence,” recalled Haynes, who did as instructed only after her mother gave the go-ahead nod. The doctor pressed ice cold hands to her chest, scribbled on a chart, and without making eye contact called the lump “probably just a benign fibroadenoma” that needed surgical removal. He told the seventh grader the scar would be minimal, “so if you want to be a stripper when you grow up, that’ll be fine,” and turned briskly out the door. “I was devastated,” said Haynes, of the seven-minute visit. “I had no idea what benign or fibroadenoma meant. I looked at mom with tears streaming down my face.” Haynes’ mother, a Baptist deaconess who didn’t back down from confrontation, left the exam room to track down the doctor, who by then was in another exam room and was unavailable. “As I slipped my blouse over my head, I made the decision that I would be a doctor … the type of doctor I wish I’d had that day,” she said. Armed with an ambitious plan to earn a dual post-graduate degree – MD and MPH (Master of Public Health) – and possibly a law degree for advocacy work, Haynes studied biology and Spanish at the University of Louisville, where she reactivated its Minority Association of Pre-Med Students chapter. Projects included a Boys and Girls Night Out Program and The Buddy Program, which coupled medical students with a chronically ill child. “I brought in medical students as speakers, because it’s so important to have a mentor rlando • Pensacola right ahead of you,” she said. During her studies at the University of m • www.dannagracey.com Kentucky College of Medicine where she orlandomedicalnews

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received the inaugural President’s Award for Diversity, Haynes grew depressed with the daunting, ever-increasing workload. She took time off to regroup, opting to drop pursuing the master’s degree, while also realizing she could do advocacy work without a law degree. “When I returned to medical school, I was very aware of the stigma surrounding physicians and mental health issues,” said Haynes, who has been speaking to high school and college groups about the red flags of depression for several years. “When Florida State University lost a second-year medical student to suicide recently, it hit me really hard because it could happen to anybody that doesn’t seek or receive the proper help.” From 2005 to 2008, Haynes participated in the Halifax Family Medicine Residency Program and became boardcertified in family medicine. She was named the Florida Academy of Family Physicians’ Resident Scholar of the Year in 2008. Rather than join a practice or hospital post-residency, Haynes took a bold step and, with no business experience, opened the Family First Health Center in Daytona Beach on Feb. 3, 2009. “I couldn’t afford an office manager

“When Florida State University lost a secondyear medical student to suicide recently, it hit me really hard because it could happen to anybody that doesn’t seek or receive the proper help.”

at first, so I made friends with office managers that provided help when needed, and I reached out to my colleagues for mentorship,” she said. “For their guidance and support, I’m still very grateful.” Haynes methodically built a sustainable solo family medical practice on a traditional model of insurance reimbursement until the fall of 2014, when after struggling “several long and laborious semesters at the school of hard knocks,” she received an insurance contract by mail specifying a 40 percent reimbursement re-

duction for certain services. “When I realized a third party could make a decision that almost put me out of business, I wasn’t working for myself or my patients,” she said. “I was working for the insurance company.” Instead of inking a new deal, Haynes changed her business model to membership-based. By offering comprehensive primary care services at an affordable monthly fee with no copays or deductibles, Family First Health Center became Volusia County’s first Direct Primary Care clinic. The innovative concierge medicine program allows same-day appointments, unrushed doctor time, and telemedicine services. Many prescriptions are offered at wholesale prices. Most minor procedures are covered, such as ear wax removal; others have a nominal fee, such as a $25 pap smear. Vaccinations are guaranteed low rates, $15 for the flu. X-rays start at $25. Around the same time, Haynes focused on community health initiatives. She began “Cut High Blood Pressure,” an innovative program at local barbershops and salons, where clients that typically wouldn’t visit a doctor may check their blood pressure. Participant lives have (CONTINUED ON PAGE 8)

There are many ways you could be wasting money on your malpractice insurance Did you know that most doctors unknowingly waste money on malpractice insurance, which is one of the largest expenses in a medical practice each year? One of the most common ways doctors continually spend too much include:

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Making Informed Decisions on Medical Marijuana, continued from page 6 nurses, physician assistants and pharmacists – for the “Medical Marijuana: an Educational Symposium for Florida Physicians” slated for Saturday, June 3, at the Wyndham Grand Orlando Resort Bonnet Creek in Orlando. The day-long program begins with breakfast at 7 a.m., includes lunch, and concludes at 4 p.m. A roster of esteemed researchers, physicians, medical practitioners, attorneys and industry experts representing states that have already legalized medical marijuana will headline the symposium, where attendees may receive up to six CME, ANCC or ACPE credits. “License holders are rolling out dispensaries very quickly,” said Greg Weiss, president of Florida-based Canna Holdings. “Without physicians taking the required coursework to recommend medical marijuana, there isn’t going to be any market.” Education is a key component to a successful rollout of the medical marijuana program in Florida, Weiss emphasized. “The number one question I get is, ‘Am I going to lose my DEA license if I pass (the required test)?’ and the answer is no,” said Weiss, who plans to have an attorney available for business-related questions surrounding medical marijuana. “If physicians don’t have the facts, along with recent science and research, it’ll be nearly impossible for the projected half a million patients in Florida to have proper access to this medicine.”

Dustin Sulak, MD, pointed out that endocannabinoid physiology is omitted from nearly every medical school curriculum. “It’s time for healthcare providers to discover what researchers know to be one of the most important physiologic system involved in establishing and maintaining human health,” he said. Weiss noted that most physicians in favor of dispensing medical marijuana have already registered with the OCU, or are in the midst of the registration process. “Most physicians who attended the last two symposiums are on the fence about the use of medical marijuana,” said Weiss. “They’re interested. They want to learn more. They want to talk to physicians who have done it before.” The symposium lineup will cover the physiology of the endocannabinoid systems, methods for making dosage and delivery system choices, and ways to use cannabis for military-related PTSD treatment, pain relief, neurodegenerative diseases and more. The topics and speakers on the agenda are: • “The Endocannabinoid System: Master of Homeostasis, Pain Control ...” Jordan Tishler, MD, an emergency medicine specialist, will emphasize practical aspects of treatment of patients with chronic pain, while also touching on dosing, administration, and preparations.

• “Cannabinoids for the Treatment of Movement Disorders.” Juan Sanchez-Ramos, MD, PhD, a neurology professor at the University of South Florida, will contrast agedependent neurological changes with more severe alterations in the endocannabinoid system. • “Delivery and Dosage of Cannabis Medicine.” Deborah Malka, MD, PhD, will discuss how to choose between six delivery systems for cannabis, and weigh the benefits and risk of each one. • “Researching Medical Cannabis Navigating Barriers to Efficacy Research.” Sue Sisley, MD, an Arizona-based internal medicine physician and psychiatrist, will discuss her experience as site principal investigator for the only FDA-approved randomized controlled trial examining the safety and efficacy of whole plant marijuana in combat veterans with treatment-resistance PTSD. • “Cannabis as Medicine: Redefining the Paradigm of the Doctor-Patient Relationship.” Jack D’Angelo, MD, CMO of CITIVA, a New York-based medical cannabis company, will cover establishing the responsibilities of the patient and provider during cannabis therapy treatments.

Also on tap: Two panels, one focusing on physicians and the other patientcentered. The patient-centered panel is comprised of parents of an epileptic child and an adult with terminal brain cancer. “Our symposium will confront the many issues Florida physicians are facing with this new medical marijuana program, which will start whether or not we’re ready for it,” said Weiss.

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HEALTH INNOVATORS

Apple and Google: The Next Big Pharma By JOHN NOSTA

The big news recently is that Apple is reportedly secretly developing a dermal sensor for measuring blood glucose and the management of diabetes. It seems to be a sensor that works with the Apple Watch to continuously and painlessly monitor glucose levels. Similarly, Forbes contributor David Shaywitz reports that Alphabet’s (Google) new wearable is “significant.” And, in a world of statistics and wordsmithing, significant seems to have real meaning for a marketplace that has been driven by emotion and limited outcomes data. Further, the Google/Novartis glucose measuring contact lens also tickles our fancy for innovation and breakthrough. Those with diabetes have long worried about “the needle” and almost constant pricks that have come to be linked with this condition. So a dermal monitor or contact lens could truly be a breakthrough. From data acquisition to durability (a one-week battery life), that Google innovation might also drive the shift for wearables from an “athletic option” to “clinical imperative.” It’s in all the papers But what really strikes me is the source of innovation and how it seems to come from “expectedly unexpected” sources like Google and Apple. We’re beyond the days when we’re shocked that a life science innovation doesn’t come from Big Pharma.

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Yet interestingly, when a Google or Amazon or Apple enters the market with a “significant” innovation, the reaction is more a nod in acknowledgment than a significant surprise. In dramatic contrast to these tech innovations, we find the pharma “big news” headlines are more along the lines of soaring drug costs and executive behavior. Today’s model of innovation is a far cry from the “molasses hierarchy” of only a few short years ago. And it’s important to point out that much of pharma must be credited for significant advances, including areas like genomics and oncology. And everyone seems to have their accelerator or center of excellence. Yet, in my experience, they are sometimes more a senior management imperative or a check in the box than something that actually moves fast or is focused on excellence. For me,

it seems that some of that molasses is still part of the mindset and methodology that might be responsible for the slumber. The wake-up calls are coming from a wide variety of industries, like retail, and defined by the long-empty corridors of malls. I wonder if the innovations of Google and Apple are another wake-up call for the life science industry which oftentimes has relied on the snooze function of line extensions and extended-release drugs as the source of income and innovation. Originally posted on Forbes.com John Nosta is the Founder of NostaLab – empowering innovation with outlandish thinking. Follow him @JohnNosta for a more informed and healthy future.

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An Open Letter to Central Florida Physicians from CPA Solutions My Mother was a Pediatrician and I grew up with an enormous admiration for doctors. Yet my academic strengths and personality did not have the calling for your profession so I became an accountant. However, there is significant synergy in what we do – You Save Lives and I Save Medical Practices from Financial Distress! You read charts and I read numbers. You entered the practice of medicine with a spirit driven mission; diagnosing and treating people. Unfor-

TIPS FOR PHYSICIANS #1 HOW TO PREVENT EMBEZZLEMENT IN YOUR PRACTICE? Physicians and dentists are more exposed to embezzlement than any other profession for multiple reasons such as their extremely busy schedule, lack of business training in medical school and their very caring and trusting personalities. Most common ways of embezzlement: • Adding family members or bogus people to payroll • Paying unknown or fake vendors • Keeping cash co-pays • “Borrowing” from petty cash draw • Issuing bogus credit card refunds where the refunds are going to the employees credit card • Pocketing patient’s payments and making billing adjustment on the patient’s account • Charging personal items on the Company credit card In my personal experience billing and collections is the most sensitive area where most theft happens and needs to be watched closely. Red flags to look for: • An employee never takes vacation or time off • An employee is not willing to cross-train • An employee constantly works overtime and takes work home • An employee is overly controlling of all finance functions • A change in employees’ lifestyle • Increase in patient refunds • Increase in billing adjustments • Drop in collection percentage • Increase in expenses Steps to prevent embezzlement: • Applying payments in the EMR and making deposits should be done by two separate employees • Bank reconciliations should be done by an outside person (usually your CPA firm) • Credit card terminals should have a orlandomedicalnews

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tunately, this mission gets overshadowed by mundane operational and financial tasks. Many physicians we speak with recognize they do not have the time to understand all the information presented on financial reports; the information literally showing the financial health of their practice. As trusted business advisers, our goal is to decrease the burden of financial concerns and educate clients on the financial health of the practice. CPA Solutions cur-

password for issuing credit card refunds • Mail should not be received exclusively by one person • Review monthly bank statements and cancelled checks • Review monthly credit card statements • Review financial trends monthly and verify that variances are explainable • Approve each payroll run Listen to your instincts! If you become suspicious don’t turn the other way but start digging. One can never imagine that such a thing can happen to their practice…but embezzlements do happen and more often that we think. If you have no segregation of duties in your practice which is common due to small size, rely on your CPA to at least prepare monthly bank and credit card reconciliations and perform monthly financial analytics. It all starts with the tone at the top so

rently serves 50+ medical practices. Over the years we have learned, that preventing embezzlement and establishing proper internal controls is consistently overlooked. Two issues routinely negatively impacting medical practices. One of the foremost reasons doctors suffer embezzlement is due to their caring and trusting personalities, as well as the time pressure placed upon them. The CPA Solutions philosophy is trust but verify. CPA Solutions is small enough to give your practice

establish strong financial practices in your office and adhere to them. Existing employees will appreciate a solid foundation and a clear understanding of how things need to be done. New hires will recognize how much you respect finances and know what is expected of them. They will understand this is a practice that “minds the money.”

#2 HOW TO CONTROL YOUR OVERHEAD? Due to declining reimbursement rates, costly new regulations and increasing costs, independent practices are faced with diminishing profits at rather drastic rates. These are challenging times for practice administrators and frustrating times for the doctors who are forced to take pay cuts. So how do you adapt to this ever changing climate and return to profitability? You can’t control certain things but you can most likely control your overhead. Start with low hanging fruits:

personal attention, yet big and established enough to provide the services and recourses needed. If this letter speaks to you and your experiences, we will gladly meet with you…Our goal being to learn more about you and your practice, in order to be of assistance. Sincerely, Dalia Cantor, CPA

Easiest ways to cut costs: • Review your clinical supplies and injectables ordering process to make sure orders get pre-approved and you have no waste • See what you are paying in merchant fees – your merchant fees should not be more than 2.5%-3% of your credit card sales • Obtain new quotes for your general, auto and malpractice insurance for potential savings • Review your office and cellular phone bills – maybe it’s time to switch to voice over IP (VOIP) or revise your mobile plan design • Review your spending on office supplies – since most practices switched to EMR your paper product usage should decrease substantially • Revisit your advertising spending – yellow pages is getting to be an outdated way to get new patients (CONTINUED ON PAGE 8)

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HEALTHCARELEADER A Few Questions with Daryl Tol, continued from page 1 Tol headed to Portland, Ore., where he began his healthcare administrator service at Portland Adventist Medical Center in 1998. In 2000, he began serving in progressive leadership positions with Florida Hospital Memorial Systems, Florida Hospital Flagler, Florida Hospital DeLand and ultimately Florida Hospital System’s Central Florida Region, which includes eight Florida Hospital campuses in metroOrlando, and Florida Hospital Waterman in Lake County. With more than 2,600 beds, Florida Hospital admits more patients annually than any other hospital in the United States, and is the largest provider of Medicare services in the country. As president and CEO of the Central Florida Region, Tol oversees more than 19,500 employees. Tol was kind enough to take a few minutes to address with Orlando Medical News some of the issues he faces as leader of one of the country’s major healthcare systems.

patients. Health care must become more connected. That lack of connection is a driver of much dysfunction in the system. But connection doesn’t require acquisition of practices by health systems. Hospitals and physicians can come together in welldesigned networks to provide well-coordinated, well-connected care even though members of the network are independent of one another. We feel this model has great promise, and we have partnered with more than 1,800 physicians to form Florida Hospital Physician Network, a Clinically Integrated Network, as a result. We also have a large, multispecialty group called Florida Hospital Medical Group that is becoming a pre-eminent medical group for those physicians who prefer to practice in that setting.

The State Legislature is considering a controversial issue for hospitals specifically related to CON repeal. How do you see the debate shaping future care delivery in the State of Florida?

Affordability and access are important. Many of our services today are too expensive. Too confusing. Too disjointed. We are working hard to create care options close to where our community lives, works and plays. Those care options must be affordable and we don’t expect our health system will own them all. We are working to create a network of connected options that meet access, affordability, connectivity and excellence requirements. Places members of our community can rely on. Places that don’t require significant selfnavigation, that don’t leave yawning gaps between settings of care. Some of the greatest shortages of care in Central Florida are at the foundational level – adequate primary care and low-cost ambulatory care settings. We want to be part of changing this story side by side with a connected medical community.

With a CON requirement in place, those proposing new hospitals generally have to place a hospital in a community where there is need, and they must commit to caring for all individuals in those communities, regardless of ability to pay. In the absence of CON, markets start to see high-income areas become overbuilt and low-income areas underserved. Niche hospitals are built to provide services only to segments of the population who can pay, rather than to all residents of a community. We know that there are many interests that would like to see CON go away for business reasons. And if it does go away eventually, we will be ready to compete in that environment. But we should not assume this will serve the public interest. It’s also important to note that the chief argument for removing the CON – that it will increase competition, thus lowering costs – has not been borne out in other states that have done away with CON requirements. There has been a significant amount of consolidation in health care over the past decade but it seems to have waned a little bit most recently, how do you see physician practice acquisition by health systems and health plans evolving over the coming years? The health care system we know today has been designed around providers, not 8

MAY 2017

In the discussion of stand-alone clinics being significantly cheaper than hospital facilities, what’s the strategic plan for FH moving forward?

What are the short-range plans for improvements/changes over the next 5 years and what about long range plans? We are serious about affordable, connected and exceptional care. This means planning health care access carefully, placing locations within 10 minutes of 90 percent of our population. It means considering health care needs of communities more broadly than acute care, designing for a lifetime of hand-in-hand relationships with consumers. It means knowing our consumers, making it easy, holding hands and providing great care every time. It means leveraging technology for instant access and communication. It means doing all of this side by side with

physician leaders who want to build health care centered around the consumer. In the next five years we will open two new hospitals, several new free-standing Emergency Rooms, numerous Health Parks and Ambulatory Care locations. We will invest heavily in care management and connecting technology that allow us to stay very close to those with high risk and chronic conditions as well as being a source of information and helpful connectivity to those who are healthy. We will eliminate the idea of discharging patients from our vocabulary. We will build and strengthen our physician-led Clinically Integrated Network and work hard to connect providers as seamlessly as possible in the interest of the consumer. We will design our care to address the whole person: emotional, physical and spiritual, recognizing that this creates total health. We will address total cost of care and work to improve affordability across the spectrum. We are enthusiastic about being part of the transformation of healthcare and being deeply part of the legacy of healthcare in Central Florida. With payment reform ideas being at the forefront for CMS in Washington, what challenges has Florida Hospital seen in regards to implementation of new programs such as bundled payments and Accountable Care Organizations. How is your institution responding to these challenges? Health care is a team sport. Seamless connectivity is required to provide the best care for patients every time. This is why we spend so much time focused on building an exceptional Clinically Integrated Network with leading physicians. Success will start with a strong primary care leadership team. Physicians who have a vision for what can be in healthcare and an energy to build it. An early challenge centers around technologic connectivity. There are over 140 Electronic Medical Records in use just across the Central Florida Community. Sharing information and designing for simplicity is difficult in this kind of scattered technologic landscape. There is no silver bullet…yet. Perhaps it is time for a healthcare “X-prize!” Fortunately, there is much we can do with the technology we do have: smart clinicians, ample data, compassion and excellent communication are already driving us forward. We have also invested heavily in a Population Health Services Organization that is providing tools and people on the ground to improve care across a lifetime.

Delicia M. Haynes, MD, continued from page 3

already been saved, including a black man who was shocked to learn his blood pressure was in the stroke range. After verifying the numbers, he was dispatched to a local hospital for urgent care. “For many people, and especially black men, the barbershop is the one place they can let their guard down and speak their mind without consequences,” Haynes explained. Patricia Cadette, owner of Styles 101 Beauty in Daytona Beach, is a staunch supporter of the program. Eight years ago, when she was a seemingly healthy 41-yearold beautician, Cadette suffered a stroke. “Now, even when clients aren’t getting their hair done, they stop in to have their blood pressure taken,” Cadette said. Haynes has continued to excel in every direction. In 2013, she became Volusia County’s first board-certified obesity physician. In 2014 and 2015, she was listed among America’s Top Family Doctors. In 2016, Daytona Beach Chamber of Commerce named Family First Health Center the area’s Small Business of the Year, and Daytona Beach News Journal named her among Top Doctors. Earlier this year, she was a Volusia-Flagler Top 40 Under 40 award winner. “I stopped asking for permission a long time ago,” said Haynes, of her out-ofthe-box thinking. “It’s so sad to me when brilliant people see a problem and have a solution and won’t do it because of some sort of bureaucracy.”

Tips for Physicians, continued from page 7

yet is still rather expensive If these initiatives are not enough to get your overhead in line, take a deeper dive into the following areas: Practice management assessment steps: Review your Accounts Receivable collection process to make sure your write offs are within the norm, rejected claims are being resubmitted timely, patient statements are being sent out periodically and past due amounts are being followed up promptly by the billing department Review possibilities of automating processes versus manual labor such as payroll, bill payments etc. which may reduce your staff needs Review your staff and their salaries to make sure you are not overstaffed and your overtime is controlled Evaluate your infrastructure – if you have multiple offices there might be possibilities of centralizing certain function and realize savings in IT, telephone, answering services and other administrative costs Changes don’t happen overnight but with a concerted effort from you and your team the results can be very welcoming. orlandomedicalnews

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Negative Reviews ≠ Bad Physician Practices By KELLI MURRAY, MedSpeaks

It’s easier than ever for consumers to provide near real-time feedback on their experiences. From Amazon, Yelp, FaceBook, and Google to GlassDoor, HealthGrades, and KLAS the consumer has multiple outlets to inform others about where to and where NOT to spend their time and hard earned dollars. What once started as 3rd party star ratings in the hospitality, restaurant, and automotive industries has now shifted to consumer ratings across not only those industries but also to product and service providers, employers, and yes, even, healthcare. Through no choice of my own (my insurance pulled out of Florida), I recently went through a change in insurance payers. That change unfortunately, left me having to select new dental, primary care, and gynecological physicians. Already put off by having to give up physicians that I have trusted with my health for over 20 years, I did what most consumers do these days and took to the Internet for help. My first stop was to my new payer, FloridaBlue, to see who was covered under my plan and, more importantly, who was accepting new patients. There was an overwhelming list of physicians to choose from. So I began the filtering process, which looked something like this: 1. Provider Type (Primary Care)

the proverbial rabbit hole without finding a primary care physician and I still had a gynecologist and a dentist to find. The intent of all the hours spent filtering, searching, reading, and evaluating was to simply find ONE physician that I felt was “good enough” on the surface to provide me with a reputable, consistent, high-quality customer experience. Notice, I did not look at quality performance indicators - I would have - but that information was not readily available to me. And, I was already frustrated having to give up my trusted physicians and my time trying to find replacements I know very little about. Which brings me to my point. The unfortunate side of today’s socially reported consumer reviews in healthcare, specifically the physician practice setting for purposes of this article, is not unlike other industries. But, let’s not fool ourselves, there are several significant

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2. Specialty (Family Practice) 3. Distance (within 10 miles of my home) 4. Gender (Female) 5. Search Results - 66 Determined, I then scrolled one-by-one through 66 results looking for:v 1. Practice Affiliation (Florida Hospital or Orlando Health) 2. First Language (English) 3. Qualifications (Years in Practice, Place of Residency) Once the physician passed the above criteria, you can probably guess what I did next. That’s right, I Googled the physician’s name. Then once I found the correct physician, I read various reviews across multiple rating sites, then headed to the physician’s web site to see if I was impressed with what I saw. Each physician took no less than 10 minutes for me to research and evaluate. One physician in particular had so many negative reviews (32 to be exact) that I read them simply out of curiosity. This physician’s first-visit patients described her using adjectives like “condescending, impatient, rude, hostile, irritated, accusatory, and grumpy.” I’d meandered down

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key variables to consider: 1. Clearly, consumers are unable to provide a fully informed review using both objective (clinical) and subjective (experiential) data because they only have access to half of the information - which is how the practice made the consumer feel at

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the time of service. Things like bedside manner, staff friendliness, ease of access, clear communication, waiting times, cleanliness, out of pocket costs, and other traditional customer service criteria generally associated in evaluating things like products and/ or a service experience, like a restaurant for example. “Blending objective measures with patient reviews would provide a more accurate, thorough evaluation of physicians. We are not yet there,” says Kevin Pho, an internal medicine physician and the founder and editor of KevinMD.com. 2. Unlike product reviews on Amazon or Yelp, most consumers of healthcare haven’t yet personally identified with where to provide their feedback. In the old days [before the emergency of social media], they’d rave or rant to their neighbors or spouse. Today, as a proactive consumer, I rely heavily on Amazon reviews to compare price, product satisfaction, and buying experience. It’s not unusual to find me standing inside a CVS Pharmacy with the Amazon mobile app (CONTINUED ON PAGE 10)

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Why is Data the Medicine to Cure Modern Healthcare? By ABHINAV SHASHANK

The world of healthcare analytics is vast and can encompass a wide range of data that has the incredible potential to tell stories about health and healthcare delivery: right from individual patients to entire populations.Having numbers and an easy-to-use visualization at hand gives providers and caregivers the power to not only look into the lives of individual patients but also track the ongoing activities in their organizations. Simply showing visualizations are not enough and to fully understand their value, healthcare organizations have to take a few steps beyond basic graphs. The Case for Data Visualization There are many disparate data sources healthcare providers have to deal with: EHRs, departmental data, claims data, resource utilization, administrative data, etc. Consolidating the data and spreading it out in a visually adaptive manner offers a more agile approach to managing complex population health data. Data visualization was developed with the aim to make it easier to gain actionable insights from volumes of information and work on improving health programs, clinical healthcare delivery, and post-episode care management. Visualization provides real value in learning from disparate data sources, finding outliers, bringing out hidden trends out on the front, and delivering better health outcomes.

Streamlining Different Data Sources into a Single Source of Truth Since the data pertaining to a patient’s health comes in from various sources, it is vital to pool all the data sets and obtain an aggregated, standard format of data every authorized person can view and manipulate. Data in the healthcare industry can broadly be categorized into two sources: • Claims data: that comes from payers and contains extremely uniform and updated data about the care patients receive and how they are billed for it. This data is usually structured and has all the meaningful data required for provider reimbursement.

• Monitoring end-to-end care delivery across a wide range of facilities.

every immediate level, and initiate corrective actions.

• Observing the progress of clinical decision support systems.

• The end user’s ultimate need: It’s paramount that end users can communicate their needs and demands and what is even more important is that their demands and performance indicators are incorporated well in advance of structuring the report.

• Identifying overhead cost drivers and detect care or documentation gaps. Since data visualization holds great advantage to understand the going-ons in the organization in real-time, here are some key elements that count as best practices for data visualization:

• Clinical data: this data comes in from the providers’ end and contains valuable information about their diagnoses, claims, and medical history. While this data isn’t often structured, incorporates data elements critical to analyze a patient’s health in every time frame. Fine-tuning Real-Time Visualization The amount of data healthcare institutions aggregate is enormous: by 2012, it was estimated to be a whopping 150 exabytes (150 million * million * million) and is growing at a rate of 48% per year. As the volume grows, healthcare organizations need state-of-the-art, real-time analytical capabilities to improve the care quality and its effectiveness. Real-time analytics can turn the tables in ways more than one:

• Customized reports: Each set of users in healthcare requires different metrics and different orders. Offering customized reports with specific visualization provides actionable insights and can answer specific questions about risks, rewards, and success of the organization. • Visually adaptive: Data presented on the dashboards has to be complete with functional and visual features that aim to improve cognition and quick interpretation. Data listed in a color coded-manner will provide physicians with functional features and real-time alerts. • Create actionable insights: A dashboard or any other visualization tool will provide clinicians with the data, but unless someone looks at it, it will go unnoticed and may have potentially critical outcomes. Users should be made aware of how to review the dashboard, drill down to

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MAY 2017

• Immediate access and sharing: Putting bidirectional interoperability to use, providers can access and share relevant data across the network, despite technological barriers. • Clear data visualization: Graphic, color-coded cues help physicians swiftly learn about the areas that need performance improvement or track the growth their organization is making. • Drilling down: To learn more about the reason behind certain shortfall, physicians can always drill down and narrow their area of focus to pinpoint the anomaly, and take quick remedial actions. Driving Value with Visualization With healthcare IT now an integral part of the value-based care system, there is little doubt that convenient, real-time data visualization will be heavily used to achieve positive health outcomes. Combining real-time data with advanced analytics will completely reshape how healthcare IT can improve clinical and operational outcomes. Once physicians move away from long, incomprehensible data flows, and find an alternative that helps them instinctively read, isolate, and act upon the insights, only then can we be one step closer to a data-driven value-based care.

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The Increasing Benefits of Using Electronic Patient Portals By SONDA EUNUS, MHA

As most medical practices move towards using electronic medical record (EMR) systems, electronic patient portals are becoming more prevalent. Most EMR systems include this feature, but many practices may not realize the extent to which the use of such a portal can benefit their operations. Collecting email addresses is an additional task for employees to complete, and patients may not always be very forthcoming with this information. However, when faced with the various benefits that increased use of a patient portal entails, it may be a good idea to emphasize the importance of collecting patient email addresses and webenabling all patients. The best way to achieve results is to educate the patients on the various things that they can do via their patient portal. Some practices have created colorful attention-grabbing posters that list the benefits of their patient portal and hung them up in their waiting rooms and exam rooms; others have trained their providers and employees to inform patients of these benefits when asking for their email address. Most portals across various EMR systems have similar features, but are also able to be customized to each practice’s specific needs. The most common features of a patient portal allow patients to do the following: • Schedule appointments. Patients can request to schedule an appointment, specifying their preferred date, time, provider, and facility (for multi-office practices). They are also asked to pick a secondary preference in the case that their first choice is not available. Some portals offer real-time scheduling, which shows patients available appointment slots in real time and allows them to schedule their own appointments directly into their preferred provider’s schedule. Real-time scheduling may, however, be tricky for some practices if they have very specific scheduling policies of which the patients may not be aware. This would require the practice to call the patient back to reschedule their appointment, which may be time-consuming as well as frustrating to the patient. • View their next appointment. Patients are able to see when their next appointment is scheduled and can easily request to reschedule it

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if necessary. This reduces no-show rates, as some patients may miss appointments because they are not aware of them or are not able to reschedule in advance. Patients can also see the dates and times of previous appointments. • View their medical record and visit summaries. Patients can view their own medical records, lab results, and progress notes over a secure connection. This allows for the patient to participate and be more engaged in their own care, as they may not always understand or hear everything that the healthcare provider tells them at their appointment. This also enables patients to request corrections to their record if necessary, if they find any information that may be incorrect. • Update their information. Patients can also update their demographic and contact information, as well as emergency contact information to keep it current. This helps the practice reach the patient when necessary, which can be tricky if patients often change their phone numbers or addresses. If a patient chooses a new preferred pharmacy or lab, that information can be updated through the portal as

well, which ensures that the practice sends prescriptions and lab orders to the correct facilities. Additionally, health insurance plan information can be updated, which allows the practice to verify the patient’s eligibility prior to their appointment without having to call the patient to obtain the new information.

and is faster and more efficient for both the patient and the practice. However, patients must be cautioned that not all prescriptions can be refilled electronically— prescriptions for controlled substances still need to be picked up at the practice. • Access patient education. Finally, patients are able to access educational material about what they or their family member is currently facing. Most EMR systems include several electronic patient libraries to choose from at a reasonable cost, which allow the physician to pick the appropriate content and publish it to the patient’s portal. For example, after a pediatrician sees a baby with a rash, he or she can upload some instructions for the parent directly to the portal for the parent to be able to access whenever needed. This eliminates the need to print such material or hand out brochures, which may be more expensive. The practice is also able to upload and share their own documents, and does not necessarily have to incur the additional costs of using an electronic library.

• Send e-messages. Patients can send secure messages to the practice, and these messages are routed as per the practice’s specified instructions. For example, questions of a clinical nature may be directed to a specified nurse, whereas general questions may be routed to a receptionist. Additionally, if the practice so chooses, patients are able to send messages directly to their healthcare provider. Using secure e-messages eliminates long on-hold times for patients who need to get in touch with the practice, and also frees up the phone lines for other calls. • Request permissible refills. Patients are able to ask for refills on their prescriptions, which eliminates the need for the pharmacy to fax over a refill request on behalf of the patient and eliminates potential printing costs. Furthermore, it prevents unnecessary phone calls

Having a patient portal brings many benefits to the practice as well as the pa(CONTINUED ON PAGE 10)

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Negative Reviews ≠ Bad Physician Practices, continued from page 9 Powering Medical City

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opened on my mobile phone while reading product reviews and comparing prices. The “Amazon of healthcare” doesn’t exist in the similar context and that leaves many consumers turning to Google for information and social platform like Facebook and Twitter to voice grievances. 3. Further, in an outpatient setting, feedback isn’t necessarily encouraged nor pulled from consumers once their “purchase” is complete. According to a 2014 poll published in the Journal of the American Medical Association, only 5% of consumers had reviewed a physician online. Small samples yield highly unreliable data yet research has shown that even a few reviews are enough to set an expectation in the mind of a potential consumer. When consumers post negative feedback, I have to wonder how many of them first sought to inform or ask for remediation by the physician practice manager? Meaning that as a service provider, you may be the last person to know that your patient has had a negative experience that may have a downstream effect on future clients choosing your practice. What’s even more difficult at first glance is that the feedback, good or bad, once published on social platforms, is there...forever. So what is a provider and practice manager to do? Consider this - negative reviews can actually be a good thing and here’s why: Customers value seeing honest feedback, even if it’s not all positive. A 2013 study by Harvard Business School found the majority of consumers trust reviews more when they see a mix of good and bad feedback because people recognize that no one is perfect. To the contrary, if feedback is all positive, 95% of consumers believe the reviews are fake and/or company-screened. Amazon is a perfect example and it doesn’t take long for consumers to call companies out about it. Yotpo conducted a study of 1.3 million

reviews and found that the most commonly used negative word in reviews is “disappointment” or “disappointed.” It was mentioned 20,000 times. In comparison, the next most common negative word is “bad,” which was mentioned 7500 times. Disappointment occurs when expectations are not achieved. You can leverage this information to find better ways to communicate to your patients about what they can expect from you. Here are some simple tips that can help you not only manage reviews but increase the value of your brand experience: • Be proactive. One simple and very inexpensive tip is to position signage throughout your practice encouraging consumers to reach out to a member of staff if they feel their expectations have not been met. It’s best to manage issues head on at the time they occur than to try to course correct after the fact. • Encourage your patients to provide an online review - it shows you value their input. • Avoid deleting negative reviews. • When possible, respond publicly to feedback. Consumers look for how complaints are resolved and covmpliments are received, and they remember the results. Once customers know that you’re making their experience a priority, it will help to lower their guard, anxiety, and expectations. This type of proactivity will also put your staff on alert to provide the best possible service. Empower them to ask the patients questions and bring any issues forward for immediate resolution. It not only holds the entire practice accountable but it sends a clear message to your “clients” that you acknowledge them and that they are important. Everyone wants to be treated like they matter and when they have a surprisingly stellar experience with a team that they trust, it is a beacon for referrals and a testimony to your commitment to care!

Using Electronic Patient Portals, continued from page 9 tients. Overall, it allows for greater communication between the practice and its patients, ultimately enhancing the patient experience. Additionally, it improves the practice’s operations and revenue cycle by accomplishing several important tasks. By allowing patients to be more self-sufficient online, electronic patient portals free up the practice’s phone lines for more revenuegenerating calls. For example, in the time that it takes for an employee to take an existing patient’s refill request, schedule their next appointment, or update their contact information, phone calls from potential new patients may be missed or placed on hold for increased periods of time. Employees relieved of picking up a large volume of unnecessary calls also have more uninterrupted time to spend with the patients that are at the practice at that time, improving those patients’ experiences and creating long-lasting patient relationships. 12

MAY 2017

Finally, financial activities are also made easier through the use of an electronic patient portal. Not only are patients able to update their insurance plan information, but they are also more easily reached in the event that their insurance is found to be inactive. If the practice is unable to reach a patient with insurance issues before their appointment, more time is spent resolving these issues when the patient shows up. This holds up patient flow, and causes the practice to run behind schedule. Furthermore, dealing with insurance issues is unpleasant when the patient is clearly sick and in need of medical care. No practice wants to turn away a sick patient simply because their insurance issues were not taken care of before their appointment. Patient portals also allow the practice to send patient statements online, which can either replace or complement traditional paper statements. If the practice can get all of

their patients registered on their portal and is able to eliminate paper statements, it can save significant amounts of money spent on supply and postage costs. Additionally, employee labor is reduced as electronic patient statements are much more time-efficient than traditional statements which must be printed out, stuffed in envelopes, addressed, stamped, and mailed. Lastly, patients are able to make payments online, which many patients find to be much faster and easier than mailing out checks or calling the practice to make a credit card payment. Sonda Eunus is the Founder and CEO of Leading Management Solutions, a healthcare management consulting company (www.lmshealthpro.com). Along with a team of experienced and knowledgeable consultants, she works with healthcare practice managers to improve practice operations, train employees, and increase practice revenue. She holds a Masters in Healthcare Management and a BA in Psychology. www.lmshealthpro.com

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