Orlando Medical News April 2019

April 2019 > $5

New Robotic Technology at Orlando Health Saving Time and Lives It is easy to understand why surgeons Taylor Thoracic Care Center. He and his coland oncologists are so excited about the latest leagues Luis Herrera, MD, also a member of technology in the fight against lung cancer: it the Specialty Section, and Mark Vollenweider, means more accurate diagnoses with less risk MD, section chief for pulmonary medicine to patients. That’s what it means now; in the at Orlando Health UF Health Cancer not-too-distant future it could mean even more.

Center are the first three physicians in The Monarch Platform manufactured by Florida to be trained on the highly Auris Health is the first FDA-cleared robot for Dr. Juan Escalon specialized technology. Escalon and diagnostic and therapeutic bronchoscopic proceHerrera are board-certified thoracic dures. Orlando Health is the first facility in Florida and surgeons, and Vollenweider is board-certified in interventional pulmonology. one of the first in the United States to put it to use so far.

“We already have techniques where we Already more than 40 patients have benefitted from it. can use cameras to look down the bronchial “It’s called Robotic Navigational Bronchoscopy,” tubes,” said Escalon. “However, traditionally said Juan Escalon, MD, a member of the Thoracic/ Head and Neck Cancers Specialty Section at the Rod (CONTINUED ON PAGE 4)

ON ROUNDS

PHYSICIAN SPOTLIGHT Robert Masson ... 3 MEDICAL CITY

The Age of Innovation: Taking Imaging to Infinity & Beyond... 6

WHITE GLOVE CONCIERAGE ESTATE ACQUISITIONS ... 8 LOWEDOWN ON HEALTH LAW Signing Senate Bill 182 into Law ... 9

The Business of Florida Medical Marijuana ... 10

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HEALTHCARELEADER

Serving Children in Need with a Humble Heart Debra Andree, MD, CMO, Community Health Centers Growing up in a Wisconsin cheese town during the 1970s and ‘80s, Debra Andree, MD, scoured the local library for inspiration.

At the age of 11, she stumbled across a Clara Barton biography, fascinated by the story of the young nurse who birthed the American Red Cross.

“I was so intrigued and inspired by Clara’s ability to ease suffering in others and truly help so many people in need,” said Andree who admitted that she couldn’t stop thinking about how amazing she felt Barton to be.

“And she was a shy person,” said Andree. “I identified with that.”

Andree shared her enthusiasm to be-

come a nurse with her dad, who questioned why stop there? Become a doctor! “I sensed there was more potential in people than I was seeing in some, due to an under-resourced area,” she said. “Developing that potential was key.”

Her medical journey – first, a pediatric nurse, and second, a pediatrician at Community Health Center (CHC) in Orlando, began with babysitting jobs and work as a summer camp counselor. Always in her forethought: working with children.

“I am in awe now of all the reading ma-

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terial available to my children and me – and at the instantaneous availability of it. Amazing! I am also keenly aware of the gifts and interests manifested in people at a young age and how that plays out in life with education or job choices and careers,” she said.

“I’m particularly intrigued by the stages of development and how that manifests at each age,” said Andree. “For example, the stage of development where a child has magical thinking is particularly interesting. It allows me to have a tea party in my office with a child when (CONTINUED ON PAGE 5)

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PHYSICIANSPOTLIGHT

Driven to Succeed

Robert Masson, MD, Neurosurgeon, Orlando Health It might seem like a play on words to describe a race-car-driving neurosurgeon as driven. But in the case of Robert Masson, MD, founder of the Masson Spine Institute and Director of the Orlando Health – Health Central Hospital JCAHO accredited Spine Center of Excellence, it is also true.

Masson, in addition to leading a revolution in the treatment of spinal cord injuries fills his spare time with extreme adventures, like driving a race car to the winners’ circle at the Rolex 24 Hours of Daytona with his oldest son or taking a helicopter to remote slopes in the Wasatch Mountains of Utah in order to ski down the purest powder snow possible.

“I’ve always led a very physical life,” said Masson.

“Performance across the board has always been a passion. I love sports. I love competition. I love pushing myself. It’s a joy and an obsession.”

Masson grew up in Los Angeles, dreaming of becoming an astronaut. He had a single mother, four younger siblings and a lot of determination. “I loved science and math. I reasoned that if I did well, if I played sports and did well academically, I could add value as a bio-medical mission specialist.”

He entered the University of Florida with plans to play quarterback for Charlie Pell’s ‘Gators. But after sustaining his fifth concussion by his sophomore year, and winning admission to Florida’s BS MD program, Masson decided on a different path: neurosurgery.

He liked everything about neurosurgery. “To me it’s the Holy Grail of human biology,” he said. “The neuroscience, the combination of intelligence, artificial intelligence, extreme performance. It’s the black box of understanding. Even to this day, it is still the organ that we know the least about. It was limitless to me. ‘Limitless’ is a big word in my family. Infinite room for advancement and improvement. I was just fascinated by it.”

The seven-year training program Masson entered placed him at the leading edge of the evolving specialty of microneurosurgery, which uses microscopes and miniaturized precision tools to perform intricate procedures, primarily in the brain. Leading this program was Albert Rhoton, MD, an internationally renowned surgeon who developed UF’s program into one of the best in the world. He became Masson’s mentor and role model.

“He was an unbelievably demanding person, but he lived up to his demands. He was easy to respect. It was different era,” said Masson, describing the grueling program. “For five of the seven years we were on house call every other night. We didn’t have protective hours-per-week guidelines.

We worked 120 to 130 hours per week. We’d go in at 5:30 in the morning one day and out at 8:30 at night the next day, and then back 3

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at 5:30 the next day. It was exhausting and stressful, but the benefit is the experiential aspect, the independence, autonomy and decision-making. We developed a very high level of technical performance, because we were immersed. And I do believe in immersion to develop mastery.”

Fresh out of his medical training, Masson led a team of 100 physicians in a new neurosurgery department in Olympia, Washington. “I am definitely someone who is always seeking out roles like that,” he said.

“Every step of my path is always aiming toward leadership in some way.”

In 1999, fed up with the Northwest’s penchant for rain, Masson and his family returned to Florida, joining the Orlando Health team. “I came to Orlando to do microneurosurgery,” he said. But he noticed a need in spine surgery. “Brain surgery was being done at one level, and spine surgery was being done at a much lower level,” he said. “I started applying higher technology microsurgery more aggressively toward spinal reconstruction. I was doing some things in spine surgery that in the early 2000s were really unique.”

By 2003, Masson was focused entirely on spine surgery. He founded the Masson Spine Institute and now heads up the Spine Center of Excellence at Orlando Health’s Health Central Hospital.

Now, Masson is an international educator in complex lumbar spine reconstruction,

microsurgical reconstruction and cervical arthroplasty. He has developed techniques and products for two of the world’s top spine companies, which produce advanced products for minimally invasive spinal reconstruction.

If you ask him for high-points in his career, he pointedly responds: “I don’t focus on milestones, I focus on relentless forward progress. I will say, however, that my greatest professional joy is turning Health Central into a destination. We brought several hundred surgeons to a small hospital in West Orlando over the last 15 years and turned it into a place where we receive world class surgeons for training and patients from around the world, and we have the data to turn it into a Center of Excellence, certified

by JCAHO (Joint Commission on Accreditation of Healthcare Organizations).”

One accomplishment that Dr. Masson is perhaps proudest of has nothing to do with surgery. It has everything to do with his family. About five years ago, Masson realized he didn’t know Kyle, the oldest of his five children, as well as he felt he should.

“When I was a young neurosurgeon, I was on call all the time,” said Masson. Kyle wanted to pursue a dream of becoming a race-car driver. So, Masson chaperoned

him to racing school, “and I was immediately destroyed (on the track) by my 16-yearold.” Kyle and his dad soon formed a racing team, competing around the country. Now Kyle has won in his class at the famous 12hour endurance race at Sebring, and the two stood together on the podium this winter at the Rolex 24 Hours of Daytona.

“I was able to reclaim a relationship with Kyle through this amazing journey. It’s been absolutely priceless to me and my family.”

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New Robotic Technology, continued from page 1

we can only look into the proximal lung, or the first or second divisions of the bronchial tubes. Before this, we didn’t have a good way to look farther out into the lungs. This is really significant, because often-times lung cancer lesions are located in parts of the lung that are hardest to reach.”

Before this technology, Escalon explained, the only reliable way to biopsy a nodule inside the lung was “for the radiologist to insert a needle from the outside through the skin and the chest and into the lung.” While that procedure works quite well, said Escalon, about 10 to 20 percent of the patients who have it done develop pneumothorax, a collapsed lung caused by air leaking into the space between the lung and chest wall. If that happens, a patient may require placement of a tube and several days of hospitalization.

“The great benefit with this technology,” said Escalon, “is that there is no incision and we don’t have to insert a needle into the patient, which reduces the chance for complications.”

The way the procedure works, a patient first has a CT scan to identify the presence of nodules, which may or may not be cancerous. If they are cancerous, it’s important to identify that quickly because lung cancer is the most-deadly type of cancer.

“The CT scan is our roadmap; it’s like a GPS for the lung,” said Escalon. “The patient is asleep on the table, and we make a magnetic field around them. Using that CT scan as a road map, we can go to all the nodules with the camera on the catheter. We can actually see the nodules and get more accurate

biopsies, with a much better safety record.

“The robot has two arms that we control,” he said. “It’s a little like a video game. With the robot, you can hold the catheter in place, and you can turn the camera 360 degrees so you can see all around. You have vastly increased range of motion. So, the robot allows us to control all the movements of this fiber optic scope and to be very precise with it.”

Using endoscopic technology to biopsy lungs is not new; Escalon has been doing it for 10 years. “The new technology is the robot,” he explained. “Before this technology was here, you would have to use your hand, and couldn’t always get to the area you needed to reach, and once you did, you couldn’t keep the catheter in place. The robotic technology holds the catheter in place, allowing you to do more.”

In addition to the immediate diagnostic value of this technology, the Monarch Platform may also become a tool for treating cancer. “Because the catheter stays put where you have it, it may become a tool that to allows us to destroy tumors in one treatment,” said Escalon. “We will be able to biopsy the nodule; diagnose the tissue immediately and burn the lesions with one treatment without having to do surgery or radiation.”

So far, the technology has a 90-percent success rate, according to Escalon, meaning that 90 percent of the biopsies performed have yielded positive test results. That, in and of itself, is a major step forward. Next, if onthe-spot treatment becomes possible, you can understand the reason for both excitement and optimism.

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HEALTHCARELEADER

Debra Andree, MD, continued from page 1 there’s no tea. I can also talk to a patient’s imaginary friend and learn the greatest details about this ‘friend.’”

Andree earned her nursing degree from the University of Florida, followed by a medical degree from the University of Miami School of Medicine. After completing a three-year residency in pediatrics in 2002 at then-Orlando Regional Healthcare, she joined CHC, where she’s been a loyal mainstay. In 2013, she was promoted to Chief of Pediatrics.

Andree, a married mother of three – Anders, 15; Eelin, 13, and Anika, 11 – along with her physician husband, also serves as Pediatric Education Director for the Florida State University (FSU) School of Medicine. She’s able to juggle various roles because, as she puts it, pediatric medicine is “also my hobby.”

“The greatest rewards of being a pediatrician come in the small moments with a child, not in the glossy awards – although those are nice, too,” said Andree, pointing to a letter written once a year by a patient, accompanied by sweet pictures, and usually ending with a plea to “not have a shot (vaccination).”

“This year, she included a pink beaded bracelet to further persuade me on the shot issue, which I found so humorous,” she said.

“Of course, she received her vaccination and … decided to let me keep the bracelet. I wore it proudly in front of her. She reassured me the shot wasn’t that bad. These are the moments that remain for me.”

At CHC, she also heads the pharmacy team. Pharmacy director Darren Marsh, PharmD, “is the brains and powerhouse guiding these operations. (CHC CFO) Mark Dickinson once told me that when you have a talented person doing a great job, just get out of their way. So, with Darren and his talented team, my job is very easy.”

Orlando Medical News talked with Dr. Andree about Community Health Centers and how they serve the Orlando area.

Tell me about CHC and when and how you came to join the community?

Community Health Centers, Inc. (CHC) was established in West Orange county in 1972 by a group of Catholic Nuns. CHC is a Federally Qualified Health Center (FQHC) that provides quality and compassionate primary healthcare services to insured, uninsured, underinsured, and underserved children and adults within Central Florida. CHC accepts Medicaid, Medicare and most private insurance plans. A Sliding Discount Program is available for those with or without insurance. CHC provides care to approximately 70,000 patients each year in the Apopka, Bithlo, Clermont, Forest City, Lake Ellenor, Leesburg, Meadow Woods, Pine Hills, South Lake, Tavares and Winter Garden communities. Margaret Brennan, CEO, leads the organization with her strong leadership skills and fresh perspective on community involvement. Nathaniel Friends, CHC Board Chair, and Tim McKinney, Immediate Past Board Chair, lead a very involved CHC Board of Directors that contribute to the overall success of CHC. All of the talented and diverse providers along with the medical staff are the 5

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driving force of the organization and commitment to quality healthcare for our wonderful CHC patients.

I joined CHC after I finished residency and have been serving patients for over 16 years. I started as a general pediatrician, then became Chief of Pediatrics, later Associate Medical Director and then transitioned to Chief Medical Officer/Vice-President. I’m grateful for all the wonderful teachers, attendings, colleagues, friends and family over the years that assisted me on this journey. It is a privilege and honor to serve CHC. What healthcare services does CHC provide?

CHC provides: Pediatrics, Family Medicine, Pediatric and Adult Dental, Obstetrics/Gynecology, Internal Medicine, Optometry and Behavioral Health. CHC, also, has their own low-cost pharmacies, on-site laboratories and X-ray.

How many locations does CHC have and how many patients are you serving annually? Are there plans for further growth in the near future?

We have 13 Central Florida centers and are the medical and dental home to approximately 70,000 patients, each year. We are opening a brand-new center in the Four Corners area in Lake County near the Lake, Orange, Osceola and Polk county lines in early 2020.

How do patients find your services and how are you funded?

Patients can find us at www.chcfl.org or by calling us at 407-905-8827. As an FQHC, we receive some of our funding from Health Resources & Services Administration (HRSA) from the HRSA Health Center Program to provide primary care services in underserved areas. We must meet a stringent set of requirements, including providing care on a sliding fee scale based on family size and income. The rest of our funding comes from patient fees, insurance re-imbursement, other grants and fundraising.

What partnerships does CHC have with hospitals and clinics?

Community Health Centers refers to and is a referral source as a medical home for all hospitals and free clinics in the area. Our obstetricians deliver more than 1,000 babies, each year, at AdventHealth for Women in Orlando. We provide Care Transition Specialists (RNs) that round at Orlando Health-Health Central Hospital, AdventHealth Apopka and Leesburg Regional Medical Center. The purpose of this position is to improve health outcomes through coordinating care, educating patients, building trust between patients and medical practitioners.

Is CHC accredited and/or a patient centered medical home?

Yes, we are accredited as a patient centered medical and dental home by the Accreditation Association for Ambulatory Health Care, Inc. (AAAHC).

Patient-focused Cardiothoracic Surgeons Caring for Greater Orlando

The Florida Heart & Lung Institute has several locations extending from Orlando to Pensacola. Through this partnership, we are able to deliver a patient-focused experience in which every provider is dedicated to excellence. We offer a comprehensive range of services specializing in heart and lung surgery, including minimally invasive and robotic surgical interventions.

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Throughout the ages, the world has undergone periods of change. The industrial revolution increased productivity and the pace at which change occurred. In the mid to late 90’s we experienced the Internet age offering the world unprecedented innovation. Some may say that change has since slowed, but it continues to evolve and will offer an even brighter future as we enter the era of rapid technological advancements and adoption.

The digital revolution coupled with multiple technologies expected to emerge in the next few years will make the transformation of the past seem elementary. Entrepreneurs and companies are on the fast track to creating technologies to far surpass where we have gone to date, but we must embrace and nurture this evolution, rather than resist progress.

Without the innovators we might never have seen the development of the X-ray. The discovery came in 1895 but took another decade before being considered the standard of

care for patients. Over time, more dramatic scientific and technological interventions occurred. Today, imaging technology has become so routine, the history of its evolution is all but forgotten.

How does the advancement in imaging affect us now? Medical imaging plays an important role in improving public health and is often justified to follow up on a diagnosis or treatment of disease. Improved policy in health care, as well as availability of imaging equipment has made imaged based procedures a standard of care.

If you think we are at the peak of our game in imaging, think again. According to Carestream and Everything Rad, the top diagnostic imaging trends for 2019 are Artificial Intelligence, wearable devices and more apps for mobile imaging devices. AI in radiology is not meant to replace humans, but rather enhance the science, results and streamline workflows, ultimately improving productivity.

What about wearable medical devices?

There are several devices currently in use, such as those measuring EKG’s, alerts for over exposure to UV rays and more. New to the scene is the MRI glove, worn next to the skin providing clear consistent images of moving joints and tendons. The benefits include clear mapping of the anatomy of the hand which helps in everything from surgery to designing a more accurate prosthesis. Researchers are encouraged that the MRI glove may become useful in diagnosis of repetitive strain injuries like carpal tunnel syndrome in office workers, athletes and musicians.

Another innovative device assisting patients with disorders that affect body movements, is the lightweight MEG wearable brain scanner. It is worn like a helmet; the MEG allows the patient to move naturally as brain activity is measured, offering improved imaging.

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The Age of Innovation, continued from page 6 (MEG), tracks brain activity at the millisecond time scale or better allowing doctors to pinpoint area of the brain responsible for abnormal activity in epileptic disorders. It is also aiding in the treatment of brain-tumor patents and opening new doors to research in neurodevelopmental disorders, stroke, brain trauma, brain plasticity, aging and memory.

From wearable devices to mobile apps, innovation is moving forward in leaps and bounds. Recently approved by the FDA for medical imaging, improving radiologists’ access in real time is the Mobile Classroom and Diagnostic Imaging Comparisons, considered the top 5 Radiology apps for 2018. All this technology is closer than you think.

Physicians at Orlando Health UF Health Cancer Center are fighting lung cancer with innovative technology to view the inside of the lungs and obtain tissue samples for biopsy.

The Monarch™ Platform, manufactured by Auris Health, is the first FDA-cleared robot for diagnostic and therapeutic bronchoscopic procedures. Orlando Health is the first facility in Florida and among the first in the country to feature the technology. The Monarch™ Platform allows physicians to see and access parts of the lungs that were previously out of reach, speeding up diagnosis and potentially

improving survival rates. It’s an exciting time to be in Central Florida with innovation in imaging and technology ever improving.

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Having our online directory and member information center gives you exclusive access to company employees. Chamber members needing your type of business reach out to other chamber members first.

We have no less than twelve opportunities a month for you to network, connect and grow. Post your jobs, deals, events or give us a call to schedule a one-on-one “Spark” session. And best yet is that the East Orlando Chamber offers Employee Health Benefits exclusively to members. Check us out and innovate your image at eocc.org or give us a call at 407-277-5951.

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The March statistics are not currently available by the time this report is due.

How is the real estate market doing?

LO: According to the Orlando Realtors Association Market Statistics for February 2019, the Orlando’s median home price and inventory rise, while sales decline in February 2019 compared to 2018. The Orlando’s housing market saw its median price increased by 3 percent.

This gives us a median home price in Orlando market at $244,000 with an average sale price of $296,703. The sale of homes decreased a small fraction, but the inventory increased for the fourth consecutive month. All of this happens just in time for the March/April busiest time for parents to start thinking about moving before the new school year.

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Is this a good time to sell?

LO: It is an excellent time to sell with parents starting to look to relocate before the new school year. We are finding most families are wanting to move in the top rated “A” school districts for a better education for their children and close driving distance to their work. If you are wanting to sell your home or rental properties, it would be advisable to start putting it on the market now with days on the market being a bit longer compared to last year. March/April begins the busiest time of year for buyers to purchase their new home. The average and median sale prices increased over January 2019 in Orange, Seminole, Osceola, Lake, Polk and Volusia counties.

REPRINTS: If you would like to order a reprint of a Medical News article in a PDF format or request an additional copy of an issue, please email: jkelly@orlandomedicalnews.com for information.

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By Michael R. Lowe, Esq. Brian C. Evander, Esq.

and

On March 13, 2018, The Florida House of Representatives overwhelmingly passed (by a vote of 101-11) the Senate’s bill to repeal the ban on the sale, possession, and use of medical marijuana in smokable form. On March 18, 2019, Governor DeSantis signed Senate Bill 182, an act relating to the medical use of marijuana; amending Section 381.986, Florida Statute (“F.S.”), and the Medical Marijuana Research Act into law, which amends Section 1004.4351, F.S. This Act redefines the term “marijuana delivery device” to provide an exception to the requirement that such devices must be purchased from a medical marijuana treatment center for devices that are intended for the medical use of marijuana by smoking, and the term “medical use” to include the possession, use, or administration of marijuana in a form for smoking.

Per this Act, qualifying physicians will now be able to issue a physician certification for marijuana in a form for smoking to qualified patients who are 18 years of age and older. This Act requires a qualified physician to submit specified documentation to the Board of Medicine and the Board of Osteopathic Medicine upon determining that smoking is an appropriate route of administration for a qualified patient, other than a patient diagnosed with a terminal condition.

Patients will be permitted to purchase a 35day supply of marijuana in a form for smoking, which cannot exceed 2.5 ounces unless an exception applies. A qualified physician may request an exception to the daily dose amount limit, the 35-day supply limit of marijuana in a form for smoking, and the 4-ounce possession limit of marijuana in a form for smoking. The Act also allows qualified patients to purchase and possess a marijuana delivery device intended for the medical use of marijuana by smoking (e.g., bongs, pipes) from third party vendors in addition to Medical Marijuana Treatment Centers. It also authorizes doctors to increase their on-hand supply of medical marijuana from 70 days to 210 days and requires doctors to provide data to be used for research into the effects of smoking. Patients who are minors must have a terminal condition to qualify for a prescription and must also get a second opinion from a pediatrician before smokable pot can be dispensed.

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The Florida Board of Medicine and the Florida Board of Osteopathic Medicine regulate the qualified physicians that can prescribe medical cannabis (Section 381.986(3-4), F.S.). Only qualified physicians can prescribe cannabis (medical marijuana). To become a qualified physician, the applicant must hold an active, unrestricted license as an allopathic surgeon or an osteopathic surgeon, and must complete a twohour course and subsequent examination (Section 381.986(3)(a), F.S.). Further, the applicant cannot be employed by, or have any direct or indirect economic interest in, one of Florida’s cannabis companies or testing laboratories (Section 381.986(3)(b), F.S.).

If a qualified physician determines that smoking is an appropriate route of administration for a qualified patient, other than a patient diagnosed with a terminal condition, the qualified physician must submit the following documentation to the applicable board: 1. A list of other routes of administration, if any, certified by a qualified physician that the patient has tried, the length of time the patient used such routes of administration, and an assessment of the effectiveness of those routes of administration in treating the qualified patient’s qualifying condition.

2. Research documenting the effectiveness of smoking as a route of administration to treat similarly situated patients with the same qualifying condition as the qualified patient.

3. A statement signed by the qualified physician documenting the qualified physician’s opinion that the benefits of smoking marijuana for medical use outweigh the risks for the qualified patient.

As amended in Section 1004.4351, F.S., Medical Marijuana Research Act, beginning August 1, 2019, and quarterly thereafter, the Department of Health shall submit to the board a data set that includes, for each patient registered in the medical marijuana use registry, the patient’s qualifying medical condition and the daily dose amount, routes of administration, and forms of marijuana certified for the patient. The department shall also provide the board with such data for all patients registered in the medical marijuana use registry before August 1, 2019.

Florida’s medical cannabis program is primarily administered by the Florida Department of Health (Article X, Section 29(d) of the Florida Constitution). The Department of Health’s rulemaking authority includes implementing and enforcing rules regarding: • the amounts of medical cannabis that can be prescribed by qualified physicians and possessed by qualified patients; • the medical marijuana use registry, which tracks the physician certifications prescribing medical marijuana to individual patients; • identification cards for qualified patients and caregivers;

• medical marijuana treatment centers, which are vertically-integrated companies that cultivate, process, and dispense cannabis in Florida; • medical marijuana testing laboratories, which test the processed cannabis that medical marijuana treatment centers intend to sell to qualified patients; and The department shall adopt rules to regulate the types, appearance, and labeling of marijuana delivery devices dispensed from a medical marijuana treatment center.

The rules must require marijuana delivery devices to have an appearance consistent with medical use.

The Florida Department of Environmental Protection is tasked with implementing and enforcing rules regarding waste from processing cannabis under Section 381.986(8)(e)(10)(c), F.S., and the Florida Department of Agriculture and Consumer Services is tasked with testing requirements for contaminants that are unsafe for human consumption in cannabis edibles under Section 381.986(8)(e)(10)(d), F.S. Michael R. Lowe, Esquire is a Florida board-certified health law attorney at Lowe & Evander, P.A. Brian C. Evander, Esquire and Mr. Lowe regularly represent providers, physicians and other licensed health care professionals, and facilities in a wide variety of health care law matters.

For more information regarding those health care law and such matters please visit our website www. lowehealthlaw.com or call our office at (407) 332-6353.

LOWE & EVANDER, P.A. Florida-based Law Practice Representing PHYSICIANS & PHYSICIAN GROUP PRACTICES Business, Transactional, Litigation, Professional Licensure, Regulatory, Operational & Administrative Matters Helping Our Clients Navigate Today’s Healthcare Challenges

MICHAEL R. LOWE, ESQ.

BOARD CERTIFIED IN HEALTH LAW, PARTNER

BRIAN C. EVANDER, ESQ. PARTNER 707 Monroe Road, Sanford, FL 32771 Phone: 407-332-6353 Fax: 407-332-7450

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GrandRounds Digestive and Liver Center of Florida Offering Fibroscan® Non-Invasive Liver Testing The Digestive and Liver Center of Florida is the first independent Healthcare Practice in Central Florida to offer FibroScan®. This a quick, pain-free, and non- invasive liver scan and also the latest innovation in measuring the stiffness of the liver. FibroScan® detects any thickening or scarring of the liver tissue (fibrosis). There is no pain or discomfort involved in this procedure and it is performed at the office and on average, it takes about 15-20 minutes to complete.

FibroScan® works by emitting a small pulse of energy, which may feel as a slight vibration on the skin. FibroScan® calculates the speed of this energy to give the healthcare provider an immediate measure of the stiffness of the liver. This measure is an important part of understanding the overall liver health.

During a FibroScan®, an ultrasound probe is placed at the surface of the skin to measure the condition of the liver via sound waves. The data created is then sent to a computer for analysis.

An image of the liver is displayed on the screen and it shows the physician the level of fibrosis or hardening of liver tissue in real-time.

Indications for a FibroScan® include: Fatty Liver Diseases, Chronic Viral Hepatitis C, Chronic Viral Hepatitis B, Alcoholic Liver Disease, Cystic Fibrosis, Autoimmune Liver Diseases, Portal Hypertension, and HIV/HCV C-Infection.

AdventHealth Brings Only Inpatient Hospital to Winter Garden Leaders and community members came together to break ground on a 100-bed inpatient pavilion at AdventHealth Winter Garden — the only inpatient facility to serve the fast-growing community.

The seven-story, approximately 300,000-square-foot building will complement the existing 24-bed emergency room and medical office building on the site at 2000 Fowler Grove Blvd.

“West Orange County is an area of high growth with tremendous demand for increased access to health care services. We want to make health care convenient and simple for consumers, and that means providing care close to

home,” said Carl Dupper, CEO of AdventHealth Winter Garden. “We want to partner with our neighbors and help them lead a life of wholeness — body, mind and spirit. We believe the growing AdventHealth ecosystem in west Orange County, which includes primary care, specialists and other services, will help equip residents to lead their healthiest lives.”

Since opening in February 2016, the AdventHealth Winter Garden emergency room has seen tens of thousands of patients — illustrating the strong and growing demand for health care services in west Orange County. The ER is expected to have treated more than

100,000 patients by the end of 2019.

“AdventHealth has had a very positive impact on Winter Garden, and we look forward to the arrival of inpatient services here in our community,” said Winter Garden Mayor John Rees. “Our community is a magnet for growth in a variety of areas, and health care is a key driver of that growth.”

The expansion is expected to create 700 hospital jobs with an annual average wage of $64,480. Total employment is projected at 5,509 people, including direct, indirect and induced jobs.

The inpatient pavilion is expected to open in 2021.

Lake Wales Medical Group Joins Heart Of Florida Physician Group As of March 11, 2019, Lake Wales Medical Group has joined Heart of Florida Physician Group to increase access to quality healthcare providers throughout Polk County.

By linking the two groups under one name, patients can be confident in knowing they have access to physicians in 11 different specialties, including primary care, breast care, orthopedics and plastic surgery, to name a few. Plus, patients can use one scheduling number for all offices: 844-634-DOCS (3627). Same-day or next-day appointments are available and patients may go to www.HeartOfFloridaPhysicianGroup.com to request an appointment. Our primary care offices also have online scheduling.

“Over the past two years, Lake Wales Medical Group and Heart of Florida Physician Group have been joining their operations in an effort to offer patients more options in specialties and locations within one convenient healthcare network,” stated Ann Barnhart, Market CEO for Heart of Florida Regional Medical Center and Lake Wales Medical Center. “The unification of our physician groups under one name is the final step in helping our communities recognize our affiliated providers.

As Lake Wales Medical Group rebrands

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itself with the Heart of Florida Physician Group name, the local healthcare providers in Lake Wales will remain the same to offer you and your family the high quality healthcare you have come to trust. The providers in Lake Wales will continue to be affiliated with Lake Wales Medical Center.

Under the name Heart of Florida Physician Group, we also remain committed to recruiting healthcare providers to the Lake Wales area. Notably, coming this Fall, two natives to Lake Wales will be joining Heart of Florida Physician Group with offices in Lake Wales. Amber Shepard, M.D., a family medicine physician, and James Pilkington, M.D., a urologist, will be returning to Lake Wales, where they grew up, to open offices and see local patients. They will be credentialed with Lake Wales Medical Center.

“As we continue to grow,” said Rebecca Brewer, CEO at Lake Wales Medical Center, regarding the name change, “you know that, regardless of where you live or how hectic your schedule is, you have easy access to a network of providers who share a passion for excellence.”

For more information on the services or providers of Heart of Florida Physician Group, visit www.HeartOfFloridaPhysicianGroup.com.

Flora Orevillo-Stabile, a registered nurse at Poinciana Medical Center, was recently honored with the DAISY Award for her commitment to providing exceptional healthcare to all patients. Presented by the DAISY Foundation, the award recognizes nurses who make special connections with patients and are outstanding role models in the nursing profession. orlandomedicalnews

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GrandRounds AdventHealth, Orlando Hand Surgery Associates Announce Affiliation AdventHealth and Orlando Hand Surgery Associates are pleased to announce an affiliation that will significantly expand exceptional upper-extremity orthopedic care in Central Florida. Together, OHSA and AdventHealth will establish The Hand to Shoulder Center, which will focus on providing personalized treatment options.

The Center will include additional offices and physicians, our new walk-in clinic, hospital facilities, specialized diagnostic facilities and a research department including a biomechanics lab, skills and cadaver lab and a microvascular lab and a new teaching and rehabilitation center.

A Hand Fellowship training the hand surgeons of the future will start in 2020.

OHSA physicians will establish satellite clinics and begin seeing patients at AdventHealth campuses. The first of these are expected to open at AdventHealth Celebration and AdventHealth Apopka this summer, with a third planned for Winter Garden in the fall. AdventHealth will also expand physical therapy and rehabili-

tation services specific to hand and upperextremity care.

In the future, AdventHealth and OHSA will work together to create a center for hand and upper-extremity care at the flagship AdventHealth campus in Orlando.

The OHSA team of physicians is recognized for excellence in managing complex issues dealing with the hand, wrist, elbow and shoulder. Dr. George White, Dr. Jason Pirozzolo, Dr. Brian White, Dr. Anup Patel and Dr. Nick Newsum are specialists in determining the best treatment options for upper-extremity issues.

As experts in upper-extremity care, OHSA’s physicians treat conditions including carpal tunnel syndrome, arthritis, shoulder pain and tennis elbow, among others.

The affiliation will help facilitate the development and implementation of consistent standards of care in the treatment of upper extremity conditions. Additionally, it will expand clinical services, promote patient access, and bring together resources to enhance patient care.

Florida Department of Health in Orange County Addresses County Health Rankings The Florida Department of Health in Orange County (DOH-Orange) recognizes the value in measuring health outcomes and has acknowledged the 2019 County Health Rankings & Roadmaps tool released by the University of Wisconsin and the Robert Wood Johnson Foundation. This study highlights the many community factors that influence health and uses established data, much of which is available from the department at /www.FLHealthCHARTS.com.

DOH-Orange is pleased to announce Orange County has improved five ranking positions from the previous year, and now is ranked 10th in the state of 67 counties.

“The leap to the number 10 spot is not by accident. No, this is the result of community collaboration and intentional efforts to address health outcomes strategically and through targeted initiatives. I am happy to share in this achievement with partners and stakeholders as our community strives toward building a culture of health in Orange County” ---Department of Health Orange Deputy Health Officer Nasseam M. James.

These rankings are a snapshot of the health of counties across the country, and they emphasize that health is not a singular effort but a combined work in progress across all community partners.

The department works in collaboration with local governments, non-profit organizations, health care facilities, business

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groups, schools, faith-based organizations and many other stakeholders to improve the health of all people in Orange County. These rankings use data related to physical environments, social and economic factors, health behaviors and clinical care.

In Orange County, the Community Health Improvement Plan (CHIP) is designed to address specific opportunities for improved health that have been identified by the community. The department has partnered with many stakeholders to implement the CHIP and collaborates regularly to track progress.

Highlight areas in the 2019 rankings where progress was made when compared to the previous year were: Length of Life (#7 to #6 ranking), Quality of Life (#28 to #26) Tracy Swanson, West Orange Healthcare District Executive Director stated, “We are thrilled to see this type of progress! It is encouraging to see the community focus on health in Central Florida and our resolve to be the Healthiest Community in the Nation is only strengthened.”

To explore more health indicators in your county, visit www.FLHealthCHARTS. com. About the Florida Department of Health. The department, nationally accredited by the Public Health Accreditation Board, works to protect, promote and improve the health of all people in Florida through integrated state, county and community efforts.

Cryos Sees Increase in Hispanic Customers, Launches Spanish Website and Blog Cryos International, a sperm and egg bank with U.S. operations based in Orlando, today announced it has launched a Spanish-language version of its website and blog. The news comes as the company reports a steady increase in inquiries from the Hispanic population across the U.S. over the last year, with approximately 25 percent of callers being bilingual and 15 percent preferring to discuss their options in Spanish.

The new website and blog will offer Spanish-speaking customers educational articles and background on home insemination, donor sperm and eggs, and embryo creation.

“As our sales volume grew over the

past few years, we began to see a need to provide the basic information on our blog and website in Spanish,” said Claus Christensen, Executive Vice President of Sales and Marketing. “The tools provide our many Spanish-speaking clients the knowledge needed to build a family with us. As we aim to better serve our Hispanic customer base, we’ll continue to identify opportunities for this growing demographic to interact, learn, and purchase from us.”

The Spanish blog and website can be accessed at usa.cryosinternational. com by clicking the Spanish flag in the top right corner or by visiting usa-es. cryosinternational.com.

AdventHealth is the First in Florida to Use State-of-the-art Robotic Technology for Spinal Procedures AdventHealth Altamonte Springs is the first in the state to use a technology to improve accuracy during minimally invasive spinal surgery. The Mazor X Stealth Edition Robotic Guidance Platform allows physicians to anticipate needs and develop a personalized surgical plan for each patient.

Minimally invasive surgeries only require small incisions, which lead to faster recovery and fewer complications. But smaller incisions can represent a challenge for surgeons due to the limited view of the patient’s anatomy. This new technology addresses this issue by integrating and streamlining three complex processes: image-based 3D planning of the surgery; intra-operative guidance using precision mechanics; and intra-operative verification of therapy placement using a specialized camera.

Before entering the OR, surgeons use

a 3D simulation of the patient’s spine to plan an optimal surgery. Computer analytics provide the surgeon with data to plan the procedure, and with intra-operative guidance during the surgery. These technologies allow the surgeon to operate with precision, efficiency and confidence.

“Robotic spine surgery has been gradually evolving over the last 10 years, and I’m enthusiastic to see how far we’ve come with technologies such as the Mazor X Stealth Edition,” said Dr. Chetan Patel, orthopedic surgeon and spine specialist at AdventHealth Altamonte Springs. “I’m proud to be part of an organization that’s embracing state-of-the-art technology to provide the highest-quality care to all our patients.”

Dr. Patel and his surgical team at AdventHealth Altamonte Springs successfully performed their first procedure with the Mazor X Stealth Edition in March.

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GrandRounds

Orlando Health South Lake Hospital board members and local physicians help break ground on the new Center for Specialty Surgery. L to R: Rob Berens; David Feiner, MD; Kevin Nowicki, MD; Julie Saranita, DO; Anthony Saranita, DPM; Julio Paez, MD; Dave Batman

Orlando Health South Lake Hospital Breaks Ground On Outpatient Surgery Center Orlando Health South Lake Hospital broke ground on a 29,000-square-foot outpatient surgery center with four operating rooms, two procedure rooms, twenty pre and post-operative rooms, located on the hospital’s main campus in Clermont, Fla. Scheduled to open in early 2020, the Orlando Health South Lake Hospital Center for Specialty Surgery will feature advanced

technology to allow our surgeons to perform complex outpatient surgeries.

The Orlando Health South Lake Hospital Center for Specialty Surgery project developed out of an identified healthcare need in the rapidly growing service areas.

The hospital worked closely with local physicians to identify the type of facility that would best benefit the surgical needs of

Osceola Regional Medical Center First in Osceola County to Offer Watchman Heart Implant Osceola Regional Medical Center is now the first and only hospital in Osceola County to offer cardiac patients an alternative to long-term blood thinner medication with the WATCHMAN Left Atrial Appendage Closure (LAAC) device.

The LAAC device is a permanent heart implant that effectively reduces the risk of stroke in patients suffering from non-valvular atrial fibrillation (AFIB). AFIB is an irregular heartbeat experienced by at least 2.7 million Americans who are five times more likely to suffer a stroke than someone with a regular heartbeat.

AFIB patients usually use anticoagulants (blood thinners) long-term to prevent blood clots from forming in an artery, a vein or the heart. AFIB can lead to blood clots, stroke, heart failure and other heart-related complications. After the LAAC device is implanted, patients can discontinue the use of long-term blood thinner medication, reducing the risk of bleeding which can occur with the use of these anticoagulants.

Patients with AFIB not caused by a heart valve problem and who are currently taking blood thinners can be eligible for this procedure. Compared to anticoagulants, the LAAC device demonstrates statistically superior reductions in condi-

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tions such as: • Hemorrhagic stroke (85 percent reduction) • Disabling stroke (63 percent reduction) • Cardiovascular death (56 percent reduction) “Our team takes great pride in expanding our community’s access to highquality healthcare,” said Davide M. Carbone, Chief Executive Officer at Osceola Regional Medical Center. “We are always expanding our innovative technologies to advance patient care, and we believe that the LAAC device will be a strong complement to the comprehensive cardiac services offered within our Heart and Vascular Institute. Osceola Regional Medical Center is the only hospital in Osceola County offering this device, along with other procedures like open-heart surgery, TAVR procedure, and our 40-member cardiovascular physician team, which includes interventional cardiac specialists and cardiac, thoracic and vascular surgeons, ensuring our patients receive expert care.”

The LAAC device is implanted with a one-time, minimally invasive procedure via the groin. Following the procedure, patients are typically discharged within 24 hours and can be taken off anticoagulants in 30-45 days.

patients in the south Lake County community. The result of this collaboration will be a unique surgery center focusing on orthopedic, podiatry, neurosurgery and pain management surgeries and procedures in an outpatient setting, with the ability to allow extended recovery.

As the hospital builds the outpatient surgery center, it is also simultaneously

expanding its surgical services footprint in the hospital, adding three additional operating rooms at the hospital. The expansion of surgical services throughout Orlando Health South Lake Hospital will allow the hospital to ensure patients have ease of access to the appropriate surgical setting for their healthcare needs.

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GrandRounds Clinical Pregnancy Rates Exceed 74 Percent Per Transfer for Cryos Donor Eggs Cryos USA - International Sperm and Egg Bank based in Orlando has announced recent data from its donor egg program revealing a clinical pregnancy* rate of more than 74 percent per transfer.

Other egg banks report a range from 54 to 65 percent for their programs.

“In 2016, we set out to create the most successful donor egg program in the U.S., and our results prove we have made good on that commitment,” said Corey Burke, Cryos USA Tissue Bank Director. “These success rates for frozen donor eggs are almost unheard of in our industry and well surpass that of our competitors. For our patients, this means a significantly greater chance at building a family they once could only dream about. We’re proud to help them on that journey.”

Cryos attributes this success to its in-house process that takes place at its facility in Orlando, the first free-standing, independent egg bank in the U.S. At this facility, Cryos maintains complete control over the process and never outsources to third parties, giving patients the best

quality eggs with the highest chance of pregnancy.

“Success rates at this level for a clinical pregnancy are really unheard of in an industry that has undergone rapid transformation in the last several years,” said Melissa M. Yates, MD, Medical Director, Advanced Reproductive Specialists. “It really speaks to the high-quality process Cryos has in place and their diligence in ensuring only the best for their patients and customers. I’m proud to be a reference IVF clinic and know that my patients have the best possible chance of conceiving thanks to Cryos.”

Cryos offers a hassle-free donor egg guarantee. With a blastocyst rate of 47 percent that beats industry standards, Cryos guarantees that on average anyone purchasing six of its donor eggs will have results of more than one high-quality embryo, yet most patients are getting two or more.

For more information on the Cryos donor egg program, visit https://blog. cryosinternational.com/usa/.

Geoffrey Rogers and Richard Walsh Elected to The Nemours Foundation Board Robert G. Riney, Chairman of the Board of The Nemours Foundation, and Hugh Durden, Chairman of the Alfred I. duPont Charitable Trust, have announced the election of Geoffrey Rogers and Richard Walsh to The Nemours Foundation Board of Directors. Mr. Rogers is a Regional Managing Director for Glenmede Trust Company, Wilmington, Delaware and Mr. Walsh is Chairman and CEO of the Knob Hill Companies, a media, investment and strategic consulting firm in Orlando, Florida.

Mr. Rogers oversees the day-to-day operations of Glenmede’s Delaware office, which he launched in June 1999. He brings more than three decades of estate planning and financial services experience to this position. Prior to joining Glenmede, Mr. Rogers was a vice president for Scudder Private Investment Counsel, responsible for new business development. He has also served as a vice president with the Wilmington Trust and Delaware Trust Companies, now operating as Wells Fargo.

He is a member of the Philadelphia Federal Reserve Nominating Committee, a board member of Washington College, Winterthur Museum (emeritus), Operation Warm and the Delaware Business Roundtable. He serves as a co-trustee of the Alfred I. duPont Charitable Trust. Mr. Rogers is past chair of the Board of the Delaware Bankers Association, the Sanford School, and the Estate Planning Council of Delaware, the planned giving committee of the Nemours/Alfred I. duPont Hospital for

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Children, Wilmington Renaissance and the Wilmington Tax Group. He is a graduate of Harvard Business School's Advanced Management Program and received his Bachelor of Arts from Washington College.

Mr. Walsh joined the Nemours Florida Board of Managers in 2012, bringing experience in corporate governance, strategic business planning and regulatory requirements, and a personal commitment to health care delivery, higher education, and community. Prior to founding Knob Hill, Mr. Walsh was senior vice president, Corporate Affairs of Darden Restaurants, and a founding member of the leadership team that took Darden public in 1995.

He also served as a member of Darden’s Executive Committee and as a trustee of the Darden Restaurants Foundation. At Darden, Mr. Walsh helped establish health care plans and wellness initiatives for all employees.

Mr. Walsh serves on the Board of the Edyth Bush Charitable Foundation, Seaside National Bank and Trust, Blue Orb Software Inc., ABC Fine Wine & Spirits, and LSQ Holdings. He also serves on the University of Central Florida Foundation Board, and is leading the $500 million UCF Ignite Capital Campaign. He is a past chair of the Florida State Chamber of Commerce and chairman emeritus of the UCF Board of Trustees, served on the Governor’s Florida Tourism Council, the Governor’s Task Force on Affordable Healthcare, Enterprise Florida.

AdventHealth University and Stetson University Announce Partnership and MHA/MBA Dual-Degree

Dr. Benita David AdventHealth University (AHU) and Stetson University are partnering to offer an innovative, dual-degree, online program leading students to degrees in both a Master of Healthcare Administration in Strategy & Innovation (MHA-SI) and a Master of Business Administration (MBA). This program is designed to be completed in as little as two years with a total of 54 credit hours, split between the two universities, with AHU conferring the MHA-SI, while Stetson confers the MBA. The dual degree combines the best of business and healthcare administration skillsets, giving graduates an advantage over their peers in both sectors. Students with this degree can expect a wide range of job opportunities upon graduation.

“I am thrilled with the way AHU and Stetson faculty worked together to bring the strengths of both institutions into an original program specifically designed with busy, working professionals in mind,” said Wendy B. Libby, Ph.D., Stetson University President. “Graduates will be at the top of their game in an industry always looking for talented and educated employees to fill high-paying jobs.”

The coursework is 100 percent online for both institutions, removing barriers to access for candidates across the nation. Additionally, the online format

Dr. Wendy B. Libby will allow students to maintain employment and their daily life schedule while advancing their education.

“Engaging in our Healthcare Administration education online marries the interdisciplinary strength of this degree with the opportunity for students to network and develop professional relationships from a distance – a skill needed in today’s electronic age,” said Dr. Benita David, Healthcare Administration Department Chair at AHU. The announcement reveals the second collaboration between AHU and Stetson University. In December 2018, the two institutions signed an agreement to provide “pathways” for Stetson University health and science students into the AHU Master of Occupational Therapy and Doctor of Physical Therapy programs beginning this fall.

“AdventHealth University, through the leadership of President Edwin Hernandez, Ph.D., and Provost Sandra Dunbar, D.P.A., has been an invaluable partner as we have worked to develop student pathways between our institutions,” said Painter.

“Our common goals of strengthening student experiences both during and after their time in college, as well as expanding student employment opportunities, have made for wonderful connections that will continue to expand moving forward.”

YOUR SOURCE FOR LOCAL HEALTHCARE NEWS JKelly@orlandomedicalnews.com

407.701.7424

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GrandRounds DOH-Orange Offers Free STD Testing on Wednesdays in April April is Sexually Transmitted Disease Awareness month. On Wednesdays during the month, the Florida Department of Health in Orange County’s Sexually Transmitted Disease (STD) Clinic in downtown Orlando will conduct free STD testing during clinic hours. The address is 832 W. Central Boulevard, Orlando, FL 32805.

The free testing is only for the month of April and only on Wednesdays. This effort is to encourage more clients to get tested and bring awareness of the subject.

For further information on testing or the program, you can contact the STD program at 407-858-1445.

The STD Program works to control transmission through four major avenues: • Education of at-risk persons on the modes of disease transmission and the means for reducing the risk of transmission by changing sexual behaviors • Detection of infection in persons without symptoms, and those who are who are unlikely to seek diagnostic and treatment services.

• Diagnosis and treatment of persons who are infected.

• Evaluation, treatment and counseling of sex partners of persons with a Sexually Transmitted Disease (STD).

AdventHealth, UCF Collaborate on Suicide-prevention Initiative AdventHealth is collaborating with the University of Central Florida to address a growing suicide crisis across the nation.

The effort is modeled after the Zero Suicide Initiative, a national program to reduce suicide deaths, which have risen dramatically in recent years. Rates of suicide have increased by more than 25 percent across the U.S. since 1999, according to the Centers for Disease Control and Prevention. In Florida, the rate of increase is more than 10 percent.

The program also addresses a need raised by AdventHealth’s Community Health Needs Assessment, which consistently finds access to mental-health treatment is lacking across Central Florida.

The UCF-AdventHealth collaboration will focus on patients who come into the emergency rooms at AdventHealth Kissimmee and AdventHealth Orlando exhibiting signs of suicidal thoughts or behaviors.

Currently, those patients might be held in the ER for up to 12 hours waiting for a spot to become available in a psychiatric facility. Or they might be discharged, only to return to the ER in the following weeks.

If a patient shows warning signs for suicide, social workers will call and check in with them to monitor suicide risk, provide psychosocial education and support, and to make linkages to community supports on a regular basis for up to 90 days.

“The idea is to establish a relationship with the patient, so if the patient goes into an acute crisis, they have a point person who has a psychiatric background and clinical training in suicide prevention,” said Robert Geissler, director of emergency services at AdventHealth Kissimmee.

“That point person can connect them with appropriate resources, rather than having them go back to the ER.”

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In addition to the social-worker support, the program involves training ER staff and chaplains to recognize and treat patients who may be dealing with suicidal thoughts or feelings.

Kim Gryglewicz of UCF’s College of Health Professions and Sciences is leading the research effort in conjunction with the AdventHealth Research Institute.

“From a research perspective, we’re trying to answer two major questions: How do we improve safety measures and practices? And how do we use outcome measures to track what we’re doing to improve suicide care?” Gryglewicz said. “We will be working to implement best practices in the ED setting using a comprehensive strategy for screening, suicide risk assessment and safety planning, and then tracking what happens post-discharge, with the ultimate goal of preventing suicides and attempts from happening.”

In the long term, the same practices and procedures could be implemented at other care sites throughout Central Florida, with the potential to expand statewide and across the nation.

Available data on young people shows similar support services allowed 80 percent to be discharged from follow-up care no longer at risk for suicide, with the remaining 20 percent needing follow-up care.

Gryglewicz expects that researchers might find similar benefits among adult patients after the 90-day program. She hopes to have preliminary data after about six months.

The program is funded by a three-year grant from the U.S. Substance Abuse and Mental Health Services Administration.

Health Scholars Introduces VR Training App to Combat ACLS Skills Decay Health Scholars has launched the first headset-based VR training simulation to provide clinicians repeatable ACLS refresher training. In-hospital cardiac arrest survival rates average 26 percent and patients in which clinical staff reported adequate resuscitation training have greater than 3-fold odds of higher survival rates than patients where adequate training programs are lacking. In fact, the rate of survival after cardiac arrest increased by 28.3 percent with implementation of ACLS training courses.

However, knowledge of this life saving competency decays within months of certification for those who work in non-critical care areas (majority of the hospital). Health systems have struggled to implement costeffective and adequate refresher training due to the volume of individuals needing training and limited numbers of clinical educators. With ACLS Virtual Reality Simulation organizations are able to provide critical refresher training at scale and for 50 percent less than the cost of physical simulation.

“Health Scholars’ virtual reality training prevents ACLS skills decay by enabling learners to physically engage in code situations at an appropriate frequency. It’s realistic, clinically accurate and can be completed at the convenience of the learner,” said Daniel Katz Anesthesiologist, ACLS Instructor.

The app was designed in accordance with American Heart Association (AHA) guidelines to complement AHA’s HeartCode® training as well as the new Resuscitation Quality Improvement (RQI) program, utilizing state-of-the-art voice recognition and motion capture technologies.

According to a recent AHA scientific statement, “Resuscitation Education Science: Educational Strategies to Improve Outcomes from Cardiac Arrest”: • The current massed approach to resus-

citation training should be replaced or supplemented with a spaced practice.

• The duration and design of each training session, the interval between sessions, and the number of repetitions should be tailored to context, learner type, objectives, and prior experiences.

• Techniques such as debriefing after real resuscitation events and in situ simulation can be used to provide spaced training experiences.

• Technology-enhanced simulators and learning management systems should be used to collect individual learner data during training to determine the interval of training.4 ACLS Virtual Reality Simulation can meet all of these needs without bulky equipment or high coordination overhead.

It immerses learners in a VR simulation that allows them to provide voice-directed commands and show they understand the core rhythms as well as how to address them while using proper communication skills. Its features allow it to: • Train to all of the AHA core rhythms including return of spontaneous circulation (ROSC) • Place the learner in the role of the team lead, as required by AHA, and recreate the stress of a mega code situation • Provide standardized practice, assessment and skills validation • Debrief on failed waveform identification and on general code management principals needing improvement • Be completed without having to schedule an entire team – extending the reach of training • Be used 24/7, at the convenience of the learner, encouraging increased training frequency

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GrandRounds

More than 400 transplant patients and their families gathered at AdventHealth’s annual Transplant Reunion.

April Declared “Organ Donation Month” in Orlando as Transplant Donors, Recipients, Caregivers Unite April was declared “Organ Donation Month” in Orlando in front of more than 400 transplant patients and their families at AdventHealth’s annual Transplant Reunion.

The annual picnic — which helps brings awareness to the importance of organ donation — unites organ donors and recipients, and the doctors, nurses and other caregivers who helped them through their transplant journey.

More than 113,000 people are waiting for a lifesaving transplant in the U.S., according to the United Network for Organ Sharing. Of those, about 450 are being cared for by teams at the AdventHealth Transplant In-

stitute, home to Orlando’s only solid-organ transplant program.

“For many of our patients, a transplant is the only option and we would not be able to help them if it wasn’t for the thoughtfulness and generosity of people in the community who become donors and give someone the gift of life,” said Dr. Bobby Nibhanupudy, medical director of abdominal transplant at AdventHealth. “We are privileged to be able to bring world-class programs that make life-saving transplantation a more viable option for families in Florida and the Southeast.”

The AdventHealth Transplant Institute

is one of the nation’s oldest and largest transplant programs. Beginning with its first kidney transplant in 1973, the program has expanded to also include kidney/pancreas, lung and heart transplants and VAD’s. According to the most recent national data, the Transplant Institute: has the best patient outcomes in the U.S. for liver transplants, performed more heart transplants in 2018 than any other program in the Southeast and has the shortest median wait time for lung transplant in the country.

The Transplant Institute team works closely with TransLife, the federally-designated organ procurement organization for

10 counties in east Central Florida. TransLife works closely with hospitals and donor families to coordinate the organ donation process. Florida residents can sign up to be an organ donor at www.donatelifeflorida.org.

Many of the innovations and programs at the AdventHealth Transplant Institute are funded though philanthropy. Among them is the Bartch Transplant House — ­ a homeaway-from-home that provides housing, support and amenities at an affordable cost for patients and families. Those amenities are funded through donations to the Patient Assistance Fund.

Toilet Seat That Detects Congestive Heart Failure Ready To Begin Commercialization With 1 million new cases of congestive heart failure diagnosed each year, a revolutionary product is making it easier for hospitals to monitor patients with the condition in the comfort of their own homes.

A toilet-seat based cardiovascular monitoring system created by a team of Rochester Institute of Technology researchers, aims to lower the hospital readmission rates of patients with congestive heart failure. The toilet seats, which will be brought through the FDA clearance process by the researchers’ company Heart Health Intelligence, would be purchased by hospitals and issued to heart failure patients after discharge. The toilet seats are equipped to measure the electrical and mechanical activity of the heart, and can monitor heart rate, blood pressure, blood oxygenation levels, and the patient’s weight and stroke volume, which is the amount of blood pumped out of the heart at every beat. Algorithms analyze the data, and with further development, will alert advanced practice providers of a deteriorating condition. A report will be passed along to cardiologists who will then determine if intervention is necessary.

Nicholas Conn, a postdoctoral fellow at RIT and founder and CEO of Heart

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Health Intelligence, is part of the university team that developed the toilet seats.

“Typically, within 30 days of hospital discharge, 25 percent of patients with congestive heart failure are readmitted,” said Conn. “After 90 days of hospital discharge, 45 percent of patients are readmitted. And the Centers for Medicare and Medicaid Services is penalizing hospitals for readmitting patients for heart failure.”

Conn, the company’s chief executive officer, further explains that using the national average for readmission rates, the penalty alone for readmitting 150 patients is approximately $500,000 annually. The total cost of providing 150 patients with their own monitored toilet seats from HHI is $200,000. With that investment, he says, hospital systems will save more than double their initial investment within one year.

According to Conn, who earned three degrees from RIT—a bachelor’s degree and a master’s degree in electrical engineering in 2011 and 2013, respectively, and a doctoral degree in microsystems engineering in 2016—the system will pick up deteriorating conditions before the patients even realize they are symptomatic.

And with the rapid data analysis, interventions can be as simple as a drug change or

Caption: Nicholas Conn, a postdoctoral fellow at RIT and founder and CEO of Heart Health Intelligence, is part of the university team that has developed a toilet-seat based cardiovascular monitoring system. Credit: A. Sue Weisler/RIT

short office visit, instead of an admission to the hospital.

HHI, which joined RIT’s Venture Creations business incubator earlier this year, is now focused on moving the product forward. The team is heavily involved in writing grants for additional funding and networking, and human-subject testing

and pre-clinical studies are well underway.

Conn and his team are working on approving the product with the FDA and rolling it out across the country.

To read more about the research behind the project, go to https://mhealth.jmir. org/2019/1/e12419/

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Saving Medicare/ Medicaid While Preventing Federal and State Insolvency

By KENNETH A. FISHER, MD

Medicare and Medicaid were passed in 1965 as an amendment to the Social Security Act after decades of political posturing. Unlike Social Security that pays a specific amount, both are open-ended benefits with the individual having no knowledge or concern about the amount being spent. Costs for these two programs have exploded far beyond initial expectations, require a huge bureaucracy and are unsustainable in the long term. Medicare costs were $702 billion in 2017 and projected to cost $1.26 trillion in 2026. It has a complicated funding and benefit scheme.

Part A is funded by ever increasing taxes on earned and in some cases invested income. This funds in-patient hospital care, skilled nursing home (not long term) and some other smaller areas. Despite these increases in taxes, the part A fund, without further changes, is projected have a shortfall beginning in 2026. Part B funds physician and other outpatient services.

Part C, Medicare Advantage, is a federally funded private insurance benefit of increasing popularity providing both part A and B benefits. Part D covers outpatient pharmacy needs. Seventy-five percent of parts B and D are funded from general tax revenues with the remainder by user fees.

The Medicare program is bedeviled by several realities, with the present funding mechanism putting an ever-increasing burden on the succeeding generation.

This is ironic as an original argument for Medicare was to afford relief for those working. Changing demographics, fewer workers supporting more recipients, longer life spans consuming more care and ever-increasing expensive medical options were not considered in the original legislation. Today, the average Medicare recipient receives 2-3 times more care in cost than they contributed when working, explaining in large part the popularity of the program, but also the difficulty of applying it to the general population.

Medicaid, part of the 1965 legislation, is funded by about 50 percent from the federal government (general tax revenues), a greater percentage for poorer states, and about 50 percent from state coffers. The Affordable Care Act (2009) expanded Medicaid eligibility limits from 100 percent to 138 percent of U.S. poverty level and federally funds 90 percent for those individuals. When initiated, Medicaid covered about 2 percent of the population, which now has grown 10-fold to about 22 percent. Spending was $565.5 billion in 2016 and projected to be $957.5 billion in 2025, another unsustainable 16

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amount. Adding to this financial problem is that many studies have demonstrated that Medicaid, with its extremely low reimbursements in many states, does NOT improve the recipients’ overall medical health. The states’ share now exceeds their expenditure for primary and secondary education, thus consuming funds that could have better educated the next generation preparing them to function in our world-wide industrial economy and thus decreasing future Medicaid roles. Lowered federal and state payments causes hospitals to lose about 10 percent from Medicare and about 50 percent from Medicaid.

Over-charging private insurance, resulting in increased premiums, compensates for these losses, which is a major factor in workers’ wage stagnation.

Congress, after many centralized, bureaucratic attempts has proven incapable of addressing the impending Medicare/Medicaid fiscal disaster. However, there is a uniquely American solution that would be acceptable to the public: an option of individuality.

For Medicare, create an option of having premium support with yearly actuarially determined deposits into the individuals’

health account. From this account, the patient would pay cash for routine needs and purchase nationally available catastrophic insurance for high priced items with the deductible equal to the yearly deposit.

To remain financially aware, individuals would pay 1 percent of these higher-end costs from their health account. Federally funded reinsurance would be necessary for ultra-expensive occurrences. Along with this option would be the choice for those of working age to have their payroll deductions deposited into their individual retirement health account consisting of half U.S. bonds and half mutual funds to grow over time. Accumulation of funds would be available for care when older, eliminating the present burden on the following generation. This option would have to be phased in over decades to support present day Medicare. Individuals would demand knowledge of actual cash prices, the bureaucracy would be drastically curtailed, care would improve, and costs would dramatically decrease.

A similar individualistic option should be available for Medicaid recipients and all those without coverage. This is tailored after the successful Indiana Medicaid plan

of 2007 to 2012 that provided better care at far less cost. A means-tested deposit by federal/state governments into the individuals’ health account was provided. As with the Medicare individual account, cash payments would be for routine care and the purchase of a high deductible catastrophic plan with the deductible no greater than the yearly deposit.

In this way, all Americans would have access to the same high quality care by paying cash for most items thus eliminating the present problems for Medicaid recipients in securing care because of inadequate reimbursements. Via this mechanism all Americans would have the same access to good care at a cost this nation can afford. Treat all people as capable of being responsible and they will act responsibly; this was proven during the Indiana experiment.

Dr. Kenneth Fisher is a Nephrologist, author of, “Understanding Healthcare, A Historical Perspective”, a member of the American College of Healthcare Trustees and an advisory board member of Practicing Physicians of America. Contact him at drkafisher@ gmail.com

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What Medical Shift Is Underway?

By QUINTON L. GUNN, Sr.

There is a medical shift underway. Can you feel it? What shift do you ask?

From Healthcare to WellCare…

Both patients and doctors have grown tired of the politics related to medicine. And because the population is getting older, the urgency to find solutions to our escalating healthcare cost has taken on more of a focused and urgent need. Finding other ways to reduce cost and to improve treatment outcomes is critical. Additionally, the politics of medicine is also slowing down the progress and discoveries of medicine.

Just as the internet changed and enhanced our ability to communicate with one another, so too will the recent medical discoveries related to cell assisted technology like exosomes, regenerative medicine using amniotic or PRP, Wharton’s Jelly, stem cell treatments using both bone marrow and adipose, not to mention, cannabis CBD oil for pain management, functional and naturopathic medicine, as well as chiropractic, acupuncture and shockwave therapies.

Each of these treatment pathways opens the door to a more scientific and modern way to treat patients, while reducing cost and bringing the patient a reasonable measure of health using nontraditional treatment options.

These new, yet older alternative modalities have reawakened the medical community’s view of the science within the body, while also showing nature’s way to healing once more. Each, in its own way, has taken us back to the future where nature has already proven its dominion removing the current unemotional or synthetic nature of prescribing medicines or using an insurance driven recommendation for treatments.

The generation of patients today, in addition to fighting sickness, is also fighting a major prescription drug epidemic

which is ravaging families and communities. Recently in Florida, there was a townhall called Opioid Crisis Town Hall. This issue is affecting a generation of families and is forcing doctors to seek alternative treatments and protocols. Without these new options, we could likely see devastating impacts on our society and country.

Science is being driven by patient demand and fear of addiction.

What we now know, more than ever, is that our bodies hold the secrets to our medical success in the future. Scientists and doctors are rediscovering their love for the natural pathways, which medicine and science connect. Everyone is checking and rechecking the science like students in medical school.

Organizations like A4M, TOBI, Boston BioLife, IFATS, AMMG, just to name a few, are among the many teaching organizations available to doctors today who are seriously seeking medical alternatives for their patients. Doctors are learning as much as they can through didactic and hands-on training as well as from medical journals like BioInformant, New England Journal of Medicine, Harvard Medical School, Stanford University and Mayo Clinic.

Through national interest and proven science, we now are being forced to acknowledge that nature knows best how to treat patients without so many side effects from prescribed pain medicine due to surgeries. As patients have chosen to move away from long-held traditions and views, which are driven by corporate governance, they want options and are driving medical discovery with potential groundbreaking cures in the very near distant future.

Quintin L. Gunn Sr. is a Practice Development Consultant with Social Media Solutions for Doctors. Visit www.SocialMediaSolutionsforDoctors.com

YOUR SOURCE FOR LOCAL HEALTHCARE NEWS JKelly@orlandomedicalnews.com

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Not Just a Spinal Cord Injury: Dual Diagnosis

By MICHAEL SAMOGALA RN, CRRN, CBIS

An individual experiencing both a traumatic brain injury (TBI) and a spinal cord injury (SCI) at the same time, often described as a dual diagnosis, can present significant challenges and complexities compared to sustaining these injuries during separate occurrences. The incidents of spinal cord injury noted by the World Health Organization (WHO) in 2013 were between 250,000 and 500,000 worldwide annually. Many publications state that greater than 60% of those individuals presenting to the trauma center with a spinal cord injury are later identified with a dual diagnosis. Further complicating the dual diagnosis is that in many cases spinal cord injuries that also involve a TBI are not being readily identified in the acute phase of treatment. In relation to initial acute care, and then again in the postacute rehabilitation phases of recovery, an occult TBI diagnosis is often first identified by behavior and may be perceived as noncompliance, inability to learn, or a negative emotional reaction to the spinal cord injury, along with a decreased motivation and poor initiation of tasks as well as participation in the rehabilitation process.

As health care professionals in both the acute and post-acute arenas, we must become aware that the common causes for not initially identifying a TBI include the concentrated efforts regarding the stabilization of the spinal cord injury as well as the consistent monitoring of its subsequent sequelae in determining the diagnosis, severity and confirming the level of injury. The TBI that at times cannot be fully evaluated during the immediate triage process often is not given consistent consideration beginning with the emergency medical services observation and description regarding cognitive deficiencies or loss of consciousness (client cannot remember what they don’t remember) followed by incomplete documentation or lack of direct observance regarding cognitive deficiency and the lack of access to specific in-depth neuropsychological examination and testing within the treatment protocol of some health care facilities.

Dual diagnosis which most often involves cervical injuries at the C1-C4 level commonly occur in motor vehicle accidents or falls (velocity to motion). In consideration of this injury level, attention must be given to the many medical complications that accompany both the TBI and SCI and how a dual diagnosis further impedes their identification and treatment. Dual diagnosis indicates recorded statistics refer to a 67 percent rehospital18

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ization rate. One of the most detrimental challenges for the individual with a dual diagnosis relating to the safety and effectiveness of the rehabilitation process is the inability to learn and retain information associated with these injuries and their complications. A perfect example would be the information that is required for the client and significant other to retain in both identifying and managing autonomic dysreflexia as experienced in a spinal cord injury above the thoracic 6 level. As we understand, this is a true medical emergency which can lead to seizure, stroke or even death.

Within a true CARF accredited program, the dual diagnosis and the specific needs related to these individuals are addressed in a formal repetitive education program by all disciplines including medicine, nursing, physical therapy, occupational therapy, speech language pathology/cognitive specialists, neuropsychology and psychiatry staff and evaluated in a consistent manner. The appropriate documentation and communication of the identified needs and barriers to effective education/retention are shared with all those individuals involved in the client’s care and discharge services.

Behaviors are apparent in various forms dependent on the area of the injury and the severity of the TBI. Of course,

the frontal and occipital areas relating to the common coup contrecoup injury is always a consideration. Impulsivity, is defined as “without regard to consequence.”

In observing, assessing and identifying cognitive/behavioral deficits and/or impulsivity the safety of the client and those in his/her environment is of paramount concern. The post-acute transition of care provides for a continuous progressive and conclusive evaluation relating to a safe and appropriate discharge location with adequate supervision and services to ensure the progress of the individual in obtaining their highest level of function and independence. In addition to the behavioral issues discussed above, general procurement of consistent supervision and reassessment by post-acute rehabilitation professionals within the client’s community is an absolute necessity. As we now understand due to secondary cascade of injury, TBI individuals often experience significant deficits/barriers far beyond their original date of injury. The responsibility to these individuals often does not end once they are discharged from any facility in that traumatic brain injury is most often a life changing event. Catastrophic injuries in the mildest form demand frequent reassessment, intervention, planning and evaluation.

In final analysis of the affect and con-

sequences of dual diagnosis in the postacute setting, behavioral incidents, length of stay, medical/nursing/therapy hours and economic resources are all negatively affected, mostly due to the occult cognitive and learning deficiencies that so often go unrecognized and/or addressed within the rehabilitation program. Early identification and specialized post-acute intervention within a CARF accredited post-acute program such as NeuLife Rehab may assist in meeting the very unique and complex demands of this population improving their quality of life, level of independence and reducing the negative impact on the health care system within the community and ensuring the most successful outcome.

Michael Samogala RN, CRRN CBIS has been directly involved in providing professional nursing and education services to the healthcare community for over 40 years. Most notably receiving board certification in rehabilitation nursing and as a brain injury specialist, he continues to provide professional credited continuing education programs to multiple professionals across the country and remains in the position of Director of Corporate Education, NeuLife Neurological Services. Michael continues as an active member of The American Nurses Association, The American Association of Rehabilitation Nurses, The Academy of Spinal Cord Injury Professionals, The Academy of Brain Injury Specialists.

Visit https://www.neuliferehab.com

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Wearable Medical Devices Give Abundant Data—and Risks

By MIRANDA FELDE, MHA, CPHRM

Since 2013, the number of US consumers tracking their health data with wearables has doubled. And that number continues to rise: During the third quarter of 2018, the wearables market saw a nearly 60 percent increase in earnings over the prior year.

Wearables are electronic devices worn on the body, often like a watch. Wearables can track patient data like heart rate, blood pressure, or blood glucose. They can also track activity level, e.g., counting steps.

Promoters of wearables say that they could provide physicians with abundant data when caring for patients with chronic health issues. They also predict that combining wearables and gamification—e.g., competing with family members to see who can “score” the most steps in a day— may lead to improved health and better health outcomes.

However, skeptics question whether gamification will really lead to healthier behaviors long-term. And questions abound about what to do with wearables’ data and how to protect it. Wearables bring promise, but also real risks for patient safety and physician liability.

Benefits of Wearables Promoters of wearables believe wearables will drive the transition to intelligent care, whereby physicians have access to more data—in which they can identify actionable components. Florence Comite, MD, a New York endocrinologist who describes wearables as “almost like magic,” uses data from wearables to tailor her interventions for patients with chronic conditions.

Wearables can help patients take action, too. In one recent study, diabetes patients using a wearable app showed randomized controlled trial results comparable or superior to patients taking diabetes medications.

Promoters of such digital strategies hope that they will encourage healthy behaviors while requiring fewer office visits purely for monitoring purposes, thereby reducing healthcare costs while improving patient experience and engagement. For instance, David Rhew, MD, chief medical officer for Samsung, hopes that wearables can help patients move to the highest level of patient activation, Level 4:

The Four Levels of Patient Activation • LEVEL 1: Predisposed to be passive.

“My doctor is in charge of my health.”

• LEVEL 2: Building knowledge and

confidence. “I could be doing more.”

• LEVEL 3: Taking action. “I’m part of

my healthcare team.”

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• LEVEL 4: Maintaining behaviors,

pushing further. “I’m my own advocate.”

Some apps promote healthy behaviors with gamification. For instance, a user might compete with family or friends to take the most steps each day, either informally or through an organized group.

Harvard professor Ichiro Kawachi, PhD, wrote in JAMA Internal Medicine that this is “an opportunity for clinicians to turn health promotion into an engaging, fulfilling and fun activity.” Sponsors hope that such groups can promote accountability, responsibility, and mindfulness about activity and health conditions.

Skepticism about Wearables It is too soon to say whether wearables will increase healthy behaviors and/or reduce office visits, thus lowering healthcare costs. Some studies have found that wearable devices have no advantage over other forms of goal tracking or social support in helping people meet their health and fitness goals. A 2016 study from the University of Pittsburgh, for instance, found that “young adults who used fitness trackers in the study lost less weight than those in a control group who self-reported their exercise and diet.”

• Poor data quality:

Data from wearables may or may not be reliable enough for medical use.

• Data fixation:

Patients may fixate on one number— steps per day, for instance—at the expense of other health variables, such as their diet, sleep habits, etc.

• Lack of interoperability with electronic health records (EHRs):

If a patient’s wearable cannot stream data to the patient’s EHR, then how can the physician’s practice securely acquire the data?

• Data saturation: Physicians receiving patient data from wearables risk being soaked by a data fire hose. Physicians need a plan and a process to determine what measurements are relevant to a given patient.

• Unclear physician responsibilities for collecting, monitoring, and protecting data: HIPAA applies to

Risks of Wearables Though each device has its pros and cons, all wearables generate concerns for physicians, including:

patient data collected by physicians, but differing state laws mean that a physician’s specific responsibilities for monitoring and protecting patient data vary by location.

• Lack of data security— and liability for physicians:

Wearables are subject to cyberattack.

In addition to presenting obvious risks to patient safety, this may also present liability risks to physicians—who may be expected to notify patients of recalls issued for their wearables.

Next Steps As more and more physicians are accepting—or requesting—their patients’ data from wearables, questions include: How can we tell when data from wearables is accurate? When it’s actionable?

When it’s secure?

Certainly, physicians interacting with data from wearables should independently confirm that data before changing a patient’s care and should store data from wearables securely.

For help implementing remote patient monitoring in your practice, see the American Medical Association’s (AMA’s) Digital Health Implementation Playbook.

Miranda Felde, MHA, CPHRM, is Vice President, Patient Safety and Risk Management for The Doctor’s Company.

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The Impact of Enhanced Home Health Patient Engagement Programs on Care Transitions

By JOHN BANKS POWELL

When patients transition from one care setting to another, there is an increased need for quality care coordination and patient support. Typically, patients will move from a care setting, such as a hospital, that is giving round-the-clock resources to monitor, help and improve a patient’s condition to a level of acuity with much fewer resources. This period of time is critical to ensure patients stay on the path to recovery and follow designated care plans.

During a transition, there are other anticipated challenges that providers aim to address in addition to fewer resources.

According to the results of the National Adult Literacy Survey (NALS), only 12 percent of U.S. adults have proficient health literacy. Add this to the fact the less than 25 percent of patients report they comprehend the instructions given to them at discharge and it is clear that care transitions can make the difference in positive or negative outcomes and experiences.

Where Home Health Agencies Play a Role in the Care Transition Process Given how important the transition of care is, it is no surprise to see that home health agencies are becoming an increasingly popular post-acute service. Instead of opting for longer hospital stays or time in a rehab facility, more and more patients are choosing to recover with home health services. Hospitals are also financially incentivized to move patients into lower cost care settings sooner. Nearly five million patients receive home health services in the United States each year, and current estimates show that the home health industry could grow to $350 billion in revenue by 2020. With this volume of activity there are many ways in which home health agencies should take advantage of being able to support better care transitions.

Patients typically receive home healthcare services after they are discharged from a hospital or skilled nursing facility, or can be referred by community physicians. With regular home visits, agencies have the opportunity to check in on patients, ensure they are adhering to care plans, and offer educational resources to help them manage any conditions. While the home visits themselves can directly improve outcomes, there are opportunities to engage patients outside of these face-toface interactions to further improve both patient outcomes and patient and family experiences.

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Patient Engagement Plays a Critical Role in Preventing Potential Issues Patients receiving home health services are face-to-face with a healthcare professional on a regular basis. Engaging patients beyond these interactions is where home health agencies have the opportunity to further improve outcomes and keep patients satisfied with their care. With telephone outreach, agencies can engage patients in the white space between their home visits and address potential gaps in care plan comprehension or adherence.

For example, if a patient receiving home health ha questions about their medication between visits, phone call outreach can engage the patient to understand his or her needs and then connect them with the proper resource to resolve this issue without having to wait until the next home visit. This proactive communication helps address potential care issues before they occur and can improve outcomes such as re-hospitalization or readmission rates.

When it comes to engaging patients throughout their episode of care, there are a few things providers should keep in mind. Although phone or text message outreach can be extremely effective, it is important to make sure the process is both scalable and personalized. Creating scalable processes is critical, not just due to the high volume of patients on census, but because staff turnover is one of the biggest challenges in the home health industry right now. When implementing a patient engagement program, agencies should focus on finding ways of ensuring staff members are working at the top of their license and helping patients more than simply completing administrative tasks like check in calls.

For patients, it also ensures outreach is tailored to their preferred language and communication method such as calls or text messages instead of emails or direct mailings, which is proven to not be as effective in resolving issues in a timely manner. By keeping patient preferences top of mind, there is an increased likelihood of engagement and therefore program success.

Improving Care Transitions Improves Reimbursements Across the Continuum For hospitals, reimbursements are tied to metrics such as readmission rates and HCAHPS scores. Oftentimes, patients will view home health as an extension of the care they received in the

hospital, even if the entities are completely separate. When patients are satisfied with their home health services, this can have a tremendous impact on their view of the hospital care as well. Additionally, if the home health agency can help to prevent avoidable 30-day readmissions, that will directly impact the hospital’s reimbursement as well.

Home Health Agencies also have the opportunity to capitalize on changing regulations with proactive patient engagement. In 2020, agencies will shift to reimbursement under the Patient-Driven Grouping Model (PDGM). The major changes with PDGM will be a shift from 60-day to 30-day payment periods, and higher reimbursement for institutional hospital referrals. By improving patient outcomes and their perceptions of care, agencies can showcase their superior quality and increase the volume of referrals from preferred institutions providers,

improving their bottom lines.

As health systems and integrated delivery networks seek to improve care transitions, home health agencies that are proactive and innovative in engaging patients can be a tremendous asset. As potential patient issues are prevented, care providers throughout the entire patient journey stand to gain both patient loyalty and financial reimbursements by keeping patients engaged during transitions of care.

John Banks Powell is the Vice President of Post-Acute Strategy at CipherHealth. Powell spearheads CipherHealth’s post-acute and bundled payment initiatives by partnering with providers across the care continuum who leverage CipherHealth’s patient engagement and care coordination solutions to meet quality initiatives.

Visit cipherhealth.com

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SERVING PHYSICIANS & HEALTHCARE PROFESSIONALS IN LAKE, MARION & SUMTER COUNTIES

Marion County Health Rankings Released The Robert Wood Johnson Foundation (RWJF) and the University of Wisconsin have released their annual rankings of overall health outcomes in each county of each state and Marion County is ranked 52nd out of Florida’s 67 counties.

Rankings are determined by scores across a variety of factors. The county ranked 59th in length of life, 41st in quality of life, 33rd in health behaviors, 18th in clinical care, 51st in social and economic factors, and 43rd in physical environment.

An annual project from RWJF, this study highlights the many community factors that influence health and uses established data.

“Data such as the County Health Rankings serve to remind us of the many different factors, both clinical and social, that influence the health of a community,” said Department of Health in Marion County Health Officer Mark Lander.

“The investment into improving commu-

nity health requires input and action from multiple partners and we are fortunate in Marion County to have leadership committed to the people they serve, in both the governmental and private sectors.”

The department is working in collaboration with local government, nonprofit organizations, health care facilities, business groups, schools, faith-based organizations and many other stakeholders to improve the health of all people in Marion County.

One initiative is its partnership with more than 20 Marion County organizations to develop a Community Improvement Plan that addresses high-priority issues affecting health of the community. While some of these issues can be considered conventional health factors, many are related to social behaviors that on the surface may not appear to have a clinical relationship, but in reality impact the ability of residents to achieve their best health.

Increase Practice Revenue Without Seeing More Patients

The United Way of Marion County is one the many partners working to develop the Community Improvement Plan.

“United Way of Marion County is proud to be a partner with the key organizations in our community that address the health of our citizens,” said President and CEO of the United Way of Marion County Scot Quintel. “By working together, we can magnify our individual abilities to affect change and address the needs identified in the county health rankings.”

Marion County Hospital District Executive Director Curt Bromund noted the steps the Hospital District has taken to address health issues over the past year.

“The 2019 health rankings were negatively impacted by factors that reduced our citizens’ life expectancy,” Bromund said. “These factors included increased incidents of suicides and overdose deaths,

and the Marion County Hospital District is making a significant investment in outpatient substance abuse treatment and mental health counseling. We anticipate spending $1.5 million in substance abuse and mental health projects this year, and we are working with Representative McClain on legislation that will provide an additional $1M to Marion County for detox, inpatient and step-down treatments.”

The department, nationally accredited by the Public Health Accreditation Board, works to protect, promote and improve the health of all people in Florida through integrated state, county and community efforts.

We Need Your Help!

Shepherd’s Hope, the largest free and charitable clinic in Florida, is seeking Orthopedists to provide volunteer care for our patients (one three hour shift per month) at one of our five convenient locations in Central Florida.

For volunteer information contact Abby Seelinger, Manager of Volunteer Programs (407) 876-6699, ext. 233 | abby.seelinger@shepherdshope.org or visit www.shepherdshope.org/volunteers.

By SONDA EUNUS, MHA, CMPE

For too many Independent Physicians and Medical Practice owners today, running their practices has become increasingly difficult due to administrative hoops that they are made to jump through in order to provide patient care. Time-consuming tasks such as credentialing, prior authorizations, referrals, medical record requests, faxes, document management, billing, and many others are forcing medical practices to inflate their staff. This in turn reduces their profit margin and brings on additional responsibilities such as required pension plans, additional space needed, as well as FMLA and health insurance coverage for practices that have over 50 employees. Additionally, with the 21

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transition from fee for service to valuebased payment systems, medical practices are now also required to meet quality measures to prove that the care they are providing meets regulated standards. Failure to meet these quality measures leads to lower payer reimbursement, so this is another time-consuming task which cannot be ignored.

In this environment, if a practice focuses on increasing patient volume to increase their revenue, then they must accept the fact that these administrative burdens will only rise with an increased patient count, which will always leave them in a vicious cycle of needing additional employees. However, with a simple mindset shift, a practice can find ways to

SHARE YOUR PASSION: Help those in need of hope and healing in our community by joining our clinical and non-clinical volunteers at Shepherd’s Hope.

More volunteer doctors and nurses needed now more than ever to help fill the immense demand for healthcare services to the uninsured and under-insured men, women and children in Central Florida.

(CONTINUED ON PAGE 22)

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SERVING PHYSICIANS & HEALTHCARE PROFESSIONALS IN LAKE, MARION & SUMTER COUNTIES

Increase Practice Revenue Without Seeing More Patients, continued from page 21 become more efficient and productive by deciding to work smarter, not harder. Instead of focusing solely on attracting new patients for increased revenue, there are many ways that a practice can find revenue that they may be leaving on the table in their current operations.

One way to increase revenue without having to see more patients is by offering new services to your existing patient base. Many of these services, often called ancillary services, can be implemented very quickly and at no cost to the practice.

The ancillary services that you choose to implement will depend greatly on your specialty, your patient population, as well as your insurance payer mix. You know your patients – what services can you offer to them onsite that they will truly benefit from? How can you make their care more convenient for them? Many ancillary services are covered by Medicare and commercial payers, but some are cash-based.

Would your patient population be able to afford cash-based ancillary services?

Here are some examples of ancillary

services that medical practices can offer to their patients: • Allergy Testing and Immunotherapy services • Chronic Care Management (CCM) & Medication Therapy Management (MTM) • Electronic Mental Health Screenings - Depression, Alcohol Abuse, etc.

• Telemedicine Visits • Sale of nutritional Supplements, Vitamins, and Home Medical Equipment/Supplies

Microdermabrasion/other cosmetic services These are just a few ideas to get you thinking. Which services could work for your practice? There are many ancillary service partners that can help you implement new services quickly and seamlessly.

While we’re being creative, here are a few other ideas that can help you become more profitable without having to see more patients: • Renegotiate existing insurance payer contracts for higher reimbursement • Reassess your self-pay fee schedule

• On-site pre-packaged Medication Dispensing

• Renegotiate current vendor contracts for lowered expenses

• Weight Loss Services and Treatments

• Join a Group Purchasing Organization (for free) for discounts on frequently used supplies, products, and services

• Onsite Lab Services (beyond CLIAwaived tests) • Physical Therapy Services • Wellness Center/Medspa: Acupuncture, Laser-Hair Removal, Botox, Massage,

• Outsource time-consuming processes such as Credentialing, Billing, Prior Authorizations, Document Management, and Medical Record

Management • Develop a system to collect outstanding patient balances, or outsource this to a qualified Collections company • Train the Front Office to collect patient share of cost prior to the visit • Participate in Clinical Research trials • Sell old Medical Equipment that you no longer use If you have other creative profitdriving ideas or solutions that you have implemented in your practice that you would like to share email me at sonda@ lmshealthpro.com Sonda Eunus is the Founder & CEO of Leading Management Solutions (www. lmshealthpro.com), a Healthcare Management and Marketing Consulting Firm working with Medical Practices and other Healthcare Businesses to help them achieve faster business growth and increase revenue. Her true passion lies in helping Entrepreneurs follow their passion and grow the business that they have always dreamt of. Connect at Linkedin: https://www. linkedin.com/in/sonda-eunus-mhacmpe-cpb-6895067b/

GrandRounds AdventHealth Ocala First in Marion County to be Named Screening Center of Excellence by the Lung Cancer Alliance

Ocala Health announces $31M expansion at Ocala Regional Medical Center

AdventHealth Ocala and its partners at Radiology Associates of Ocala have been named a Screening Center of Excellence by the Lung Cancer Alliance (LCA).

Lung cancer is the number one cancer killer in the U.S., and lung cancer screening with a low-dose CT scan makes it possible to detect the disease early when it is most treatable and even curable. Low dose CT screening for lung cancer carried out safely and efficiently, saves tens of thousands of lives a year.

“We are dedicated to providing the highest quality of care to every patient, every time,” said Joe Johnson, President and CEO of AdventHealth Ocala. “This recognition highlights our commitment to elevate the level of health care in our community and our dedication to help all we serve live their healthiest lives possible.”

AdventHealth Ocala and Radiology Associates of Ocala offer the lung cancer screening initiative at the Medical Imaging Center of Ocala and the TimberRidge Imaging Center.

“We are pleased that our centers are being recognized as Centers of Excellence by the Lung Cancer Alliance,” said

Ocala Health leadership has released details on the continued investment into expansion projects at Ocala Regional Medical Center.

The project at Ocala Regional Medical Center will add nearly 29,000 square feet of new space dedicated to cardiovascular inpatient services. The latest project will include the addition of 34 inpatient beds, bringing the total to 290 inpatient beds. These 34 beds will create a new, dedicated cardiac unit which will include a 10-bed CVICU, 8-bed CV step-down, and 16-bed cardiac procedural. This unit is scheduled to open in December 2020.

Recent projects at Ocala Regional Medical Center include: • Addition of 34 inpatient beds at ORMC (scheduled to open May 2019) • Addition of 12 emergency room beds and new entrance to the emergency department, bringing the total to 32 emergency room beds at ORMC (scheduled to open October 2019) • Comprehensive Stroke Center status (March 2019) • Addition of two large operating suites and support areas, bringing the

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Dr. Brian Cartwright of Radiology Associates of Ocala. “The remarkable detail of the low dose CT scans reveals even the tiniest lung abnormalities. The clarity captures minute nodules that x-ray can miss.”

Designated Screening Centers of Excellence are recognized for their ongoing commitment to lung cancer screening and to complying with comprehensive standards based on best practices developed by professional organizations such as the American College of Radiology, the National Comprehensive Cancer Network and the International Early Lung Cancer Action Program.

“We are honored to be working with AdventHealth Ocala as a Lung Cancer Alliance Screening Center of Excellence.

Their commitment to practice responsible lung cancer screening will lead to advancements in research and many lives saved. They are an example to follow,” says LCA President and CEO, Laurie Fenton Ambrose.

total to 13 operating rooms at ORMC (completed December 2018) • Addition of biplane for interventional procedures at ORMC (completed March 2018) Since 2012, Ocala Health has made investments totaling more than $277M which represent the addition of 45 emergency department beds, 194 inpatient beds, and 502 jobs for our community.

These expansions, along with the addition of a freestanding emergency department in Summerfield in October 2016, exemplify Ocala Health’s commitment to adding new services and more access points for residents and visitors of Marion County.

“We continue to invest in advanced capabilities for our facilities so we can provide the level of care our community needs,” says Chad Christianson, Ocala Health CEO. “Cardiovascular services is a foundational service at Ocala Health and this investment reflects our continued commitment to deliver the highest quality of care for the cardiovascular patients of Marion County.”

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The Business of Florida Medical Marijuana -Regulatory Structure Affects Profitability

By MICHAEL PATTERSON As of March 15, 2019, Florida had over 250,000 patients in the Department of Health Office of Medical Marijuana Use (OMMU) registry approved to use Medical Marijuana (MMJ). These numbers keep increasing 3,000-5,000 patients per week. With marijuana flower (“bud” or plant material) recently being approved to sell at dispensaries, we expect those numbers to climb to 5,0007,000 patients per week in 2020. With this rapid growth of the industry in Florida, how does Florida compare to other states from a regulatory and business perspective?

Florida MMJ is a vertically integrated licensed industry.

The technical name for the license is a Medical Marijuana Treatment Center (MMTC). Vertical integration means that license holders must cultivate, process, transport, and dispense MMJ by themselves.

There is no wholesale market. Other states like Colorado, Oklahoma, Pennsylvania, Illinois, Nevada, Oregon, and Washington are horizontal integrated licenses. You must apply or purchase a license to cultivate and/or process cannabis, a separate license to process cannabis (in certain states), a separate license to transport, and a separate license to dispense. (FYI- No license in any state allows you to transport product across state lines because marijuana is still illegal at the federal level).

Florida MMJ patient numbers are increasing faster than any other state

New York State, which has a similar population of Florida, legalized MMJ in 2014 and

had approximately 80,000 patients as of 2018, compared to Florida’s 250,000 patients. Florida is expected to have half of the medical marijuana patients in the entire country by 2020.

Florida MMJ Industry only has 14 licensed entities.

To compare, California recently had over 8,000 licensed cannabis businesses in 2017.

Each FL MMTC licensee can open as many stores as they would like after April 2020. This unlimited dispensary per license policy is extremely unique in the United States. There is no other state which has an unlimited dispensaries per license policy. This policy leads to extremely high valuations of licensed companies.

Two MMTC licenses were recently sold in November 2018 for $70 million (Harvest Health) and January 2019 for $67 million (Acreage Holdings). Trulieve, Florida’s largest MMTC, recently went public on the Canadian Securities exchange (CSE) with a valuation close to $1 billion (upon going public, Trulieve only had business in the state of Florida).

The OMMU has been scheduled to issue more MMTC licenses since October 2017 (potentially up to 10 or more). However, due to litigation these licenses have not been issued.

The issue should be resolved in the current Florida Legislative Session which will end in May 2019, and more licenses should be available for application in late 2019. Currently, Florida has approximately 110 licensed MMJ Dispensaries open and operating around the state with 2-3 new dispensaries opening weekly.

The average price per month of MMJ is between $150-$250. This price should continue to decline as competition continues to increase.

JOINY!

Where is the Florida market going?

Up, Up, Up! In 2018, the Florida MMJ market generated approximately $250 million in total sales. In 2020, Forbes and the University of South Florida have predicted the FL MMJ Industry to surpass $1.5 BILLION in 2020 in total sales (yes, that is next year) and 140 percent compounded growth by 2024. Cannabis is the fastest growing industry in America, and Florida is one of the fastest growing cannabis states in the US. The reason for the rapid growth is multifold: Licensed MMTCs coming to market with medicine

After each MMTC license is awarded, it can take up to 18 months to bring a consistent MMJ product to market. With almost half of the licensed MMTCs yet to open stores as of 2018, all licensed producers will have stores open in 2019 dramatically increasing access to medicine for more patients.

More Physicians participating writing MMJ recommendations

As of March 2019, there were over 2,100 Florida Physicians who have taken the required 2-hour CME on Florida MMJ. However, up until 2018, most MMJ recommendations were coming from approximately 500-750 Physicians across the state. As the MMJ stigma decreases and Physicians can see that no punitive consequences have happened to FL Physicians who recommend MMJ, more and more doctors will begin writing MMJ recommendations. This will bring the price down per Physician recommendation (which currently is between $150-$300 per MD visit).

The Unequivocal Solution to the Healthcare Crisis!

IPNetworkFlorida.com

Hemp becoming 100 percent legal in the United States

The 2018 Farm Bill declared hemp as a 100 percent legal crop to grow and use in the United States. Most people know that hemp is used to make many products including rope, clothing, and food. But hemp also has CBD, a cannabinoid which has shown many benefits to health without getting a person euphoric or “high.” Marijuana is known for its euphoric effect caused by the cannabinoid THC, but marijuana also has CBD. As the use of Hemp and CBD proliferate rapidly across the USA and the globe in 2019 and 2020, it will continue to decrease the stigma of its cousin, marijuana.

This will lead to more acceptance of cannabis as a safe, natural medicine with few minor side effects (hunger, dry mouth) and potential alternative to prescription and opioid medications.

Michael C. Patterson, founder and CEO of U.S. Cannabis Pharmaceutical Research & Development of Melbourne, is a consultant for the development of the medical marijuana industry nationwide and in Florida. He serves as a consultant to Gerson Lehrman Group, New York and helps educate GLG partners on specific investment strategies and public policy regarding Medical Marijuana in the U.S. and Internationally. He can be reached at mpatterson@uscprd.com

Social stigma continues to decrease

Independent Physicians

TODA

The fasting growing demographic of cannabis users in Florida is residents over 65 years old (the average MMJ user in 2018 was approximately 50 years old). As more and more seniors begin to see the first-hand benefits of MMJ from friends, relatives, and others, they are a lot more willing to consider MMJ as a medicine rather than sticking to the old ideology that marijuana will destroy our society and become the “devil’s lettuce.”

PUBLISHER John Kelly, jkelly@orlandomedicalnews.com AD SALES John Kelly 407-701-7424, Di-Anne Elise 407-579-9903 EDITOR PL Jeter, editor@orlandomedicalnews.com CREATIVE DIRECTOR Katy Barrett-Alley, kbarrettalley@gmail.com CONTRIBUTING WRITERS Michael Lowe, Andrew Cole, Brian C. Evander, Michael Patterson SOCIAL MEDIA DIRECTOR Trish Murphy, 863-899-3703, trish@tridentorlando.com LIPSCOMB UNIVERSITY INTERN Noelle Kelly

Managing patients in an independent environment saves significant healthcare dollars for payers, employers, and consumer-patients.

ENABLING PHYSICIANS TO: •

Compete in Todays Environment

•

Learn about Alliance Health, a new direct-to-employer insurance platform, beginning on July 1, 2019

• •

Provide What is Required to be a High Performing “In Demand” Practice Be prepared for the transition to Value-Based Care

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CIRCULATION jkelly@orlandomedicalnews.com All editorial submissions and press releases should be emailed to editor@orlandomedicalnews.com Subscription requests or address changes should be e mailed to jkelly@orlandomedicalnews.com ORLANDO MEDICAL NEWS PO Box 621597, Oviedo, FL 32762 Orlando Medical News is published monthly by K&J Kelly, LLC. ©2018 Orlando Medical News. All Rights Reserved.

Reproduction in whole, or in part without written permission is prohibited. Orlando Medical News will assume no responsibility unsolicited materials.

All letters to Orlando Medical News will be considered Orlando Medical News property and therefore unconditionally assigned to Orlando Medical News for publication and copyright purposes.

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2019 Annual

Florida Resident of the Year Awards Dinner May 10, 2019 LA JOLLA BALLROOM 301 Alcazar Ave, Coral Gables, FL 33134

Honoring Residents, Fellows, Physicians & Program Coordinators for outstanding performance, superior dedication & exceptional leadership PHYSICIAN NOMINEES Angel Fernandez, Anesthesiologist

Justin Rubin, Dermatologist

Maykel Trotter, Internal Medicine

Eric Schiffman, Orthopedic Surgeon

Edelberto D. Cuevas, Veterinarian

Ankeet Choxi, Anesthesiologist

Liza Brown, Dermatologist

Mohsin Siddique, Internal Medicine

Robert Norton, Orthopedic Surgeon

Jose Gorostiza, Veterinarian

Benjamin Krasne, Anesthesiologist

Joubin Meta, Emergency Medicine

Paul Casanova, Internal Medicine

Roger Walker, Orthopedic Surgeon

Oscar Paez, Veterinarian

Javier Rojas, Anesthesiologist

Dileep Ravi, Emergency Medicine

Sergio San Jose, Internal Medicine

Samuel Popinchalk, Orthopedic Surgeon

Renato Mendez, Veterinarian

Julio Peguero, Cardiologist

Jonathan Rakofsky, Emergency Medicine

Sheeraz Baig, Internal Medicine

Sergio Lenchig, Orthopedic Surgeon

Linda Collado, Psychiatry

Pablo Urbandt, Cardiologist

Scarlet Benson, Emergency Medicine

Soroush Aghigh, Internal Medicine

Thomas Walker, Otolaryngologist

Javier Baez, Emergency Medicine

David Barkoe, Critical Care

Ariel Benjamin Grobman, ENT

Travis Smith, Internal Medicine

Alfonso Henriquez-Villarreal, Pediatrician

Judith Cornely, Pediatrician

Judex Ramirez-Sanchez, Dentist

Ana Lugo-Lopez, Family Medicine

Abdur Baig, Nephrologist

James Fletcher, Plastic Surgery

Brian Valle, Interventional Cardiologist

Luis Quinones, Dentist

Annie Casta, Family Medicine

Parham Eftekhari, Nephrologist

Pedro Miguel Abrantes, Podiatrist

Aurelio Torres Consuegra

Andy Gaertner, Dentist

Tiffany Sizemore, Family Medicine

Linda Chen, Neurologist

Teri Rossi Beers, Psychiatrist

Chris Schettino, Internal Medicine

Tommy Gaertner, Dentist

Shane Gober, Family Practice/ Emergency Medicine

Jabal Uffleman, OB/GYN

Gerardo Ferrer, Psychiatrist

Hernando Chong, Family Medicine

Tammy Birbeck, Gynecologist

Ramon Sanchez-Rauder, OB/GYN

Geetika Klevos, Radiologist

John M. Childress, Emergency Medicine

Sharise Richardson, OB/GYN

Jose Rodriguez, Radiologist

John Didovic, Radiologist

Natalya Medrano, OB/GYN

Jose Baez, Surgeon

Juan Camilo Gomez, Geriatrics

Jennifer Conde, OB/GYN

Vicente Gari, Surgeon

Joshua Coussa, Dentist

Carlos Villalba, Internal Medicine

Jose Ignacio Garri, Oral Surgeon / Plastic Surgeon

Alvaro Garcia, Surgeon

Julio Peguero-Moreno, Cardiology

Juliet Vento, Internal Medicine

Bradley Roth, Orthopedic Surgeon

Romualdo Segurola, Thoracic & Cardiac Surgeon

Steven Spinner, Podiatrist

Linda Lazar, Internal Medicine

Eric Lloyd, Orthopedic Surgeon

Darren Bruck, Urologist

Nick Coretti, Podiatry

Sameer Gupta, Internal Medicine JFK Medical Center

Salih N. Grevious - JMH Medical, Internal Medicine University of Miami

Aventura Hospital & Medical Center

Juan Esteban Rey Rueda, Internal Medicine JFK Medical Center

Reginald Pereira Jr. - JMH Ambulatory, Internal Medicine University of Miami

Suchismita (Tia) Paul, Dermatology University of Miami

Manuel Rivera Maza - Miami VA, Internal Medicine University of Miami

Andrea Maderal, Dermatology University of Miami

Sabrina Taldone – UMHC, Internal Medicine University of Miami

Porscha Bailey, Podiatry Westchester General Hospital

Daniel Klein, Internal Medicine Broward Health Medical Center

Valerie Alfonso, Podiatry Westchester General Hospital

June Kunapareddy, Dermatology Broward Health Medical Center

Marina De Amorim, Anesthesiology University of Miami

Trevor J. Batty, Dermatology Broward Health Medical Center

Michael Kuntz, Anesthesiology University of Miami

Kevin Weiss, Orthopedic Surgery Broward Health Medical Center

Paul Potnuru, Anesthesiology University of Miami

Michael Madden, Orthopedic Surgery Broward Health Medical Center

Shailee Patel, Dermatology University of Miami

John Howard, Dermatology Larkin Community Hospital

Janelle Vega, Dermatologist Thomas Singer, Dermatologist Anna Falabella, Dermatologist Bertha Baum, Dermatologist Brittany Smirnov, Dermatologist Chris Spock, Dermatologist Denise Guervara, Dermatologist Elissa Norton, Dermatologist

Jean Jacque Vel, Internal Medicine Jessica Hughes, Internal Medicine Ana Silva, Internal Medicine

RESIDENT NOMINEES Janice Leon, Neurology University of Miami

Richard Lewis, Neurology University of Miami Salem Jafilan, Neurology University of Miami Le Treice Irving, Neurology University of Miami Lisa Oliveri, Psychiatry and Behavioral Sciences University of Miami Mousa Botros, Psychiatry and Behavioral Sciences University of Miami Amalia Martinez, Psychiatry and Behavioral Sciences University of Miami Chae Hwa Kim, Pathology University of Miami Rochelle Freire, Pathology University of Miami Audrey L Cox, Dermatopathology & Cutaneous Surgery University of Miami Tony Nguyen, Family Medicine Westchester General Hospital Mayank Ohri, Internal Medicine Kendall Regional Medicine Center Joseph D. Reimon, Internal Medicine Kendall Regional Medicine Center

Vanessa Blumer - Miami VAMC, Internal Medicine University of Miami

Lianne Zaragoza, Internal Medicine Kendall Regional Medicine Center

Stephanie Clauss - Patient Safety VA, Internal Medicine University of Miami

Micaella Kantor, Internal Medicine Kendall Regional Medicine Center

Marcelo Fernandes - Patient Safety VA Internal Medicine University of Miami

Miguel Villacorta, Dermatology University of Miami

Chadwick Flowers – JMH, Internal Medicine University of Miami

Derek Murphy, Family Medicine Larkin Community Hospital Sean Kelly, Orthopedics Larkin Community Hospital Carmen Cartwright, Emergency Medicine Aventura Hospital & Medical Center Carmen Elena Cervantes, Emergency Medicine

Nader Lamaa, Emergency Medicine Aventura Hospital & Medical Center

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APRIL 2019

Chester “Chet” Donnally III, Orthopedic University of Miami Alex Ghasem, Orthopedic University of Miami

Ernesto Martinez Duarte, Pathology University of Miami

Augustus “AJ” Rush III, Orthopedic University of Miami

Daniel Cassidy, Pathology University of Miami

Matthew Hamedami, Oral and Maxiofacial Surgery University of Miami

Michelle Torres, NSU College of Dental Medicine Ajaypal Gill, Internal Medicine Mt Sinai Medical Center Jorge Perez, Internal Medicine Mt Sinai Medical Center Angelica Torres, Internal Medicine Mt Sinai Medical Center Jeffrin Joseph, Internal Medicine Mt Sinai Medical Center

Andres Carmona Rubio, Cardiology Cleveland Clinic Adam Oxios, Podiatry Westside Regional Medical Center Tarak Amin, Podiatry Westside Regional Medical Center Christine D’Aguillo, Otolaryngology University of Miami Neil Nayak, Otolaryngology University of Miami

Thomas Capasso, Surgery Mt. Sinai Medical Center

Jason Rudman, Otolaryngology University of Miami

Andre Coombs, Surgery Mt. Sinai Medical Center

Christopher Alexander, Physical Medicine & Rehabilitation University of Miami

Conrad Macon, Cardiology University of Miami

Jesse Charnoff, Physical Medicine & Rehabilitation University of Miami

Andrew Pankos, Cardiology University of Miami Ashley M. Crane, Ophthalmology Bascom Palmer Eye Institute

Michael C. Ianniello, Osteopathic, Palmetto General Hospital Le Treice Irving

Kimberly D. Tran, Ophthalmology Bascom Palmer Eye Institute

MEDI-LAW FIRM MISSION Ensuring Healthcare Professionals are protected & comfortable with their lives. Clients include Doctors, Dentists, Physician Assistants, Nurse Practitioners, Veterinarians.& other Physician Extenders. — MAX A. ADAMS, Esq.

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Brian Nitzberg, Dentist

305-444-3484

THEMEDILAWFIRM.COM FAITH@THEMEDILAWFIRM.COM

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Choose a leader in cancer treatment.

Once again, Orlando Health UF Health Cancer Center is the first to offer a new, state-of-the-art cancer treatment in Central Florida. MRIdian® is a magnetic resonant imaging (MRI)-guided radiation system that offers: • Extremely precise treatment of tumors in real time • Safer treatment by exposing patients’ healthy tissue to less radiation

MRIdian treatment is now available at

Orlando Health UF Health Cancer Center –

Health Central Hospital. For more information, visit OrlandoHealthCancer.com/MRIdian