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PHYSICIAN SPOTLIGHT PAGE 3

Hank Hill, MD

ON ROUNDS

HEALTHCARELEADER

Larry Jones

Larry Jones isn’t certain that much will change about the ACA after President Barack Obama leaves office ... 4

CAPI Expands Philanthropic Outreach

Executive Committee Sets Goals for 2017 ... 6

Lake Nona Dentist Partners with Physicians to Treat Sleep Apnea Many patients are surprised when presented with a Sleep Health Questionnaire (SHQ) ... 7

Using Engineering Principles and Data to Perfect Healthcare Stephanie Alexander was an unusual engineering student ... 9

Very Serious Games

Dr. Beidel is a Pegasus Professor of Psychology at UCF and director of UCF RESTORES ... 9

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Unprecedented Policy Agreement AMA House of Delegates’ 2016 Interim Meeting Included Changed Focus after Surprising Outcome of Presidential Election BY PL JETER

LAKE BUENA VISTA – Health reform was top-of-agenda at the American Medical Association (AMA) House of Delegates 2016 Interim Meeting, held just days

after the presidential election. The Nov. 12-15 meeting of the principle policy-making body of the AMA attracted nearly 600 participants from all 50 states to the Walt Disney World Swan & Dolphin Resort in Lake Buena Vista.

AMA delegates, representing 170 state and specialty medical societies, adopted a resolution emphasizing “firm commitment” to AMA’s policy on healthcare reform. In preliminary discussions with President-elect (CONTINUED ON PAGE 3)

The Power of the Patient

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In the not-so-distant past, patients looked to their doctors and healthcare professionals as experts. There were rarely, if ever, questions like, “How much with this procedure cost?” or “Is that treatment really necessary?” Doctors were elite and privy to knowledge only they had access to. Doctors were respected and patients took their word as gospel. But, those days are gone. Why is that? The healthcare industry is now driven by consumerism and the growing “power

of the patient.” In this age of technology, patients can find out anything they want to know about you and your competitors without ever contacting you. Many times, they make the decision to consult with

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PHYSICIANSPOTLIGHT

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Hank C. Hill, MD

Surgical Oncologist; Associate Program Director of General Surgery, Osceola Regional Medical Center BY PL JETER

KISSIMMEE—Hank Hill, MD, recalls a pivotal moment in high school when a guidance counselor recommended bypassing biological research to pursue a medical degree instead. The concept sounded appealing to Hill, yet he wondered about the cost and length of studies. His parents had emigrated from Guyana in the 1950s so their children would be born American citizens. Hill, the firstborn, realized that following the path of a doctor was a very big dream indeed. If Hill had any doubts, they were nullified as a college sophomore on the Brooklyn campus of Long Island University, when his dad was diagnosed with stage 4 colon cancer. When checking the extended family’s medical history, he learned a cousin developed breast cancer at an early age. “It reinforced my dedication to become a physician,” said Hill. Two months after enrolling at the Morehouse School of Medicine in Atlanta, Hill learned that a great uncle was a gynecologist. “I didn’t know him and hadn’t heard about him until then,” recalled Hill, who earned his MD in 1991. His residency training was at Harlem Hospital Cancer Center - Presbyterian Medi-

cal Center where he met Chairman of Surgery Harold Freeman, MD, known as the godfather of breast navigation. Freeman urged Hill to further his training at MD Anderson Center, at a time in the mid-1990s when surgical residents pursuing oncology were needed for an expanding research program. Afterward, Hill returned to Harlem Hospital and completed surgical residency training, he joined as attending staff surgeon while also completing surgical critical care and endoscopy. Hill’s specialty training in surgical oncology fellowship was completed at Roswell Park Cancer Institute, Buffalo, NY where he focused in gastrointestinal cancer. “Medical school confirmed my passion for surgery; my focus on surgical oncology wasn’t until surgical residency training,” he said. After arduous years of training, Hill set his sights on Florida, first stopping in Jacksonville for nearly six years before finding a dream fit at Osceola Regional Medical Center in Kissimmee earlier this year. “I was on a personal search to identify a location that would allow me to focus on surgical oncology and to also get into education,” said Hill. “It turned out that Osceola Regional was looking for such an individual. It was as if there was a calling

and I heard it.” At Osceola Care Specialists, an affiliate of Osceola Regional, Hill provides surgical oncology management of myriad solid organ cancers, including breast, colorectal, esophagus, hepatobiliary pancreas, stomach, sarcoma, and skin cancers. Hill will be involved in the new surgical residency program starting in 2017 that resulted from the partnership between Osceola Regional and the University of Central Florida College of Medicine. Already, Hill has played a key role in helping Osceola Regional earn The Joint Commission’s Disease-Specific Certification for its breast, lung and colorectal cancer programs in its oncology unit. “It’s important to know that Osceola Regional is committed to bringing highquality surgical oncology to this community, where there’s been a void for a period of time,” noted Hill. “Our cancer patients now can stay at their medical home and still be connected, not only to their family members, but also to their family doctor. Their physicians can be right there nearby, involved in their care.” Hill also serves as Cancer Liaison Physician for the North Florida Division for Commission of Cancer of American College of Surgeons and secretary of the

Florida Society of Clinical Oncology. “Being an officer for the Florida Society of Critical Oncology has allowed me to better understand the challenges of cancer patients in Florida, and to help do something about those challenges,” said Hill, of the cancer patient advocacy organization. Hill is also involved with the Society of Surgical Oncology, Society of Black Academic Surgeons, National Medical Association and Orange County Medical Society. A recent appointment: member of the American Cancer Society Volunteer Leadership Board. He developed Hill Charitable Foundation with his brother who is in the finance industry. They hope to launch it in 2017 “to reduce medical disparities in a variety of ways that are taken for granted here.” “The foundation will also look at economic development, disaster relief, agricultural innovation and other programs,” he added. For pleasure, Hill heads to the tennis court. “It’s been an integral part of my life since my father exposed me to the game at age 11,” he said. “The sport challenges your individual patience, persistence and concentration while also maintaining or increasing your fitness level. It teaches you to deal with adversities, keep pursuing excellence and stay the course.”

Unprecedented Policy Agreement, continued from page 1

Donald Trump’s Transition Team and Congress, the AMA will continue efforts to cover the uninsured and strive to assure that future proposals don’t result in coverage loss for insured patients. AMA President Andrew W. Gurman, MD, pointed to policymakers, who have a notable opportunity “to reduce excessive regulatory burdens that diminish physicians’ time devoted to patient care and increase costs.” AMA delegate Jason Pirozzolo, DO, director of sports medicine and trauma for Orlando Hand Surgery Associates and assistant clinical professor at Florida State University, said the meeting was livelier than usual, primarily because of the surprising results of the presidential election. “Delegates were completely caught off guard because for the first time, we saw an opening for real change in healthcare,” said Pirozzolo. When the ACA quickly moved through Congress, Pirozzolo noted the then-unwritten bill passed primarily because of the AMA’s support. (CONTINUED ON PAGE 7) ORLANDOMEDICALNEWS

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DECEMBER 2016

HEALTHCARELEADER

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Larry Jones

Health Policy Expert; CEO, HPOF Holdings LLC; Executive Director, Integrated Independent Physicians Network LLC BY PL JETER

Health policy expert Larry Jones isn’t certain that much will change about the Affordable Care Act (ACA) after President Barack Obama leaves office Jan. 20, even though President-elect Donald Trump vowed to “repeal and replace” Obamacare. “First off, the Trump Administration and Republicans will not in any way want to displace the 20 million Americans insured through healthcare.gov,” said Jones, CEO of HPOF Holdings LLC, and executive director of Integrated Independent Physicians Network LLC in Orlando. He pointed out the Congressional Budget Office’s estimate last month of Medicare, Medicaid, Healthcare Exchange and Children’s Health Insurance Program of $15.5 trillion between 2016 and 2026. “Can you imagine? There’s got to be an alternative.” Even though Jones has focused his work on health policy for nearly a quarter-century, he began his career with 17 years at the Kimberly-Clark Corporation. For nine years, he worked with Abbey Home Health Care, now called Apria, a home health DME (durable medical equipment) company. In the 1990s,

he joined other investors to establish an HMO (Health Maintenance Organization). In 1998, after WellCare acquired the DME company, Brevard Professional Network physicians asked Jones to join their IPA (Independent Physician Association) as CEO, a position he held for a decade. Jones then returned to Orlando to establish HPOF Holdings LLC, an umbrella company that developed a network of nine IPAs across Florida. Word spread about Jones’ IPA successes. He was asked to manage the Clinical Alliance Network (CAN) statewide specialty pediatric IPA. Last May, George White, MD, and Mark Chaet, MD, asked Jones to manage their newly formed IP Network (Integrated Independent Physicians Network LLC), an Orlando-based IPA representing more than 1,300 multi-specialty physicians in Central Florida. Physicians Collaborative Trust MSO, which provides primary care networks for Medicare advantage plans, was also added to HPOF. “The whole premise of everything we do involves looking out for independent physicians, giving them tools they need to compete in this new healthcare paradigm, while also preserving and protecting the independent practice of medicine,” said Jones. “Everyone (discussing

health policy) has a seat at the table but the independent physician.” The unexpected presidential outcome brought to question the viability of the ACA. If Secretary of State Hilary Clinton had won, she’d already said she planned to retain the ACA and hinted at possibly doubling down on various mandates. “The initiative in moving from feefor-service to fee-for-value has always been a bipartisan collaboration,” explained Jones. “That’s not going away and neither is MACRA.” Jones believes ACA changes the Trump Administration is discussing involves restructuring the subsidies and penalties regarding employees and employers, and uninsured individuals. “An initiative President-elect Trump mentioned in his campaign was opening up borders, and allowing insurance companies to sell policies across state lines … to add competition to the marketplace,” said Jones. “Let’s face it. Healthcare.gov premiums went up 25 percent Jan. 1. An individual making $40,000 a year with an $800 policy and a $5,000 deductible may as well be uninsured.” U.S. healthcare expenditures for the last 12 months reached $3.36 trillion, Jones pointed out, emphasizing that

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physicians garnered only 8 percent of the healthcare dollar. “We’ve got to change the balance of money,” he insisted. “Shifting money to physicians, particularly independent physicians, lowers the overall size of the pie.” Republicans, now holding power over the Oval Office, House and Senate, tend to make quick changes, Jones observed. “There’s got to be some restraint on repealing and replacing all these policies. We’ve been under the ACA since March 2010,” he cautioned. “Physicians and healthcare are just now beginning to respond and react and accept the movement from fee-for-service to feefor-value. We educate, prepare and engage with our physicians about coming healthcare changes – and we don’t need too much too fast.” At Jones’ core, his top priority is to preserve and protect the independent practice of medicine. “All our leadership,” he said, “understands that very clearly.”

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CAPI CONVERSATION

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CAPI Expands Philanthropic Outreach Executive Committee Sets Goals for 2017 BY JUDY OTTO

As an organization of medical professionals dedicated to the care of others, it’s not surprising that the Central Florida Association of Physicians from the Indian Subcontinent (CAPI) stresses volunteerism and community service, and its governing board continually seeks new avenues for its philanthropy. That Executive Committee consists of CAPI’s past president, current president, executive officers, and two members at large, who are volunteers who may stand at election for the future. The 2017 officers were installed at an early December gala, and will serve for a one-year term. It is the role of the governing board to execute the long-term goals of the organization and its 600+ membership – which are to engage with the community, to promote healthcare in general, and to provide services where needed, including volunteering in educational roles as well as patient care. A recent change of focus has directed their efforts toward hospital outreach – where support in the form of CAPI’s energy and experience may be most helpful. “For the future, it’s important that we have a voice in the advocacy area – something we’ve not done thus far,” said Sudhir Bhaskar, MD, a gastroenterologist

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CAPI EXECUTIVE COMMITTEE 2017 PRESIDENT: Vijay Patange, MD IMMEDIATE PAST PRESIDENT: Atul Madan, MD VICE PRESIDENT: Priya Vishnubhotla, MD SECRETARY: Rohit Bhatheja, MD TREASURER: Sri Pottamsetty, MD MEMBER AT LARGE: Hari Madhosing MEMBER AT LARGE: Suchi Dura in Orlando for 15 years, and a past president of CAPI. “But some of our members have been elected to hospital boards and the Florida State Medical Board, and we are nicely poised now to have an even more beneficial effect – it’s just a matter

of time,” predicted Bhaskar. “Our goal is to engage the local hospital systems; all of the members of our board serve different hospitals around the city; their diverse input provides a more complete and comprehensive picture of the hospital community’s needs,” he noted. The organization has developed collaborative relationships with the area’s three major health systems, and plans to also continue in supportive and productive partnerships with other community service organizations, including Orlando’s Indian American Chamber of Commerce (IACC), the University of Central Florida College of Medicine’s (UCF-COM) Knights Clinic,

Shepherd’s Hope, and more. Under the board’s direction, a variety of philanthropic opportunities are proposed, examined, and implemented as needs arise. On a case by case basis, funds are dispensed to the City of Orlando to support families of victims, police, etc., as in the case of the Pulse tragedy, for which CAPI members raised $15,000. Efforts can range from support of a hospital’s 5K run or health fair to an event or program developed and sponsored by CAPI. CAPI stresses the importance of education, so scholarships in amounts ranging from $2,000 to $5,000 are also a part of their endowments to the deserving, and are awarded in recognition of achievement. CAPI also encourages and rewards outstanding service and performance through monetary awards recognizing Orlando Health’s best outgoing hospital resident, administrator, and faculty member of the year. The amount of endowments is decided by a newly created Philanthropic Committee and is limited to $20,000 per case. Funds are raised exclusively from member contributions to the CAPI Foundation. Individual member donations to a favored charity or beneficiary are matched by organizational funds. The Board meets four to six times per year to select, plan and execute logistical details for funding, donations, awards, events, and endowments. Each president strives to improve on previous accomplishments, contributing something different that adds value through his annual agenda. “Each president wants to leave a lasting legacy,” said Bhaskar. “We want to make sure we’ve done enough.” All efforts on the part of CAPI and its officers are strictly voluntary in nature: Each executive officer dedicates at least an hour a day – and often more – in support of CAPI’s philanthropic goals, Bhaskar estimates. What motivates an already-busy professional to sacrifice free time which is already in short supply? “It comes from the heart,” said Bhaskar. “Some people are by nature more social, more philanthropic, than others. Even in college, I found myself leading efforts to benefit others less fortunate, such as leading a drive to improve conditions for lepers in my country.” Historically, CAPI has raised close to $25,000 for UCF-COM, $70,000 for the Florida Hospital Foundation, more than $56,000 for Orlando Health, and $20,000 for A Gift for Teaching, and it continues to make its presence felt in myriad ways beneficial to the Orlando community.

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Unprecedented Policy Agreement,

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continued from page 3

“However, the way AMA supported it was analogous to how it passed through Congress, which used procedural chicanery and parliamentary techniques to move the resolution along,” he said. “Following that support, many delegates were frustrated with the AMA and the AMA lost a large portion of its membership. Over the past eight years, as we’ve seen patients lose their doctors and premiums skyrocket, the AMA has tried to reverse course on its ACA policy and change the healthcare system for the betterment of patients and physicians. Obviously with a democratic White House, the ability to make substantive changes was never really a possibility – until the election results were made public. “As soon as delegates assembled in Orlando, they frantically pieced together a powerful and meaningful proposal that would lend guidance to President-Elect Trump’s transition team as we lay the groundwork for meaningful reform,” Pirozzolo said. “With the Florida Delegation and Chairman Dr. Corey Howard of Naples helping lead the discussion, we were able to work with most other states and large associations to accomplish this by developing policy that ultimately passed the House with absolutely no controversy or opposition.” AMA delegates discussed other issues including: • Physicians backing steps toward value-based drug pricing. • Easing student loan debt as one of various new medical education policies. • Physicians setting the right tone regarding ethical obligations as care team leaders. • Wounded veterans deserving infertility benefits via assistedreproductive technology. • Public health concerns (distracted driving, dangerous coal-tar sealcoats and smoking among youth) prompting physician policy. Joining the call-to-action to minimize gun violence by seeking universal background checks on gun purchases, restrictions on the sale of military-style weapons, and large-capacity magazines to civilians, plus more research on how to cut morbidity and mortality cases involving firearms. “The other hot issue was Maintenance of Certification reform,” said Pirozzolo. “With full support of the Florida delegation, I personally proposed an amendment that would result in a dramatic and immediate escalation of the effort the AMA will be imposing onto the ABMS (American Board of Medical Specialties) and member boards to modify their re-certification policies and cease the requirements for a high-stakes exam. After almost an hour of debate, we were successful.” Pirozzolo testified on the floor: “Most of us helping to lead state medical asso-

Powering Medical City Lake Nona Dentist Partners with Physicians to Treat Sleep Apnea At Lake Nona Dental Group, many patients are surprised when presented with a Sleep Health Questionnaire (SHQ) as part of their new patient paperwork. Many people suffer from snoring activity during sleep. While half of these people are “simple snorers,” the other half may have a serious sleep disorder called Obstructive Sleep Apnea (OSA). Treating simple snoring, while not medically necessary, can have dramatic effect on one’s quality of life. OSA, however, is on the other end of the spectrum: it is a very common and potentially life-threatening medical disorder that prevents airflow during sleep. As much as 20 percent of the adult population in the United States has sleep apnea, and many are not receiving treatment or even aware that they have the condition. Sleep apnea occurs when tissue in the back of the throat collapses and blocks the airway, reducing the amount of oxygen delivered to all your organs including your heart and brain. People with sleep apnea may snore loudly and stop breathing for short periods of time. When the blood-oxygen level drops low enough, the body momentarily wakes up. It can happen so quickly that you may not even be aware that you woke up. This can happen hundreds of times a night, and you may wake up in the morning feeling unrefreshed. In addition to snoring and excessive daytime sleepiness, sleep apnea can cause memory loss, morning headaches, irritability, depression, decreased sex drive and impaired concentration. Sleep apnea patients have a much higher risk of stroke and heart problems, such as heart attack, congestive heart failure and hypertension. Sleep apnea patients are also more likely to be involved in an accident at the workplace or while driving.

For years, the treatment of choice has been the CPAP machine, which uses mild air pressure to keep the airways open. But now, more and more patients are looking for alternatives. Oral appliances have become a desirable alternative due to its many advantages. The American Academy of Sleep Medicine recommends oral appliance therapy for patients with mild to moderate OSA and for those with more severe OSA who cannot tolerate CPAP or refuse surgery. A custom dental appliance helps to reposition the jaw and tongue to improve airflow while reducing or eliminating the patient’s snoring. There are currently eleven FDA approved devices used to treat OSA. There are factors in the patients bite and tooth form that determines which appliance works best. It is also important that the patient have a healthy and stable mouth before fabricating one of these appliances to ensure long-term success. For these reasons, a dentist is the ideal health professional to ensure that these devices are properly fitting and cared for. And once an appliance is delivered, it is important that the dentist partner with the patient’s physician to provide oversight on the efficacy of the appliance. Oral appliances are appealing because they are less invasive than surgery and have a higher compliance than CPAP. It’s important to partner with a dentist who is familiar with the process of medical diagnosis, evaluation of dentition and mastication, delivery of appliances, proper follow up, and medical insurance billing. I encourage patients to reach out to dentists who regularly treat these conditions so patients can be educated about all their options. Dr. Ivan Montijo earned his Doctorate in Dental Medicine from the University of Florida and practices at Lake Nona Dental Group. He is trained in all aspects of dentistry and stays on the cutting edge of dental technology. Dr. Montijo is a Fellow of the Academy of General Dentistry. Visit www.lakenonadentalgroup.com

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ciations have been involved with the road show put forth by the ABMS, ABIM, and the ABFM, where they send representatives to present us their prefabricated and well-orchestrated talking points as they try to explain why they’ve been so painfully slow at eradicating the re-certification high-stakes exam and rolling back their costly and burdensome MOC mandates. This amendment will help to further strengthen and support state medical associations as we continue to help physicians practice medicine.” At the meeting, the physician who discovered CTE (chronic traumatic encephalopathy) in the death of an NFL player in 2002, received the AMA’s highest honor: Distinguished Service Award. Bennet I. Omalu, MD, MBA, a forensic pathologist and neuropathologist, made the discovery while working at the Allegheny County Coroner’s Office in Pittsburgh, Pa. He overcame a strong movement to discredit him and his research, and later became

the chief medical examiner for San Joaquin County in California. He also serves as a professor at the University of California-Davis in the Department of Medical Pathology and Laboratory Medicine. In summing up the historical meeting, Pirozzolo said the outcome of “having policy of this magnitude, which can frequently be polarizing, pass with no opposition on the floor of the House of Delegates, was an absolutely incredible feat and completely unprecedented.”

FOR MORE INFORMATION on the AMA House of Delegates’ reports and resolutions from the mid-November meeting, visit https://assets.ama-assn.org/ sub/meeting/index.html.

Power of the Patient, continued from page 1 ing industry is to understand that patients are consumers who are shopping for good service at a competitive price. They’re looking for low cost without sacrificing quality, state-of-the-art facilities, convenience & simplicity, and fast service. With out-ofpocket expense on the rise and the new normal set at high deductibles and copays, medical debt is the number one cause of bankruptcy today. With instant access to information all over the world, buyers are under intense emotional pressure to not making buying mistakes. Choosing a service provider is often an emotional decision rather than a logical one. Improving patient experience without increasing cost is critical to the future success of health care institutions everywhere. So, how is it done? How can your treatment center or office differentiate in this highly competitive and ever-changing industry? Consider some of these tips to set yourself apart: Be likeable. Patients want to feel like you are listening to them. Since they can do their own research, they are often looking to you to validate their concerns and then provide them with the care they can’t provide for themselves. They want to feel important. They want to trust you and believe you. They want to feel connected to their providers. If you are the one who solves their problems and resolves their concerns, you build a relationship of trust and in turn, your patient retention will increase, and new patient acquisition will increase over time as friends spread the word over social media. Provide price transparency. Patients need to know what your services cost upfront. Openly discuss options so the patient feels like she has choices and can make an informed decision while having control over what she spends on her family’s care.

Identify your differentiating factors and market them. Your specialization, the fact that you have the best physicians supported by leading-edge technology, coupled with shorter wait times—these are selling points that you need to make clear in your direct mailings, email newsletters or any other digital contact, social media campaigns, signage, etc. Offer amenities. Does your facility offer free Wi-Fi, free parking, or hotel-quality accommodations? Sometimes the little perks go a long way in making a good impression and making the patient feel he is important. Engage in Content marketing. High quality content is one of the most valuable currencies on the Internet today. Educating your patients can reignite that old feeling that the healthcare professional is the expert. Provide value to your services by producing exceptional, well-written blog posts and email newsletters. Share informative industry specific articles, high quality HD videos, and infographics showcasing interesting data relevant to your patients via social media. The more your patients engage with you online, the more they trust you feel a connection to your particular institution. Is marketing the real solution to this wave of healthcare industry transformation? The fact is that a patient is a consumer shopping for a product, and your product is topnotch healthcare services. And according to Rx MD Marketing Solutions, healthcare professionals who actively engage in marketing increase their annual revenues by 20-30 percent. The overall health of your facility or office depends on your ability to understand the power of the patient. Elaine Vail is a marketing solutions consultant at PIP Printing, Signs & Marketing and focuses on helping companies throughout Florida and across the country to grow their businesses. She is also a member of the Lake Nona Regional Chamber of Commerce in Central Florida.

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HEALTH INNOVATORS Using Engineering Principles and Data to Perfect Healthcare BY BETH RUDLOFF

Stephanie Alexander was an unusual engineering student 30 years ago. Not only was she a woman, she wanted to focus her engineering skills on healthcare. “I love to learn, I’m constantly trying to learn, and that’s why I stay in healthcare. I’m constantly learning what nurses do, what physicians do, and will most likely always stay in this industry because it has so many improvement opportunities.” Stephanie was one of the pioneers at Premier, Inc. where the first Medicare demonstration project rewarding hospitals for their quality results was awarded in 2003. “It was one of my proudest moments...we were able to leverage hundreds of hospitals through the commitment of health system CEOs who believed in what we were doing. We had not fully defined the project, much less secured a contract with Medicare. There was a lot of courage on the CEO’s part to be early adopters in quality improvement with the largest healthcare payor – and be fully transparent with their data,” said Stephanie. The risk paid off, CMS awarded incentive payments of more than $60 million to the participating hospitals. The secret to their success? Standardizing the data available for hospitals to see their performance, as well as comparing it to the data of other hospitals to facilitate further improvements. While Stephanie was honing her engineering skills in process improvement with the use of data, Michael and Steven Rothman were also entering the healthcare field, albeit unexpectedly. The pair began innovating in healthcare after a personal tragedy highlighted cracks in the system. After their mother suddenly took ill, she was admitted to a hospital, fully equipped with an electronic medical records system and a physician at the helm – all of which were quite unusual at the time. Despite receiving excellent care from the skilled nurses and physicians, she slowly deteriorated and died. But what went wrong and why? With an electronic medical record in place, shouldn’t there be sufficient data to give clinicians enough meaningful information about a patient to prevent this? With Michael and Steven’s mathematical and data analytics expertise, they took routine data points in an EMR to develop a standardized risk index for each patient. Named the Rothman Index, this index can MedSpeaks™ is an engagement focused organization created to showcase the most exciting events, experts, and healthcare developments within our region. Our strength isin our community network of Health Innovators as well as our platform for promoting/facilitating medical events and expertise. Our engagement model has enabled us to converge over 1,300 healthcare professionals, clinicians, entrepreneurs, and technology enthusiasts to fuse ideas on the problems and solutions facing healthcare.

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be monitored over time as well, highlighting deterioration requiring intervention. Think of it as a computerized, predictive, hardwired “rapid response team” to avoid unnecessary deaths. They tested their theory and their index at a few pioneering hospitals, and determined that it could in fact make a statistically significant difference in patient outcomes. In 2012 Stephanie joined forces with the Rothman’s, developing the Rothman Index into PeraHealth and taking the helm as CEO. Now integrated into the EMRs of more than 80 hospitals, the team has developed additional uses for the data that are keys to solving some of the most vexing problems healthcare systems face: bed management, readmissions, and palliative care. She bases all these assumptions on strong, scientific and peer-reviewed data. “Physicians are unlikely to use tools that are based on algorithms that are not peerreviewed, so we put a lot of focus around research and publishing,” said Stephanie. “Once the Rothman Index was published, the technology was scaled, and outcomes were achieved – 30 percent reduction in mortality at two sites – then I was willing to invest in growing the business.” What does the future hold for Stephanie and PeraHealth? They have three major goals: increase usage of the PeraHealth solutions by more hospitals, develop telehealth surveillance using the Rothman Index, and involve the family in the monitoring of the patient using the PeraHealth tools – all of which align PeraHealth even more closely to IHI’s Triple Aim. To see the science behind the technology, go to www.perahealth.com or call 704-385-4660

Very Serious Games BY COLIN FORWARD

AND KELLI MURRAY, MEDSPEAKS

“I can’t blow up Memory Mall,” jokes Dr. Deborah Beidel, “President Hitt told me I couldn’t.” Dr. Beidel is a Pegasus Professor of Psychology at UCF and director of UCF RESTORES, a clinical research and treatment center for Post Traumatic Stress Disorder (PTSD). RESTORES uses virtual reality (VR) headsets to deliver an experience that makes “serious games” seem like an understatement. They transport their clients back to Iraq and Afghanistan where their original trauma occurred. The virtual environment is enhanced with haptic feedback, and scents that they recall from the traumatic experience. “It can be pretty overwhelming,” says Beidel. “As tough as it is to get through, they’re willing to do it to have a good outcome on the other side.” Serious games has been an important component of the research conducted at UCF for years. Researchers at the Institute for Simulation and Training use virtual worlds to create immersive training programs, and to evaluate how people react to situations that are hard to study in the real world (e.g. wartime environments). And now Beidel’s team is using virtual reality

to push the limits of behavioral health. RESTORES is the only program in the country that is treating combat military personnel with PTSD in 3 weeks, whereas traditional programs are 17 weeks long. Despite the compressed timeframe, Beidel says their clients report that the treatment is effective for at least 6 months after the program, and some clients are even reporting that it is effective 2-3 years from the time of treatment. The program was originally funded by research grants from the U.S. Army to study the effectiveness of combat-related PTSD treatments. Now that the effectiveness of the program has been scientifically validated, RESTORES is expanding the populations they treat, and working toward training other mental health providers to deliver the program. RESTORES has already treated civilian patients, including a first responder to the Pulse nightclub shooting. “What we have done is take therapies that already exist, and packaged them in a way that seems to be producing a very good result. So we do hope…that we can be the place or have the therapy that other people can use.” For more information on how to support this program, go to http://sciences.ucf.edu/psychology/ucf-restores/ or call 407-823-3910.

FEATURED INNOVATIONS CHILDREN’S HOME SOCIETY: now oﬀ ers telemedicine services in select cities where children and families lack access to counseling resources. www.chsﬂ .org THE SCOTT INSTITUTE: assists children with autism and other developmental

disorders using the science of Applied Behavior Analysis and telemedicine. Ask the experts at www.thescottcenter.org/advisor

SERVING ALL OF EAST ORLANDO & LAKE NONA AREA

DECEMBER 2016

GrandRounds Florida Hospital Awards More Than $1 Million In Community Projects to Meet Needs of Underserved Florida Hospital has awarded more than $1 million to community projects that provide important medical services to the underserved in Central Florida, including a new mobile dental unit that will provide free or reduced care to Osceola County residents. “We are passionate about serving others and improving the health of all Central Floridians. By partnering with local organizations and supporting innovative projects, we can change — and save — lives,” said Yamile Luna, assistant vice president of Florida Hospital Community Impact. “Providing services at the appropriate time and setting also helps reduce medical costs and the overall financial strain on the health-care system.” Florida Hospital’s Community Health Impact Council, commonly known as CHIC, announced its latest recipient projects today: • Osceola County Mobile Dental Unit: The CHIC grant supports the Osceola County Health Department as it launches a mobile dental program to serve low-income, uninsured residents in the Holopaw, Kenansville and Narcoossee areas. The mobile unit will operate three days a week and provide free or low-cost services, beginning in January. ($304,903) • Care Coordination at Florida Hospital: This program provides patients with complex cases an advocate to ensure they receive proper support after discharge. The advocates will help patients make follow-up appointments, navigate community resources such as specialty clinics where they can receive free followup care, resolve barriers that prevent them from accessing health care, and help patients define their overall needs and goals. ($142,300) • Asthma Project Connect: The CHIC grant extends funding for this community-based asthma education and outreach program, which provides home visits, medication management and treatment plan assistance to minority communities in Orange County. ($175,702) • Aspire Health Partners: This navigation program provides a seamless transfer of patients in need of substance abuse or mental health services from hospital emergency departments to Aspire. ($474,654) • Senior Care Companions: The Osceola Council on Aging initiative provides chronically ill seniors with companions who help with their daily needs such as transportation, emotional support, health education and other assistance. ($150,692) • Healthy Eatonville Place: CHIC granted a request to roll over unused funds and allocate an additional $25,000 to continue the services

DECEMBER 2016

of Healthy Eatonville Place. The program seeks to improve the health of Eatonville by reducing the prevalence of diabetes, obesity, hypertension and smoking. Osceola Council on Aging CEO Beverly Hougland said the Care Companion program helps both low-income seniors who want to volunteer and those who are struggling with chronic illnesses. Senior volunteers receive a small stipend and mileage reimbursement, which not only makes it affordable for them to volunteer but the program also supplements their income, she explained. “The senior clients who suffer from chronic health problems have a friend in their Care Companion, who encourages healthy behaviors and provide health education,” Hougland said. “But they also help reduce social isolation which results in an improved quality of life for the program patients.”

MitraClip® at Orlando Health Orlando Regional Medical Center to treat a patient with severe mitral valve regurgitation. The MitraClip team includes Vijay Kasi, MD, PhD; Steven Hoff, MD; Deepak Vivek, MD; Carolina Demori, MD; Illena Antonetti, MD; Arnold Einhorn, MD; and Aurelio Duran, MD. Mitral regurgitation (MR) is the most common type of heart valve disease. Nearly 1 in 10 people age 75 and older have moderate or severe MR, affecting approximately 4 million people in the U.S. MR is a progressive condition that occurs when the flaps of the heart’s mitral valve do not close completely, causing blood to flow backward into the left atrium of the heart. This requires the heart to work harder, placing an extra burden on the heart and lungs. If untreated, MR can eventually cause serious problems, such as heart failure, which can be lifethreatening.

Orlando Health Introduces New MitraClip® Procedure — A Minimally Invasive Technique to Treat Mitral Valve Regurgitation

Kimberly Edwards Joins Avalon Park Group as Director of Health Care Operations

The Heart Valve Center at Orlando Health Heart Institute is proud to now offer a minimally invasive treatment option for patients suffering from mitral valve regurgitation. On October 17, 2016, an Orlando Health cardiac team successfully implanted the first totally percutaneous MitraClip® at Orlando Health Orlando Regional Medical Center to treat a patient with severe mitral valve regurgitation. The MitraClip team includes Vijay Kasi, MD, PhD; Steven Hoff, MD; Deepak Vivek, MD; Carolina Demori, MD; Illena Antonetti, MD; Arnold Einhorn, MD; and Aurelio Duran, MD. Mitral regurgitation (MR) is the most common type of heart valve disease. Nearly 1 in 10 people age 75 and older have moderate or severe MR, affecting approximately 4 million people in the U.S. MR is a progressive condition that occurs when the flaps of the heart’s mitral valve do not close completely, causing blood to flow backward into the left atrium of the heart. This requires the heart to work harder, placing an extra burden on the heart and lungs. If untreated, MR can eventually cause serious problems, such as heart failure, which can be life-threatening. Orlando Health Introduces New MitraClip® Procedure — A Minimally Invasive Technique to Treat Mitral Valve Regurgitation

Bringing with her more than two decades of health care experience, Kimberly Edwards has joined Avalon Park Group as its director of health care operations. In addition, Edwards has Kimberly Edwards assumed the top position at Encore at Avalon Park, the company’s assisted living facility. “Bringing in a person with the background and knowledge of this industry, such as Kim, brings our health care division into an entirely different level,” says Beat Kahli, CEO, Avalon Park Group. “Over the next few years, we’ll be starting many new initiatives that are ground breaking in this industry and there is no better person than Kim to lead our efforts.” Edwards is a licensed nursing home administrator and comes to Avalon Park Group with more than 25 years of longterm care experience, managing assisted living communities, skilled nursing facilities and continuing care retirement communities. She last worked at the Cameron Group as director of business development. She earned her undergraduate degree from Gustavus Adolphus College in Minnesota and an MBA from Florida Institute of Technology. “Very few companies are taking on health care in a manner such as Avalon Park Group and I’m proud to be a part of their long-term plans,” Edwards says. “No place else looks at the entire life of our citizens, working to provide healthy initiatives for younger people and immersive care for our seniors. Our goal is to make Avalon Park Group a model for how businesses can be a part of caring for our population in the best manner possible.”

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Superior Mesenteric Artery Syndrome: Diagnosis, Management and Treatment By SRINIVAS SEELA, MD

Superior mesenteric artery syndrome (SMAS) is a digestive condition that occurs when the duodenum is compressed between two arteries (the aorta and the superior mesenteric artery). This compression causes partial or complete blockage of the duodenum. Superior mesenteric artery (SMA) syndrome is an uncommon but well recognized clinical entity. Superior mesenteric artery syndrome was first described in 1861 by Von Rokitansky, who proposed that its cause was obstruction of the third part of the duodenum as a result of arteriomesenteric compression. Some studies report the incidence of superior mesenteric artery syndrome to be 0.1-0.3 percent. Approximately 0.013-0.78 percent of barium upper GI studies evaluating for superior mesenteric artery syndrome support the diagnosis. Despite the fact that about 400 cases are described in the English language literature, many have doubted the existence of superior mesenteric artery syndrome as a real entity; indeed, some investigators have suggested that superior mesenteric artery syndrome is over diagnosed because it is confused with other causes of megaduodenum. Nonetheless, the entity (also called cast syndrome) is a wellknown complication of scoliosis surgery, anorexia, and trauma. It often poses a diagnostic dilemma; its diagnosis is frequently one of exclusion The superior mesenteric artery usually forms an angle of approximately 45° (range, 38-56°) with the abdominal aorta, and the third part of the duodenum crosses caudal to the origin of the superior mesenteric artery, coursing between the superior mesenteric artery and aorta. Any factor that sharply narrows the aortomesenteric angle to approximately 6-25° can cause entrapment and compression of the third part of the duodenum as it passes between the superior mesenteric artery and aorta, resulting in superior mesenteric artery syndrome. In addition, the aortomesenteric distance in superior mesenteric artery syndrome is decreased to 2-8 mm (normal is 10-20 mm). Alternatively, other causes implicated in superior mesenteric artery syndrome include high insertion of the duodenum at the ligament of Treitz, a low origin of the superior mesenteric artery, and compression of the duodenum due to peritoneal adhesions. Mortality/Morbidity Delay in the diagnosis of superior mesenteric artery syndrome can result in malnutrition, dehydration, electrolyte abnormalities, gastric pneumatosis and portal venous gas, formation of an obstructing duodenal bezoar, hypovolemia secondary to massive GI hemorrhage, and even death secondary to gastric perforation. orlandomedicalnews

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Symptoms: The patient often presents with chronic upper abdominal symptoms such as epigastric pain, nausea, eructation, voluminous vomiting (bilious or partially digested food), postprandial discomfort, early satiety, and sometimes, subacute small bowel obstruction. Symptoms of superior mesenteric artery (SMA) syndrome often develop from 6-12 days after scoliosis surgery. • abdominal fullness, • bloating after meals, • nausea and vomiting of partially digested food, and • Mid-abdominal “crampy” pain that may be relieved by the prone (lying on the stomach) or knee-chest position. An asthenic habitus is noted in about 80 percent of cases. Abdominal examination may reveal a succussion splash. Peptic ulcer disease has been noted in 25-45 percent of the patients, and hyperchlorhydria has been noted in 50 percent. Patients can present with signs of subacute small bowel obstruction. Important etiologic factors that may precipitate narrowing of the aortomesenteric angle and recurrent mechanical obstruction include the following: • Constitutional factors • Thin body build • Exaggerated lumbar lordosis • Visceroptosis and abdominal wall laxity • Depletion of the mesenteric fat caused by rapid severe weight loss due to catabolic states such as cancer, surgery, burns, trauma, or psychiatric problems • Severe injuries, such as head trauma, leading to prolonged bedrest • Dietary disorders • Anorexia nervosa • Malabsorption • Spinal disease, deformity, or trauma (use of body cast in the surgical treatment of scoliosis or vertebral fractures): Superior mesenteric artery syndrome cases after corrective spine surgery are due to the result of spinal elongation, which decreases the superior mesenteric/aortic angle. Postoperative weight loss is an important factor for development of superior mesenteric artery syndrome. Although use of Harrington rods for corrective surgery commonly used in the 1950s and 1960s was an important contributory factor for development of superior mesenteric artery syndrome, newer derotation/translation corrective techniques can also rarely be associated with this disease entity. • Rapid linear growth without compensatory weight gain, particularly in adolescents: Adolescents with low body mass index (< 18 kg/m2) may be at higher risk for developing superior mesenteric artery syndrome after

spinal fusion for scoliosis than patients with a higher body mass index. • Anatomic anomalies (rare) • Abnormally high and fixed position of the ligament of Treitz with an upward displacement of the duodenum • Unusually low origin of the superior mesenteric artery • Unusual causes • Traumatic aneurysm of the superior mesenteric artery after a stab wound • Abdominal aortic aneurysms and mycotic aortic aneurysms • Familial superior mesenteric artery syndrome • Recurrent superior mesenteric artery syndrome • Idiopathic neonatal superior mesenteric artery syndrome Diagnostic Considerations: The differential diagnosis includes anorexia nervosa and bulimia. In addition, superior mesenteric artery (SMA) syndrome should be differentiated from other causes of megaduodenum or duodenal ileus, including diabetes mellitus, collagen vascular conditions, and chronic idiopathic intestinal pseudoobstruction. Mechanical obstruction secondary to peptic ulcer disease or duodenal web should also be considered. Diagnosis: The diagnosis of superior mesenteric artery (SMA) syndrome is difficult. A high index of suspicion is required since symptoms can be nonspecific. A diagnosis of superior mesenteric artery syndrome is often a diagnosis of exclusion. If not already performed, patients should undergo judicious testing for other disorders that can cause similar symptoms. Confirmation usually requires radiographic studies, such as an upper GI series, hypotonic duodenography, and CT scanning.

Treatment Reversing or removing the precipitating factor is usually successful in a patient with acute superior mesenteric artery (SMA) syndrome. Conservative initial treatment is recommended in all patients with superior mesenteric artery syndrome; this includes adequate nutrition, nasogastric decompression, and proper positioning of the patient after eating (i.e., left lateral decubitus, prone, knee-to-chest position, or Goldthwaite maneuver) Enteral feeding using a double lumen nasojejunal tube passed distal to the obstruction under fluoroscopic assistance is an effective adjunct in treatment of patients with rapid severe weight loss and also eliminates the need for intravenous fluids and the risks associated with total parenteral nutrition. In some instances, both enteral and parenteral nutritional support may be needed to provide optimal calories. The patient’s weight should be monitored daily. Subsequently, the patient can be started on oral liquids followed by slow and gradual introduction of small and frequent soft meals as tolerated. Finally, regular solid foods are introduced. Metoclopramide treatment may be beneficial. Review of the orthopedic literature reveals that the success rate is 100 percent with medical management, only in cases with an acute presentation of superior mesenteric artery syndrome. Surgery: Surgical intervention is indicated when conservative measures are ineffective, particularly in patients with a long history of progressive weight loss, pronounced duodenal dilatation with stasis, and complicating peptic ulcer disease. A trial of conservative treatment should be instituted for at least 4-6 weeks prior to surgical intervention. Options for surgery include: Strong’s procedure, Gastrojejunostomy and Duodenojejunostomy. Srinivas Seela, MD, is board certified in both Internal Medicine and Gastroenterology. He is a member of the American Gastroenterological Association (AGA), the American Society for Gastrointestinal Endoscopy (ASGE), the American Association for the Study of Liver Diseases (AASLD), and Crohn’s Colitis Foundation (CCF). In addition to being an Assistant Professor at the University of Central Florida School of Medicine, he is also a teaching attending physician at both the Florida Hospital Internal Medicine Residency and Family Practice Residence programs. Seela is a gastroenterologist at Digestive and Liver Center of Florida.

DECEMBER 2016

The strength of a team with a single focus – you. In today’s busy world, your financial needs can be complex and ever-changing. It takes more than an individual to meet those needs. It takes a team. At Synovus Bank, we have a team of professionals with the expertise and resources you need. 407.839.6278

We work together with a single focus – helping you reach your financial goals.

Pictured left to right: Don Gaudette, CEO; Marc Powell, Commercial Banker; Bobby Cooper, Commercial Banker; Bobby Roehrig, Commercial Banker; Ken Eller, Private Wealth Manager

Banking products are provided by Synovus Bank, Member FDIC. Divisions of Synovus Bank operate under multiple trade names across the Southeast. Investment products and services provided by Synovus are offered through Synovus Securities, Inc (“SSI”), Synovus Trust Company, N.A. (“STC”), GLOBALT, a separately identifiable division of STC and Creative Financial Group, a division of SSI. Trust services for Synovus are provided by Synovus Trust Company, N.A. The registered broker-dealer offering brokerage products for Synovus is Synovus Securities, Inc., member FINRA/SIPC. Investment products and services are not FDIC insured, are not deposits of or other obligations of Synovus Bank, are not guaranteed by Synovus Bank and involve investment risk, including possible loss of principal amount invested. Synovus Securities, Inc. is a subsidiary of Synovus Financial Corp and an affiliate of Synovus Bank and Synovus Trust. Synovus Trust Company, N.A. is a subsidiary of Synovus Bank.