Orlando Medical News December 2019 by Orlando Medical News

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SB 732: The New Office Surgery Statute Can You Afford Not to Comply? By Gregory A. Chaires, Dr. Richard J. Brooderson & JoAnn M. Guerrero

As discussed in last month’s issue, a doctor’s office can be many things these days - a laboratory, a pharmacy, a beauty salon, a weight loss clinic; and contain surgical office suites where procedures can be performed. Office surgery has been around for many years and has continued to expand in scope and operation over the course of the last several years. The Florida Board of Medicine promulgated the Office Surgery Rule years

ON ROUNDS NURSE SPOTLIGHT Dr. Elizabeth “Daleen” Penoyer ... 3 EOCC MEDICAL CITY Yes, Small Business Owner … There IS Value in Chamber Membership ... 6

VOLUNTARYBENEFITS Voluntary Benefits are Becoming not so Voluntary in the Changing Landscape of Employee Benefits ... 8

ago to provide guidance on how such officebased surgery facilities must operate and has amended it periodically since its inception. Like many things in health care, the business world got creative in what procedures could be performed in the office setting and where they could be performed. Concomitantly, concerned about multiple poor and sometimes fatal outcomes (especially in the field of plastic surgery), the Legislature took great interest in the matter, which lead to the passage of Senate Bill 732, and was signed into law by Governor

DeSantis on June 25, 2019. Effective January 1, 2020, this law is codified in Sections 458.328 and 459.0138, Florida Statutes, and simply stated is a game changer in the regulation of office-based surgery. So, what is office surgery? Further to Rule 64B8-9.009, F.A.C. (the Rule), surgery is defined as the manual or operative procedure, including the use of lasers performed upon the body of a living human being for the purposes of preserving health, diagnosing or curing disease, repairing injury, correcting deformity or defects, prolonging life, relieving

suffering or any elective procedure for aesthetic, reconstructive or cosmetic purposes. Under the Rule, office surgery is anything performed outside of an ASC, which in and of itself is a licensed and regulated facility. WHO HAS TO REGISTER? A physician office which has a physician that performs a liposuction procedure in which more than 1,000 cubic centimeters of supernatant fat is removed, a Level II (CONTINUED ON PAGE 2)

Florida’s Medical Marijuana Patients Double in 2019 How is your healthcare practice affected? By MICHAEL C. PATTERSON

The Florida Medical Marijuana (MMJ) industry has doubled in less than one year. As of November 22, 2019, there are over 400,000 patients who are qualified to use MMJ in the Florida Department of Health, Office of Medical Marijuana Use (OMMU) system. The number of patients in the OMMU system has doubled since the beginning of 2019. This trend will most likely continue as more dispensaries open and become more prevalent across the state. There are

currently 200 dispensaries open in Florida with 2-3 dispensaries opening each week. One of the areas of the Florida MMJ program that is somewhat surprising is the amount of use of marijuana “flower” – or better known as “bud” – as the form of MMJ used for medicine. More than 1.82 million ounces of smokable medical marijuana were ordered for 128,040 patients over a six-month period, a new state report shows. That translates to 113,922 pounds, or 57 tons, of flower marijuana within the last six months (since smokable flower just

became officially legal in March 2019). The report, compiled on behalf of the state Board of Medicine and the Board of Osteopathic Medicine, shows that 44 per(CONTINUED ON PAGE 2)

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SB 732: The New Office Surgery Statute, continued from page 1

office surgery, or a Level III office surgery must register with the Department of Health (the Procedures). A Level II procedure is one where any surgery in which the patient’s level of sedation is that of moderate sedation and analgesia or conscious sedation occurs. A Level III procedure is one in which the patient’s level of sedation is that of deep sedation and analgesia or general anesthesia. DESIGNATED PHYSICIAN AND PHYSICIAN NOTIFICATION? Each physician office location that wishes to perform office surgery that meets the above thresholds, must register by January 1, 2020. That includes any office that is currently registered. In other words, all physician facilities must re-register. At the time of registration, the office must designate a physician who is responsible for the office’s compliance with all applicable rules regarding the office’s health and safety requirements. The designated physician must have a full, active, and unencumbered license under Medical Practice Act or the Osteopathic Practice Act. Further, each physician that practices at a registered office must, within ten (10) calendar days, notify the Florida Department of Health in writing of starting or ending his or her practice at a registered office. FINANCIAL RESPONSIBILITY REQUIREMENT As a condition of registration, each office must establish financial responsibility by demonstrating it has met and continues to

maintain, at a minimum, the same financial responsibility requirements applicable to physicians. Further each physician practicing at a registered office must meet the financial responsibility requirements under the appropriate practice act. IDENTIFYING NON-COMPLIANCE Traditionally, the Florida Department of Health has registered office surgery locations and inspected such facilities annually. When deficiencies have been identified in such practices at the time of inspection, the physician office has submitted a Corrective Action Plan that addressed the deficiencies, resolving the matter. However, over the last couple of years, there was a push by the Florida Department of Health and the Florida Board of Medicine to hold the physicians associated with the office surgery locations responsible for violations of the Rule, though there were challenges in that regard. SB 732 was intended to address some of the glaring issues and challenges experienced in prior years. It is important to note, that there will continue to be annual inspections of such office facilities by the Florida Department of Health, and now such inspections may be unannounced except in limited circumstances, unless the office is accredited by a nationally recognized accrediting agency approved by the Florida Board of Medicine. (CONTINUED ON PAGE 3)

Florida’s Medical Marijuana Patients Double in 2019, continued from page 1 cent of 291,865 patients certified to use medical marijuana as of September 30, 2019 are smoking it. Patients in Florida can use medical marijuana to treat 10 specific conditions which include cancer, HIV, AIDS, chronic neuropathic pain, and post-traumatic stress disorder. Additionally, patients who suffer from conditions that are the same kind as the 10 specific conditions can qualify for MMJ. Most of the patients who qualified, or 162,277, had just one condition. A small number of patients, or 5,644, suffered from four or more qualifying conditions, the report showed. Most patients, 34 percent, qualified for medical marijuana for treatment of non-malignant pain, followed by the broader “same kind” category, 29 percent, and posttraumatic stress disorder, 22.6 percent. The report is based on data from the Medical Marijuana Use Registry which contains information about patients and physicians who certify patients. It also relies on information from the Division of Medical Quality Assurance licensure database, which contains the licensure data for all licensed practitioners, as well as the practitioner profiles for allopathic and osteopathic physicians. HOW DOES THIS INFORMATION AFFECT MY HEALTHCARE BUSINESS? This trend of increasing use of MMJ will continue for multiple reasons: decreased stigma of MMJ use, increased physician sup2

DECEMBER 2019

port via more physicians qualified to recommend MMJ (over 2,500 MDs in FL now eligible to recommend MMJ), and more access via increased dispensaries and home delivery. As a healthcare business owner, more and more of your patients will be using MMJ and it will be affecting their overall health. As a physician or physician practice, it is imperative to learn more about MMJ and how it can affect patients, good or bad, in your area of practice. The more you can open up a conversation about MMJ use with your patients, the better equipped you will be to properly ascertain their true medical history and current medications being taken. If you don’t think MMJ will affect your patients or your clinical practice, you are mistaken. Your patients are already using MMJ, but not telling you about it. Open up the dialogue about MMJ. Record data on which patients are using MMJ and document the progress of their health. This data will help you understand if your patients are benefitting from using MMJ or if it is inhibiting their health in some way. 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

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SB 732: The New Office Surgery Statute, continued from page 2 PENALTIES FOR VIOLATION The Florida Department of Health may suspend or revoke an office surgery registration in which Procedures or registration of any office in which Procedures are performed for failure of any of its physicians, owners, or operators, to comply with Section 458.328 and Section 459.0138, Florida Statutes, or any rule adopted thereunder. Importantly, if an office’s registration is revoked, the Department may deny any person named in the registration documents of the office, including those that own or operate the office, from registering an office to perform procedures or office surgeries for five (5) years after the registration date. In essence, a five (5) year suspension. In addition, under the new law, the Florida Department of Health has independent authority to impose penalties against a designated physician for failure of an office to comply, which includes suspension or revocation of a license. This can be effectuated independently of the Florida Board of Medicine, the body that has had the exclusive authority to discipline a physician’s medical license prior to this new law. Thus, the Florida Department of Health can theoretically revoke a designated physician’s license, whether the Florida Board of Medicine agrees or not. The new law also provides that the Florida Board of Medicine is required to impose a fine of $5,000 per day on a physician who performs a procedure or surgery in an office that is not registered. This could be the

designated physician (if he or she performs procedures), or any other physician affiliated with an office that performs Procedures. It is incumbent on any physician that intends to perform Procedures that such physician ensures that an office is properly registered, and that the physician is properly registered at that office location. That penalty is significant and mandatory but may not be the only penalty a physician incurs. It is critical that all offices that perform Procedures register or re-register prior to the end of 2019 and designate a physician that is responsible for the compliance of the office. It is important that compliance be something that is done on an ongoing basis, since the Department may now perform inspections unannounced. It is critical that physicians that perform Procedures at offices ensure that the office location is properly registered and that the physician performing the Procedures is registered at the applicable office location. The penalties are significant, and the risk of non-compliance simply is not worth it. We would encourage any office that performs procedures to visit the Florida Board of Medicine’s website and review its “Frequently Asked Questions” section concerning compliance with SB 732. We would also encourage any physician that performs Procedures at an office, become aware of the requirements of the rule. Ignorance of the new law or its rules will not be a defense, and certainly ignorance of whether an office is properly registered, will not serve a physician

well. The non-permissive penalty that must be imposed by the Board of Medicine can be financially devastating. As always, any practitioner or office requiring assistance or further information is encouraged to contact their health care attorney. While this articles touches on the new statute that is taking place on January 1, 2020, regarding office based surgery, it is not a comprehensive review of all the relevant statutes, rules and laws that govern the delivery of such health care services in the office setting and thus, is not, nor should it be construed as, legal advice. Compliance will require analysis of multiple statutes and rules, including the Board of Medicine’s Office Surgery rule which is currently being revised further to the new statute discussed in this article.

PROVIDING DIVERSITY & INCLUSION EDUCATION

to Physicians & Healthcare Providers on Behalf of the Lgbtq+ Community

ARE YOU AWARE • LGBTQ+ Patients face worse health outcomes than straight or cisgender peers? • Physicians & Healthcare Providers receive little-to-no LGBTQ+ Patient training?

Attorneys Gregory A. Chaires, Dr. Richard J. Brooderson and JoAnn M. Guerrero are attorneys and advisors serving health care providers. We are happy to assist in providing legal services concerning office-based surgery that you may have. Visit www.chlawyers.com

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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.

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.

DECEMBER 2019

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.

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NURSESPOTLIGHT

Believing in Curiosity, Excellence and Fried Chicken Dr. Elizabeth “Daleen” Penoyer You can hear Florence, South Carolina – where she grew up – in Elizabeth “Daleen” Penoyer’s voice as she professes amazement that anyone would want to interview her for an article. Finally, she consents. And then after the answers to questions come trickling out, you begin to understand how someone who, at first, dreamt of becoming a concert pianist and who graduated from high school at age 16, who seems driven, not by ambition, but by the kind of curiosity that makes children exclaim, “Cool!,” how that person ends up with half the alphabet behind her name in the form of various degrees and in charge of the Center for Nursing Research and Advanced Nursing Practice at Orlando Health. “My parents were really smart. When I was 15 and in my senior year of high school, my mother, who was a nurse, told me I needed to get a real job, so I could pay my way in life,” Penoyer said with a laugh. She entered a vocational program her senior year in high school and later graduated from the local community college’s nursing program with an associate degree at age 18. “It’s funny, I wasn’t even at the legal drinking age, but I could administer narcotics. However, once I got into it (medicine), I was hooked and never ever doubted my career choice. It has given me more than I gave it. It has been a true blessing to serve patients and members of the health care team. Nothing but a true honor to me.” Now, Dr. Penoyer is a PhD, RN, CCRP, FCNS, and FCCM. She has been a staff nurse, a university professor, a clinical nurse specialist, and a clinical nurse research scientist before taking on this role. Born and raised in the American South, she’s traveled to far corners of the world and spent some of the happiest years of her life as the Clinical Supervisor/Head Nurse of the medical surgical/ophthalmology unit at the King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia. In describing her current role – which she has had since 2010 – Penoyer’s voice turned serious. “We are trying to build the best evidence-guided nursing practice, so our patients are safe, and they have efficient and effective treatment, and therefore the best outcomes,” she said. “Seriously, that is our main goal. We want to contribute to excellence in the nursing practice that yields the best outcomes for our patients and their families.” Dr. Penoyer is a research scientist and teacher at heart, so the role she is in is a natural fit. All 12 of Orlando Health’s adult hospital clinical nurse specialists report directly to her. She helps to mentor them and to put the best scientific evidence in practice. She also meets with nurses across all hospital sites to identify new research projects and 4

DECEMBER 2019

guide them through the process from idea to approval to presentation. She continues to conduct her own research projects. “Last week I spent time out on the nursing units, working with the care team on a study I am doing to understand their work with intravenous therapy,” she said. And finally, she is also on the Corporate Quality Team, leading the team charged with improving the quality of care for patients who develop sepsis, a potentially lifethreatening condition caused by the body’s response to an infection and one of the deadliest challenges in hospitals. “It is unusual to have such a robust research department in a community health care system,” said Penoyer. “The kind of activities we do are usually beyond the scope of a community hospital setting. They are usually reserved for places of academic affiliation like a major university hospital.” In the past year, the Center for Nursing Research has helped guide approximately 30 different studies, said Dr. Penoyer. Those studies have included such topics as how to prevent non-ventilator-associated pneumonia in patients with increased teeth brushing and oral hygiene, improvements in handoff communication with patient engagement, and best clinical practices and products for

patients undergoing intravenous therapy. Having such a commitment to research helps drive a culture of curiosity and high achievement throughout the nursing ranks, and it plays to Penoyer’s love of teaching. Having been on the faculty of several universities, Dr. Penoyer called teaching her “Love Job.” “I wanted to give advance practice nurses the solid knowledge and science behind what they are doing, so they are not just following a checklist,” she said. Her own desire to understand the science behind the medicine she was learning was fueled by Dr. Lois Malasanos, the late

former nursing dean in the college of nursing at the University of Florida. “She’s the one who really shaped and molded me. The way she taught was so clear and so interesting,” said Penoyer. “It was intellectually stimulating to me to understand how a body works and mechanisms behind disease when it doesn’t work. And I learned from her so well. Her passion for it just stimulated a need in me to know more. Dr. Malasanos had her doctorate in physiology and I wanted to be just like her.” “Physiology is the foundation for almost everything we do. I just love it. Anybody who has been in my program can testify to that,” she said. And then a note of southern mischief crept into her voice. “I also talked about the benefits of fried chicken. All your body cells have a 2-layer membrane that has proteins, fat and water. You need cholesterol in your cells’ membranes to hold you together. So, I think it is absolutely appropriate that you have fried chicken so you can keep your cells together. So, you don’t land in a puddle somewhere. I stand by it. I have fun teaching. I laugh a lot.”

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How to Increase Patient Loyalty in 2020 By AMBER WOJCEK

The new year is when business owners often start thinking critically about changes they want to see in the new year. This is the time to put into place new processes and technology to build revenue and value for your practice. While some practice managers are hesitant to change the status quo – whether due to costs or training – it’s easier than ever to use technology to drastically impact your bottom line. If you want to increase revenue for your practice in the new year, it’s vital to focus on retaining loyal patients, attracting new patients, and ensuring that both groups make and keep their appointments. These areas can all be improved with affordable technological enhancements. WHAT DO PATIENTS WANT? One healthcare consumer experience study found that 41 percent of patients would change providers due to a poor digital experience, and 1 in 5 have already switched for this reason. Consider the impact not only of lost patients, but of lost referrals – just for something as simple as not providing online statements. The key to improving your patients’ experience is realizing that they aren’t comparing their experience at your office with other doctors. They’re comparing it to every other service they use. In other aspects of their lives, people can pay bills, make appointments, and get help from their phone’s internet browser. With nearly every other industry allowing self-service, on-demand assistance, why has medicine fallen so far behind?

A new patient portal may seem like an expensive upgrade, but consider this: according to one study, the loss of a patient due to dissatisfaction can result in a lifetime loss of $200,000 in revenue. 1 in 5 Boomers and 43 percent of Millennials and Generation Xers are likely to change physicians in the next few years. By improving your technology now, you’ll be cutting the costs of losing patients in the long run. GAIN NEW PATIENTS WITH UPDATED PHONE SYSTEMS While improving your patients’ digital experience will go a long way in improving their loyalty and engagement, don’t take your other communication outlets for granted. Phone calls remain as the top way that Boomers prefer to be communicated with by their doctors. Plus, over 70 percent of Millennials still like getting phone reminders and appointment alerts. However, that doesn’t mean that your phone system should remain unchanged. It’s been shown that 60 percent of patients won’t stay on hold for more than a minute, and only 32 percent will call back. With a traditional phone system, you’re just losing these patients to your competition. By

updating to a cloud or VoIP system, you can keep callers on the line with several features:

1. Custom hold messages. These are shown to increase the time people are waiting to stay on hold and provide valuable updates. 2. Interactive Voice Response (IVR). With caller input (such as saying “billing” or “appointments”) you’re routing calls to the correct party more quickly, providing better service and lessening the load on your reception team. 3. Unlimited lines. By switching from a landline to a cloud service, your callers will never hear a busy signal and will be more likely to stay on the line. 4. Online call portal. Find call history to return missed calls, dropped calls, or calls with vague messages. 5. Practice integration. Connect your phone lines to your practice management software to record notes and update records automatically.

MEET YOUR REVENUE GOALS IN 2020 Medical providers everywhere have more competition than ever for their patients’ attention. As technology makes other areas of life more streamlined, patients want to be empowered to have more control over their experience with medical practices. Simple advancements in your practice’s website and phone services can go a long way in getting ahead of your competition. Make it easier for your patients to get the information they need and to communicate with you on the platform they prefer. You’ll see more appointments, keep a higher percentage of your patients, and earn more client recommendations by modernizing your practice. Amber Wojcek is the marketing director for Vonix, an Orlando-based cloud communications provider. With a M.A. in Mass Communication from UCF, Amber studies and writes about trends in digital media and marketing for B2B businesses. To learn more about Vonix business phone solutions, including VoIP calling and software integrations, visit vonix.io or email awojcek@vonix.io.

EARN LOYALTY WITH A BETTER DIGITAL EXPERIENCE Making it easier for patients to make or pay for appointments on their own time means that they’ll be more likely to make them. Plus, by empowering patients to make, change, and cancel appointments online, you’ll be reducing the number of calls your office needs to handle, giving patients who are at your office more attention. Consider updating your practice’s website to include a portal that patients can log into. Here are a few tasks your practice’s online portal should offer to attract new patients and retain existing ones:

• Appointment requests • Account updates (name, address, phone number, and communication preferences) • Online bill pay • Cost estimator • New patient forms • Follow up requests • Access to care notes

DECEMBER 2019

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EAST ORLANDO CHAMBER OF COMMERCE

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Yes, Small Business Owner … There IS Value in Chamber Membership

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Tuesday, Dec 10, 2019 8:30 – 9:30 AM

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On the Menu Educational Series:

“Raising Capital & Ways to Do It” Featuring Jennifer Englert, Darnell Mahone & David Michalski

Wednesday, Dec 11, 2019 11:30 AM – 1:30 PM

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12301 Lake Underhill Rd., Ste 245 | Orlando, FL 32828

On the Menu Educational Series:

“Raising Capital & Ways to Do It” Featuring Jennifer Englert, Darnell Mahone & David Michalski

Wednesday, Dec 11, 2019 11:30 AM – 1:30 PM

EAST ORLANDO CHAMBER

12301 Lake Underhill Rd., Ste 245 | Orlando, FL 32828

Coffee Club Goldenrod EOCC 2020 Events, Sponsorships & More

Thursday, Dec 12, 2019

By DOROTHY HARDEE

Dear Editor, I am a small business owner in health care. Some of my neighbors say there is no value in Chamber Membership. A trusted health care business friend says, “If you see it in The Orlando Medical News, it is so.” Please tell me the truth, is there value in becoming an East Orlando Chamber (EOCC) Member? - Virginia, Small Business Owner & Physician practice Dear Virginia, your neighboring businesses are wrong. They have been affected by the skepticism of a skeptical age. They do not believe there is benefit if they don’t see immediate results from simply becoming a member. They are unable to see beyond the sticker on their door and the annual membership payment made as a means of expanding their footprint in the community. Yes, my friend there is value in a Chamber Membership. It exists in knowing 3 million businesses are currently part of a chamber of commerce throughout the country. When your clients know you are part of a local chamber, business will have a 63 percent increase in the likelihood that consumers will shop with you. Joining a chamber is a great way to be part of the

community. This is important since 8 percent of small businesses fail because they don’t have a network. Alas! How dreary would the community be if there was no Chamber of Commerce to further the interests of businesses, helping to lobby for laws favorable to you. The Chamber of Commerce was instrumental in persuading the federal government to institute a national budget and in gaining passage of the Federal Reserve Act in the early 1900’s. Its chief aims were to stop perceived over-regulations; increase production, develop new markets; provide more jobs; raise educational levels; build better cities; and keep organized business strong and increasingly effective. In the 60’s the Chamber thought of business in a different way, fighting a war against crime and poverty. During the oil crisis of 1973, the Chamber pushed for expanding domestic production. In 1981, the Chamber launched the Let’s Rebuild America campaign to help support President Reagan’s Economic Recovery and Tax Act. The Chamber of Commerce was instrumental in the building of the Golden Gate Bridge. Not believe in the Chamber of Commerce! You might as well not believe in small business. There is a 45 percent in-

crease of favorability among consumers as a member of the Chamber. There is a 43 percent increase in awareness among consumers as a Chamber member. Your local reputation is increased 82 percent when consumers know you are a member of the Chamber and an 82 percent increased likelihood of future patronage from consumers. The data doesn’t lie. Some business owners and physician practices say their schedule is demanding enough, thinking adding one more activity is unbearable. So why should you consider cramming time into an already hectic schedule to join and actively participate in the East Orlando Chamber of Commerce? Membership offers numerous benefits and keeps your business on top of important, ever-changing issues and trends within the 440 square miles of East Orlando where you do business. In addition to increasing your credibility and visibility within the community, the EOCC has many committees, networking and professional leadership development opportunities. You can build your business while promoting developments of keen interest to the community. You will gain a voice in government (CONTINUED ON PAGE 7)

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Thursday, Dec 12, 2019 4:30 – 6:00 PM

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EOCC Golf Outing 2020 Wednesday, Jan 8, 2020 7:00 AM – 2:00 PM

RIO PINAR COUNTRY CLUB

8600 El Prado Ave. | Orlando, FL 32825 Registration is Required at eocc.org | Sponsorship Opportunities available

Chamber Luncheon Board Installation & 2019 Chamber Awards Wednesday, Jan 15, 2020 11:30 AM – 1:15 PM

BONEFISH GRILL WATERFORD LAKES

2301 Lake Underhill Rd. | Orlando, FL 32828 Registration is required

Please visit www.EOCC.org for a complete listing of December’s events. 6

DECEMBER 2019

(CONTINUED ON PAGE 7)

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Less Than 30 Days to Take Advantage of the 30 Percent Solar Tax Credit

By JENNIFER FLOREZ

Since the solar tax credit is already on its second renewal and it is unknown if it will be renewed again, we recommend homeowners contact their local energy specialist to start the consultation process and review their specific savings, since energy consumption is different for each family. Homeowners may have seen the credit advertised from various solar companies, but they may not realize how enticing the deal really is. A number of benefits in the credit make this unique and one that homeowners should take advantage of. The credit doesn’t have a cap. This means homeowners can really take advantage of getting the home solar system that works for their house regardless of size. While homeowners average over $8,000 in savings, homeowners with extensive and larger solar panel installation will be able to get more than that. The definition of “residence” is very open. Although primary single-family dwellings are the most common residence, mobile and manufactured homes are also included. Investors or landlords can also use the credit on rental properties. Additionally, the credit isn’t limited to just primary residences. Even second or vacation homes qualify. Home solar systems only have to be installed, not operational, by the end of the year. With previous tax credits, installation

had to be operational in order to claim the tax credit. Now, the only requirement is to have the installation completed with an operational date of before December 31, 2019. Credits can roll over from one year to another. If a homeowner doesn’t have the full tax liability to claim the entire 30 percent credit, it can be rolled into the next year. Besides the benefit of the Federal Tax Credit incentive, going solar makes sense because it brings savings in comparison with a traditional electric bill over time, increases the value of the property and offers a clean, renewable way to power your house. Ask your energy specialist about it. It’s no surprise to Central Florida residents that solar energy is a growing source of renewable energy. Afterall, Orlando has an average of 233 sunny days a year. Currently, Florida is 5th in the country for solar energy, but that should continue to rise. Rising energy costs, lowering cost of installation and available solar tax credits are all factors in making solar energy attainable. Time is running out. Start your consultation now. Jennifer Florez is the business developer for Clever Energy, in Orlando, a family-owned solar company specializing solely in solar panels and offering free personalized consultation in both Spanish and English with licensed installers. Customized solar proposals are based on the specifics of the house – roof space, shade analysis and energy consumption. Clever Energy is part of Pro Who Knows presented on Channel 6 every Saturday at 6:55 am. Call 407.274.1531 or book your consultation online at https://gocleverenergy. com/calendary/

EOCC MEDICAL CITY

Yes, Small Business Owner… There IS Value in Chamber Membership, continued from page 6 as the EOCC takes on tough issues and opposes new regulations, taxes, fees, assessments and costs directed at small businesses. It helps to protect the principles of free enterprise and aids businesses in being treated fairly. Make business contacts, receive the Chamber Newsletter, acquire customer referrals, expand your prospect base through events and programs, promote to potential clients through member exclusive advertisings and B2B advertising, as well as access to member-only discounts and services. The EOCC has something for everyone. Health care providers are important to the community because they offer essential services. Health care is also a thriving industry sector offering a significant impact on our local economy. They are businesses providing vital jobs and have made the Chamber part of their success strategy. For one optometrist, networking was a small part of the key to success. The Chamber programs and relationships made through networking helped her practice grow exponentially. For a Marketing Director at a 76-bed rehab hospital, hosting After Hours, opening their doors to the community, as well as participating in events and forums has been a vital addition to business expansion. Building trust and confidence within the community and networking of-

fered a springboard of success for an orthodontist seeking to expand business. How is the East Orlando Chamber helping you grow your business? As we approach year 2020, our focus is on each industry offering tailored opportunities for exponential growth. From a Health Council focusing on the entire landscape with special attention to quality, cost and access; a Roundtable offering you a BNI focused referral network for healthcare professionals; events, programs and sponsorship to elevate your visibility; networking opportunities helping your business thrive; advocacy efforts with your business in mind and so much more. No value in the Chamber of Commerce? Thank goodness chambers have been around since 1599 and the East Orlando Chamber since 1946. Let’s meet to discuss your business objectives and how the EOCC helps drive results making you a long-term member of one of the oldest established chambers in Central Florida. 407277-5951 or eocc@eocc.org. Dorothy Hardee is the administrator of the East Orlando Chamber of Commerce. Contact her at DorothyH@eocc.org

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VOLUNTARYBENEFITS: NOT SO VOLUNTARY

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Are you sick and tired of talking to your employees until you’re blue in the face about their work performance? Try providing feedback. Criticism is not feedback. Criticism assumes your way is the better way and inhibits the brain from learning. Paying attention to weaknesses smothers the brain. Your brain responds to critical or negative feedback as a threat and narrows its activity. In a scientific study noted in “Nine Lies About Work” and “The Feedback Fallacy” (both by Marcus Buckingham and Ashley Goodall, Harvard Business Review) students hooked up to MRIs were asked what

they were doing wrong and what needed to be fixed - their sympathetic nervous system lit up. The sympathetic nervous system prepares the body for intense physical activity and is often referred to as the fight-or-flight response. When students were asked about their dreams and how they might achieve them, their parasympathetic nervous system lit up. The parasympathetic nervous system has almost the exact opposite effect. This stimulates a sense of well-being, and even better immune system functioning. So, it’s good for your health claims too! The study also argues that disturbing the PEA is critical when creating or affirming a personal vision. The PEA

is an endogenous stimulant of the human brain that amplifies the activity of major neurotransmitters for multiple bodily reactions including a sense of well-being and higher performance of your body and brain. Again, all positives for your health insurance claims. So now what? Focus on positive outcomes and experiences. Discuss scenarios or meetings that went well. Such as “here are three things that went really well.” Tell your team - “let’s do more of that! I want all of our meetings to look like that. That - yes, that!” Describe your experience when you catch them doing something good. Trust me, they already know how you felt when they screwed up.

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Electronic Health Records Continue to Lead to Medical Malpractice Suits By DARRELL RANUM

age of claims where EHRs are a factor:

A patient was treated with trigger point injections of opioids for pain management. The physician intended to order morphine sulphate 15 mg to be administered every eight hours. The electronic health record (EHR) drop-down menu offered 15 mg and 200 mg. The physician mistakenly selected 200 mg. The patient filled the prescription and took one dose with Xanax. The patient developed slurred speech and was taken to the emergency department (ED), resulting in overnight hospitalization and a malpractice claim against the physician for emotional trauma and the costs of the ED and hospital stay. This type of EHR-related medical malpractice suit is becoming more common. For 8 years, claims in which the use of EHRs contributed to patient injury have been on the rise. The Doctors Company’s analysis of claims in which EHRs contributed to injury show a total of 216 claims closed from 20102018. The pace of these claims grew, from a low of 7 cases in 2010 to an average of 22.5 cases per year in 2017 and 2018. EHRs are typically contributing factors rather than the primary cause of claims, and the frequency of claims with an EHR factor continues to be low (1.1 percent of all claims closed since 2010). Still, as EHRs approach near-universal adoption, they may become a more prevalent source of risk.

*Note that the percentages are of the total number of electronic health record claims (n=216).

CASE EXAMPLES: USER-RELATED ISSUES

10 5%

Case 1: Electronic Systems/Technology Failure Presentation: An elderly female patient presented to an otolaryngologist for sinus complaints. The physician intended to order Flonase nasal spray. The patient took the medication as directed. Two weeks later, the patient went to the ED for dizziness. Outcome: The ED physician discovered the patient was taking Flomax—a medication for enlarged prostate, one side effect of which is hypotension. The original ordering physician had entered “FLO” in the medication order screen, and the EHR automatically selected Flomax. Not noticing the error, the physician selected it. There was no EHR drug alert for gender. Case 2: Fragmented Record Presentation: A 55-year-old male patient presented to the ED with back pain. He was diagnosed with severe lumbar stenosis. Following surgery, nurses noted neurological changes. They documented the changes and called the physician, but no action was taken. Outcome: Due to a fragmented record (both paper and EHR), information was not communicated to the correct physician. The delay in contacting the correct physician resulted in a delay of return to surgery and partial paralysis.

8 4%

TOP USER- RELATED ISSUES

CLAIM COUNT

PERCENT

Incorrect information Pre-populating/ copy & paste Hybrid health records/ EHR conversion issues User error-other Training and/or education Alert issues/fatigue, user-related Computer order entry workarounds Grand Total

13%

The EHR-related claims closed from 2010-2018 were caused by either system technology and design issues or by user-related issues. CLAIM COUNT

Other Electronic systems/ technology Failure-EHR Lack of or failure of EHR alert or alarm Fragmented record Failure/lack of electronic routing of data Insufficient scope/area for documentation in EHR Lack of integration/ incompatible systems Failure to ensure information security Grand Total

PERCENT

30 14% 26 12% 15 7% 14 6%

5 2% 1 0% 104* 48%

*Note that the percentages are of the total number of electronic health record claims (n=216).

DECEMBER 2019

HEALTH RECORD FACTORS

CASE EXAMPLES: SYSTEM TECHNOLOGY AND DESIGN ISSUES

WHERE DO EHR-RELATED RISKS COME FROM?

TOP SYSTEM TECHNOLOGY & DESIGN ISSUES

TOP 12 CLINICAL SERVICES WITH ELECTRONIC

25 12% 16 7% 5 2% 4 2% 129* 60%

Case 1: Copy & Paste Presentation: A physical medicine physician followed a patient with extreme weakness due to cervical vascular malformation. Nurses and a physical therapist noted neurological changes, but the physician’s note indicated no changes. The physical therapist contacted the attending physician to discuss neurological changes including increased weakness. The physical therapist asked the physician to order a neurological consult due to the patient’s deteriorating condition. Outcome: The physician ordered the consult but did not explain why his documentation did not address the patient’s changing condition. The patient was taken to surgery and now has incomplete quadriplegia. The physician was criticized for copying and pasting the same note for four days and delaying the intervention. Case 2: Copy & Paste Presentation: A 38-year-old obese patient presented for medical clearance. His test results were normal. Three months later, the patient presented with shortness of breath and dizziness. His blood pressure was 112/90 and pulse was 106. No tests were ordered. Outcome: Five days later, the patient expired from pulmonary embolism. Experts questioned whether the physician had conducted a complete assessment. The progress note was identical to the previous note from three months earlier, including old vital signs and spelling errors. WHICH SPECIALTIES ARE MOST AT RISK? In an effort to identify and communicate system failures that result in patient harm, The Doctors Company identified the specialties who receive the highest percent-

1 2 3 4 5 6 7 8 9 10 11 12 13 14

Family Medicine 8% Internal Medicine 8% Cardiology 6% Radiology 6% Obstetrics 5% Orthopedics 5% Nursing 5% Hospital Medicine 4% Gynecology 4% Emergency Medicine 3% Anesthesiology 3% Plastic Surgery 3% Urology Surgery 3% General Surgery 3%

WHAT ARE THE INJURIES AND ALLEGATIONS? Of those injuries that occurred in 7 percent or more of claims, adverse reaction to a medication and death were by far the most (CONTINUED ON PAGE 12)

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Electronic Health Records Continue to Lead to Medical Malpractice Suits, continued from page 11 prevalent in EHR-related claims. Patient Injuries • Death 25% • Adverse reaction to medication 23% • Need for surgery 15% • Emotional trauma 14% • Undiagnosed malignancy 13% • Organ damage 11% • Infection 9% • Ongoing pain 7% • Mobility disfunction 6% In terms of the top allegations, diagnosis-related allegations represented nearly one-third of the total: • Diagnosis related 31% • Improper medication management 11% • Improper management of surgical patient 8% • Improper management of treatment plan 7% • Improper performance of surgery 7% • Medication ordering / Wrong medication 5% • Medication ordering / Wrong dose 5% • Improper performance of treatment or procedure 5%

TOP 5 TIPS TO AVOID EHR-RELATED CLAIMS As a foundation, practices should have processes in place to monitor EHR issues and prioritize the need for EHR redesign based on risk. Identifying common EHR-related pitfalls and establishing risk mitigation strategies to minimize the chance of patient harm are important results of closed claims studies. Here are the top five risks and suggestions to avoid an EHR-related malpractice claim: Risk: Copy/paste may perpetuate incorrect or outdated information. Solution: Avoid copying and pasting except when describing the patient’s past medical history. Risk: Many EHRs auto-populate fields in the patient’s history and physical exam and in procedure notes, causing the entering of erroneous or outdated clinical information Solution: Contact your organization’s IT department or your vendor if you notice that the auto population feature causes erroneous data to be recorded. If the auto populated information is incorrect, note it and document the correct information. Risk: Templates with drop-down menus facilitate data entry, but an entry error may be

perpetuated elsewhere in the EHR. Solution: Review your entry after you make a choice from a drop-down menu. Risk: Doctors are responsible for the information to which they have reasonable access. EHR metadata documents what was reviewed. A patient injury may result from a failure to access or make use of available patient information. Solution: Review all available data and information prior to treating a patient. Risk: The computer may become a barrier between the doctor and the patient. Solution: Relocate the computer so the physician’s back is not to the patient and so the patient can view the screen. Remind the patient that you are listening carefully, even though you may be typing during the appointment and summarize or read the note to demonstrate you have listened.

Darrell Ranum, JD, is the Vice President of Patient Safety and Risk Management for The Doctor’s Company. Visit https://www.thedoctors.com/

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

DECEMBER 2019

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Tackling Physician Burnout Requires Unprecedented Leadership By ROBERT D. MORTON

The term “burnout” has been questioned as a labeling error – and rightfully so. Burnout implies victim shaming. What many healthcare professionals on the frontlines are experiencing is a normal response (symptoms) to an abnormal situation (cause), like sick fish in a tank of toxic water. A diagnosis of burnout suggests that the solution is to medicate the fish. A more holistic view is to say, “There’s really nothing wrong with you; let’s clean the tank.” The World Health Organization (WHO) announced plans to include what it labels “burn-out” as an occupational phenomenon in the International Classification of Diseases (ICD-11). The syndrome, which results from chronic workplace stress, is characterized by feelings of exhaustion, increased mental distancing from one’s work or cynicism about work, and reduced professional efficacy. The WHO’s actions seem to further legitimize what many are experiencing: an ever more exhausting, distancing, and chronically stressful healthcare system that makes connecting with patients and providing quality care more challenging and contributes to burnout, healthcare professional distress, or to what some have even labeled moral injury or human rights violations. PHYSICIAN BURNOUT THOUGHT LEADERS WEIGH IN Drs. Simon Talbot and Wendy Dean, who co-founded the nonprofit organization MoralInjury.healthcare, borrowed the expression “moral injury” from Jonathan Shay, MD, PhD, a clinical psychiatrist who coined the phrase. Briefly, it is (1) a betrayal of what’s right, (2) by someone who holds authority, (3) in a high-stakes situation. Discussions of moral injury include the view that repeated daily betrayals by authorities within the system are manifest in healthcare every day in the form of mandates from leaders to see more patients with less time to care for them, forced use of dysfunctional electronic health record (EHR) systems, overburdens by payers, competing financial considerations, fear of litigation, and more. These types of betrayals run counter to patients’ best interests—which pains doctors, whose unifying creed is that patients come first. While other physician thought leaders like Dr. Dike Drummond (thehappymd. com), Dr. Paul DeChant (author, Preventing Physician Burnout), Dr. Zubin Damania (aka ZDoggMD), and Dr. Pamela Wible (idealmedicalcare.org) may differ on the terminology, each makes a similar call for leadership and action equal to the severThe guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

DECEMBER 2019

ity and scope of the dilemma. They all call for partnering with enlightened leaders to change the systemic and institutional patterns that inflict betrayals on the practice of good medicine. Dr. Wible calls these issues human rights violations that begin in medical education and training due to labor law abuses, sleep/ food/water deprivation, discrimination, violence, understaffing, and more—driving up depression and suicide rates. Because of the profound impact on individuals, there is broad consensus about the immediate need to expand access to confidential, nonpunitive mental healthcare for doctors and nurses. In response to systemic conditions, some doctors are quitting because having less time with patients has driven morale to rock bottom, and those who remain are warning of a mass exodus if things don’t improve. According to Paul DeChant, MD, MBA, a failure to step up and meet this challenge is a failure of leadership and constitutes management malpractice, with some administrators asserting that they are suffering from management burnout. Dr. Howard Marcus, an internist in Austin, Texas, responded, “Most of us do not see our administrators as oppressors but, rather, as stuck along with the rest of us in a system that has piled on time-consuming burdens—which saps us of the time and energy required to do the best we can for our patients in the time available.”

An Annals of Internal Medicine costconsequence analysis reported that physician burnout is costing $4.6 billion per year related to physician turnover and reduced clinical hours. The authors offer a prescription that burnout “can effectively be reduced with moderate levels of investment,” suggesting there is “substantial economic value for policy and organizational expenditures for burnout reduction programs for physicians.” The National Academy of Medicine issued a report that offers a bold vision for systemic change—because “the system,” the amorphous healthcare-industrial complex, is designed, unwittingly or not, to produce the results it is producing. When you take what is at its core a moral and scientific enterprise, that is the practice of medicine, and relentlessly mess with it in an unscientific manner driven by economics and regulation, physician burnout is the expected outcome. The scope and breadth of the problem requires unprecedented leadership, shared “collective and coordinated action across all levels of the health care system—front line care delivery, the health care organization, and the external environment.” Leadership matters. The Mayo Clinic reported that a one-point increase in the leadership score of a physician’s immediate supervisor was associated with a 3.3 percent decrease in the likelihood of burnout. This and other reports support the often-quoted conclusion that your supervisor is more im-

portant to your health than your primary care doctor. If leadership will not make this issue a priority, lead as though no help is coming. Executive leaders in some healthcare systems are beginning to require all executive staff to frequently round with or shadow physicians and to ask questions like “What isn’t working?” To be of value, executive leaders must be armed with the courage to lead and an organizational commitment to change. Some systems have appointed chief wellness officers and formed clinician wellness teams, giving them authority to create opportunities to support well-being and resiliency. Steven Beeson, MD, founder of the Clinician Experience Project, urges “to advance care for patients and take on the healthcare imperatives in front of us, we have to care for those caring for others first. To care for the care team we must listen to clinicians, respond to the things they need, invest in burden reduction, support and develop them to be their best, empower them to lead the way, allow them to be the clinician they envisioned, and appreciate the impact they make when we do these things.” (Stephen Beeson, MD, email communication, July 17, 2019.) EFFORTS TO IMPROVE EHR USABILITY EHR rescue and optimization work is becoming more common to regain lost (CONTINUED ON PAGE 14)

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Importance of Updating Your Website Now That Google Has Gone Mobile First By QUINTIN L. GUNN, Sr.

In the last two years, there have been significant changes within and surrounding the internet as mobile phones have become a dominant factor in terms of how everyone communicates. These changes have been so dramatic that Google even had to modify its search perimeters to a Mobile-First platform. Mobile online traffic has already blown by desktops, laptops, and iPads. Google using sound business practices decided to go where the traffic is leading, and that traffic is mobile-first search. On the other hand, Facebook has also made significant adjustments with mobile phone use on their platforms. Now with the acquisition of Instagram, Messenger App, WhatsApp, and Chatbot autoresponders, Facebook is able to deliver rapid and responsive services via your cellphone. These are just a few of the recent changes which may be causing your website to become obsolete. If you haven’t updated your website in the last two years, you are likely to quickly fall behind in new customers and new business. The hard facts are, how you look online will attract or repel new consumers and or patients. If your website style, image, and colors appear outdated, new patients are likely seeking out your competition. Customers might

think if the website is outdated and unresponsive your business might also be out of date. By updating or creating a mobile-first, responsive, and visually compelling website, we believe this could be the ticket to driving many new consumers and patients to your practice. This, in turn, will help you get back on the road to success! And by the way, we updated our own company website if that gives you any indication of the urgency. Here are a few additional reasons why Mobile First is important: Mobilization of Websites Need For Updated Content Https Security Integration Google Mobile-First Change Social Media Integration Updates ChatBot Integration Updates Terms Of Use and Privacy Policy Ongoing WordPress and Mobile Updates

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Tackling Physician Burnout Requires Unprecedented Leadership, continued from page 13 relationships with patients. Executive leaders who are desperate for help often contact firms like Medical Advantage Group (MAG), a subsidiary of The Doctors Company. MAG conducts system database audits, followed by workflow analysis, previsit planning, and redesign of work screens to make the EHR function better as a convenient, accessible clinical source of truth. Ironically, this improvement in EHR accessibility and usability makes the EHR function more like old paper charts when everything was at hand. Other benefits of this work include increases in quality-based payments, improved EHR user efficiency and experience, reduced time spent searching, and reduced or eliminated “pajama time” (charting at home). On a smaller scale, Dr. Gabe Charbonneau (fightburnout.org), a family physician and EHR problem-solver who is on a mission to disrupt burnout, finds his greatest fulfillment in helping doctors one-on-one. Another example related to EHR usability is at Atrius Health, where a collaboration with its IT department reduced inefficiencies by cutting 1,500 clicks per day per physician. This sustained, resourced com-

mitment to improvements resulted in less time spent in the EHR and improved professional satisfaction. Like any meaningful change, improvements require leadership with a growth mindset that demonstrates a deep respect for people and for the nature of their work. This means exhibiting leadership behaviors such as deference to expertise and sensitivity to clinical operations—two characteristics of the continuous improvement mindset on the journey toward high reliability. Effective leaders meet physicians where they live—on the frontlines of care—and seek to understand what is getting in the way of connecting with patients and providing quality care. The best leaders then work tirelessly to remove the barriers. ADDITIONAL RESOURCE American Hospital Association and AHA Physician Alliance. Well-being playbook: a guide for hospital and health system leaders. https://www.aha.org/system/files/media/ file/2019/05/plf-well-being-playbook.pdf. Published May 2019. Robert D. Morton, CPHRM, CPPS, is the Assistant Vice President in the Department of Patient Safety and Risk Management for The Doctors Company. Visit https://www.thedoctors.com/

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The Physical Therapist: An Important Member of the Wound Management Interdisciplinary Team By DR. NILMA ELIAS SANTIAGO

The growing prevalence and incidence of acute and chronic wounds in the United States is a major concern for the healthcare system. One wound alone can cost the system up to $28 billion. Therefore, patients with wounds must be managed by the best clinicians to achieve the best possible outcomes. Wound management should involve an interdisciplinary team with each member providing their area of expertise collaboratively to benefit the patient and facilitate positive results. Physicians, nurses, dietitians, pharmacists, the patient as an active member of his/her care, caregivers, occupational therapists, and physical therapists must be part of this team. Physical therapists are healthcare providers who diagnose and treat individuals with medical conditions that impact their mobility and functional independence. The American Physical Therapy Association indicates that “PTs examine each individual and develop a plan, using treatment techniques, to promote the ability to move, reduce pain, restore function, and prevent disability.” Most healthcare practitioners know the role of the PT in rehabilitation and pain management. However, the PT’s scope of practice involves other areas, including wound management. Patients with acute and chronic wounds often present with pain, edema, inflammation, among other impairments causing limitations in the ability of the individual to perform daily tasks. Aside from the medical complications an open wound can cause, lack of social participation, inability to work, need for a caregiver and increased burden of care can arise due to this integumentary compromise. The PT can assess a wound, establish an adequate plan of care, provide interventions to facilitate healing, and manage the functional limitations associated with having the wound. Hence, PTs are an important member of the interdisciplinary team for wound management. Self-care, ambulation, transfers, etc., are just a few of the problems a patient with an open wound may present that a PT can treat. In addition, PTs engage in education, health promotion, and wellness, facilitating primary, secondary and tertiary prevention to decrease the risk for individuals to develop wounds. Wounds undergo four physiological phases of healing: hemostasis, inflammation, proliferation, and remodeling. Local and sys-

DECEMBER 2019

temic factors can affect the normal progression of these stages affecting the closure of a wound. Impaired oxygenation, infection, and venous insufficiency are examples of local factors that affect the characteristics of the wound itself. Smoking, alcohol abuse, diabetes, age, obesity, and stress among others are examples of systemic factors, which involve the overall health of the individual and their ability to heal. PTs provide patient education to manage these systemic factors affecting wound healing. Nevertheless, PTs can also manage local factors with specialized interventions and modalities to facilitate wound healing. These interventions include but are not limited to sharp debridement, pulse lavage, specialty dressings to facilitate moist wound healing, compression therapy, electrical stimulation, low-frequency ultrasound, and low-level laser therapy. Upon assessment of the wound, the PT can determine which interventions are more appropriate to assist the wound to progress to the next stage, not to mention the comprehensive functional evaluation to assess how the wound affects the patient’s ability to perform his/her activities of daily living and/ or instrumental activities. For example, an elderly patient presents with an acute wound from a skin tear. He/she benefits from the expertise of the PT who will not only examine

the wound and provide the most appropriate intervention but also determine how to prevent another one by providing education and treatment on how to care for the skin, issue arm/leg sleeves to decrease friction forces that breakdown the skin, and teach proper mobility techniques to prevent falls, skin trauma, etc. Another example would be a patient with a diabetic foot ulcer. The PT can assess the wound and evaluate the patient’s strength, range of motion, sensation, deep tendon reflexes, balance, gait, assess the shoewear and provide education on off-loading, diabetes, foot care, daily skin inspection, etc. to facilitate wound healing and prevent further skin breakdown. Nonetheless, it is important to remark that should the wound present with characteristics requiring interventions outside of the PT’s scope of practice, the therapist has the competence and obligation to make a referral to the appropriate practitioner. One example would be a wound demonstrating upon assessment 100 percent of eschar or slough that requires surgical debridement, the patient will be referred to a general surgeon. Physical therapists can provide wound management across different practice settings such as acute/intensive care, outpatient, rehabilitation, home health, skilled nursing, and sports medicine. Since wound management needs may vary among patients and clinical

settings, examination, evaluation, interventions, and goals are adjusted to the individual patient needs in each setting. As mentioned above, physical therapists are important members of the wound management interdisciplinary team because of their expertise in functional mobility and how this is affected by an acute or chronic wound. In addition, PTs can pursue board specialized certifications in wound management demonstrating a high level of training. Consequently, for a patient with a wound to reach his/her functional goals along with wound healing, the physical therapist is, without a doubt, a crucial member in the wound management interdisciplinary team. In the words of Dr. Carrie Sussman, a pioneer physical therapist in the field of wound management and a member of the Academy of Clinical Electrophysiology and Wound Management: “Treat the whole patient, not just the hole in the patient.” Dr. Nilma Elias Santiago, PT, DPT, WCC, CLT, OMS, is the owner and Physical Therapist at Integumentary Physiotherapy Clinic. She is Board Certified in Wound Care, Ostomy Management and Certified in Lymphedema Management. She can be reached at nilma@integumentarypt. com. Also visit http://www.integumentarypt.com

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The Aide Crisis in Healthcare 1.2 million additional aides needed in the next ten years By TINA MARRELLI

The lack of qualified and compassionate aides is a crisis that impacts many facets of health care adversely. We are all aging, and many of us work, play and live in Florida, which has one of the fastest growing populations in the U.S. Think about the age of those around you. 10,000 Baby Boomers turn 65 every day! As a long-time nurse and author of books on home health care, hospice, and family caregiving, it is obvious to me that the need for caring and competent aides has never been greater. For those who are in a caregiving role, the challenge to find and hire aides can be difficult. Organizations who provide aide services experience the task of finding qualified aides and also may struggle with turnover and retention. Regardless of our roles and business, there is a need to increase the number of aides who provide this essential health care. Depending on the scope of the aide’s skills and training, “aides” can be called a number of titles such as a home health aide,

hospice aide, home care aide, personal care aide, certified nursing assistant (CNA) or state- tested nursing assistant (STNA). According to the Bureau of Labor Statistics (BLS) it is projected that by 2028, approximately 1.2 million additional home health and personal care aides will be needed to provide this fundamental care. I believe we all have a role in identifying people who might be/become great aides and helping them in that mission. Aides should be valued and recognized as the foundational structure for health care in the United States. They work in a variety of settings, such as nursing homes, home health, hospice, hospital, assisted living and other community and home-like settings. So, what exactly do home health and personal care aides do for patients? Simply put, they assist with or perform tasks and activities we do (and sometimes take for granted that we can do) every day. This includes activities of daily living and at times very personal care. Think about this from an aide’s perspective—the environment and culture can be very different from one patient home to

another. Oftentimes, within an hour, an aide is assisting the patient sometimes to awaken/ get up, take a shower or help with bathing, oral care, encouraging independence and assisting when needed in activities such as choosing clothes, dressing, preparing and serving meals. Depending on the patient’s needs, sometimes the patient is fed, toileted and assisted with other basic elements of body functions. Depending on the organization in which the aide is employed, other tasks may include observation, taking vital signs, practicing infection control, documentation of the patient’s status, and tasks performed. The aide must be knowledgeable and aware of changes to report to their supervisor. Communication and interpersonal skills are so important for those who are infirmed, may live alone and be isolated, and who are very dependent on others for their needs. This is where aides come in. The challenge of successfully recruiting over a million more aides is complex and nuanced. R and R, or recruitment and retention, needs to be reframed and switched to retention and recruitment. The emphasis on retention is important to keep great aides in

the profession. This then is the challenge and also a great opportunity for performance improvement and to drill down and identify the real reason(s) aides leave. Analyzing those reasons, exploring potential solutions, and working toward defined objectives are all parts of this process. Of course, there may not be one answer. Remaining at home is most often preferred as we age. For many this requires the valuable skills of that qualified and compassionate aide, wherever the healthcare setting. The future is here, and so the aide shortage should be approached with new eyes when seeking a workable solution. Let’s encourage a collaboration with stakeholders in the challenge of promoting aide -related initiatives and work together toward the goal of effective long-term answers to this dilemma of the aide crisis. Tina Marrelli, MSN, MA, RN, FAAN is the President of Marrelli and Associates, Inc. a consulting and publishing firm. Tina is the Chief Clinical Officer for e-Caregiving.com and the author of a number of books including the award-winning, “A Guide for Caregiving: What’s Next? Planning for Safety, Quality, and Compassionate Care for Your Loved One and Yourself” which recently was awarded a 2019 Caregiver Friendly Award by Today’s Caregiver Magazine. This book is also an e-book. Tina is also the author of “Home Health Aide: Guidelines for Care –Instructor Manual” www.marrelli.com

CBD and Baby Boomers By CONNIE ORTIZ

Are you part of this amazing generation known as the Baby Boomers? Baby Boomers grew up during a period of prosperity. Present day baby boomers control 70 percent of the nation’s disposable income, and they are the driver of many modern solutions in healthcare and retirement as they continue to age. More and more baby boomers are looking at CBD products to assist them with some of their health challenges. CBD is a natural Phyto cannabinoid known as cannabidiol. Unlike Marijuana, CBD derived from hemp does not give you that euphoric feeling. However, research does suggest that CBD may have a lot of analgesic properties and over a period of time, CBD can help by promoting overall wellness. CBD interacts with our body’s natural endocannabinoid system. Our endocannabinoid system is involved in every system in our bodies. It interacts with our CB1 and CB2 receptors. They’re either fully activated by the receptor that it binds to, or it binds to the receptor but does not activate it and can block the activity. CDB has also been known to interact with other non-cannabinoid receptors like our serotonin receptor, the feel-good receptor. As baby boomers and their parents get older, there is more anxiety and stress; it’s pretty common as we get older. Baby boomers tend to have more stress as they become the care takers of their parents. There are many things that can set off anxiety in seniors, but there are studies that suggest that CBD can be a benefit because it can boost the levels 16

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of the neurotransmitter Anandamide, which promotes the good feelings of happiness and it can help Anandamide last longer. Serotonin receptors are important in our mental health, and the evidence is that CBD helps activate the serotonin receptor. Serotonin receptors help regulate our mood and anxiety. As we age, we are prone to aches and pains. But if you begin a regimen of CBD, after a while you will notice, like so many athletes have, that CBD is naturally anti-inflammatory and can help with muscle recovery. It’s a natural alternative that is non-addicting and does not come with a long list of side effects. It’s easy to get on a regimen by starting your day with a cup of CBD infused Organic Coffee. CBD coffee with its low dose of CBD gives you that boost and could elevate your mood and increase mental clarity without giving you that jittery feeling that you sometimes get from caffeine. Also consider adding a sublingual CBD tincture/oil, or an edible CBD Gummy. These are a tasty little treat that are very easy to take, but they are a great way to keep CBD in our systems. Consider too a CBD Topical for external use only. A topical is absorbed directly through the skin for localized relief of pain, soreness or inflammation. A topical is used more often.

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Four Types of Commercial Real Estate Properties to Consider for Your Healthcare Practice: Office vs Retail vs MOB vs Hospital Campus By DOUG PRICE

There are four main types of commercial real estate properties that best fit the needs and requirements of healthcare professionals: office buildings, retail space / shopping centers, medical office buildings (MOB’s) and hospital campuses. While there are distinctions between the classes, variations and vintages of these types of spaces, the comparisons typically boil down to several main considerations:

• Visibility, signage and exposure • Window lines and natural light • Monthly cost • Who performs property maintenance • Building amenities • Synergy with other practices or businesses • Accessibility, including parking and walking distance to the space’s entrance • And more… Each property type has benefits and understanding what those are will help you determine the type of space that best suits your practice.

OFFICE SPACE Traditional office spaces typically provide more natural light and better window lines than retail spaces, and often at a lower cost. Office spaces provide a traditional business setting with other professional office or corporate based entities and offer a familiar experience for patients. Most office buildings provide more assistance and maintenance from landlords as well, as many of the systems and amenities in the building serve and benefit multiple tenants. Office buildings often have common area benefits such as shared restrooms, vestibules, lobbies and sometimes common meeting spaces such as conference facilities. The cost of office space is greatly dependent on location, quality and age of the property, as well as supply and demand. But as a whole, traditional office buildings are usually priced the most competitively compared to retail, medical office buildings or hospital campus spaces. Taxes and maintenance expenses are also typically lower in office buildings compared with the latter three property types as well. The competitive pricing along with ideal window lines, natural light and a professional office setting make office spaces an attractive option for healthcare practices. RETAIL SPACE / SHOPPING CENTERS The primary benefits of retail spaces are that they typically provide more visibility, exposure and signage than other commercial property types. Signage and exposure are very important to public-facing, retail companies as they rely heavily on top of mind awareness and brand recognition. Hundreds or even thousands of potential customers or 17

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patients that drive by a sign every day generally creates additional revenue for those companies. Another benefit of locating in a retail or shopping center is the synergy of other diversified tenants who drive traffic to the center. For example, having restaurants, a grocery store or other retail or service-based businesses in a shopping center will likely help you glean extra patients from their traffic. Many patients also find added convenience in being able to frequent neighboring retailers and businesses in the same trip. Additionally, many healthcare providers like the simplicity of patients parking right in front of their spaces and being able to walk directly into their office. Being in a retail center typically provides the benefit of ample parking due to the need to accommodate traffic for multiple businesses, both large and small. Lastly, retail properties usually offer easy access and have identifiable cross-streets and landmarks nearby. They are developed with high traffic flow and growth in mind, making it easy for patients to access. Depending on the location and quality of property, retail spaces can be some of the most expensive options in the market due to the many advantages described. If evaluated properly, the benefits of placing your healthcare practice in a retail space can far outweigh the costs. MEDICAL OFFICE BUILDINGS (MOB’S) Medical office buildings are dedicated exclusively to healthcare tenants and often provide an atmosphere that creates strong referral partners and synergies from healthcare related tenants. This is the greatest benefit of being in a Medical Office Building. If your practice operates off of a strong referral base of practices located nearby, then an MOB could be a great location for your practice. MOB’s usually offer an increased supply of janitorial and utility services, and often, other healthcare related amenities. Medical Office Buildings are typically more expensive than traditional office buildings, but again, cost depends on many factors; including location, quality and age of the property and so forth. Medical office buildings typically communicate professionalism in the healthcare community along with ideal synergies of other providers. HOSPITAL CAMPUSES Hospital Campus spaces are very similar to an MOB, and in fact many MOB’s are located on hospital campuses. The differentiating factor is the hospital itself. The number one reason a practice would desire to be located in or near a hospital campus would be its affiliation with the hospital itself or other complimentary

building vs. retail space vs. MOB vs. a Hospital campus, your healthcare real estate agent should help you fully evaluate all your top options. Your agent should provide you a detailed breakdown of the pros and cons of each top property option and how they would positively or negatively affect your practice. Budget typically plays one of the main factors in making your choice. However, there are many other pros and cons of each property option that your agent should fully evaluate with you, to ensure you make the best choice for your office location. practices that are affiliated with the hospital. Hospital affiliation is largely intended to create a strong referral base for a practice or the ability to easily access amenities such as a surgery or delivery center, etc. Being located on a Hospital Campus is not the right fit for all healthcare related practices. But for the providers that find value in the benefits described above, it can be the exact location they want. When considering if your practice should stay or locate in a traditional office

Doug Price is an agent with CARR Healthcare, the nation’s leading provider of commercial real estate services for healthcare tenants and buyers. Every year, thousands of healthcare practices trust CARR to achieve the most favorable terms on their lease and purchase negotiations. CARR’s team of experts assist with start-ups, lease renewals, expansions, relocations, additional offices, purchases, and practice transitions. Healthcare practices choose CARR to save them a substantial amount of time and money; while ensuring their interests are always first. Contact Doug at Doug.Price@carr.us

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GrandRounds Unified Communications Provider Vonix Launches in Florida ORLANDO – Vonix announces the launch of their office in Central Florida, joining the growing number of innovative technology companies that call Orlando home. Vonix provides businesses with telephone and unified communication services with onsite installations and in-house support. Owners John Vinci and Christian King have collectively spent over 20 years working in cloud communications and phone technology. They found that there was a need for better, hands-on support which wasn’t being met by the national providers. “When business owners have a phone issue, they aren’t getting the help they need,” said Vinci. “They wait on hold, get transferred between call centers, and end up not finding solutions to their problems.” Vonix seeks to change the reputation behind business telephone providers by offering in-house installation and support. Vinci continues: “With Vonix, when people call for help, they get a person in our office – not outsourced support.” Aside from offering businesses with better service, Vonix also seeks to help companies delight their own customers with better communication features. On average, customers hang up after waiting on hold for 90 seconds, and 34% of those customers will not call back. With features like call queuing and call history, businesses can reach their callers instead of losing them. “We’re thrilled to join Central Florida’s tech scene. We’re really looking forward to partnering with other Florida-based technology providers,” says Duncan. “We have some other really exciting communications solutions for businesses in development right now and we can’t wait to share them with Orlando’s business leaders.” Vonix, LLC is an Orlando-based cloud communication provider offering VoIP solutions for small and medium sized businesses in Florida. Features include unlimited lines, call recording and transcription, call queuing, mobile forwarding, and software and CRM integrations. With onsite installations and in-house support, Vonix customers get the personalized help they need to always stay connected. To learn more, visit https://vonix.io.

Nemours Children’s Hospital Again Wins FHA Award for Innovation in Patient Care The “Path to Home” patient discharge improvement process at Nemours Children’s Hospital (NCH) was honored Thursday night by the Florida Hospital Association (FHA) with The Innovation of the Year in Patient Care award during the Celebration of Achievement in Quality and Service ceremony in Orlando. The process – developed by a crossfunctional process improvement team at Nemours in response to an increasing number of overstay days – is used as a means

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AdventHealth Celebration Debuts Specialized ER for Kids

for ensuring patients and their families are better prepared for discharge as soon as they are clinically ready. The “Path to Home” patient flow is based on the following process improvements: working with nurses to modify the questions asked of families to better identify a patient’s barriers to discharge; integrating responses into a patient’s health records to be available in real time; and implementing daily rounding with the patient’s entire interdisciplinary team so discharge planning stays top-of-mind. “Nemours Children’s Hospital has a steadfast commitment to family-centered care, and part of that care is getting them back home as soon as they are ready,” stated Monica Nebel, nurse manager in the NCH medical-surgical unit. “When we started looking at the barriers to discharge, we noticed that many of them – such as adequate planning for transportation or home healthcare needs – represented delays that were actually under our control.” Helping families plan ahead and understanding their needs well in advance of discharge allows the team to anticipate barriers and reduce the amount of extra time children stay in the hospital. “Keeping a patient here longer than they need to be here not only disrupts the lives of a patient and their family, but also occupies a bed when another patient needs us,” stated Kellie Olmstead, Operational Vice President, Continuous Improvement. “We are honored to receive this distinction from the Florida Hospital Association. This recognition among our peers is encouraging, and we hope this process improvement helps others in the industry.” This is the sixth time the FHA has honored Nemours Children’s Hospital with an Innovation of the Year award and the seventh year the FHA honored the hospital. The hospital opened its doors just seven years ago on October 22, 2012. The awards ceremony was held during the FHA’s annual meeting on October 24 at the Hyatt Regency Grand Cypress in Orlando.

Orlando Health Receives its 30th A Grade from the Leapfrog Group With today’s release of hospital safety grades by The Leapfrog Group, Orlando Health has earned 30th A grades since 2015. The Leapfrog Group releases safety grades for more than 2,500 hospitals nationwide twice a year. In the current rating period, four Orlando Health hospitals received A Grades; Orlando Health Dr. P. Phillips Hospital, Orlando Health – Health Central Hospital, Orlando Health Orlando Regional Medical Center (ORMC), and Orlando Health South Lake Hospital. Orlando Health South Seminole Hospital received a B. “Maintaining our high standards for quality patient care is our top priority and an ongoing effort,” said Thomas Kelley, MD, vice president, quality and clinical transformation, Orlando Health. “While the criteria and methodologies of the various rating ser(CONTINUED ON PAGE 19)

AdventHealth Celebration today opened a new, specialized emergency department designed exclusively for children. For kids, a visit to the emergency room can be a frightening experience. The new ER, created in collaboration with AdventHealth for Children, combines a child-friendly ambiance to help alleviate those fears and a comprehensive care team that specializes in pediatrics. That care team includes boardcertified emergency physicians, nurses and child-life specialists, who ensure each patient’s emotional, development and psychosocial needs are met. AdventHealth Celebration sees roughly 85,000 ER visits each year and serves the Walt Disney World area along with Orange, Osceola, Lake and Polk counties. “For parents and children, a visit to the ER can be a stressful and fearful time. As the Celebration area continues to grow and we see more visitors, it’s important that we provide specialized care that’s designed around the needs of children and their families,” said Doug Harcombe, CEO at AdventHealth Celebration. “Our new ER provides a calming environment for families, and importantly, our caregivers are experts in pediatric medicine. It’s

important that we provide that specialized care in a setting that’s close to home for many of our patients.” The ER features a dedicated pediatric emergency entrance, triage, registration, and waiting area. The unit also features ocean murals with friendly, colorful characters on the walls designed to be soothing for children. Both AdventHealth Celebration and AdventHealth for Children are recipients of the Magnet recognition for excellence in nursing from the American Nurses Credentialing Center. Only seven percent of the nation’s hospitals receive the recognition. The pediatric emergency room is located adjacent to the main ER at AdventHealth Celebration, 400 Celebration Place, Celebration.

Community Health Centers, Inc. Names New President/CEO Community Health Centers, Inc. (CHC), has announced that Debra Andree, MD will become the health system’s next President/CEO. Dr. Andree, who has served as the organization’s chief medical officer since 2015, will succeed Margaret Brennan, upon her retirement in January 2020. Dr. Andree earned her Doctor of Medicine degree from the University of Miami and obtained her Bachelor of Science degree in Nursing from the University of Florida. She began her career at CHC as a Pediatrician in 2002 and was later promoted to Chief of Pediatrics in 2013 and then Associate Medical Director. “I am proud to recognize our organization’s rich 47-year history and appreciate the opportunity to serve our diverse patient base. Our success is directly attributed to enthusiastic team members, dedicated board members, a passionate leadership team and valuable community partners,” said Dr. Andree. “As the incoming President/CEO, I look forward to our continued work in providing quality and compassionate primary healthcare services in a timely and affordable patient centered medical and dental home,” she said. Dr. Andree believes strongly in developing a workforce from the community, in life-long learning and the importance of educating future medical professionals. She maintains a prestigious faculty position with Florida State University College

of Medicine and is active with the Florida Association of Community Health Centers. Dr. Andree’s goal is to ensure that CHC provides optimal, safe patient care leading to the improved health and wellbeing of patients. “Dr. Andree is an exceptional choice to lead Community Health Centers into our next stage of growth and success,” says Board Chair Nathaniel Friends. “She is an accomplished physician leader who has a passion for patient safety and quality of care. Through her years of experience, education and research she has developed a reputation as an innovative leader and a strong patient advocate.” “It has been my sincere pleasure to lead this organization that is deeply dedicated to improving the lives of those within our communities,” said Margaret Brennan, President/CEO. “I am confident that Dr. Andree will further enhance the reputation and abilities of our health centers. This is an exciting time for our organization, our patients and our team members.”

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GrandRounds vices continually change, our focus remains on providing our patients with safest, highest quality care available.” “I am extremely proud of these results and what they mean for our patients,” said David Strong, president/CEO, Orlando Health. “Patients can trust that we will provide high quality, safe care in all of our facilities; both inpatient and outpatient. We are honored to be recognized by these three highly respected organizations.” The Leapfrog Group is a national organization committed to improving health care quality and safety for consumers and purchasers. The organization assigns an A, B, C, D or F grade to more than 2,600 hospitals across the country based on their performance in preventing medical errors, infections and other harm to patients. Pediatric and specialty hospitals such as Orlando Health Arnold Palmer Hospital and Orlando Health Winnie Palmer Hospital for Women & Babies are not included in Leapfrog’s grading process. IBM Watson Health uses advanced technology to enable the sharing of health data and insights to further patient care. The company introduced the Top Hospitals program in 1993. CMS is a U.S. federal agency that administers the Medicare program and works in partnership with state governments to administer Medicaid services. More than 100 million people receive services from CMS.

Why is Exercise Good for You? Researchers Recruiting Central Floridians to Find Answer From the sedentary to the super-active, people across Central Florida can now take part in a groundbreaking study about the benefits of exercise. The MoTrPAC study (Molecular Transducers of Physical Activity in Humans) aims

to discover why exercise helps the body’s cells and organs at the molecular level. It’s taking place at 11 sites around the country, including the Translational Research Institute for Metabolism and Diabetes at AdventHealth Orlando. “The bottom line is it’s the first largescale effort to investigate the why and the how of exercise benefits,” said Bret Goodpaster, Ph.D., principal investigator for the TRI portion of the study. “We know exercise can be very powerful, but we don’t know why it works. What are the molecules involved?” Goodpaster and his team are seeking 150-200 volunteers, classified into three groups, for the study. The three groups are sedentary people — those not currently exercising; those who focus on aerobic exercise, such as cyclists or Ironman athletes; and anaerobic athletes, such as powerlifters and bodybuilders. The sedentary group will be placed on a 12-week exercise program, which some subjects doing cycling and other aerobic activities, and others focusing on weight training. Researchers will collect blood and tissue samples from all three groups before and after exercise, Goodpaster said. The three-year study is funded by NIH’s common fund and will involve 1,500-2,000 participants nationwide. In addition to AdventHealth Orlando, clinical research sites include Duke University, Ball State University, the University of Pittsburgh, the University of Colorado and the University of California-Irvine. The blood and tissue samples will be sent for chemical analysis to sites including the Mayo Clinic and Stanford University. “MoTrPAC is here, it’s starting, and we’re excited to get volunteers in,” Goodpaster said. “This is a great opportunity for Central Floridians to play a role in major research that can shape how we understand and maximize the disease-fighting properties of exercise in the future.”

More information about the TRI and studies being conducted there is available at 407-303-7100.

Orlando Health South Lake Hospital Receives Third Consecutive A Grade from the Leapfrog Group Orlando Health South Lake Hospital was honored with its third consecutive A hospital safety score by The Leapfrog Group, an independent national nonprofit run by employers and other large purchasers of health benefits. Three other Orlando Health hospitals also received A grades this current rating period: Orlando Health Dr. P. Phillips Hospital, Orlando Health Orlando Regional Medical Center (ORMC), and Orlando Health – Health Central Hospital. Orlando Health South Seminole Hospital received a B. “Achieving our third consecutive A grade is a direct result of the hard work of doctors, nurses, clinicians and the entire staff at Orlando Health South Lake,” said hospital President, John Moore. “Every day, our teams of highly qualified teams collaborate to focus on providing the safest, highest quality of care to our patients.” Some of Orlando Health South Lake’s most successful quality initiatives include early recognition and treatment for sepsis and a focus on hospital inquired infections, which

have led to a decrease in overall mortality and hospital acquired infections year over year. “Earning three consecutive A grades for patient safety is an amazing achievement,” said David Strong, president/CEO, Orlando Health. “I am extremely proud of everyone who had a hand in helping to reach this milestone.” The Leapfrog Group is a national organization committed to improving health care quality and safety for consumers and purchasers. The organization assigns an A, B, C, D or F grade to more than 2,600 hospitals across the country based on their performance in preventing medical errors, infections and other harm to patients. Pediatric and specialty hospitals such as Orlando Health Arnold Palmer Hospital and Orlando Health Winnie Palmer Hospital for Women & Babies are not included in Leapfrog’s grading process.

Osceola Regional Medical Center Nationally Recognized with ‘A’ for the Fall 2019 Leapfrog Hospital Safety Grade Osceola Regional Medical Center was awarded its third consecutive ‘A’ in fall 2019 Leapfrog Hospital Safety Grade, a national distinction recognizing the hospital’s achieve(CONTINUED ON PAGE 20)

Orlando Health Magnet Program Director Appointed to American Organization for Nursing Leadership 2020 Board of Directors The American Organization for Nursing Leadership (AONL) appointed Joy Parchment, PhD, RN, system director of the Magnet program at Orlando Health, as a member of its 2020 leadership board. The organization boasts a membership of 9,800 nurse leaders from around the country and acts as a voice for nursing leadership in healthcare. Parchment serves as system director of the Magnet program at Orlando Health, a designation given by the American Nurses Credentialing Center that recognizes organizations demonstrating nursing excellence and exemplary patient care. In addition to attracting highly qualified team members, Magnet hospitals offer nurses an environ-

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ment focused on innovation and professional development. To date, only eight percent of all hospitals in the country hold this designation. In addition to providing nurses nationwide with educational opportunities to further professional development, AONL advocates for conditions to improve the quality of patient care and provides nurses throughout the country with educational opportunities to encourage career advancement. Parchment, along with the rest of the six-member board, will serve a two-year term starting next year.

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GrandRounds ments in protecting patients from harm and providing safer healthcare. The Leapfrog Group is an independent national watchdog organization driven by employers and other purchasers of healthcare committed to improving healthcare quality and safety for consumers and purchasers. The Safety Grade assigns an ‘A’, ‘B’, ‘C’, ‘D’ or ‘F’ grade to all general hospitals across the country based on their performance in preventing medical errors, injuries, accidents, infections and other harms to patients in their care. “Safety is a major priority in hospitals across the country, which is why we are so proud to earn a third consecutive “A” from The Leapfrog Group for being one of the safest hospitals in America,” said Davide Carbone, Chief Executive Officer at Osceola Regional Medical Center. “Our hardworking team is a big reason for that distinction. They work tirelessly every day to uphold the highest standards in safety, delivering top-notch healthcare to each patient they treat.” Developed under the guidance of a national Expert Panel, the Leapfrog Hospital Safety Grade uses 28 measures of publicly available hospital safety data to assign grades to more than 2,600 U.S. acute-care hospitals twice per year. The Hospital Safety Grade’s methodology is peer-reviewed and fully transparent, and the results are free to the public. To see Osceola Regional Medical Center’s full grade details, learn how employers can help, and access patient tips for staying safe in the hospital, visit hospitalsafetygrade. org and follow The Leapfrog Group on Twitter and Facebook. To learn more about Osceola Regional Medical Center, visit OsceolaRegional.com.

Central Florida Regional Hospital Receives Level II Trauma Center Verification The American College of Surgeons (ACS) Committee on Trauma (COT) has verified Central Florida Regional Hospital as a Level II Trauma Center. Designated as a Level II trauma center by the state of Florida in 2015, Central Florida Regional Hospital recently underwent a voluntary review by the COT’s Verification Review Committee (VRC) that confirmed the hospital’s demonstrated commitment to providing the highest quality trauma care. “While Central Florida Regional Hospital’s trauma center already has Level II designation, we wanted to take it a step further by voluntarily seeking verification from the ACS Committee on Trauma,” said CEO Trey Abshier. “Opportunities for review by some of the nation’s experts in trauma care confirm we are doing everything we can to meet patient needs. It is one more way we demonstrate our commitment to providing the highest quality care to our most critically injured patients.” Central Florida Regional Hospital’s Level II trauma center offers around-theclock surgeons and specialists, ensuring rapid access to timely care for acute patients. In addition to the trauma team, physician specialists, medical personnel, equipment 20

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and facilities are available 24 hours-a-day, seven-days-a-week for immediate or followup treatment. To learn more, visit www.centralfloridaregional.com.

American Lung Association’s ‘State of Lung Cancer’ 2019 Report Finds Florida Must Act to Reduce Burden of Lung Cancer Lung cancer is the #1 cancer killer of women and men in the United States. While it’s estimated that 18,560 Florida residents will be diagnosed with this disease in 2019 alone, fortunately more Americans than ever are surviving the disease according to a new report from the American Lung Association. The annual “State of Lung Cancer” report examines the toll of lung cancer throughout the nation, and outlines steps every state can take to better protect its residents from lung cancer. This year’s “State of Lung Cancer” seeks to continue the positive trend of increased lung cancer survival, as the nationwide five-year lung cancer survival rate of 21.7%, up from 17.2% a decade ago, reflects a 26% improvement over the past 10 years. In Florida the survival rate is 23.1% among the highest in the nation. “While we celebrate that more Americans than ever are surviving lung cancer, the disease remains the leading cause of cancer deaths, and much more can and must be done in Florida to prevent the disease and support families facing the disease,” said Ashley Lyerly, Director of Advocacy, American Lung Association. “There are a variety of risk factors associated with lung cancer, including smoking, exposure to radon gas, air pollution and secondhand smoke. Radon testing and mitigation, healthy air protections, and reducing the smoking rate (CONTINUED ON PAGE 21)

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Ryan Seacrest Foundation and Orlando Health Arnold Palmer Hospital for Children Partner to Open Seacrest Studio for Patients Today the Ryan Seacrest Foundation announced that Orlando Health Arnold Palmer Hospital for Children will become home to a Seacrest Studio, a state-of-theart broadcast media center for patients to explore the creative realms of radio, television and new media. The Seacrest Studio will be located on the first floor of the hospital, adjacent to the main atrium. The approximately 1,200-square-foot studio will be encased in glass, allowing patients and visitors to view the daily programming happening inside. Seacrest Studios are charitable endeavors of the Ryan Seacrest Foundation, founded by radio and television host and producer Ryan Seacrest along with his family. Orlando Health Arnold Palmer will be the foundation’s 11th studio of this kind placed inside a pediatric hospital, and the first location in Florida. Construction of the new space is expected to begin in late 2019, with a grand opening slated for summer 2020. “I have always believed in the healing power of entertainment, but when we opened our first studio nearly nine years ago, I had no idea the extent of the benefits that these creative outlets could bring to patients and their families,” said Ryan Seacrest. “As we open our 11th Seacrest Studio, we could not be more excited to bring these opportunities to the families of Orlando Health Arnold Palmer Hospital for Children and look forward to many memories to come in the Orlando community.”

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The goal of this studio is to help patients and their families through the healing process during their stay via music, entertainment and creative expression. Seacrest Studios will be used to provide a variety of programming to patients, whether they are physically in the studio or watching through a closed-circuit network from their in-room TV screen. Patients will have the opportunity to host their own radio and television shows, watch live musical performances, play games and even interview celebrity guests that visit. Patients will also have the ability to call down to the studio via their hospital room phone to engage in events they are watching on their screen. “We are thrilled to become the next site for a Seacrest Studio,” said Cary D’Ortona, president of Orlando Health Arnold Palmer. “Every day we care for kids, not only from our community, but from all over the world. Whether their stay is just a few days or several months, we’re excited to partner with the Ryan Seacrest Foundation to give these patients a unique way to heal and learn.” The studio will have several full-time hospital team members dedicated to creating fun and educational programming for patients and guests. Another initiative for the studio is to offer internships for college students and give them hands-on experience in the broadcast and entertainment industry.

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GrandRounds through tobacco tax increases, smokefree air laws and access to comprehensive quit smoking services are all effective ways to prevent new lung cancer cases.” Part of the reason that lung cancer is so deadly is because most lung cancer cases are diagnosed at a later stage, after the disease has spread. Lung cancer screening is the key to early detection, when the disease is most curable, but only 21.5% of lung cancer cases nationally are diagnosed at an early stage. While this simple screening test has been available since 2015, 22% of those eligible in Florida have been screened. “This simple test - lung cancer screening - is a powerful tool to save lives,” said Lyerly. “Yet we’re only seeing a fraction of those who qualify actually getting screened. We’re pushing for greater awareness of this test to save more lives here in Florida.” The “State of Lung Cancer” 2019 report finds that the burden of lung cancer varies on a state by state basis. By better understanding the impact of lung cancer across the nation, efforts and policies can be focused where the needs are greatest, and this year’s report finds Florida can and must do more to protect residents from lung cancer. Below are the key findings for Florida: Survival: Lung cancer has one of the lowest five-year survival rates because cases are often diagnosed at later stages when it is less likely to be curable. Florida ranks (12 out of 45) one of the highest at 23.1%.

Nationally, only 21.5 % of cases are diagnosed at an early stage when the fiveyear survival rate is much higher (57.7%). Unfortunately, about 48.5% of cases are not caught until a late stage when the survival rate is only 6%. Florida ranks (21 out of 48) among the average at 22%. Surgical Treatment: Lung cancer can often be treated with surgery if it is diagnosed at an early stage and has not spread widely. Nationally, 20.6 % of cases underwent surgery. Florida ranks (14 out of 48) among the average at 21.1%. Lack of Treatment: There are multiple reasons why patients may not receive treatment. Some of these reasons may be unavoidable, but no one should go untreated because of lack of provider or patient knowledge, stigma associated with lung cancer, fatalism after diagnosis, or cost of treatment. Nationally, about 15.4% of cases receive no treatment. Florida ranks (37 out of 45) among the highest at 19.7%. Screening and Prevention: Screening for lung cancer with annual low-dose CT scans among those who qualify can reduce the lung cancer death rate by up to 20%. Nationally, only 4.2% of those who qualify were screened. Florida ranked (41 out of 51) among the lowest with 2.4%. Medicaid beneficiaries are disproportionately affected by lung cancer, yet standard Medicaid programs are one of the only healthcare payers not required to cover lung cancer screening.

Elisa Maria Bianchi, MD Joins Digestive and Liver Center of Florida Elisa Maria Bianchi is a Board-Certified General Surgeon who completed a Colorectal Surgery Fellowship at Zucker School of Medicine at Hofstra/Northwell Health in New York, where her specialty training encompassed a variety of small bowel, colon, rectal and anal pathologies which included malignant, benign and inflammatory disease (Crohn’s disease and ulcerative colitis). She previously completed her residency in General Surgery at Loma Linda University Health with particular emphasis in robotic techniques. Dr. Bianchi completed her medical training at the University Illinois at Chicago. Prior to that she completed an undergraduate degree in Bioengineering at

As of January 2019, 31 Medicaid fee-forservice programs cover lung cancer screening, however Florida is one of 12 programs that does not provide coverage. The Lung Association urges all state Medicaid programs to cover lung cancer screening based on evidence-based guidelines across all feefor-service and managed care plans and to remove any financial or administrative barriers that limit access to this lifesaving service. Learn more about “State of Lung Cancer” at Lung.org/solc.

the University of Illinois and worked as an engineer at Abbott Laboratories. Dr. Bianchi is a fluent Spanish speaker. Elisa Bianchi prides herself on developing a close rapport with her patients and making sure that all medical options, not only surgery, are explored to optimally treat disease. She takes a holistic approach to the practice of medicine that is rooted in her desire to engage her patients as equal partners in shared medical decision-making.

New Research Intensifies AMA’s Call for Improved EHR Usability Correlation Found Between Poor EHR Usability and Physician Burnout In a statement by Patrice A. Harris, MD, MA, President, American Medical Association she says: “A new study issued today found electronic medical records (EHRs) - as currently designed, implemented and regulated - lack usability as a necessary feature, resulting in EHRs that are extremely hard

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GrandRounds to use compared to other common technologies. Poor EHR usability was found to be highly correlated with physician burnout. “While the study was conducted by leading clinical institutions in collaboration with the American Medical Association (AMA), the findings will not come as a surprise to anyone who practices medicine. Too many physicians have experienced the demoralizing effects of cumbersome EHRs that interfere with providing first-rate medical care to patients. “It is a national imperative to overhaul the design and use of EHRs and reframe the technology to focus primarily on its most critical function - helping physicians care for their patients. Significantly enhancing EHR usability is key and the AMA is working to ensure a new generation of EHRs are designed to prioritize time with patients, rather than overload physicians with type-and-click tasks. “Through its ongoing work, the AMA is committed to help physicians and their practices thrive so they can continue to put patients first. Through our research, collaborations, advocacy and leadership, the AMA is working to make the patient‐physician relationship more valued than paperwork, preventive care the focus of the future, technology an asset and not a burden, and physician burnout a thing of the past.”

Special Olympics Florida Taps Orlando Health to Provide Medical Care for Athletes Orlando Health will be the official Medical Team for the 2022 Special Olympics USA Games to be held in the greater Orlando area. The arrangement is part of a new multi-year partnership agreement between Orlando Health, the 2022 USA Games and Special Olympics Florida that also designates Orlando Health as the official Central Florida Medical Home for Special Olympics Florida (SOFL). “We’re very excited to be able to partner with Special Olympics and work with their athletes throughout Florida and from all over the country.” says Cary D’Ortona, Orlando Health executive champion for the Special Olympics partnership and president of Orlando Health Arnold Palmer Hospital for Children. “People with unique abilities are very frequently some of the most underserved patients in healthcare so this partnership is not just about helping these athletes compete and succeed, it’s also about working with Special Olympics Florida to learn how we, as a health system, can become more attuned to the needs of our patients with intellectual disabilities.” The 2022 Special Olympics USA Games will take place June 5-11, 2022.

More than 4,000 athletes, 10,000 volunteers, 1,500 coaches and 125,000 fans from all 50 states, the District of Columbia and the Caribbean will travel to Orlando to unite and participate in one of the world’s most cherished sporting events. As the official Medical Team for the 2022 USA Games, Orlando Health physicians and athletic trainers will work directly with the athletes as they compete in the Games. In addition, Orlando Health will be a platinum sponsor for the Games, a presenting partner for the Special Olympics Healthy Athletesâ experience and presenting sponsor for the Young Athletes Festival for athletes age 2 - 7. “We could not be more thrilled to have Orlando Health as the official medical team of the 2022 USA Games,” said Joe Dzaluk, President & CEO of the 2022 Special Olympics USA Games. “With more than 3,300 individual sports competitions taking place during the week of the Games, our athletes will have the best medical resources in Florida available to them.” Orlando Health will also partner with SOFL as the official Central Florida Medical Home for its athletes. In addition, Orlando Health is designated as the presenting sponsor for SOFL’s Central Florida Health Programs and Young Athletes Program. “Orlando Health has a long, proud history of serving the residents of Cen-

tral Florida and we’re delighted to have their expertise and commitment to Special Olympics Florida’s athletes,” said Sherry Wheelock, President & CEO of Special Olympics Florida. “Partnership and support from organizations like Orlando Health are important as we look for ways to enhance how we serve our athletes.” The announcement of the partnership with Orlando Health comes as Special Olympics Florida gears up for its annual State Fall Classic, November 15 and 16 at the ESPN Wide World of Sports® Complex at Walt Disney World. Thousands of athletes from across Florida will gather over the two-day event to compete in sports competitions such as powerlifting, softball, flag football, and more.

U.S. Department of Justice (DOJ) Accepts Oberheiden, Proposal to Coordinate P-Stim Medicare Fraud Investigations Oberheiden, P.C., a federal health care fraud defense law firm based in Dallas, Texas, has announced that the U.S. Department of Justice (DOJ) has accepted the (CONTINUED ON PAGE 23)

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GrandRounds firm’s recommendation to appoint a national coordinator to oversee Point-Stimulation Therapy (“P-Stim”) Medicare fraud investigations under the False Claims Act. The appointment of a national coordinator is intended to streamline federal investigations targeting alleged billing violations related to P-Stim devices and electro-therapeutic point stimulation (ETPS) treatment services. In conjunction with its representation of several health care providers across the country, Oberheiden, P.C. encountered a recurring issue of providers being forced to defend against multiple independentlyconducted investigations related to their P-Stim and ETPS billings under Medicare. Typically, providers would first be contacted by the Centers for Medicare and Medicaid Services (CMS) about potential recoupment liability; and, while attempting to resolve any issues with CMS, these providers would then be contacted by the DOJ, the U.S. Attorney’s Office, and/or the U.S. Department of Health and Human Services’ (DHHS) Office of Inspector General (OIG) regarding the same alleged billing violations. This lack of coordination presented unnecessary burdens for health care providers, and it also resulted in unnecessary duplication of efforts by the federal authorities involved. As a result, Oberheiden, P.C. recommended that the DOJ undertake efforts to streamline federal P-Stim Medicare fraud investigations. “We are continuing to see a high volume of False Claims Act investigations targeting health care providers’ purchase and use of P-Stim devices,” said Dr. Oberheiden, founding attorney. “We are pleased with the DOJ’s decision to appoint a national coordinator, as this will streamline the process of resolving these investigations for all parties involved.” According to Dr. Oberheiden, health care providers’ Medicare billings for P-Stim devices and related ETPS services have recently been the subject of intense federal scrutiny. In particular, he says, CMS, the DOJ, the OIG, and the U.S. Attorneys’ Of-

fice are targeting providers’ use of HCPCS Code L8679 and CPT Code 64555. In some cases, providers are also facing allegations of improperly applying Modifier 25 to Code L8679, which CMS states should only be used in cases where a patient receives a “significant, separately identifiable E/M service” in connection with the implantation of a qualifying medical device. While coordinating the federal government’s efforts to recoup improper Medicare billings for P-Stim devices and related ETPS services will streamline the investigative process, Dr. Oberheiden cautions that this does not mean the providers targeted in these investigations are less at risk. “The federal government tends to focus on cases in which the recoupment potential is substantial,” he says. “As a result, health care providers that bill Medicare for P-Stim devices and related services should carefully review their billing policies, and those that are targeted in False Claims Act investigations should seek legal representation immediately.”

$15 Million Being Spent on Orlando Health Dr. P. Phillips Hospital Expansion The expansion of an existing shell space on the fifth floor at Orlando Health Dr. P. Phillips Hospital is slated for completion in February 2020. The cost of the construction, which will add 48 private rooms to the 237bed hospital, is approximately $15 million. The development taking place at Dr. P. Phillips Hospital builds on the hospital’s longstanding approach to delivering quality care and patient safety. Located in southwest Orlando, the hospital has been serving the local community, as well as visitors from across the United States and around the world for over 25 years. Last year, the hospital had 15,575 acute care admissions (CONTINUED ON PAGE 24)

New Wound Care, Lymphedema and Ostomy Clinic Integumentary Physiotherapy Clinic is delighted to announce the opening of the office in 616 E. Altamonte Drive Suite 203, Altamonte Springs, FL this December 16th, 2019. We provide optimal wound care, lymphedema therapy, and ostomy care management. Our approach includes physiotherapy interventions tailored to the patient’s functional goals. Modalities, along with a proper selection of wound dressings, facilitate healing and maximize patient outcomes. Our evidence-based practice includes the use of electrotherapy, hydrotherapy, laser, infrared light, among other exclusive physical therapy interventions. Integumentary Physiotherapy Clinic is what wound care, lymphedema, and os-

DECEMBER 2019

tomy patients need -- a highly specialized practice providing cost-effective physical therapy treatments tailored to facilitate wound healing and better results.

Nurses at Dr. P. Phillips Hospital Benefiting People and the Environment Just in time for the holidays, a clever idea is turning into an act of kindness that is catching on at hospitals across the country. Nurses at Orlando Health Dr. P. Phillips Hospital have found a new use for something that usually ends up in the trash. They are sewing together sterile surgical equipment wraps into sleeping bags that are being donated to the homeless. The wraps, which are used to keep trays of equipment clean before surgeries, are normally thrown away because they

can’t be reused or recycled. But instead of going to waste, nurses realized the wraps would make great sleeping bags for the homeless because the material is soft, durable, heat retaining, and water resistant. The nurses are inspiring others to go above and beyond to benefit both people and the environment, too. A Facebook post about the project has been shared thousands of times, leading to calls from hospital employees in at least eight states wanting to know how to make the sleeping bags.

DOH-Orange Welcomes James Pate as Director of the Office of Performance and Quality Improvement Dr. Raul Pino, Interim Director of the Florida Department of Health in Orange County (DOH-Orange) appoints James E. Pate as the head of the department’s Office of Performance and Quality Improvement. Mr. Pate will start in his new position on December 13, 2019. “With the hiring of James Pate, we reinforce our commitment to system improvement and performance management with accountability at all levels,” said Dr. Pino. “The Office of Performance and Quality Improvement will play a crucial role in the next steps we will be taking.” Mr. Pate joins DOH-Orange from AdventHealth where he was the Educational Assistance Program Manager. He began this position in November 2012 and was instrumental in expanding usage of the program while at the same time reducing overall costs through strategic partnerships with several colleges and securing the ser-

vices of EdAssist, the industry leader in educational coaching and payment processing. Prior to his position at AdventHealth, Mr. Pate worked for DOH-Orange as the Strategic Planning Manager and Emergency Operations Manager. During his tenure with DOH-Orange he started many new initiatives to improve processes for both disaster operations and internal operating processes. For the 29 years preceding his service with the DOH-Orange, he rose through the ranks of the United States Air Force, culminating his career as the Command Chief Master Sergeant for the Air Armament Center at Eglin Air Force Base, Florida.

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GrandRounds which was an increase from 13,794 in 2016. “Orlando Health Dr. P. Phillips Hospital has seen tremendous growth, particularly over the last two years with significant increases in surgeries and hospital admissions,” said Thibaut van Marcke, president of Orlando Health Dr. P. Phillips Hospital. “This expansion is in response to the ongoing growth in southwest Orlando and in the tourism industry. The additional patient rooms will allow us to better meet those needs.” Work started on the project back in June 2019. The architect for this project is Dallas-based HKS, while the general contractor is Southfield, Michigan-based Barton Malow Co.

Oviedo Medical Center Receives the Florida Award for Safely Reducing Primary C-Sections The Agency for Health Care Administration (AHCA) and the Florida Department of Health (DOH) announced Oviedo Medical Center as one of 19 Florida hospitals in 2018 that achieved the Healthy People 2020 (HP2020) Maternal and Child Health goal focused on reducing cesarean section deliveries for first-time mothers with low-risk pregnancies. Once a woman has a cesarean, she has a greater chance of having a C-section for subsequent births, increasing her risk of major birth complications. For the baby, some of the consequences can include a longer hospital stay in the neonatal intensive

care unit, as well as higher rates of respiratory infection. The goal of the Florida Award Program for Safely Reducing C-sections is to highlight the importance of this health care quality issue statewide and to recognize those hospitals that are contributing to providing quality health care for mothers and infants. Both AHCA and DOH have recognized that the high rate of low-risk cesarean births is a major maternal and child health issue in Florida, as the state has one of the highest rates in the nation. C-section rates for first-time, low-risk pregnancies in Florida range from 13 percent to 60 percent. In response to the rise of unnecessary C-sections across the United States, the U.S. Department of Health and Human Services adopted the HP2020 target of reducing nationwide C-section rates for low-risk births to 23.9 percent. Oviedo Medical Center’s C-section rate in 2018 was 17.7%, well below the 23.9 percent national goal. SAMPLE FACTS:

Each year, about 4 million babies are born in the United States2, with Florida accounting for 5.5 percent of all U.S. births (222,000 babies per year).3 Florida’s 2018 C-section rate is 36.8 percent4, one of the highest state rates in the nation.5 “Oviedo Medical Center has invested time and talent to ensure our Memorable Beginnings mother/baby unit provides the best possible experience for guests during this joyous occasion – the most important

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part being the delivery itself,” said KC Donahey, CEO. “Achieving the Healthy People 2020 (HP2020) Maternal and Child Health goal highlights our ongoing commitment to prioritizing the long-term health of both mother and child.”

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Orlando Health Heart Institute Acquires Vascular Surgery Practice

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The Orlando Health Heart Institute recently announced the addition of G. Kendrix Adcock, MD, FACS, and Robert Winter, MD, FACS, from Florida Vascular Consultants to the institute’s Vascular Surgery Group. The acquisition of the practice will be effective January 2, 2020. Florida Vascular Consultants has been caring for patients in Maitland and the surrounding areas since 1986. “Both physicians specialize in the diagnosis and treatment of vascular conditions and will add valuable expertise and experience to the institute’s Vascular Surgery Group team,” said Farhan Khawaja, MD, president, Orlando Health Heart Institute. Dr. Adcock and Dr. Winter will be practicing primarily in Orange and Seminole counties at Orlando Health Heart Institute Vascular Surgery Group offices in Maitland and Lake Mary and serving Orlando Health South Seminole Hospital. “As the heart institute continues to grow, we are committed to providing high quality, accessible care to the communities in Central Florida,” said Cindy Reed, assistant vice president, Orlando Health Heart Institute.

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December 2019

AdventHealth Waterman Opening New Pediatric ER Event wraps completion of phase II expansion TAVARES - As AdventHealth Waterman celebrates the completion of its $85 million phase II expansion, it will be opening the doors of a new pediatric ER on December 10. “Before our new unit was built, the closest dedicated pediatric ER was in Ocala, Orlando and Gainesville. Knowing we cared for nearly 12,000 patients under the age of 18 in our emergency department last year, we wanted to develop a pediatric ER for families right here in Lake County that could be staffed 24-7. As part of a collaboration with AdventHealth for Children, the new ER’s clinical team is specially trained in pediatric care, including board-certified emergency physicians, nurses and child-life specialists, who ensure each patient’s emotional, development and psychosocial needs are met,” said Laura Perry, director of the emergency department at AdventHealth Waterman. Since 2000, the population of Lake County has grown by nearly 50 percent, and it’s expected to grow by another 12 percent over the next four years, according to U.S. Census data. “Caring for the additional 15,000 pa-

DECEMBER 2019

tients over our originally intended capacity was a strain, and we knew we needed to expand our ER to meet the needs of patients today, as well as plan for the growing need for emergency care in the future,” she said. More than 80 percent of the hospital’s patients originate from the emergency department. “While the pediatric ER is a new and important service, this expansion project is so much more than that. This construction project doubled the footprint of our ER and grew capacity from 35 to 58 beds, making it the largest ER facility in Lake County. This expansion project also improved privacy and patient flow within the ER and added a 12-bed area for minor care for adults, such as treating lacerations, broken bones or flu symptoms,” said Perry. Patients in this area will receive rapid treatment, including physician evaluations and test results, and will be discharged to the comfort of their own home. The hospital invites members of the community to come for the celebration, tour the pediatric ER and meet the medical team. In addition, family activities during the celebration will include free photos with Santa and Mrs. Claus, ornament crafts, a

live nativity scene, and more. Open house hours will be from 5 - 7 pm. In May, more than 700 community members joined AdventHealth Waterman to celebrate the completion of Phase I construction on the new four-story patient tower, dedicated to emergency care, women’s services, pediatrics, inpatient rehabilitation and future growth. Phase I grew AdventHealth Waterman from 269 beds to 287 beds. This project is the second largest investment in a healthcare facility in Lake County’s history – since AdventHealth Waterman’s Tavares campus was completed more than 15 years ago. The second floor of the patient tower is home to the 24-bed Center for Women and Children and includes gynecology, labor and delivery, postpartum care and inpatient pediatrics. The third floor is still under construction and will soon bring a brand-new healthcare service to the Lake County community:

a 12-bed inpatient rehabilitation unit that opens to patients on December 13. The fourth floor is shelled for future growth. The patient tower was constructed to support an additional future expansion and could one day add two more floors, bringing the tower up to six floors. The project was designed by Gresham, Smith and Partners of Jacksonville. Construction was completed by Robins & Morton of Orlando.

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GrandRounds Check Your Contract We Care of Lake County is required to re-contract their volunteer physicians every 5 years. Is your contract still sitting on your desk? Volunteer physicians are critical for this organization that provides free specialty medical care to underserved, indigent and homeless adults. Please sign your contract today! We Care of Lake County is required to re-contract their volunteer physicians every 5 years. Is your contract still sitting on your desk? Call the Executive Director of We Care, Debra Paradis at 352-742-0021, ext 11, or click here to email for further information.

Ocala Regional Medical Center and West Marion Community Hospital Named America’s 100 Best Hospitals for Orthopedic Surgery Ocala Regional Medical Center and West Marion Community Hospital are one of America’s 100 Best Hospitals for orthopedic surgery according to a national study by Healthgrades, the leading online resource for information about physicians and hospitals. The achievement is part of findings released today in the Healthgrades 2020 Report to the Nation. The new report demonstrates the importance of hospital quality to both hospital leaders and consumers. Additionally, from 2016 through 2018, patients treated at hospitals receiving the America’s 100 Best Hospitals for Orthopedic Surgery Award have, on average, a 39.7% lower risk of experiencing a complication while in the hospital than if they were treated in hospitals that did not receive the award. And patients treated at hospitals that did not receive the award were 1.66 times more likely to experience a complication in the hospital than if they were treated at hospitals that received the award*. “As consumers navigate their health, it is important to consider a number of factors, including hospital quality, before deciding where to access care,” said Brad Bowman, MD, Chief Medical Officer, Healthgrades. “Healthgrades’ America’s 100 Best Hospitals for orthopedic surgery recognizes those hospitals that have proven their dedication to quality care and exceptional outcomes over time and we applaud their efforts and achievement.” This commitment to quality care is showcased through the investment Ocala Health has put toward their orthopedic service line. Earlier this year, Ocala Health completed another phase of a $65 M expansion project at West Marion Community Hospital with the opening of 36 new beds dedicated to orthopedic services. West Marion Community Hospital has established itself as one of the premier joint care centers in the state of Florida, with over 15,000 total joint surgeries since 2009. “West Marion Community Hospital 26

DECEMBER 2019

and Ocala Health are dedicated to our high quality, best in class orthopedic services and are excited to continue investing in facilities that match the premier level of orthopedic care given to our patients,” says Chad Christianson, CEO of Ocala Health. Healthgrades recognizes a hospital’s quality achievements for cohort-specific performance, specialty area performance, and overall clinical quality. Individual procedure or condition cohorts are designated as 5-star (statistically significantly better than expected), 3-star (not statistically different from expected) and 1-star (statistically significantly worse than expected) categories. The complete Healthgrades 2020 Report to the Nation and detailed study methodology, can be found at https://partners.healthgrades.com/healthgrades-quality-solutions/ healthgrades-quality-awards/.

Central Florida Health Welcomes New Chief Operating Officer Central Florida Health is pleased to introduce David H. Berger, MD, FACS, MHCM, as the newest member of its senior executive team. Dr. Berger will serve as senior vice president and chief operating officer for the organization. In his new role, Dr. Berger will provide management oversight for the development of high quality, cost-effective and clinically integrated patient care services. Dr. Berger comes to Central Florida Health from the Baylor College of Medicine in Houston, Texas, where he served as professor and vice-chair for quality and safety in the Michael E. DeBakey Department of Surgery. Dr. Berger previously served as the senior vice president and chief operating officer of Baylor St. Luke’s Medical Center, chief medical officer of the Baylor College of Medicine McNair Facility and operative care line executive of the Michael E. DeBakey VA Medical Center. Dr. Berger has more than 25 years of healthcare leadership experience and is an expert in patient flow, operating room throughput, quality and patient safety. He has extensive experience identifying cutting edge health care technology and effectively implementing those technologies in the hospital setting. “It is truly an honor to be able to support Central Florida Health’s mission of improving the quality of life of the residents of Lake, Sumter and South Marion counties,” says Dr. Berger. “What excites me most is that as a physician senior executive leader within the organization, I will be uniquely positioned to facilitate continuous improvement of the patient care delivery experience by aligning the goals of community physicians with the overall goals of Central Florida Health.” Dr. Berger is a native of New York, where he received his medical degree from the State University of New York Health

Science Center at Brooklyn. He completed a general surgery residency at SUNY-Brooklyn, fellowship in surgical oncology at the University of Texas MD Anderson Cancer Center in Houston and holds a Master of Science in Healthcare Management from the Harvard University T.H. Chan School of Public Health in Boston, Massachusetts.

AdventHealth Waterman Nationally Recognized With An ‘A’ For the Fall 2019 Leapfrog Hospital Safety Grade With another ‘A’ rating in the Fall 2019 Leapfrog Hospital Safety Grade, AdventHealth Waterman becomes one of only four hospitals in Florida to earn 14 Straight A’s in a row. This national distinction recognizes AdventHealth Waterman’s achievements protecting patients from harm and providing safer health care. The Leapfrog Group is an independent national watchdog organization committed to improving health care quality and safety for consumers and purchasers. The Safety Grade assigns an ‘A’, ‘B’, ‘C’, ‘D’ or ‘F’ grade to all general hospitals across the country based on their performance in preventing medical errors, injuries, accidents, infections and other harms to patients in their care. “AdventHealth Waterman has consistently proven that our patients’ safety is our top priority,” said Abel Biri, AdventHealth Waterman CEO. “We are proud of the honor and our track record. The 14 consecutive ‘A’ grades we have received since Spring 2013 proves that our team is dedicated to providing safe, quality and compassionate care in a patient-centered environment.” “‘A’ hospitals show us their leadership is protecting patients from preventable medical harm and error,” said Leah Binder, president and CEO of The Leapfrog Group. “It takes genuine commitment at every level – from clinicians to administrators to the board of directors – and we congratulate the teams who have worked so hard to earn this A.” Developed under the guidance of a national Expert Panel, the Leapfrog Hospital Safety Grade uses 28 measures of publicly available hospital safety data to assign grades to more than 2,600 U.S. acute-care hospitals

twice per year. The Hospital Safety Grade’s methodology is peer-reviewed and fully transparent, and the results are free to the public.

AdventHealth Waterman Raises Nearly $60,000 to Support the Local Fight Against Breast Cancer Throughout October, AdventHealth Waterman hosted and attended several activities and educational events to promote the importance of breast health and the early detection of breast cancer. Through events such as the women’s health expo Pinking Ceremony, the sixth annual PINK OUT™ 5K Walk/Run, and the sixth annual Ladies Legacy Luncheon, the hospital raised more than $57,000 for the AdventHealth Waterman Foundation’s cancer care fund which supports cancer education and screenings, including mammograms for those in need. Attendees were encouraged to donate a new bra for the Haven of Lake and Sumter Counties women’s shelter. The community helped AdventHealth Waterman donate nearly 300 bras for local women in need. In addition, local businesses in Lake County also supported these fundraising efforts. During October, several area businesses donated a portion of sales, while others sold tags for AdventHealth Waterman’s signature lawn flamingos. The participating businesses included: • Bella Toscana Med Spa, 1699 Mayo Dr., Tavares • Danny Len Buick GMC, 17605 US-441, Mount Dora • SuperWash Express, 18805 US-441, Mount Dora • Lake/Bay Pharmacy, 710 N. Bay St., Eustis • Gator Harley-Davidson, 1745 US-441, Leesburg

AdventHealth Waterman also supported various community events during October, including the Food Bank Screening event, Mount Dora Chamber of Commerce breakfast, Tavares Chamber of Commerce member luncheon, National Night Out, City of Eustis benefit fair and Lake Sumter State College benefit fair. In addition to the funds raised, AdventHealth Waterman also perform 3D mammograms for a special low-rate of $30 during October. During the month, AdventHealth Waterman provided more than 1,000 3D mammograms.

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December 2019

Parrish Healthcare and Mark Licht, MD, Establish Region’s First Men’s Reproductive Health Program GrandRounds

Patients appreciating the convenience of local care TITUSVILLE – Filling a pressing need for specialized local care, Parrish Medical Group (PMG) has established the region’s only medical practice focusing on men’s reproductive health. Board-certified and fellowship-trained urologist, Mark Licht, MD, provides care for prostate health, male fertility, vasectomy reversal, erectile dysfunction, and incontinence. Licht says that men’s urology issues are very common, but most men avoid talking about them, and worse, hesitate or fail to seek treatment. “I want every man to know that most male urology problems are almost always treatable,” says Dr. Licht. “The reason I focus on this area of medicine is seeing men who thought there was no hope, or no chance for improvement or recovery feel as if they have been given a new life.” Formerly, patients for male reproductive services had to drive long distances to see a specialist. “In analyzing the services provided by local providers, it was noticed that this gap in service was something that could be a benefit to our community,” said Drew Waterman, vice-president of ambulatory services for Parrish Healthcare. Now, patients are traveling from Miami, Jacksonville, and other Florida communities to seek treatment from Dr. Licht. One patient, from Boca Raton, declares Licht a life-changer. “Dr. Licht enabled me to get my confidence back as a man,” he said. Licht received his medical education and specialty training at Columbia University, Cleveland Clinic Foundation, and Mayo Clinic, regularly ranked at or near the top among American’s health care providers by U.S. News & World Best Hospital list and other ratings organizations. Parrish Medical Center is a member of the Mayo Clinic Care Network. “These important clinical services for

DECEMBER 2019

Family Medicine Physician Joins AdventHealth’s Employed Physician Group

men, provided by a physician who is an acknowledged medical authority in these areas, comes out of our continuing assessment of community needs,” said George Mikitarian, Parrish Healthcare President and CEO. “It’s another component of Parrish Healthcare’s integrated care program that provides healing experiences for everyone all the time.” An estimated 30 million men in the U.S. suffer from prostate conditions that, if left untreated, can become major health issues. In the U.S., one in five men is diagnosed with prostate cancer. It is the second leading cause of cancer deaths for men. Approximately 50 percent of men experience erectile dysfunction at some point in their lives, and another 10 percent deal with bladder control issues. About 9 percent of men in the United States struggle with infertility. Dr. Licht is recognized as an expert on men’s urology and microsurgery and is invited to speak regularly at conferences nationally and internationally. Among the professional acknowledgements Dr. Licht has earned are Most Recommended Physicians in Florida in 2011, Best Doctors in America by Best Doctors in 2001-2016, and Top Doctors in America by U.S. News & World Report in 2016. Dr. Licht is located at 825 Century Medical Drive, Suite B in Titusville.

Family medicine physician Dr. Angelic Alvarez has joined AdventHealth Medical Group. As an AdventHealth Medical Group physician, Alvarez joins AdventHealth’s employed group of physicians with more than 300 providers, including 160 primary care doctors and specialists in Volusia, Flagler and Lake counties. Alvarez provides routine wellness visits, annual physicals and women’s health exams. She also focuses on preventive medicine, geriatric care and manages acute and chronic conditions. Her specialty services include minor musculoskeletal injections, minor dermatological procedures and contraceptive therapy. A graduate from Seabreeze High School, Alvarez earned her medical degree from Universidad Central del Este in the Dominican Republic. She completed her residency at Yuma Regional Medical Center in Arizona and her fellowship at the University of Arizona in Phoenix. She is board certified by the American Board of Family Medicine. Her practice accepts new patients and most insurance plans. Her office is located 1050 West Granada Blvd., Suite 2A, Ormond Beach and she can be reached at 386231-3050.

Parrish Medical Center Partners with New Food Service Provider HHS Parrish Medical Center (PMC) is pleased to welcome Austin, Texas-based and award-winning food service provider HHS to its family of integrated care partners. HHS began operating the medical center’s food service on November 14, 2019. In August, PMC issued a 90-day notice of intent to terminate the hospital’s agreement with Sodexo, to whom the medical center outsourced management services for its food and nutrition operations. The agreement formally ended November 14, 2019,

ending a long-term relationship between PMC and Sodexo. PMC has transitioned its food service operations to international award-winning HHS. George Mikitarian, PMC President/ CEO, said that Sodexo demands were the determining factor in the hospital’s decision. “There were a set of difficulties which reached a critical mass,” Mikitarian said. “We regret this, as we had had a long relationship with Sodexo; however, recently their corporate philosophy and dynamics have changed in a manner that no longer aligns with our mission, vision and values. We ultimately concluded that the company’s significant and mandated annual increases in their fees and among other contractual issues required a change of vendor.” HHS brings more than 45 years of healthcare support services experience to our organization. We are confident patients, visitors and our care partner will be pleased with the innovation and service levels that HHS and its team will provide.

AdventHealth Daytona Beach Earns National Spine Certification AdventHealth Daytona Beach has earned the Gold Seal of Approval® for Spine Surgery by the Joint Commission, an independent, national not-for-profit organization. The Gold Seal is recognized as a symbol of quality that reflects an organization’s commitment to providing safe, consistent, high-quality patient care. To achieve this certification, the Joint Commission requires hospitals to demonstrate compliance with national standards and evidence-based clinical practice guidelines for three distinct procedures: 1) Discectomy: Surgical removal of all or a part of an intervertebral disc 2) Laminectomy: Surgery to remove the back of one or more vertebrae to give access to the spinal cord or to relieve pressure on nerves, and 3) Spinal fusion: A surgical technique that joins two or more vertebrae together for stability. In addition to earning this designation for spinal surgery by the Joint Commission, (CONTINUED ON PAGE 28)

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GrandRounds AdventHealth Daytona Beach has also earned the Joint Commission’s Gold Seal of Approval® for total hip, total knee and shoulder replacement surgery. Earning these certifications demonstrates AdventHealth Daytona Beach’s commitment to providing a higher standard of service. Collectively, the AdventHealth facilities in Volusia and Flagler counties have earned a total of 13 disease-specific certifications from the Joint Commission. AdventHealth Daytona Beach and AdventHealth Fish Memorial are the only hospitals in the area to earn this designation for spine surgery.

AdventHealth Daytona Beach has earned the Gold Seal of Approval® for Spine Surgery by the Joint Commission, an independent, national not-for-profit organization. The AdventHealth Daytona Beach team, pictured from left to right: Suzanne Stein, rehab therapy supervisor, Jessica Geddings, surgical services director, Melissa Shephard, clinical educator, Wendy Weisheimer, interim neurosciences administrator, Michelle Goeb-Burkett, chief nursing officer, Aletha Boyd, surgical services manager, Dr. Federico Vinas, neurosurgeon, Dr. Gregory Velat, neurosurgeon, Dr. Robert Martin, neurosurgeon, David Weis, chief operating officer, Deb Abbott, neurosciences nurse navigator, Rose Watroba, regional director of neurosciences services, and Matt Norwood, surgical services nurse manager.

Golf Tournament Raises Over $100,000 for AdventHealth Daytona Beach On Nov. 8, nearly 150 golfers joined the AdventHealth Daytona Beach Foundation for their sold-out 10th annual golf tournament at LPGA International in Daytona Beach. The scramble’s net proceeds totaled over $103,000 and will support crucial programs at AdventHealth Daytona Beach. Orlando-based contractor Robins & Morton was the event’s presenting sponsor. “We are extremely grateful to Robins and Morton, as well as all of our other community partners,” said Julie Rand, AdventHealth Daytona Beach Foundation executive director. “We very much appreciate the support we receive from all our amazing sponsors and volunteers that help us achieve our goals year after year. Their generosity helped ensure this year’s event success and will help us continue with our mission to extend the healing ministry of Christ.”

In November, nearly 150 golfers helped the AdventHealth Daytona Beach Foundation raise over $103,000 during the sold-out 10th annual golf

DECEMBER 2019

tournament at LPGA International in Daytona Beach. Pictured from left to right: Angel Colon of Robins and Morton; Julie Rand, AdventHealth Daytona Beach Foundation executive director; Ed Noseworthy, AdventHealth Daytona Beach CEO; David Weis, AdventHealth Daytona Beach chief operating officer; and Bruce Adams of Robins and Morton.

AdventHealth Celebrates Deltona ER Opening On Dec. 3, the community joined AdventHealth for the grand opening celebration of the new freestanding AdventHealth Deltona ER at 3108 Howland Blvd., Deltona (near Deltona High School). The 12-bed AdventHealth Deltona ER is a $12 million investment in the community’s healthcare and will open to patients seeking comprehensive emergency services, including imaging and laboratory services for both adults and children, on Dec. 4 at 8 a.m. The facility will be staffed by highly trained physicians and clinical practitioners with specialized training in emergency medicine, advanced trauma life support, and cardiac life support - including pediatric cardiac life support. “This facility will be a pillar in this community for years to come,” said Dr. Stephen Knych, board-certified orthopedic surgeon and chief medical officer of AdventHealth Fish Memorial. “It is top notch and can care for the sickest types of patients, from cardiac arrest and stroke patients, to pediatric patients and moms who are expecting to deliver.” The lab at the AdventHealth Deltona ER will perform the testing necessary to give patients and the care team immediate results for urgent clinical decisions. The emergency department also has a CT scan and x-ray equipment onsite for any emergency imaging needs. “If for some reason, a patient needs to be admitted for additional care or observation, they will be seamlessly connected to AdventHealth Fish Memorial, just six miles away,” Knych said during the event. “Your care will be prioritized for placement in one of our inpatient or observation beds for further care as necessary.” During the community celebration, AdventHealth Fish Memorial CEO Rob Deininger explained that this project took several years of planning. “AdventHealth has been serving the West Volusia community for 25 years now, and as it so happens, Deltona has been a city for 25 years as well,” Deininger said. “We have been growing and expanding alongside each other to meet the needs of our communities here in West Volusia.” “For me personally, AdventHealth has been my choice of care for years, and for my mom as well,” Heidi Herzberg, Deltona mayor, said during the event. “I feel safe and I feel secure, and now I know I have something in the City of Deltona if needed. I’m excited that AdventHealth has chosen to put this building in Deltona.” The architect was Orlando-based HuntonBrady and the contractor was Batson Cook.

AdventHealth Fish Memorial Recognizes Nurse with DAISY Award AdventHealth Fish Memorial recognized registered nurse Charlotte Rivera with the DAISY award. The DAISY Award is an international program that rewards and celebrates extraordinary clinical skill and compassionate care provided by nurses. Rivera is a nurse in the intensive care unit (ICU) and was nominated for this recognition by a patient at AdventHealth Fish Memorial. “Charlotte took excellent care of me and went out of her way to make me feel at else. She explained everything that was going on in a way that I could understand,” the patient wrote. “She showed me that she is invested in her job and the people that she cares for. Thanks to her care, my recovery has gone much smoother than I expected,” the patient added. “She is an outstanding person and you should be proud to have her on your team!” Created in 1999, more than 2,500 healthcare facilities in all 50 states, as well as 15 other countries, use the DAISY Award to honor nurses. In recognition of this honor, Rivera received a bouquet of daisies, a certificate, a tote bag, and a hand-carved stone sculpture of the “Healer’s Touch” by an artist of the Shona Tribe in Zimbabwe. Her department, the AdventHealth Fish Memorial medical/surgical unit, also received cinnamon rolls and a DAISY banner to display.

Charlotte Rivera, a registered nurse in the AdventHealth Fish Memorial medical/surgical unit, received the DAISY award, an international program that rewards and celebrates extraordinary clinical skill and compassionate care provided by nurses. Pictured here, Rivera is surrounded by nursing colleagues from the medical/surgical unit, as well as nursing leaders. From left to right: Jennifer Meyer, patient care technician; Jasmin Jenkins, registered nurse; Sara Cianciarulo, nurse manager; Terri Youngbar, registered nurse and clinical case manager; Rivera; Michele Johnson, chief nursing officer; Danielle Brooks, assistant nurse manager; Ashlee Kay, assistant nurse manager; and John Lazarus, emergency department director.

Daytona State College Announces Unique Scholarship Agreement with Halifax Health Halifax Health and Daytona State College, two of the area’s most recognizable names in healthcare education and service, announced a new sponsorship agreement in a ceremony. This new agreement provides

$500,000 in scholarship funding for DSC students in nursing and health-related fields, and guarantees post-graduate employment for all scholarship recipients. The agreement begins with the current academic year and students may begin applying for the scholarship in the spring 2020 term. Also, in recognition of the agreement, the College will rename its softball stadium the Halifax Health Softball Stadium for a term of 25 years and designate Halifax as the “Official Healthcare Provider of Daytona State College Athletics” for five years. Officials from DSC and Halifax unveiled a rendering of the new entrance to the Halifax Health Softball Stadium at the joint ceremony. Halifax Health is the first business to kickoff this new Education to Employment Scholarship Program and is encouraging other companies to participate. “Halifax Health represents opportunity to so many in our area,” said Jeff Feasel, Halifax Health President and CEO. “Every year we provide scholarships for our Team Members to enhance their education. This program with Daytona State College, Education to Employment, is a great way for us to build a sustainable pipeline of life saving care givers and increase the economic vitality of our area. In addition, we are pleased to continue to support the athletes at Daytona State College as their official healthcare provider.” “This is a partnership that has tremendous benefits for students at Daytona State and future employees of Halifax Health,” said Dr. Tom LoBasso, DSC President. “By working together to provide both educational and employment opportunities, we’re able to address the needs of our local communities by filling critical healthcare positions with home-grown talent. Daytona State College has enjoyed a long and successful partnership for many years, and we’re confident that this new scholarship will provide long-term benefits for everyone.” As part of the agreement, the Halifax Health Scholarship Fund has been established with the DSC Foundation, with Halifax contributing $100,000 annually over the next five years. Each year, the fund will provide $50,000 in scholarship money for employees of Halifax Health who are students in Daytona State’s BSN program, $35,000 for students in the BSN or AS nursing programs, and $15,000 for students in other health related fields. The scholarship will pay the full amount of tuition and fees for each semester awarded. All scholarship recipients will be selected by Daytona State College and may be either full- or part-time students. They must have a minimum GPA of 3.0 and be a resident of Volusia, Flagler or Brevard counties. Scholarship recipients must enter into a separate agreement with Halifax or a Halifax affiliate regarding their future employment with Halifax or one of its affiliates.

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