Orlando Medical News February 2017 by Orlando Medical News

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Medical Practices Facing Woeful Collection Rates Developing Deﬁned Revenue Strategy Can be Key to Flourishing By pL JETER

Based on an average physician practice submitting 83 claims daily, industry collection statistics are sobering: multispecialty practices collect only slightly more than half of accounts receivable within 30 days. Up to two-thirds of physician practice revenue is lost because of billing leakage. More to the point, a full 30 percent of claims are denied (or ignored) on first submission. Of those claims, 60 percent were never resubmitted, per the Center for Medicare & Medicaid Services (CMS).

It doesn’t help to learn that 42 percent of claims are coded incorrectly, per a recent U.S. Department of Health & Human Services (DHHS) study. “It’s estimated that doctors in the U.S. leave approximately $125 billion on the table each year due to poor billing practices,” said Leidy Arguelles, CPC, CPMA, revenue cycle operations manager at Florida-based Bravado Health, pointing out that practices should have a target of 5 percent of claims with (CONTINUED ON PAGE 6)

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PHYSICIAN SPOTLIGHT

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Edward J. Gross, MD

HEALTHCARE LEADER PAGE 4

Jeﬀrey J. Lehman, MD CAPI 2017 President Addresses Philanthropic Goals New Philanthropy Committee Reflects Patange’s Principles; Streamlines the Charitable Process ... 8

HEALTH INNOVATORS Five Simple Ways to Invest in Today’s Health Tech How the Lake Nona Impact Forum 2017 Can Change Orlando’s Health Innovation ... 11

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Florida Hospital Radiology Residency Program Delivering Outstanding Graduates By pL JETER

Last year, Florida Hospital’s diagnostic radiology residency program graduated its first class, with all four MDs earning a 100

percent first-time Boards pass rate. “Our goal is to have the residents become confident in the interpretation of a wide range of imaging, and become facile with image-guided procedures,” said Laura

W. Bancroft, MD, radiology residency program director, chief of musculoskeletal imaging of Florida Hospital Orlando, radiology professor at Florida State University College of Medicine, the Department Chair (CONTINUED ON PAGE 6)

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Edward J. Gross, MD

Facial Plastic Surgeon, Primera Plastic Surgery, Lake Mary By pL JETER

Edward J. Gross, MD, recalls the very special treat he enjoyed on weekends as a child when he tagged along with his dad on rounds at Hialeah Hospital in Miami. “My sister and I knew we’d get a pony ride afterward,” recalled Gross, a facial plastic surgeon at Primera Plastic Surgery in Lake Mary. “There was a pony ride next to the hospital parking lot and that was always our big treat.” Along the way, Gross realized he wanted to follow in the footsteps of his dad – the late Edward F. Gross, MD – but perhaps not as a general practitioner. Tinkering in the wood shop with his grandfather and nurturing the family garden prompted insight into a surgical inclination. “Putting those two pieces together came pretty naturally for me in terms of choosing plastic

Faces of Honor Faces of Honor is a program of the American Academy of Facial Plastic and Reconstructive Surgery Foundation (AAFPRS) that provides pro bono medical and surgical expertise to honorably discharged veterans and active duty members of the U.S. military who were injured while deployed in support of the wars in Iraq (Operation Iraqi Freedom) or Afghanistan and the Middle East (Operation Enduring Freedom). “Many veterans aren’t aware of this resource, which is relatively new,” said Edward J. Gross, MD, a facial plastic surgeon at Primera Plastic Surgery in Lake Mary, a practice that partners with the Faces of Honor program. “We’re always looking for opportunities to help local veterans that need facial reconstruction or burn care or laser treatment for facial injuries.” AAFPRS president Donn R. Chatham, MD, said the purpose of the 8-year-old program is a way to “thank the brave men and women who have served our country” through coordinated pro bono specialized care. “Some (veterans) may have already received treatment in a military hospital while on active duty and may have been discharged,” he said. “Others may have relocated to their home base and remain on active duty, being cared for by a DOD or VA medical facility. Some veterans may be from the National Guard or Reserve, (perhaps) geographically separated from a VA facility, and some may just want an additional caregiver consultation.” Chatham encourages qualifying veterans to contact the AAFPRS to determine eligibility. For more information, visit http://www.facesofhonor.org/servicesmembers-veterans.html.

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surgery,” he recalled. “To know I could rejuvenate patients with my hands and nurture them along the healing process provided great rewards.” To make sure he has the time to get to know his patients, Gross usually schedules some 10 patients daily. “All my patients have my cell phone number, which gives them peace of mind and maintains good communication,” he said. “I cherish the bond I’ve created with patients, and now I’m taking care of their children, which is pretty amazing.” Born and raised in Miami, Gross earned a chemistry degree from the University of Miami, followed by a medical degree from its School of Medicine. A lengthy stint “up north” convinced Gross to return to a subtropical climate for the bulk of his medical career. First, he completed surgical residency at Tufts University Hospital in Boston, Mass., followed by a fellowship in facial plastic surgery at Indiana University, where he focused on rhinoplasty and revision rhinoplasty procedures. He also served as chief of staff at the busy HealthSouth Surgical Center in Elizabethtown, Ky., which served an 11-county market, before transitioning to Central Florida in 1999. Initially back in Florida, Gross joined a Melbourne practice, OMNI Healthcare. In 2000, he opened a solo practice in Altamonte Springs. In 2006, he joined Prim-

era Plastic Surgery Center & Day Spa in Lake Mary. The Orlando Regional Health Systems-affiliated practice also has a Winter Park location. Board-certified in facial plastic and reconstructive surgery by the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS) – he’s among only 750 surgeons worldwide in the organization – Gross is also certified in otolaryngology. (The ABFPRS was organized to recognize facial plastic surgeons who have moved beyond initial certification. Among other requirements, ABFPRS certification includes peer review of at least 100 facial plastic surgery cases over a two-year period.) Gross quickly became one of the region’s top go-to surgeons for facial plastic and reconstructive surgery. He has graced the cover of at least two annual Best of Orlando Magazine special publications, and has been recognized by the American Medical Association as a “Physician Who Cares.” Gross’s face lights up when he talks about his work with Faces of Honor, a program of the American Academy of Facial Plastic and Reconstructive Surgery Foundation that coordinates pro bono medical and surgical expertise to special veterans who have suffered face, head or neck injuries while serving overseas in the United States military. (See sidebar.)

“We’ve done very well here and return that good fortune to our local community,” said Gross, who also provides scar revision and laser treatment for facial injuries involving victims of domestic violence through a charitable partnership in Seminole County with Nemours Children’s Hospital and A Place Called Home (APCH). A volunteer faculty member at the University of Central Florida (UCF) College of Medicine, Gross often has students shadow him to get a better idea of plastic surgery as a specialty. “Progressive medical schools like UCF are exposing medical students at an earlier stage in their medical career to have an idea what they might want to pursue,” he said. “It’s a newer idea and a good opportunity.” Gross’s sons, UCF students ages 22 and 23, sometimes watch their dad complete surgical procedures from the practice operating room’s observatory. “One of them might pursue a career in medicine,” he said, then chuckled. “The other might go into business or law.” Outside the practice, Gross enjoys a bit of golfing, some cycling, playing chess with his son, puttering around with his longtimegirlfriend, and pursuing his passion project – the restoration of a 1970 Chevelle. “Actually, I’m pretty much of a homebody,” he joked. “I like it that way.”

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Jeffrey J. Lehman, MD Otolaryngologist, Ear Nose and Throat Surgical Associates; Cofounder, Center for Voice Care and Swallowing Disorders, Winter Park By pL JETER

WINTER PARK – Singing was a catalyst for Jeffrey J. Lehman, MD, to pursue a career in medicine, but it was midcollege before he made a commitment, a surprise to his extended family of doctors. “My second-grade teacher had each child sing a song,” recalled Lehman, a board-certified adult and pediatric otolaryngologist at Ear Nose and Throat Surgical Associates and co-founder of the Center for Voice Care and Swallowing Disorders in Winter Park. “I hadn’t really thought about singing before then, but I recall thinking that if I breathed deeply and let the sound flow out, a good performance could result.” Lehman was spot on, and soon began singing solos at school concerts and church. As a teenager, he learned his body’s limits while singing in a rock ‘n’ roll band, where he also played guitar, keyboard and trumpet. “I became personally acquainted with vocal strain resulting from vocal overuse,”

he admitted. “I found little in the way of helpful resources to help me cope.” At the University of Wisconsin (UW), Lehman earned a degree in molecular biology with a plan to focus on research. He soon decided life in a lab wasn’t for him and pursued medical school at UW to blend his scientific interests with more personal interaction. Also, the specialty of otolaryngology intrigued him. Perhaps, he thought, there’s a way to help vocalists with performance problems. “The care of voice problems was undergoing a revolution at that time, and UW was one of the hotbeds of change,” said Lehman of the late 1980s, pointing out that mentors Charles Ford, MD, and Diane Bless, PhD, worked to refine the use of new technology in voice evaluation and treatment. For example, a voice lab was developed around new techniques available for examination, including videostroboscopy. “A scope is placed in the patient’s mouth to look at their vocal cords with a 70-degree angle lens,” he explained. “At the same time they’re voicing, a micro-

phone catches their voice frequency and triggers a strobe light flash. It’s almost like a slow-motion movie of vocal fold vibration.” Heading South Tired of long, cold Wisconsin winters, Lehman joined Ear Nose and Throat Surgical Associates in Orlando after completing an internship in general surgery and residency work in otolaryngology at UW. Because multi-disciplinary involvement provided a way for ENTs to provide voice patients with more personalized care, he became resolved to develop a multidisciplinary voice center and incorporate it into his clinical practice. “In the past, ENTs worked somewhat in isolation, as did speech pathologists, when it came to voice problems,” Lehman explained. “ENTs would refer patients to speech pathologists, who would listen to the voice without any idea of what was going on from the perspective of images or anatomy. It wasn’t a true multi-disciplinary approach.”

To Lehman’s delight, “this single-specialty group practice was very receptive to my idea, especially since the Orlando area has a large population of vocal performers working in some very challenging venues,” he said. Lehman established the Center for Voice Care with David Ingram, PhD, a progressive and energetic speech pathologist at the University of Central Florida (UCF). When Ingram retired, his student Hoffman Ruddy, PhD, stepped in to help Lehman continue molding the program into a regional center of excellence with an active clinical research program. Among their projects: studying 3-dimensional modeling of the airway with engineers to better understand chronic cough and sleep apnea. Lehman’s practice has expanded to focus on adult and pediatric otolaryngology, voice disorders, head and neck, sleep apnea, and robotic and endoscopic sinus surgeries. In fact, he was among the first physicians to perform endoscopic sinus surgery in Central Florida. “I was the first resident trained in it, and had a broad (CONTINUED ON PAGE 6)

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coding errors, and that practices should collect 90 percent of their accounts receivable within the first 30 days. Up to 80 percent of medical bills contain errors because of strict insurance medical billing and coding practices and regulatory changes, Arguelles pointed out. “The rules are constantly changing, requiring physicians and administrators to spend time and money on continuing education, software, or staff training to stay current, having a direct effect on the cash flow and profits of a practice,” she said, pointing to the implementation and balance of three pillars of medical billing – back office, front office and technology – to headline a welldefined revenue cycle strategy. Back Office Don’t settle for writing off or waiting on owed money, urged Arguelles. “Work with someone who knows your contracts, payer rules, patient responsibilities and timeframes inside and out,” she explained. “They should run an extremely tight ship and be up-to-date on all changes each year with your specialty, down to your local coverage determination (LCDs). These critical areas should be communicated and marked immediately for any correction, so that a billing team is sending clean claims the first time – and quickly.” Known as the first-pass resolution rate, it should be in the upper 90th percentile, lower than 100 percent only because rules change constantly and rogue denials exist, noted Arguelles. “You just need a team who catches it immediately and provides correction immediately where needed,” she explained. “Additionally, having the notifications with proper timeframes in place to know when something needs to be corrected, is also crucial to timely, accurate payments, which also means cash flow. So, if a payment doesn’t come back in the predetermined, understood timeframe, or it doesn’t come back paid to the full contracted rate, then collections and appeals should be automatic, immediate and efficient in terms of action, which ultimately affect the success.” Front Office From front desk to physician to patient and insurance collection, a practice’s RCM partner should be able to help adjust these areas to maximize collections owed, based on contracts with payers, said Arguelles. “For example, many denials and rejections reflect poor front desk training, process and incentives,” she said. “In fact, it’s often the lowest paid employee who is the most crucial piece to ensuring proper collections, both by the payer and the patient. They also account for the biggest deficit in the practice collections overall. Having a billing team that can quickly find these issues – narrowing in on the root cause and quickly making corrections through good training and buy in with the practice – is crucial to optimal success as well.”

Technology A successful practice must be electronic, emphasized Arguelles. “While some may want to debate the clinical charting side of things, the billing portion must be automated as much as possible for efficiency, timeliness and tracking,” she said. “At the same time, it’s not easy to use technology to its fullest, even if you’ve bought or subscribed and trained on a top system. So, you should have a partner who understands how to help optimize the use of the investment you’ve made, and do this over time, as they find areas that will yield proper return on investment (ROI), even if it’s just the investment of time.” For example, even though an electronic system may already have templates, setting those up with fewer keystrokes can be liberating and more profitable when done correctly, said Arguelles. “And if they’re really good, they can also help you understand where features, interfaces and other technology can be implemented to increase efficiency, volume and revenue,” she said. “Finally, it’s always a big bonus if they have experience with multiple systems and software, so they can truly convey objective and effective best practices.” When all three areas are covered, a strong RCM partner should be able to assess billing practices, find accounts receivable leaks, and implement a plan that secures 100 percent of money owed. “As in any investigation, a more thorough assessment is likely to provide more enlightenment,” said Arguelles. “A good evaluation should include information such as your denial report and clearinghouse rejection report, which can shed light on error trends and enable process improvement. Reviewing your accounts receivable by aging report and most frequently used CPT codes helps identify bottlenecks in the billing process and which services you’re collecting the most on. These are some of the items you should have prepared when doing a review of your practice’s revenue cycle.” When a billing partner operates quickly and efficiently through experience, process knowledge and technical know-how, a practice should expect vast improvement, said Arguelles. “For example, a 30 percent denials will go down below 5 percent … 60 percent of non-resubmissions go to 100 percent resubmitted and paid to full contracted rate,” she said. “More importantly, you should see your practice in a whole new light, where physician owners experience less stress, have a growth strategy securely in place, and enjoy better quality of life.”

HEALTHCARELEADER

Jeffrey J. Lehman, MD continued from page 4 depth of experience,” he said. “My endoscopic sinus surgery practice took off because when others who were just starting out had a difficult case, they’d all send it to me.” Awarded Otolaryngologist of the Year by the Florida Network of Otolaryngologists in 2012, Lehman was acknowledged among “Best Doctors in America” in 1996, 2001-02, and 2007-16. He also serves as a clinical professor at the University of Central Florida’s College of Health and Public Affairs, where he helps train rotating speech pathology students. Broader Leadership Role At Florida Hospital, after serving in various hospital physician leadership roles including several years as Chairman of the Otolaryngology Department, Lehman undertook an eight-year track that led him to his position as president of the medical staff, or as he calls it in the year of unprecedented change in regulatory policy, “the hot seat.” In his role, he oversees some 2,500 hospitalemployed and independent physicians plus the allied health practitioners. “All the problems, all the calls come to me,” he said, emphasizing that his role differs from that of Chief Medical Officer David Morehead, MD. “Dave and I are on the phone all the time.” When Lehman was secretary-treasurer of the medical staff, in a two-year term leading to his rotation as president, he was tapped to chair the newly developed Medical Staff Information Technology Committee. “We were going through the integration of information technology with the electronic medical record system, and we wanted to make sure it was done in a way to enable technology to serve physicians, rather than impede their work,” he said. Lehman continued to chair the committee until his turn as medical staff president. “I guess I only have so much (personal) bandwidth,” he joked. “Between keeping a busy clinical full-time practice going and being medical staff president, there’s just not a lot of time.” Lehman likens the repeal and replacement efforts of the Affordable Care Act to ongoing construction of Interstate 4 in Orlando. “Traffic patterns will change, but the overall direction of the road will remain the same – heading toward more integrated healthcare,” he said. “Our larger employers are demanding more integrated care. They want physicians and hospitals to take more risk concerning population management.” Lehman foresees many challenges in the transformation of the national healthcare system. “Like shifts in the traffic pattern require constant communication,” he said, “we’ll require constant communication through strategic planning with all care providers.”

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Florida Hospital Radiology, continued from page 1

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Florida Hospital’s radiology residency program also provides training with Adobe Acrobat encompassing the six ACGME competencies – patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism and systems-based practice. “Our residents have been very successful, with 100 percent first time Boards pass rate, excellent ACR in-service scores – 99 percentile for our third-year class, 97 percentile for the second-year class and 93 percentile total for the first-year class – and impressive fellowship matches,” said Bancroft, pointing out that residents and faculty hold academic rank at the University of Central Florida and some at Florida State University College of Medicine. “Radiology residents have obtained fellowships at Johns Hopkins University, Duke University, Mallinckrodt, the Children’s Hospital of Philadelphia, the University of Maryland, University of Michigan and the University of Florida so far.” Bancroft pointed out the program provides complimentary food for residents, educational funding for scientific presentations at national meetings, research opportunities, American Institute for Radiologic Pathology stipends and team-building opportunities at Orlando Magic games. “They’re all bright physicians and it’s fantastic to see them maximize their potential as future radiologists,” said Bancroft.

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CAPI 2017 President Addresses Philanthropic Goals

New Philanthropy Committee Reflects Patange’s Principles; Streamlines the Charitable Process By JUDY OTTO

It is fitting that, as a new president took the helm of the Central Florida Association of Physicians from the Indian Subcontinent (CAPI) in December, a new and powerful arm of the organization also made its debut alongside him. During the preceding year, current President Vijay Patange, MD, had worked tirelessly alongside his CAPI executive committee colleagues to develop the structure and purpose of the new Philanthropy Committee, which will facilitate and regulate CAPI’s future charitable efforts and endowments to deserving entities and individuals within the Orlando community. CAPI’s stated mission and purpose are built around service and support to their community; the new Philanthropy Committee enhances CAPI’s ability to execute that mission: “The Committee was formed to create guidelines for the future, with special attention to transparency and accountability in decision-making,” Patange explained. “As president, this allows me to direct funds to charities of the members’ choice.” Where the CAPI membership has previously raised and donated money and time to various local and national charities and foundations on a less formally-structured basis that depended on general membership involvement, now the process of earmarking and expediting delivery of endowments rests with the Philanthropy Committee’s five members—the current president, presidentelect, a past president, and two elected rep-

resentatives from the membership at large. Funds are raised exclusively from member contributions to the CAPI Foundation; Individual member donations to a favored charity or beneficiary are also matched by organizational funds. In practice, the Committee’s work is expected to increase the organization’s efficiency in disbursing awards, thanks to oversight and consensus from the experienced decision-makers who comprise the Committee. Patange was initially drawn to the CAPI organization by personal ideals that mirrored CAPI’s mission of serving others through charitable efforts. Patange learned early, during his childhood in Mumbai (formerly known as Bombay), India, the value of both education and service. “My father, a textile engineer, always said that education is the key to success in life – a jewel no one can steal. I adopted my parent’s mantra – to serve others first, to share and be selfless.” The profession of medicine is a natural choice for those who hope to help others; Patange attended medical school at the Government Medical College at Nagpur, India. During his pediatric residency at home in Mumbai, he discovered a fascination for radiology that captivates him still. “I realized that radiology touched every specialty of medicine, so I was able to help a variety of patients and clinicians. I jointed Tata Memorial Hospital as a radiology resident and completed a post-graduate degree in radiology from the University

of Bombay in 1992,” he said. After marrying his wife, Rita, he moved to the United States in pursuit of his passion for advanced studies and higher learning. He finished a residency in radiology from the University of South Alabama and a fellowship in nuclear medicine at the University of Texas Medical Branch at Galveston. Determined to excel in the field, he completed an additional fellowship in MRI (magnetic resonance imaging) at Cincinnati’s MRI Education Foundation/The Christ Hospital. In 2001, he relocated to Orlando and joined the Medical Center Radiology Group, where he has been a partner for 15 years. He has served as Chief of MRI for Orlando Health, Chief of Radiology at South Lake Hospital in Clermont, and has been invited to serve as director on the South Lake Hospital Foundation Board. He is active as an educator for residents, medical students, and conference attendees. A career rich in giving and serving was paralleled by his early membership in CAPI, which was then regarded as a great networking platform for doctors and dentists, but grew and evolved rapidly into a strongly charitable entity. Patange began volunteering, which helped to hone his organizational skills, and he was soon encouraged to join CAPI’s leadership team. At the end of the day, Patange finds it gratifying to be involved in a purpose larger than his own daily duties for his job and cherished family, including children

aged 12, 15, and 17, “…without whose unconditional love and support this journey is not possible.” “Capi gave me an opportunity and a platform to serve others as I have been helped by many friends and mentors along the way. It is a rewarding journey—and I am blessed.”

CAPI PHILANTHROPY COMMITTEE 2017 PRESIDENT: Vijay Patange, MD PRESIDENT ELECT: Priya Vishnubhotla, MD PAST PRESIDENT: Amish Parikh, MD ELECTED MEMBER: Uday Desai, MD ELECTED MEMBER: Sumeet Bhavsar, MD Please visit capimed.com for more details.

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The 3 Essential Rules for Content Development By BETH RUDLOFF, InnOVATIOn EXECUTIVE, MEDSpEAKS

When you are ready to build your social media presence, you will need to develop content. If you aren’t as comfortable tweeting off the cuff like Donald Trump is, you will want to spend some time developing a strategy. So how do you create content that doesn’t get you in hot water but is also interesting enough so that you develop a following? John Nosta, President of NostaLab and member of Google Health Advisory Board states, “Social media means that you must recognize that there is a social aspect (for example saying thank you to a patient for a follow), that is integrated with media that can be more traditional information sharing.” Content is the way potential customers will get to know you before they decide whether or not to make their appointment. Content needs to reflect your personality as a physician and draw people (potential patients) to dive in deeper to get to know you and your brand. It is important that

you don’t use a generic service but create personalized content. Three points that you will want to remember as you develop content: Clear - Before you post, think about what you are trying to communicate. If you have an area of expertise, most of your posts should reflect that expertise. If you post about random topics, your message will become muddied. “It does not always need to be about medical care. You can borrow fun facts from related areas to enhance the conversational tone of social media; for example, if you have a practice that is mostly about cosmetic surgery, you may want to include posts about fashion or art,” according to Nosta. Decide on your top areas you want to be known for, and keep it in mind every time you post. Concise - The beauty (or curse) of Twitter is its 140-character limit. You

clear

concise

“Craft the content very carefully. Avoid inundation of generic, mundane information but focus on ways to makes it unique, with wording, like Top Health Tip of the Day,” said Nosta. Talk about breaking medical news in your specialty, or common medical problems in your geographic area that relate to your practice in a conversational manner. If all of this seems overwhelming to you in the midst of running a busy practice, you may want to contract out for these services with a company that can develop content customized for you. “Content marketing can help already established experts become wider known for their expertise…it is not what makes them an expert. The content marketing pieces is what helps them become known a little wider than perhaps might have been known today,” according to Christoph Trappe of Authentic Storytelling.

creative

must be concise in making your content known. There are statistics that state that 80 percent of Facebook users don’t open a post or turn the sounds on the videos. Therefore, your post needs to either be able to be read from the summary or tweet people are scrolling through or interesting enough for clicking through to your website (not an easy task!). Creative - Social media content is not like writing a research paper or scientific presentation. It needs to be well written and understandable for potential patients so that they can get to know you as they decide with whom to seek medical care.

How to Access HIMSS Using Twitter By nInA TALLEy, MEDSpEAKS

Social Media Ambassadors

Hashtags by Interest

HIMSS17 is finally here! The destination for all things HealthIT. Through the years HIMSS has positioned itself as the healthcare conference that you cannot miss. The event is filled with expert speakers, like former Speaker of the House John Boehner, and Chairman & CEO of IBM Ginni M. Rometty, and will span a total of 5 days with over 300 sessions. Sadly, many of us cannot make it to HIMSS due to either travel, time, or cost constraints. Luckily for all of us we live in the digital age and HIMSS17 is fully integrated with social media, making it possible for us to access large swaths of its content from the comfort of our homes. Let’s take a look at how you can use Twitter to engage with the HIMSS17 conference and community.

Like true social media pros, HIMSS17 put together a list of Social Media Ambassadors to help curate the massive amounts of content for their digital consumers. These SMAs were hand selected by the Healthcare Information and Management Systems Society and were chosen for their social media expertise as well as their unique insights into healthIT. Make sure to follow each of these SMAs on Twitter to stay up to date on all things HIMSS17 as the conference progresses.

Trying to stay up to date on a large scale event via social media can be frankly overwhelming. With so many attendees, reporters, and speakers, it can be difficult to sift through the digital landscape for the conversations you’re interested in. Streamline the tweets you’re consuming by utilizing these HIMSS curated hashtags based on your specific interests to help filter out the noise. Try combining multiple hashtags into one search for even more granular results!

MedSpeaks Coverage The MedSpeaks editorial team will be at HIMSS for all 5 days, and will be covering all things health innovation for Orlando Medical News. Make sure to follow our team on Twitter for insights into some of the most impactful new technologies at the conference. Kelli Murray: @med_speaks Beth Rudloff: @beatrix_health Colin Forward: @healthinnovate_

You can also check out our hashtag #HealthInnovators for HIMSS coverage, as well as past and future Health Innovators community event information! 10

FEBRUARY 2017

Andrew DeLaO: @CancerGeek Bill Bunting: @WTBunting Charles Webster: @wareﬂo Colin Hung: @Colin_Hung Danielle Siarri: @innonurse Drex Deford: @drexdeford Geeta Nayyar: @gnayyar Jane Sarasohn-Kahn: @healthythinker Janice McCallum: @janicemccallum John Lynn: @techguy Linda Stotsky: @EMRAnswers Lygeia Ricciardi: @lygeia Mandi Bishop: @MandiBPro Matthew Fisher: @Matt_R_Fisher Max Stroud: @MMaxwellStroud Nick Van Terheyden: @drnic1 Rasu Shrestha: @RasuShrestha Shahid Shah: @ShahidNShah Tamara StClaire: @drstclaire Vanessa Carter: @_FaceSA

#HIMSS17 This is the general use hashtag for all things HIMSS. #Engage4Health Focused on the exploration of tools, strategies, and technologies that engage patients and caregivers.

#HITworks Focused on highlighting the value of healthIT through structure, strategy, and analytics. #EmpowerHIT Hashtag focused on discussing opportunities in achieving healthcare interoperability. #Connect2Health Conversations exploring the future impact of fully connected, anytime-anywhere healthcare models. #Aim2Innovate Inspiring conversations that investigate disruptive products and strategies aiming to innovate healthIT solutions, care, and quality. #PrecisionHIT Discussions focused on how we can transform patient care through healthIT and the personalization of medicine. #GovHIT Showcasing the dynamic conversations at the intersection of public policy and healthIT.

#HITcloud Conversations centered around cloud-based computing in healthcare, including security concerns and interoperability difﬁculties.

#RethinkRCM Hashtag coordinating opportunities to create value-based collaborations centered around rethinking efficient revenue management processes.

#HITsecurity Covers discussions on healthIT security, training, preparedness, and response techniques.

#PutData2Work Explorations in the best practices of health data management and optimization strategies.

#Nurses4HIT Engage with the heart of any hospital system, the nurses, and discover how they are using healthIT to drive positive patient outcomes.

#PopHealthIT Conversations about facilitating improvements in population health organizations through healthIT.

#DrHIT Physician hashtag being utilized to connect healthIT focused doctors to engage with both their peers and patients.

#HITVenture Hashtag covering the Venture+ Forum and Startup Boot Camp, exploring the latest health tech investment trends and current market opportunities.

#WomenInHIT Hashtag being used to empower women in healthIT, shining a spotlight on the accomplishments, advocacy, and resources of women at HIMSS.

#IHeartHIT This hashtag will highlight meaningful and personal stories of healthIT, that illustrate human outcomes for healthIT end users.

#GenY4HIT Connecting millennials and future leaders of healthcare at HIMSS17.

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HEALTH INNOVATORS

Five Simple Ways to Invest in Today’s Health Tech By KELLI MURRAY, Founder, MedSpeaks

The Central Florida market is ripe with a variety of emerging technologies and ambitious inventors positioning to bring meaningful solutions to our local healthcare ecosystem. Despite the diverse talent and creativity, a consistent challenge facing ideators and founders is the ability to effectively engage the physician community in validating that these solutions are not just viable from a business perspective, but are also meaningful and impactful to outcomes, productivity, and cost savings. I recently reached into my network of physicians in order to get to the root of the problem. Surprisingly, the most common reason is not a lack of time or interest on the physician’s part. The problem is an inherent lack of reciprocal value that physicians receive in exchange for providing their specialized knowledge, which startups need to validate their company’s direction. According to Christian Assad, MD, Interventional Endovascular Cardiologist at RGV Cardiology, and Co-Founder of Curely Health, “(Startups) should not expect different from a physician than what you would expect from any other professional, such as an attorney. If my knowledge can help make a successful million-dollar company, then things change. A free consult to a patient is far different than a free consult to a startup because they are here to make money. Taking calls from start-ups may be cool in the beginning, but in the end, it’s a waste of time without incentives.” Given the fact that the a physician’s unique medical knowledge and experience may make the difference between an innovation never making it off the ground, and one that hits a moonshot in the market, consider these options as a means to invest in the health tech scene that won’t break the bank, or your schedule, yet offer a variety of incentives.

• Follow Innovation Leaders on Social Media - healthcare thought leaders such as Daniel Kraft, Robert Scoble, John Nosta, Eric Topol, Peter Diamandis, Christian Assad, Shafi Ahmed, Brian Ahier, Jane SarasohnKahn, Nick van Terheyden, and Unity Stoaks are ahead on current trends and provide insightful commentary. Follow them on Twitter and LinkedIn. • Be a hired consultant for a startup or venture capital firm - often roles of this capacity are part-time positions and offer opportunities for creativity as well as equity ownership and/or fees, either of which can open new doors and help keep your knowledge base on point with current and futuristic trends. • Invest using a self-directed IRA companies like Orlando-based NuView IRA and more traditional firms like Fidelity offer a simple way to convert your 401k into a self-directed IRA, which means you can financially invest in opportunities you have personally vetted. Although risky, the returns - if invested and diversified wisely - can result in hearty returns well above stock averages.

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How the Lake Nona Impact Forum 2017 Can Change Orlando’s Health Innovation By BETH RUDLOFF, Innovation Executive, MedSpeaks

Orlando might best be known for theme parks and citrus, but the Lake Nona Institute wants to make it a destination for health innovation as well. That is why Amit Sood MD, Michael Rhodin of IBM, Sanjay Gupta, MD, Margaret Truman, and many other well-known health experts will be coming to Lake Nona in mid-February to speak at the invitation only Lake Nona Impact Forum. The forum, now entering its fifth year, is known for bringing together leaders with wide-ranging perspectives to spark new ideas and work on how to apply these ideas in the real world. Bill Fair, director of Life Sciences Business Development, Lake Nona Medical City, for the Tavistock Development Company says this is much different than the conferences healthcare professionals may be used to attending. Most of the time conference goers pay to attend, the speakers parachute in and out to speak, and you have to pick a certain “track” according to your occupation or special interest group.

FEATURED EVENTS FEBRUARY 19-23

HIMSS Conference & Exhibition, Orange County Convention Center, Orlando, www.himssconference.org

FEBRUARY 28

HIMSS 2017 Coverage Event, Orlando, Entrance $15, www.healthinnovators.info

MedSpeaksTM showcases the most exciting experts, events and innovations in Central Florida by bringing together the state’s largest community network of Health Innovators. We have converged over 1,400 healthcare professionals including clinicians, entrepreneurs, and technologists to discuss and promote the problems facing healthcare today and the innovations reshaping the future. www.medspeaks.com

In contrast, the Lake Nona Impact Forum is a free event for the participants (who are mostly from the C-suite of healthcare companies), and the speakers stay before and after their presentations to participate in discussion. “It’s not like a conference, but a conversation,” according to Fair, “There is cross-pollination that is thought provoking and that can accelerate new and different collaboration and connection.” The topics this year are major issues that can use some innovation: • The aging population and how we can keep them healthy • Problem populations that contribute to high healthcare costs, such as diabetics • Mental health solutions that can really make a difference • Models to promote drug development With this cross-pollination of speakers, attendees and topics, new breakthroughs can happen. The innovation skyline of Lake Nona has been growing and developing at a rapid pace in the last seven years. Bill talks about “not just a constellation of buildings, but a weaving of the fabric of an innovation community.” The forum will be held at the Veterans Health Administration simHEALTH Center, the Guidewell Innovation Center, the University of Central Florida College of Medicine, United States Tennis Association National Campus, and University of Florida Research and Academic Center, all located within the Lake Nona Medical City. (CONTINUED ON PAGE 13)

• Get involved in the local Health Innovation Community - there’s a network of over 1,400 healthcare founders and technologists right here in Central Florida. Monthly meetings are designed to facilitate organic relationships via constructive, creative dialog between “problem owners” and “problem solvers.” Learn more at healthinnovators.info. • Join an Investor Network - groups like the Florida Angel Nexus and FAN Fund offer structured visibility into startups and provide a platform to invest financially. These networks of investors typically focus on a variety of industries, including health, which not only provide you with an opportunity to diversify your portfolio but the potential to function as a domain expert for evaluating the viability of healthcare startups. orlandomedicalnews

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FEBRUARY 2017

BEST PRACTICES

A Molecular Receptor Theory Of Trigeminal Neuralgia Type 2: A Duality Illness DR. BRIAN FUSELIER, DR. MELVIN FIELD, AND DR. BARRY LOUGHNER

True trigeminal neuralgia can be divided into 2 categories: trigeminal neuralgia type 1 (TN1) and trigeminal neuralgia type 2 (TN2). The Facial Pain Association defines TN2 as a “constant, mild to moderate, aching or burning, mostly unilateral, face pain associated with brief episodes of severe, paroxysmal, ipsilateral face pain.” The pain is often associated with stereotyped triggers, such as jaw movement, cool breeze, or light touch to a discrete cutaneous area of the face. This difference in pain between TN1 and TN2 is illustrated in Figure 1. The area within the red box of Figure 1 displays the constant, mild to moderate face pain that represents on-going central sensitization that occurs with TN2. Central sensitization is induced by brief, severe, repeated paroxysms of TN1, and continues even in the absence of severe TN1 peripheral input. The hallmark of TN2, however, is that while central sensitization continues unabated, occasional severe TN1 paroxysms occur (right side of Figure 1). In contrast to other chronic pain syndromes where central sensitization is no longer coupled to the presence, intensity, or duration of particular peripheral stimuli, TN2 is marked by periods of severe TN1 attacks of spontaneous or stereotyped peripheral stimuli. When central sensitization is initiated, the trigeminal system at the first central synapse undergoes a process called “wind-up” - the nociceptive component of the trigeminal system manifests an upward spiraling course into a persistent state of high reactivity. Central sensitization is an expression of the CNS plasticity producing alterations in somatosensory processing. Plasticity is an essential intrinsic state of the trigeminal system that allows for development and maintenance of TN2 pain. Central sensitization of TN2 is defined as chronic, constant, excitatory, post-synaptic activity of 2nd order pain transmission neurons located in the medullary dorsal horn. Temporal summation of sub-threshold excitatory post-synaptic currents in the cell body of the 2nd order neuron will eventually evoke action potential firing and transmission of pain signals that decussate, and

ultimately target the rostral, sensory-discriminative, perception centers of the posterior central gyrus of the neocortex. There are 2 separate presentments of central sensitization of TN2. The first presentment of TN2 central sensitization occurs at the first central synapse of the nucleus caudalis in the medullary dorsal horn of the trigeminal nuclear complex (Figure 2, solid line). The genesis of TN2 central Figure 1 sensitization begins with a barrage of severe TN1 paroxysms that are generated at unmyelinated areas of the trigeminal nerve at the peripheral root entry zone (Figure 2). Mechanical stimulation by vascular and/or fibrous elements at the root entry zone is transduced, thus causing the generation of ectopic action potentials carried primarily by A delta mechanoreceptors or polymodal C fiber nociceptors. The ectopic action potentials wend centrally into the pons, then immediately descend caudally into the medullary dorsal horn, and Figure 2 ultimately terminate in the nucleus caudalis. When these nociceptive action potentials propagate centrally to the pre-synaptic terminal, special voltage-gated Ca2+ channels open, thus causing an influx of Ca2+ ions into the pre-synaptic terminal. The result is a release of excitatory neurotransmitters, such as glutamate, that then binds with receptors of post-synaptic 2nd order pain neurons. Multiple second messenger systems, in response to noxious peripheral nociceptive input, act to develop sensitization of the post-synaptic pain transmission neurons. “Wind-up” is the consequence of cumulative membrane depolarization by a train of C-fiber input that gets larger with each successive stimulation. For example, in the setting of a barrage of severe TN1 paroxysms, glutamate release is increased from the pre-synaptic terminal, depolarizes the post-synaptic neuron, binds to, and turns on previously silent, metatropic, ligand-gated NMDA receptors

Dr. Melvin Field, MD, FAANS is a member of the Facial Pain Association, American Association of Neurological Surgeons, North American Skull Base Society, and the World Federation of Neurologic Societies. Dr. Field specializes in the neurosurgical management of Trigeminal Neuralgia and various skull base disorders. Dr. Field is a partner of Orlando Neurosurgery in Winter Park, FL and operates at Florida Hospital Orlando and Orlando Regional Medical Center. For contact information visit his website at www.orlandoneurosurgery.com

FEBRUARY 2017

leading to an influx of Ca2+ ions. Similar to short-term memory development caused by hippocampal longterm potentiation, central sensitization at the cellular level is dependent, in part, on NMDA-mediated elevations of intra-cellular Ca2+ ions at the post-synaptic terminal. Ca2+ acts as a second messenger that plays a role in downstream activation of multiple signaling molecules, notably protein kinases. Elevation in intracellular Ca2+ is the major trigger which activates multiple, Ca2+- dependent kinases that phosphorylate NMDA receptors leading to an increase in NMDA currents that heighten synaptic efficiency and further increases the excitability of post-synaptic neurons, thus accentuating the development and maintenance of central sensitization. This late post-translational modification in neuronal signaling ap-

pears to be a function of a delayed latency effect of “wind-up”. Clinically, an increase in excitability of post-synaptic neurons causes the patient to experience an elevation of pain intensity from a constant, mild level to a constant, moderate to severe level. This elevation of pain intensity has several consequences: An inflated state of central sensitization in the trigeminal system caused by TN2 can potentiate the onset of “tic migraine”- a modified expression of a migrainous disorder characterized by a constant headache and brief episodes of severe, spontaneous head pain analogous to TN1 paroxysms. Another consequence involves an accentuation of the affective-motivational trigeminal pathway which navigates rostrally within the ascending reticular activating system (ARAS) and targets limbic nuclei, such as the amygdala which is, in part, linked to fear responses and depression. The stress of these morbidities can, in turn, further exacerbate the reactivity in the 2nd order post-synaptic neurons of the nucleus caudalis, thus fostering up-regulation of central sensitization. An additional consequence of an elevation of pain intensity is a down-regulation of the descending inhibitory system. The second presentment of TN2 central sensitization involves an area of high reactivity in the nucleus oralis and nucleus interpolaris (Figure 2). These central nociceptive nuclei are located in the most rostral extent of the medullary dorsal horn. They are targets of myelinated, large diameter, low threshold A beta mechanoreceptors that are activated by innocuous peripheral stimulation (Figure 2, dotted line). Clinical consequences resulting from C fiber-evoked, central sensitization which occur in the nucleus caudalis similiarly occur in the nucleus oralis and nucleus interpolaris evoked by A beta somatosensory neurons.

Brian D. Fuselier, DDS and Barry A. Loughner, DDS, MS, PhD are members of the American Dental Association. Dr. Fuselier and Dr. Loughner are in private practice at Central Florida Oral and Maxillofacial Surgery in Orlando, Florida. For contact information visit their website at www.cforalsurgery.com

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Can Lake Nona Impact Forum Change Orlando’s Health Innovation, continued from page 11

And this idea generation produces results. An example of the innovations that have come from the forum include the WHIT (Wellness Home Innovation Technology) home, where new technology is put into practice so participants can see how it works and coordinates with other newly developed technologies in a realistic setting, not just a trade show booth or video. The WHIT home opened in the fall and has two “living” areas, one where prototypes are being developed, and one to demonstrate those new technologies that have been moved from testing to real world use. What other health companies are making the investment in new technologies with a Lake Nona address? Nemours Children’s Hospital, Florida Hospital’s Health Park, UCF’s Burnett School of Biomedical Science are some of the larger entities calling Lake Nona home, which is helping Lake Nona’s reputation as a national model where serious medical innovation takes place. After this year’s Impact Forum, we may see even more.

Powering Medical City

LAKE NONA EVENTS FEBRUARY 8 BREAKFAST CONNECTIONS 8:00AM - 9:30AM @Lakehouse (13623 Sachs Ave) FEBRUARY 24 BUSINESS LUNCHEON 11:30AM - 1:30PM @Village Walk at Lake Nona Town Center Sponsored by Village Walk APRIL 22 NONA CHAMBER FESTIVAL 10:00AM - 4:00PM @Sam’s Club Breakfast Connections are the 2nd Wednesday of each month. Business Luncheons are the 4th Friday of each month. Stilettos & Stogies networking events are once per quarter.

T U E S D A Y, M A R C H 2 8 T H | 6 : 3 0 P M

Volusia County Medical Society’s Physician

General Meeting & Social M A S E R AT I A L FA R O M E O O F D AY T O N A D AY T O N A A U T O M A L L | | 1 4 5 0 N . T O M O K A FA R M S R D D AY T O N A B E A C H , F L 3 2 1 2 4

• VCMS 2017 General Meeting followed by an evening of physician fellowship • Hors D’Oeuvres, Cocktails & Beverages, Door Prizes • Meet Your Orlando Medical News Team • ‘Experience’ the all-new 2017 models, including the Alfa Romeo Guilia

RSVP No Later than Monday, March 27th at 386.255.3321 or docs420@aol.com

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FEBRUARY 2017

Communicating with Patients for Increased Patient Collections

PUBLISHER John Kelly jkelly@orlandomedicalnews.com ——

AD SALES John Kelly 407-701-7424 Shannon Springhorn Business Development Intern 321-557-4755 ——

EDITOR PL Jeter editor@orlandomedicalnews.com ——

CREATIVE DIRECTOR

By SOnDA EUnUS, MHA

Collecting patient payments at the time of service is one of the most daunting tasks that a medical practice’s front office employees face on a daily basis. Asking for money may be uncomfortable for some employees, and even more so without the right training. Additionally, patients may get irritated when they are asked to make a payment, especially if they are not clear on why they need to pay. It is therefore important to communicate with the patient and inform them of the office policies for patient payments from their first visit to your clinic. Even prior to the patient’s first visit, the practice must make an effort to collect as much information as possible as far as this patient’s payment method. If the patient has insurance coverage, it is important to obtain the accurate information about their plan as well as their policy number.

The patient must be informed that this information and the patient’s eligibility will be verified, and that if any issues arise the patient will be notified before they come in for their visit. When verifying coverage, whether through an electronic portal such as Availity, on individual insurance plan websites, or by calling the insurance carrier, it is important to note several pieces of information. First, verify whether or not the patient has met their plan’s deductible amount, or if there is a co-payment or coinsurance required. Additionally, check if the patient’s plan has assigned them to another physician, and if you will need to obtain an authorization to render services to this patient. Furthermore, if the patient is coming from another area, your practice may be out of network with their plan which will lead to denial of payment or a high patient share of cost. Once the patient arrives for their

first appointment, he or she should be given the office policies document to read, which should detail the patient payment and billing process in terms that are simple enough for the patient to understand. The patient should be asked to sign the office policy along with the rest of the new patient registration paperwork. This signed document should then be scanned and entered into the patient’s chart. This way, if the patient tries to dispute a bill or avoid a payment down the line, this document can be proof that they have previously acknowledged understanding of your practice’s patient billing policies. Here are some of the points that you may want to cover in the office policies for patients to be aware of from the start: It is your responsibility to keep us updated with your correct insurance information. If the insurance information that (CONTINUED ON PAGE 15)

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Communicating with Patients, continued from page 14

GrandRounds

you have provided us with is incorrect, you may be responsible for the payment of your visit. You are expected to pay any co-pay, co-insurance, known non-covered services, and/ or any deductible estimates at the time of service (this should also be displayed on a sign or plaque at your check-in window). Patient balances that are not collected at check-in are billed immediately on receipt of your insurance plan’s payment and Explanation of Benefits. Your payment is due within ____ business days of your receipt of your statement. We will send a maximum of ___ statements, and if payment is not made the account will be transferred to a Collections Agency and reported to credit bureaus. If you are covered by a commercial insurance plan that we accept, we will file a claim to your insurance carrier. A commercial plan will always be primary to a government plan such as Medicare or Medicaid. The secondary insurance, if any, will be billed upon receipt of your primary insurance’s Explanation of Benefits and may pick up some or all of your share of cost as established by your primary insurance on a case by case basis. Not all plans cover annual healthy (well) physicals, sports physicals, mental health visits, etc. (should be tailored to the specific specialty of your practice). If these services are not covered, you will be responsible for their payment. Take some time to familiarize yourself with your insurance plan and covered services. It is your responsibility to know if a written referral or authorization is required to see specialists, or whether a preauthorization is required prior to a procedure. Please inform us if they are required. If we are not contracted with your in-

Radiology Specialist of Florida at Florida Hospital Welcomes Di-Anne Elise Torrente

surance plan, payment in full is expected from you at the time of visit. We will sup-

ply you with an invoice that you can submit to your insurance for possible reimbursement (you should have a Self Pay Schedule prominently displayed so that patients are aware of how much their visit will cost in advance). We accept cash, all major credit and debit cards, or checks with a copy of a valid driver’s license. Bounced checks will incur a Bad Check fee of $___. Sometimes patients will ask if they can make their payment at a later time after being seen (such as after they get their next paycheck). If your practice allows this, it is best to ask the patient to securely store a credit card number on file and to draft the payment on the day that they receive their paycheck. Assure the patient that this information will be safe and will be disposed of appropriately after the payment has been drafted. Depending on the relationship that you have with your patients, it is possible to make it common practice to keep credit cards on file for all future payments as well. It is important to have an authorization signed by the patient in the patient’s chart that allows the practice to draft payments automatically. If, however, you are not able to secure a credit card number for the pay-

ment, you should get the patient to sign a Financial Responsibility form which states that the patient acknowledges the balance and will make the payment by the agreed upon date. If the payment is not made by the patient before this date, the patient should receive a phone call from your office to collect the payment. By ensuring that patients are aware of your practice’s billing and collection policies in advance, you can significantly increase your patient payment collection rate. Your front office and billing employees should be adequately trained and knowledgeable enough to clearly explain these policies to new and existing patients. Additionally, these employees must be trained on how to ask for payment prior to checking the patient in for their appointment, both for time of service collections as well as for previous account balances. They should be prepared to answer questions about what the payment is for, as well as explain previous balances. With improved communication between your practice and its patients, as well as appropriate staff training on patient payment collections, your practice will be able to greatly improve your patient payment collection rate as well as eliminate any patient confusion or conflicts that may arise in the future. Sonda Eunus, MHA, CPB, is Founder & CEO of Leading Management Solutions. She manages a primary care pediatric practice with three locations in Marion County, FL. She holds a Masters’ degree in Healthcare Management, and a BA in Psychology. Visit www.lmshealthpro.com

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Di-Anne Elise

Radiology Specialists Torrente of Florida (RSF) at Florida Hospital, one of the largest sub-specialty radiology groups in the nation, has announced it has hired their first statewide marketing/public relations physician’s liaison, Di-Anne Elise Torrente. Di-Anne has over 20 years of experience in the communication field. She will provide her extensive knowledge in the areas of marketing, public relations and social media strategy. She will represent RSF in the marketing, public relations, and social media arena. She will work with all Florida Hospital’s marketing departments in providing imaging marketing content and collaborating with the imaging marketing campaigns in order to be consistent with the Florida Hospital’s brand. In the public relations role, she will serve as RSF’s publicist, conducting awareness campaigns, arranging speaking engagement opportunities, sending out press releases to seek media attention, and external and internal communication exposure. Lastly, as a physician liaison, she will work internally and externally to facilitate relations with doctors and hospitals within the Florida Hospital system and outside of the system.

It’s time to go social,

Doc! Reach out to more than 1 million Orlando residents on Facebook!

Trish Murphy 863-899-3703 TridentOrlando.com

Social Media Strategy, Facebook Advertising, Online Marketing Materials, Web Development

C o n ta c t J o h n k e l ly for advertising opportunities

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