February 2018 Orlando Medical News

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UCF Lake Nona Life Sciences Incubator to Open Early Spring “No one has access to turnkey space,” … the UCF Life Sciences Incubator is a ‘game-changer’

By PL Jeter

Central Florida’s Medical City is taking another bold step in technological development with the Lake Nona Life Sciences Incubator coming online in early spring. A partnership consisting of the University of Central Florida, Florida Hospital,

ON ROUNDS

PHYSICIANSPOTLIGHT

Andreia Moraes Acuna, MD ... 3 Change in the Weather?

The Top 10 Health Care Law Areas For Physicians and Providers for 2018 ... 5

HR LADY... 6 HEALTH INNOVATORS Physician Innovation …What If ... 9 The Case for SOGI Data

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the Tavistock Group, the City of Orlando, the state of Florida and the Florida High Tech corridor has brought the first life sciences incubator in Central Florida to fruition in the GuideWell Innovation Center.

The 10,000 sq. ft. facility, operated by the UCF Business Incubation Program,

is equipped with 7 high-demand wet lab spaces, robust infrastructure, unparalleled business support and state-of-the-art shared equipment, all available to the region’s most promising life science and biotech startups.

The incubator will be a hub of entrepreneurial activity, from university spin-

outs commercializing UCF technologies to local startups filling critical needs in the local healthcare community. The incubator will create an environment of innovation, collaboration and comprehensive support programs for promising life sciences and CONTINUE TO PAGE 4...

HEALTHCARELEADER

George J. Haidukewych, MD Orlando Health Orthopedic Institute, Academic Chairman and Chief of Joint Replacement Internationally recognized for joint replacement surgery and trauma, George J. Haidukewych, MD, serves as director of orthopedic trauma, chief of complex joint replacement, academic chairman for the Orthopedic Faculty Practice and professor at the University of Central Florida College of Medicine. He trained at the Mayo Clinic in Rochester, Minn.

Dr. Haidukewych specializes in total hip and total knee replacements as well as orthopedic trauma. He brings extensive experience in the management of failed and infected total hip and total knee replace-

ments and in reconstruction of the joints after trauma.

In the Fall of 2017, Dr. Haidukewych was inducted into the International Hip Society, an exclusive association of joint surgeons from all over the globe that have demonstrated excellence in hip surgery.

The society is comprised of top surgeons from various countries who specialize in hip replacement surgery. Dr. Haidukewych is the only Florida surgeon in the society.

Dr. Haidukewych is also an awardwinning researcher who has published more than 100 peer reviewed publications

and book chapters and has presented hundreds of educational lectures on trauma and hip and knee replacement. Dr. Haidukewych holds over 20 patents and has developed multiple innovative implants for fracture fixation and joint replacement.

Dr. Haidukewych earned his medical degree from Wayne State University School of Medicine in Detroit, Michigan. He was CONTINUE TO PAGE 8...

RADIOLOGY INSIGHTS Heart Attack and Prevention ... 22

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Here’s to home.

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PHYSICIANSPOTLIGHT

Andreia Moraes Acuna, MD Clearing up confusion on laser vaginal revitalization Andreia Moraes Acuna, MD, is a board-certified Gynecologist and Obstetrician and fellow of the American Congress of Obstetricians and Gynecologists.

Acuna obtained her medical degree at the University of Mogi das Cruzes, in Sao Paulo, Brazil. She completed her medical residency at Joan C. Edwards School of Medicine-Marshall University in West Virginia. During her training, she participated in medical research as well as volunteer work.

She received additional training in the Da Vinci Surgical System, MonaLisa Touch CO2 laser therapy, weight loss, hormone replacement therapy, sclerotherapy, Botox injections and dermal fillers.

Acuna’s special interests include minimal invasive surgery, menopausal management and hormonal replacement therapy, diagnostic hysteroscopy in office, Essure tubal sterilization, aesthetics and high- risk pregnancy. She is a member of the American Association of Gynecological Laparoscopist, the International Society for the Study of Women’s Sexual Health, the American Medical Association, the Florida Medical Association, and the American Col-

lege of Obstetricians and Gynecologists.

She’s fluent in English, Portuguese and Spanish.

In her time away from work, she enjoys empowering women, spending time with her family, and traveling.

IN OTHER WORDS with Andreia Moraes Acuna, MD Blessings Women’s Care & Medical Spa is a wellness-focused OB/GYN practice in Central Florida, providing health and wellness support for women of all ages, from obstetric care to general gynecology and menopausal conditions.

I want to discuss one of the conditions we see many patients for, which is change in a woman’s optimum vaginal and sexual health and how it affects her overall wellbeing and quality of life.

Vaginal health can change as a woman goes through different stages of her life cycle, which can include childbirth and menopause. The drop in estrogen that comes with menopause or even during breastfeeding after delivery, causes a series of problems that have a severe impact on one’s social life and personal relationships.

Among the most bothersome problems is atrophic vaginitis, which is the lack of nourishment and hydration of the cells of the vaginal mucosa. This condition causes a progressive thinning of the vaginal and vul-

var mucosa which then becomes more delicate, sensitive and more exposed to trauma.

Some of these hormone changes can contribute for what is known as pelvic relaxation.

Other factors that directly affect vaginal health are certain medical conditions and treatments that affect a woman’s ability to produce hormones such as some cancer treatments.

Laser vaginal revitalization is a nonsurgical solution available to correct these changes and enhance the vaginal muscle tone, strength, and control. I was trained on the MonaLisa Touch, which is a minimally invasive procedure that uses CO2 fractional laser technology to reverse vaginal atrophy and laxity due to various conditions discussed here. The laser is inserted into the vagina and laser pulses stimulate new collagen production in the vaginal wall. The outpatient procedure lasts less than 10 minutes. It is recommended that each patient undergo 3 separate treatments spaced 6 weeks apart for maximum results.

Laser vaginal revitalization is indicated for urinary incontinence, vaginal laxity (especially after childbirth), dyspareunia (painful sex), dryness, itching, and atrophic vaginitis (vaginal atrophy).

The advantages of laser vaginal tightening are the lack of downtime, the rapid return to sexual activity, and lower upfront cost. The tradeoff is a less intense effect

and a temporary duration of effect versus surgery with vaginoplasty. This might be an ideal choice for women who suffer from vaginal laxity, but wish to have more children, have a busy schedule or can’t afford surgery. Some effects of laser vaginal tightening such as increased lubrication can’t be replicated by surgery.

Many women experience at some point in their life vaginal health changes and may not know that there are safe options available and that their optimum sexual health can be restored without surgery and with no down time.

There is also some confusion among some clinicians as to what laser resurfacing of the vaginal skin accomplishes. This is probably due to the fact that a company who sought FDA approval for vaginal atrophy is only allowed to market their product for that indication while a company sought FDA approval for skin tightening is only allowed to advertise that indication.

In essence, all nonsurgical vaginal CO2 lasers drill a matrix of holes into the vaginal epithelium. That process stimulates the production of collagen as the body seeks to repair the holes. The production of new collagen tightens the skin, corrects vaginal atrophy and enhances vaginal lubrication.

Reach Dr. Andreia Moraes Acuna at Blessings Woman’s Care & Medical Spa at 407-571-9185.

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UCF Lake Nona Life Sciences Incubator, continued from page 1 biotech startups in Central Florida.

Other amenities include private offices, conference rooms and a large fully equipped communal laboratory with shared research instrumentation and autoclave facilities.

UCF BUSINESS INCUBATION PROGRAM

The UCF Business Incubation Program is an economic development partnership designed to help create & sustain jobs in the community and spur economic growth throughout the region. This goal is accomplished by helping new and struggling early-stage businesses grow to the point where they need to hire employees in order to continue operating and growing.

Since 1999, the program has assisted more than 350 early-stage companies, who’ve sustained nearly 3,700 jobs throughout Central Florida. These companies have also had a total impact on regional economic output (GDP) in the amount of $2.48 billion.

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UCF ACCESS

Access to additional specialized equipment and expertise is available through the UCF core facilities on a fee for use basis.

Through the incubator network, university relationships and community partnerships, the UCF Life Sciences incubator will connect tenants with all the resources needed to innovate and flourish.

FACILITY FEATURES INCLUDE:

• Suite of support services including grant development, equipment training, business coaching and mentorship, • Biosafety Level II facility, • Secure entry to facility, private labs and offices, • High-speed Internet, • Mail & package reception, • Lake Nona ‘Medical City’ business address, • Backup power for critical equipment, • Ample parking, • Fee-based access to UCF core facilities Orlando Medical News asked Dr. Tom O’Neal, Associate Vice President of Research & Commercialization at the University of Central Florida for more information on the development and operation of the incubator.

Q: What’s the genesis of the idea for the incubator?

Wet-lab space is in high demand, but until now, budding life science and biotech startups had few options for access to state-of-the-art equipment and business support in one place.

The 10,000-square-foot UCF Life Sciences Incubator is the first of its kind in Central Florida, and helps to fill that need.

Q: Is this the same project that was

envisioned nearly 10 years ago? What brought it together now?

CONTINUE TO PAGE 7...

INCUBATOR SHARED EQUIPMENT RESOURCES

The incubator will allow tenants to focus on research and building the latest innovations, instead of fretting over expensive purchases or jumping through hoops for access to equipment. The shared lab workroom is fully outfitted with the best in life sciences instrumentation.

Thermo Fisher Scientific NanoDrop 8000 Spectrophotometer UV/VIS Fisher Scientific Accuspin 8C Benchtop Centrifuge Thermo Scientific Sorvall MTX Ultra Centrifuge Thermo Fisher Scientific Forma Steri Cult 3310 CO2 Air Jacketed Incubator

Primus PSS500 Steam Sterilizer Mettler-Toledo Analytical Balance Fisher Scientific Isotemp Dual Chamber Water Bath Branson Ultrasonic Bath Vacuubrand ME 1C Oil-less Vacuum Pumps

Thermo Fisher Scientific Forma Environmental Chamber (Incubator)

Thermo Revco Lab Refrigerator

Shel Labs SSI10 Large Capacity Shaking Incubator

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Thermo Fisher Orion Star A111 pH Meter

Thermo Scientific Barnstead Pacific TII 40 RO/DI water purification

Labconco FlaskScrubber Glassware Washer

Thermo Fisher TSX -20oC Freezer

The incubator will provide each lab with the essentials for life science product development.

Each lab is plug and play, so tenants can quickly set up and begin operations

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Change in the Weather?

The Top 10 Health Care Law Areas For Physicians and Providers for 2018

By MICHAEL R. LOWE, Esq.

What do they say about the weather in Florida? If you don’t like it, wait 5 minutes and it will change. Health care and health care laws are exactly the same and will experience even more rapid and dynamic changes in 2018 from what we have been experiencing in Florida these past several years. Here are 10 of the top health care law areas that will affect physicians and providers in 2018:

1. HIPPA/Business Associate

Agreements/Privacy/Security/Data Breaches and Cybersecurity.

Ransomware, phishing, hacking and other forms of intrusion continued to be paramount issues for physicians, group practices and providers. It is important for all covered entities to ensure that they have appropriate business associates agreements and privacy and security measures in place to prevent, detect and respond to breaches and cybersecurity threats. Expect increased enforcement and investigation activity from HHS/ OCR in 2018 and start now in developing an effective compliance program including appropriate private and security safeguards and breach prevention and response components which should include purchasing appropriate cyber liability insurance coverage for your group practice or entity.

2. Private Equity Investment Within the Physician Health Care Provider.

2017 saw a huge uptake in private equity investment in the health care arena.

With hedge fund and private equity managers having less options to invest in income stream producing investments and assets, they are looking more and more to health care entities as investments. These types of transactions are complex and require corporate and health care regulatory expertise in order to properly structure them. We anticipate further activity in the private equity/ health care marketplace throughout 2018.

3. The Opioid Crisis.

With the opioid crisis in national headlines on a weekly basis, physicians and providers need to be cautious about prescribing any narcotic pain medications for their patients. There are a whole host of potential legal issues from professional liability/medical malpractice claims to professional licensure and federal government investigations to criminal action which can arise if a physician or provider is accused of misprescribing or facilitating the trafficking of opioids. Pain management, medications, contracts are an area of particular focus and concern for physicians treating chronic pain patients.

4. The Amazon/JP Morgan/Birkshire Hathaway Joint Venture.

Recently announced the plans by these 3 mega-giants in the corporate and financial world could change the entire face and structure of the health care delivery and payment system. Although in its infancy, this joint venture should be monitored closely by all physicians, providers, facilities and 5

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other players in the health care delivery system as contractual relationships, structure of health care networks, and the way in which providers are reimbursed for the provision of health care goods and services could all rapidly change over the next several years depending on the implementation and outcome of this joint venture.

5. Medicare Access and Chip

Reauthorization Act of 2015 (MACRA) and Merit-based Incentive Path (MIPS).

Physicians and providers need to understand what financial opportunities and pitfalls would result from the application of MACRA, particularly with regards to physician compensation for employed physicians. Significantly, CMS recently announced the launch of its New Bundled Payments for Improved Advanced Model in an attempt to address Advance Alternative Payment Model issues which have risen with the initial implementation of MACRA, while the Medicare Payment Advisors Commission (“MedPAC”) decided last month to ask Congress that it repeal and replace MIPS with more of a voluntary participation model. Both Part A and B providers should continue to monitor MACRA for the remainder of 2018.

6. Ancillary Services (i.e. diagnostic imaging, labs, physical therapy, dispensing practitioners)/Acquisition of Them by Physicians and Providers/ Stark Law Reform and Considerations.

On January 17 of this year, CMS announced that it would be establishing an inter-agency group to review the current Stark Law in particular referral by physicians for designated health services such as diagnostic imaging procedures, labs and physical therapy. While we do not expect any short-term changes to the Stark Law, CMS has signaled that it is going to look at long-term sweeping changes in particular changes to the existing regulatory exceptions. Therefore, until newer amended legislation is officially signed into law, physicians and health care organizations providing designated health services should ensure any current or future transactions in which they are involved, fit squarely within the parameters at least within one (1) of the Stark Law exceptions. Physicians and providers should consider having existing transactions and potential future transactions reviewed by competent and experienced health care regulatory counsel in order to ensure compliance with the Stark Law.

ness advice before agreeing to enter into one of these types of entities.

8. What’s the Future of 60-day Overpayment Rule.

Physicians and providers that submit claims to and receive payment from the Medicare and/or Medicaid programs need to be familiar with the 60-day overpayment rule and how it is triggered, when the government will consider that a provider knew that they had an overpayment, and the steps to take to report and refund the overpayment in order to avoid federal false claims act investigation and/or proceeding. It is critical to understand the time frames involved in an overpayment situation and when the 60-day deadline begins to run, as well as how to respond to a correct/ address an overpayment in order to avoid federal False Claims Act issues.

9. Peer Review Re-Engineered/New Paradigms for Employed Physicians and Value-Based Purchasing Within the Employment of Them by Hospitals.

With the continuing emphasis on value based reimbursement in health care, many hospitals and facilities are incorporating value-based principles in internal peer review analysis. This is a relatively new phenomenon, and as it progresses it will involve defining and distinguishing adverse peer review incidents from simple economical credentialing, as well as the

careful analysis of how value-based peer review situations must comply with applicable Federal and Florida health care regulatory laws. The physicians and medical staff would be well served to work with hospitals and facilities to develop valuebased peer review criteria and programs, as the current peer review landscape adverse incident reporting and discovery environment in Florida will present significant hurdles for the cooperative development of value-based peer review.

10. Increased Enforcement and Scrutiny by the Florida Agency for Health Care Administration of Licensed Providers and Facilities and the Florida Department of Health of Licensed Professionals.

While these are 10 of the top health care law areas that will affect physicians and providers in 2018, they are not all of the health care law areas that will affect physicians and providers and are by no means exclusive. If you are facing issues in these areas or issues in other health care law areas, please consult with an attorney.

Michael R. Lowe, Esq. is a board-certified health law attorney at Forster, Boughman, Lefkowitz & Lowe. The firm regularly represents providers, physicians and other licensed health care professionals, and facilities in a wide variety of health care law matters.

For more information regarding those health care law and such matters please visit our website www.FBL-Law.com

Workplace Violence Situational Awareness

ARE YOU PREPARED? WHAT WOULD YOU DO?

This is information and education you not receive anywhere else. Do Not Miss this opportunity to protect yourself, your family, your business and your employees and patients!

SPEAKER: Corporal Kevlon Kirkpatrick, Community Liason Offi cer, Orlando Police Department LIASON OFFICERS: Eddie Rosado

7. Clinically Integrated Networks

and Accountable Care Organizations.

We continue to see consolidation in the health care world and continued growth of clinically integrated networks and accountable care organizations. These types of entities implicate not only corporate, tax and business, but also detailed health care regulatory law considerations involving Stark Law, the federal Anti-Kickback Statute, and a number applicable Florida laws as well. Physicians and providers are well served to obtain financial, legal, and busi-

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THE HR LADY

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Q: I am a small business with three employees. Do I have to obtain workers compensation insurance?

Technically, Florida law only requires non-construction employers with four or more employees (owners included in that headcount) to obtain workers compensation insurance.

Even though you believe the biggest injury may be a papercut, you will be surprised how easy it is to trip and fall over a box of copy paper or acquire wrist or back

pain, even in an administrative function.

Strains and sprains are actually the top 30 percent of worker injuries according the Insurance Journal and the top causes of injuries are material handling at 32 percent and slips, trips and falls at 16 percent. So, what does this mean for you? Even though the law does not require workers compensation insurance for small businesses under five employees, this does not mean you are still not responsible and face major risk of financial ruin. The good news is for administrative functions, workers compensation insurance is not very expensive, and owners can exclude themselves. Call your local

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broker for further advice.

Q: I am having a really hard time retaining employees. We have a great family culture here, however, I simply cannot afford to compete with the bigger firms in regard to pay. What advice do you have?

Contrary to popular belief, pay is not the highest motivator for most employees.

A Gallup survey reports that 1 in 2 employees leave to get away from their manager. They were miserable at work which followed them home and simply made their life unsatisfying. The most important thing to understand is that employees leave managers, not companies. If you are a small company with only one manager (you), then you may be part of the problem. Should you care about improving employee satisfaction? Yes! Why? Because satisfied employees are productive employees and productive employees positively affect the bottom line. Employees want these items in no particular order: • Clear communication. “What are your expectations of me so that I can meet them?”

• Support of employee’s strengths.

“Bashing me about my weakness is not going to change them.”

• Approachability. “I would like to come to you to discuss challenges at work rather than hide them from you due to fear.”

One side note, as a small business you can offer your employees benefits that may not even cost you a penny. Consider flexible work hours, working from home, bringing pets to work, bringing children to work, voluntary benefits that employees pay for but can only get through an employer pay deduction, monthly educational “lunch and learns” provided by vendors and of course complimentary medical care for staff and family members.

Q: As the business manager of a medical practice, I cannot get the doctor to understand that his direct and abrupt personality is offensive to our team and some of our patients, too. He just says they need to get over it. How can I get through to him?

His personality style responds to facts not emotions, so show him the data and stop focusing on emotions. His behavior may have affected the bottom line. If you are losing staff and/or losing repeat patients, this has a major impact on revenue growth and of course on company profit. Gather information on how much it costs to replace an employee including costs of advertising, drug tests and background screenings. Remember that time is money, therefore you will also need to estimate the number of hours each person spends on reviewing resumes, doing phone interviews, conducting in person interviews, completing new hire paperwork and orientation and then all the hours every person on the team has to take to train the new hire. If hourly, nonexempt staff are involved, do not forget to add overtime numbers. Also, calculate

how much of that time could have been used dealing with patients and refer to that as “lost time or lost profit.” A person only changes when they want to. If your doctor is bottom line motivated, this may be a great time to educate him on understanding personality styles and the effect on a business. When he is ready, call BlackRain Partners for coaching.

Q: All of our employees have been with us for at least 10 years each and are over 55 years of age. While most of our patients seem to really connect with our team, we are trying to hire younger individuals to bring in new skills and prepare for our current team’s retirement.

Unfortunately, our new hires leave within a few weeks of starting. No matter who we hire, I feel I need to “cut the tension with a knife.” What are we doing wrong?

First, congratulations for recognizing the need for age diversity in your medical practice. For the first time in history we have five generations in the economy. In your practice, your patients may include all of these generations: Silent Generation, Baby Boomers, Generation X, Millennials/ Generation Y and Generation Z. While it is important for your patients to connect with your team due to their age, it is more important for your team members to understand that different generations communicate differently and are motivated by different things. The issue you are experiencing with younger generations leaving your practice is probably due to communication challenges amongst your team. Baby Boomers and older Generation Xers tend to tell people what to do with the expectation that there will be no questions asked because that is how it used to be. Often, they may also believe that “if it is not broken, we do not need to fix it.”

Younger Generation Xers and Millennials question everything as they want to know why things are done in order to understand the end goal, and even improve processes to become more efficient. This simple difference in communication styles and motivations may not sit well with current or incoming staff, with frustrations being noticeable by all and causing major tension in the workplace. Educating your staff to understand all generations, particularly their communication styles and what motivates them will help your retention rate. Additionally, being clear about the company vision for the next ten years is no longer optional. Millennials demand knowing: where are we going so I can help get you there.

They also want to know how they will fit in.

If you do not know where the company is headed, Millennials will struggle to stay engaged. Old ways will not bring new results.

Wendy Sellers, MHR, MHA, SHRMSCP, SPHR, “The HR Lady” is the COO of BlackRain Partners, a business consulting company. She is a Master of Health Care Administration, a Master of Human Resources, SHRM-SCP and SPHR certifications and is also a licensed Florida 2-15 life and health agent which she uses solely to advise and educate BlackRain’s clients. Visit www.blackrainpartners.com

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UCF Lake Nona Life Sciences Incubator, continued from page 4

The idea for a life sciences incubator in Central Florida has been discussed for several years. A combination of available funding, a location in the heart of Lake Nona’s Medical City, and increased demand for a fully equipped wet-lab facility made this the perfect time and place to open the UCF Life Sciences Incubator.

Q: What will be the cost to tenants for the use of the facility?

Companies can expect flexible lease terms and varying cost options depending on the space and services needed in this turnkey incubator. Move-in ready, fully equipped office and lab space is $35 per square foot and $47 per square foot, respectively, and grants access to collaboration space, shared equipment and support services.

Q: Will there be a component of the

research facilities at UCF to assist the companies that use the incubator? If so, how will that work?

Yes, incubator clients have access to a suite of support services, plus additional specialized equipment and expertise from UCF core facilities ranging from imaging to advanced microfabrication.

Q: How will the incubator benefit

the UCF/Florida Hospital partnership and the Central Florida area?

Central Florida’s growing life sciences community is increasingly in need of a turnkey life sciences incubator as more biotech and life sciences companies emerge and flourish.

There isn’t a better location for it than Lake Nona Medical City, at the heart of promising life sciences research and innovation.

UCF believes in the power of partnerships and this exemplifies how they make things possible that would just not happen without them. The incubator has many partners that will benefit from the Life Sciences Incubator. We appreciate that Florida Hospital assisted in getting grant dollars directed to the project from the state and city of Orlando and believe that is just the beginning.

Q: Are there plans to expand the facility in the future?

We are excited to be opening the doors soon to help fill a need for wet-lab space in the area. There are no current plans for expanding the space at this time but hopefully that will change in the future.

Q: What does this program mean for life sciences development in Central Florida?

We’re looking forward to contributing to the exciting work in Lake Nona by helping our clients fill critical needs in life sciences, health care, biotechnology and more. I often hear ‘no one has access to turnkey space,’ so the UCF Life Sciences Incubator is a game-changer. We need a robust set of tools and infrastructure to build a thriving life sciences industry sector and believe this is a critical addition to this industry sector.

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HEALTHCARELEADER George J. Haidukewych, MD, continued from page 1 a resident in orthopedics at the Mayo Graduate School of Medicine in Rochester, Minnesota and then a fellow in orthopedic traumatology and post traumatic reconstruction at Florida Orthopedic Institute in Tampa, Florida.

In this month’s In Other Words segment, Dr. Haidukewych discusses The Future of Joint Replacement: Getting Patients Back on Their Feet Faster.

IN OTHER WORDS

by George J. Haidukewych, MD Every time the next generation iPhone comes out, it’s practically hailed as a national holiday. Hundreds of thousands of people stand in line just to be among the first to get their hands on the latest, greatest technology. And for good reason; each year, there’s typically something new and exciting that makes our smart phone experience even better than it was the year before.

Believe it or not, rapid technological advancements are also changing the world of orthopedic surgery – and there’s much to celebrate. Changes in major joint replacement procedures along with the increased use of new and improved materials are making our daily lives better than they were not so very long ago.

I performed my first joint replacement

surgery more than 20 years ago. Since then, I’ve replaced joints in thousands of patients – and I’ve seen the technology improve dramatically. The artificial joints we used when I first started back in the 1990’s look quite antiquated when you compare them to what we’re using today. There are various new designs, including new materials – even ceramics – that are truly groundbreaking, and they’re giving orthopedic patients new opportunities to live full and active lives with artificial joints that can potentially last them the rest of their lives.

Comparing today’s artificial joints to the ones in the past is like comparing a new iPhone to an old rotary dial phone.

And the advancements go well-beyond just the technology. Replacement surgery is becoming more and more customized for each patient. During an initial consultation with a potential patient, they usually ask an important question about lifestyle: “Will I be able to do many of the things I’ve done in the past?” As an orthopedic doctor, I’m genuinely excited to be able to tell them “yes” –and to say it with enthusiasm.

As technologies, materials and surgical techniques have improved, we have also seen a trend in recent years toward younger orthopedic patients. These patients not only want to return to their pre-surgery activities, but they want to do so quickly. Because of improved surgical practices and less-invasive procedures,

we’ve been able to cut the average hospital stay after a joint replacement surgery to one to two days. In fact, some patients are even able to have replacement surgery as an outpatient procedure – something unheard of just a few years ago.

Meanwhile, the need for hip and knee replacements is growing because Americans are literally growing too. Sadly, about one-third of our nation’s population is clinically obese, and that is causing issues in the world of orthopedics – with increased wear and tear on overburdened joints. Before undertaking any replacement procedure with an obese patient, we always discuss overall health improvements, including weight loss, which can help shorten the recovery process, improve surgical outcomes and minimize complications. Sometimes, a patient may need to work with a weight loss specialist for several months before we even schedule a joint replacement surgery.

Joint replacement is a fast-growing and active field, which requires surgeons like myself to keep up on the latest trends, materials and state-of-the art techniques being used by orthopedic specialists around the world. I was recently invited to join both the North American and International branches of the International Hip Society. Each branch is an invitationonly group, made up of fewer than 100 of the best joint replacement surgeons from around the world.

My involvement in the society allows me to tap into the collective knowledge of orthopedic surgeons worldwide and bring it back to Central Florida where we can use it on behalf of local patients. This means we can have the best possible joint replacement patient care and outcomes right here at home. During a recent gathering of the Hip Society members, I was fascinated to learn how certain international surgical teams are treating infections differently than we do here in the United States, with demonstrable positive results. I also heard from my European colleagues about the implant registries they maintain in Europe as a way to track which implants work best.

Having access to this kind of information and cutting-edge techniques makes me better as a surgeon and that’s obviously good for my patients.

As a young medical student, I became enthralled with joint replacement surgery because of the ability of orthopedics to positively impact people’s lives. Happily, I remain just as excited about working in orthopedics today. Whether I’m addressing a congenital knee issue, malformed hips, arthritis, or the impacts from a severe joint injury – it is extremely gratifying as a doctor to be able to help relieve people’s pain and to get a patient literally and figuratively – back on their feet.

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HEALTH INNOVATORS

Physician Innovation…What If By, KELLI MURRAY, MedSpeaks

What if…“we could develop a (method) that was faster, and provide the type of clinical expertise that a clinical neurologist would ask, to the fingertips of laymen,” asked Anitha Rao, MD, MA. I recently met Dr. Rao, who is one of just 1,000 physicians globally with training in geriatric neurology and dementia, to learn about why and how she is answering this question.

Unbeknownst to her at the time, the path to entrepreneurship began with clinical experience in helping patients and their caregivers diagnose and navigate the various stages of memory loss. Dr. Rao identified common threads across symptoms, questions, and frustrations expressed by caregivers. These commonalities led her and a social worker to wonder if dementia care plans and education could be accurately generated using technology.

Through experimentation, they found that it can - even in difficult cases.

Using evidence-based research and clinical guidelines, the Neurocern platform guides family members and caregivers through a series of questions about the

patient’s symptoms and concerns. The answers are analyzed using a proprietary algorithm and a series of predictive and prescriptive analytics to create a care plan from the personalized brain profile of the patient. Additionally, it provides a library of suggestions on managing and mitigating certain behaviors and situations. For instance, educating on how mirrors may cause a patient to have a traumatic response and/or an aversion to bathing out of fear that their own reflection is a stranger or intruder in the room.

The case for this type of caregiver resource is significant - particularly for geographic areas identified as “dementia deserts.” Desert designations have been assigned to 20 states in Neurocern’s ANDI study (Alzheimer’s Disease and Related Disorders Neurology Desert Index) as having the lowest projected ratio of neurologists per 10,000 dementia patients based upon population health data from the Centers for Medicare and Medicaid Services. The list includes states such as Wyoming, North Dakota, South Carolina, South Dakota and Oklahoma.

type of engagement but the progression of its use is inevitable. For more information go to www.neurocern.com.

Look for additional physician driven innovations in future articles. If you’d like to nominate a company, invention, or process to be considered, please email info@medspeaks.com.

UPCOMING EVENTS TechStars Startup Week According to Beth Kallmyer, MSW, Vice President of Constituent Services at the Alzheimer’s Association, “This intriguing study highlights several issues, including the clear inequality that exists across the United States in distribution of health resources and specialist knowledge to diagnose and treat brain diseases, such as Alzheimer’s.”

Clinical extension solutions like Neurocern have a fit in helping providers and payers reach and leverage an untapped valuable resource - the family and caregivers within the patient’s home. The industry is at an infantile stage when it comes to this

Early last year, sexual orientation and gender identity (SOGI) questions were quietly removed from two federal surveys, the National Survey of Older Americans Act Participants and the Annual Program Performance Report for Centers for Independent Living. This move was a huge loss for both the LGBTQ+ and research communities.

“It’s a big deal to make this change,” Michael Adams, CEO of Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders, or SAGE, said.

“What this is about is stripping out an entire population.”

Having only been in circulation since 2014, the collection of SOGI data was described as “a pilot test” with an “insufficient” sample size by Kelly Mack, a spokeswoman for the Administration for Community Living, of the Health & Human Services (HHS) division, which oversees the surveys. LGBTQ+ advocates are incredulous of this claim.

The National Health Interview Survey (NHIS), which the HHS relies on to monitor trends in illness and disability and to track progress toward achieving national health objectives, has collected ethnicity data of its respondents for almost 20 years. This has resulted in a wealth of minority health data.

For example, we know that older African Americans and Native Americans have the highest disability rates in America, followed by older Hispanic/Latinos. What we don’t know is what percentage of those disabled 9

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populations identify as LGBTQ+. This is particularly notable as the tracking of these disability trends, which often project future disability rates, are especially important for the shaping of public policy.

The implications of the erasure on the LGBTQ+ patient population are stunning.

As of 2000, there were more than 2 million older adults that identified as gay, lesbian, or bi-sexual. This number is on track to more than double, with a likely population of over 6 million LGBTQ+ seniors by 2030. Can you imagine? 6 million minority Americans becoming more reliant on physician care, with little to no data to support their aging transition, or to support the doctors who will care for them. But what can be done about this?

“The collection of SOGI data is important for understanding potential disparities and for building mutual trust and respect among healthcare providers, researchers, and our LGBTQ community,” says Dr. Jason Flatt, an Assistant Professor at UCSF’s Institute for Health & Aging.

The unique stressors facing the LGBTQ+ population are sure to create health trends unique to the population. The first step to identifying, and eventually treating those trends, is including SOGI-based questions, not just in federal surveys, but in all medical forms. We must modernize what we consider to be standard patient data to be inclusive, and to reflect our expanded understanding of the human condition.

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The Case for SOGI Data

By NINA TALLEY

FEBRUARY 12-16, 2018 | TAMPA, FL

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Standard Sexual Orientation and Gender Identity Questions as identified by the The Williams Institute are:

What is your current gender identity?

(Check all that apply.)  Man  Woman  Trans male/Trans man  Trans female/Trans woman  Genderqueer/Gender non-conforming ANOTHER IDENTITY:

What sex were you assigned at birth, on your original birth certificate?  Male  Female

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

FEATURED INNOVATORS: TSOLIFE (The Story of Life) is creating innovative ways to preserve legacy and pass down life stories. The software solution enables assisted living communities, memory care communities, hospices, and funeral homes the ability to easily capture the life stories of their residents, while its family-facing online platform organizes and preserves these stories. For more www.tsolife.com

How would you describe your current sexual orientation? (Check all that apply.)        

Asexual Bisexual Gay Lesbian Queer Questioning Straight/Heterosexual Not listed above (please write in):

This is a highly emotional issue, with passionate arguments coming from both sides. But we must think of and understand our patient populations, all of them, in order to best serve them. In this case, a small but inclusive change could have a massive impact for generations of LGBTQ+ Americans.

Special thanks to Dr. Jason Flatt of the Institute for Health & Aging at University of California San Francisco for providing his unique insight on this matter.

NEUROCERN – Founded by Anitha Rao, MD, MA, Neurocern is a caregiver platform aimed at the early identification and management of dementia and Alzheimer’s patients living at home. The tool utilizes algorithms and family reported data to provide families with personalized care plans and access to the same types of tools used by neurology and geriatric care professionals.

For more www.neurocern.com

Disclosure: Readers, please take note that the companies featured in the Health Innovators section have not paid for or bartered for these acknowledgements.

All companies are selected based on merit, intrigue, and their potential to move healthcare forward towards the Quadruple Aim. In a noisy and biased market, we believe this to be a valuable distinction.

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Here’s to Good Cyber Health

By RON FRECHETTE, THE CYBER GUY

This is the time when we are super motivated to crush the goals we set out to achieve in the new year. It is also the time when many of us schedule our annual physicals or what are known today as Preventive Healthcare exams. A routine examination typically includes our doctors asking a series of questions related to our lifestyle activities, an inspection of our physical bodies and some internal testing such as blood pressure, heart rate and lab tests.

Preventive healthcare exams allow our healthcare providers to find potential problems BEFORE we get sick. They also share their expertise to help us ward off potentially fatal infections and prevent long term negative healthcare consequences. There are simple things we can do to increase our health and vitality like, eat nutritious meals, exercise, and get the appropriate amount of rest.

As we embark further into the new Digital Age, we must adopt a similar practice of performing Preventative Cyber Health Exams to protect our digital presence from being infected in cyberspace.

The average American spends more than 10 hours a day in front of a digital screen, 5 hours of which are on a mobile device.

Most mobile devices have little to no security controls in place. Combine that with 500,000 new malware viruses being launched into cyberspace daily. The risk of infection is eminent unless we begin to take proactive cyber health measures.

The following checklist will help de-

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CYBER HEALTH EXAM CHECKLIST ____ Do you Use Unique Passwords for EACH of your on-line accounts? ____ Do you routinely scan your devices to insure they are free from viruses? ____ Do you have passcodes set up on all your devices? ____ Do you VERIFY all links and attachments are legitimate before clicking? ____ Do you have a VPN (Virtual Private Network) service in place? ____ Do you clear your cache in all your devices on a routine basis? ____ Do you have the “auto save password” in your browser turned off? ____ Do you use Two-Factor Authentication where sensitive data is stored? ____ Do you know how to use the security features on your devices?

termine your cyber health status.

If you answered “No” to most of these questions, it is likely you have poor cybersecurity hygiene and your risk of contracting viruses and becoming a victim of a cyber-attack is extremely high. Don’t be discouraged. Rather use this as a wakeup call to take the appropriate actions towards becoming more cyber health conscious in 2018. If you happened to answer “yes” to most of these questions… congratulations!

You are most likely in good health on line.

Like improving our overall physical health, the practice of improving and

maintaining good cyber health is a journey not a destination. For detailed instructions on how to implement the above checklist cyber health practices, I highly recommend reading Jill Duffy’s online article in PC Magazine titled, “10 Simple Things You Can Do to Be More Secure Online” The url is also listed in the sources below.

Add increasing cyber health to your to do list and I guarantee 2018 will be a year that will truly bring peace of mind and much less worry about having your personal information compromised and used for malicious purposes in the years to come.

QUESTIONS?

Send me a tweet @GoldskyRon. Sources:

https://www.pcmag.com/article2/0,2817,2478462,00.asp http://www.cnn.com/2016/06/30/health/americansscreen-time-nielsen/index.html Ron Frechette, Co-Founder & Managing Partner of GoldSky Security is a cybersecurity and healthcare entrepreneur who over the last several years dedicated his career to helping enterprise companies reduce the risks of cyber-attacks. Ron left the enterprise security world in 2015 and co-founded GoldSky Security, LLC. Ron’s vision is to build cybersecurity firms across the US that exist to help small-midsize businesses implement affordable cybersecurity solutions. Ron can be reached at ron.frechette@goldskysecurity.com

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Top Tips to Consider When Hiring a Strong Staff

By JAY SHORR, BA, MBM-C, CAC I-XII and MARA SHORR, BS, CAC II-XII

Selecting the proper employee can make or break your medical practice, regardless of your specialty. At some point in your career, present or past, you’ve worked with that staff: the one filled with drama, disrespect toward leadership and constant turnover. Ultimately, you want to do everything possible to keep from finding yourself in that position again.

Whether you’re looking to hire an aesthetician, medical assistant, nurse, receptionist or even another provider, all members of your practice are incredibly important. They represent you, your brand and the manner in which you are perceived by your patients and the public as a whole. A rude receptionist sets the tone for the entire visit, should a patient choose to book that appointment after a less-than-lovely phone interaction at all.

From poor bedside manner, to employee theft and clerical errors in your practice management software, curb the issues before they arise with a few of these simple selection tips: STEP #1: RECRUITMENT

• Refine the job description so that it’s one you’re happy with. Examine what the true and current needs for your practice are. If you had employees leave recently, examine the skill set of your current team and look for gaps. Be honest about what you’re looking for, and if recent graduates don’t fit your search terms… say so in the description.

• Establish what you’re willing to pay the position ahead of time. Are you looking for a full or part-time employee? Hourly or salary? What benefits are you willing to provide, if any? Is this person an employee or a contractor? Will they receive a bonus or commission based on certain guidelines? Establish this prior to starting the interview component.

• Once you post the position, carefully scrutinize the resumes as they begin to arrive. Eliminate typos, illegible formats and other initial turnoffs. Review the length of time the candidate spent with his/her previous employers. Warning signs appear when you see a series of five-month employers. You don’t want to add your name to that list of shortterm employers if you’re looking for someone who will help you grow in the long term.

STEP #2: INTERVIEWING

• It goes without saying you’ll want to conduct an interview in person… not just over the phone. However, feel free to hold a brief phone interview first to ask any initial questions that may serve as deal breakers down the

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line. For example, are they looking for full or part-time work, and does this match what you’re looking for?

• When you schedule the in-person interview, be sure to not only conduct these with the doctor, but with additional staff members down the line as well. Other team members will pick up on things that you may not, and this allows you the opportunity to sit back and see how the candidate interacts with your other team members as well.

• Ask pointed questions about the candidate’s knowledge about both your practice and your industry. For example, find out what they know about your practice, your reputation in the community, and the treatments you offer. Ask them why they would want to work in YOUR office?

What do they consider they greatest accomplishments, and what would they like to achieve in the next five years? How do they handle stress or drama in the workplace? Ask why they’re leaving their last job as well; you’ll be surprised at the answers that some people give!

• Be sure to review scheduling conflicts.

If the possible new employee is unavailable during your peak hours, for instance, wish them well on their search, and explain you’re not the office for them. You want to make sure that this is addressed right off the bat.

• Consider, when your state allows, a working interview. Use this time to see how your potential new staff member interacts not only with other employees, but with your patients as well. How do they react to the stress load in your office when the phone

rings all day, when there’s down time… or no moment to breathe?

• Check references for at least three previous employers and verify your prospect’s industry-related experience. We’ve seen people claim they’ve held jobs that they haven’t and, even scarier, claim they’ve held certifications and degrees that they never earned. Double check as many of these as possible.

• Perform a background check, and consider the results as they relate to the position. A new bookkeeper, for example, should not be hired if s/he has a history of fraud, embezzlement, or bankruptcy. Is a current valid driver’s license valid for the position, or does the candidate live within walking distance? Make sure that s/he has a reliable form of transportation to work each day, as well as a valid form of identification.

STEP #3: ORIENTATION AND ONGOING TRAINING

• Let your new staff member know right off the bat about your code of conduct. This should include, but is

not limited to, your policies on staff uniforms, body piercings, tattoos, hair color, tardiness and cell phone usage on the job. This should all be included in an easy-to-locate Employee Handbook. (We always recommend having ALL employees, both new and existing, sign off on these policies.) This should include a staff social media policy as well.

• Training should occur not only when a new employee starts with your practice, but throughout his or her time with you. Ongoing, clear, concise and consistent training, both in your workplace and taking place as teambuilding outside of the office do wonders for both employee development and morale.

When looking at ongoing training opportunities, don’t be afraid to recruit outside vendors, as state and local laws apply.

• Meet with your staff members on a regular basis to go over their performance.

Recognize opportunities for improvement as well as outstanding behavior you wish to see duplicated in the future. Be sure to work with your staff members in a way that offers incentives for them.

For example, some people do better being praised publicly, while others prefer to be praised in private. Pay attention to your individual team member’s motivators.

STEP #4: INCENTIVES TO MOTIVATE STAFF

• From healthcare benefits to cash bonuses, not all incentives have to come in the form of dollars from your CONTINUE TO PAGE 12...

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Doctors, Physicians, and Clinicians Need a Check – Up

By Cornell L. Newbill

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When was the last time you as a doctor, physician and /or a clinician had a checkup – that is a check up on your business, your practice?

Fact – Year 2016, one third of practices closed their doors. With the ever-changing world we live in and the laws governing our lives, how great would it be to have a system would assist us in achieving our goals whether personal or professional.

In the beginning of the year, we all take some kind of inventory to see where we are, where we have fallen short, and with that assessment we can make a cognitive determination as to what we would like to achieve in the future. A medical practice should operate on the same logic.

Don’t wait until it is too late Allow a revenue management company to assess your practice for you. Some will charge you and there are a few who will not. How great would it be to have an expert who is certified in revenue medical management to provide a free assessment, and what if the revenue management company after the assessment, would provide you with a free demo that would give insight on how to stop the bleeding (loss of revenue and profits) in your practice?

The medical profession is struggling.

Remember the previous statement one third of doctors in 2016 closed their doors.

You must ask the question why? Answer: • The “National Rejections Rate is 34 percent

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• Slow Payment by carriers as long as 120 days • National Average of $22 per claim • Providers facing mandatory audits

by CMS • 70 percent of Covered Entities are NOT compliant • HIPAA Fines/Penalties are increasing nts & Families from $50,000 up to $ 1.5 million Direct Supportt For Patie & Families nts tie cards to make Pa r Fo t or pp Su Direct es Option Bus Passes and gas Rid ke ma gle lie to mi Sin x ds Fa Lyn & car s • nts ga d tie an Pa r ses Fo t ort Bus Supp– ectPas e Option Dir ier easke x Single Rid to ma cen dsters lthcar • LynRevenue Cycle Management gas andhea sesour Pasng reachi Option Bus e Rid ier gle eas Sin s x ter Lyn • cen rds lth Ca hea that manages claims (RCM) theour process reachiisng W almart or Target Gift lix, ier Pubeas • ters lth cen hea our rds ng s, and games for chi Ca t rea Gif get ks Tar almart or and revenue generaD’s, Coloring boo & crayon DV Publix, Wpayment •processing, rds and Ca t eos for Gif s Vid • me get ga Tar d or an artyons, W alm & cra Pubbo oks • ing er for esvid pro Color gam D’s,technology It entails using tolix,keep andthe it tos,see and DV wayon wh&ocra Videos •tion. boonks ngldre , Colorichi D’s DV medical ser vices and eos Vid • er vid the pro track of the process at every point of ns to support patient visits and it to see utio trib who wa er con en claims vid ial pro anc childr the es Fin vic • see ser to it o wa whtien chiorldre t visits and medical ient visits and medical ser vices rtn pa po its life, so the healthcare provider medisup • Financial contributions to contributions to support pat ial anc Fin • Center Managers cal billing company doing the medical Support of Our Health ect Dir rs Manage alth Ce billing can followt of the Ou process rs er Towels gePap na h Center of old Ma altaddress lti-F nterMu r Heand Our •HeKleenex and Suppor ectissues, ort Dir Supp Direct any allowing for aold steady stream of els Paper Tow itizer Sanels ndTow Haer and Multi-F KleenexThe enex and Multi-Fold• Pap •revenue.

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• Kleenex and Multi-Fold Doctors, physicians, clinicians and • Hand Sanitizer any/all medical practices, why not take • Disinfectant Wipes care of your practice, so you can continue • AA and AAA Batteries taking care of your patients. gs • Tall Kitchen Garbage Ba ves • Non-Latex Medical Glo Cornell L. Newbill is the owner of Newbill’s Revenue Network in Winter Springs.

• Forever Mailing Stamps Visit www.newrevnet.com • White Copy Paper and 10” x 13”) elopes (Size #10, 9” x 12” • Plain White Mailing Env Cuffs Volunteer your time at a er Trainings • Automatic Blood Pressure eer nte unt olu Vol n for Every $ Makes a Dif and double your donation.

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Volunteer Shepherd’s $ Makesvisit a Difference:ShepherdsHope.org Visit and double your donation. Selected items are shipped AmazonSmile.com For moreEvery information, Hope Healtha Center.

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Top Tips, continued from page 11

ShepherdsHope.org/DonateNow Selected items are shipped ShepherdsHope.org/Volunteers Volunteer yourdirectly time to at Shepherd’s a For moreHope.

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Every $ Makes a Difference: youralmost donation. bank account. We suggest flexible and double We can guarantee they’ll come Hope.

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ShepherdsHope.org/Volunteers CallVisit 407-876-6699 Ext. 230. directly toShepherd’s Shepherd’s ShepherdsHope.org/DonateNow itemsmotivated are shippedand servicing For schedules, when available, or an extra Selectedback yourmore information, visit ShepherdsHope.org/Volunteers Call 407-876-6699 Ext. 230. directly topatients Shepherd’s Hope. day of vacation. better than ever!

• Looking for FREE ideas? A certificate to your Employee of the Month costs Ultimately, hiring and training a you only the ink from your printer, strong staff will help grow your practice by as does posting a duplicate version leaps and bounds… and it all starts with of the certificate in your reception the right hire. area for patients and clients to see.

In addition, include an Employee Mara Shorr, B.S., CAC II-XII, serves as the vice president of marketing and business development for Shorr Solutions. of the Month section in your office’s She is level II-XII certified aesthetic consultant, utilizing her Volunteer your time at a knowledge and experience to help clients achieve their pomonthly e-newsletter, and ask your and double your donation. tential. She is also a national speaker and writer.

Shepherd’s Hope Health Center. clients to show their gratitude when Jay A. Shorr, B.A., MBM-C, CAC I-XII, is the founder and Selected items are shipped For more information, visit managing partner of Shorr Solutions, assisting medical they see your staff member in the practices with the operational, financial, and administrative ShepherdsHope.org/Volunteers directly to Shepherd’s Hope. health of their business. He is also a professional motivaoffice on their next visit. tional speaker, an advisor to the Certified Aesthetic Con• Looking to make an investment sultant Program, and a certified medical business manager from Florida Atlantic University. in your staff ’s education, and the education of your practice? Consider taking them to an industry conference.

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The Advantages to Having a Credible Electronic Health Records System

By MARK LANTON, CMRM

Expenses for an individual to receive healthcare in America steadily increases, although the general health of our country continues to fall behind other countries. A transformation began to take place within the U.S government, as the use of the electronic health record (EHR) technology hit the scene. The EHR was meant to convert all patient medical records from paper to a digital format.

A move was initiated in 2009 to create a movement for physician practices to convert to electronic medical records systems. This was an idea of the 111th Congress on February 17, 2009, where President Barack Obama signed into law the American Recovery and Reinvestment Act. This Act was to furnish funding to strengthen the health information technology infrastructure through the Health Information Technology for Economic and Clinical Health (HITECH) provision.

At the June 15, 2009 American Medical Association (AMA) Conference, President Obama emboldened the healthcare industry to depart from the paper medical records and adopt EHR’s. There is a multitude of advantages in converting to an electronic health record system. The EHR is an important way doctors commu-

nicate with each other in that treatments, diagnosis’/prognosis, therapies are clearly documented for review. One of the great features of an EHR is that a patient’s medical information is all in one place. The information is quick to access in real-time from doctor to doctor, and easy to read (we all know the handwriting of a physician).

Electronic medical record systems have a myriad of benefits that will help a doctor. EHR records are safe in that they cannot be destroyed. They are stored in a cloud-based system that automatically and regularly backs itself up. EHR records can be accessed from anywhere you have an internet connection. You are not limited to the confines of your practice to view records. For paper charts, if there is a fire that destroys all of the paper medical records, they are forever gone. EHR’s have a feature where a doctor has real-time access to complete a patient record at the time of care, which improves the quality of care and enables doctor’s to better communicate with each other. EHR’s will reduce and prevent medical errors by sending clinical alerts and reminders. It gives a coordination of care and they can interface with labs. The patient portal enables the patient to directly communicate with their doctor. EHR’s also increase the doctor’s cash flow with the improved billing and coding features. The

insurance claim denial rate will dramatically decrease with a good EHR. And to top it off, the records are legible.

The usage of an EHR can have some challenges, so paying attention to detail and being meticulous is paramount.

Being watchful can save your practice loads of agony. One of the challenges is security and privacy. Although documenting patient care will greatly improve, the security to prevent unauthorized persons to access a patient’s health information (PHI) should be in place. A practice should have security features set up to prevent illegitimate usage and access to patient information. An EHR can improve the quality of healthcare given. A doctor has quick access to patient records from inpatient and remote locations for more coordinated, efficient care. There are enhanced decision support, clinical alerts, reminders, and medical information. They can also interface with labs, registries and other EHR’s.

Also, reliable prescribing of narcotics is another great feature of an EHR. There are some precautions to employ when switching from paper to electronic health records. Paper records are more permanent, and it is easy to discern if they have been altered in any way. It may be

difficult to determine if edits were made in the EHR. A solution to this may be that whoever documents or edits a chart, to indicate the date/time of the edit entry.

I hope this writing helps physicians recognize the importance of transitioning from paper medical records to a quality electronics health records system. The Centers for Medicare & Medicaid Services (CMS) provides healthcare for millions of Americans and is the single largest payer for healthcare in the United States. The best way to keep the CMS away from your practice and your wallet is to utilize a quality EHR and use the proper codes. The U.S government passed laws that assist eligible providers through financial incentives, to switch from paper health records to EHR’s. Visit https:// www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html to learn the Medicaid and Medicare EHR incentive programs.

Mark A. Lanton, CMRM, is founder/CEO of Lanton Consulting, LLC., specializing in increasing physician practice efficiency, compliance and cashflow via Practice Management, Revenue Cycle Optimization and Private Practice Business Support. Visit www.LantonConsulting.com or email Mark@ LantonConsulting.co

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How Businesses Commonly Make HIPAA Violations Without Even Knowing It

By JIM PEAKE

The Health Insurance Portability and Accountability Act (HIPAA) requires all health care professionals to safeguard patient protected health information. The United States Department of Health and Human Services Office for Civil Rights is responsible for enforcing HIPAA standards and investigating claims of HIPAA violations.

For some treatment facilities, marketing and compliance can become an issue.

To generate leads and find clients, addiction centers need to partner with a firm like us, Addiction-Rep, for rehab lead generation that is HIPAA compliant. Runof-the-mill marketing firms don’t tend to understand the delicate nature of secure data, putting you at risk for common rehab HIPAA violations. We can help your treatment facility stay full, without violating HIPAA regulations.

While many health care professionals have lost their jobs and faced substantial lawsuits for knowingly compromising patient data, it’s important for health care employees to realize that even unintentional HIPAA violations can have the same result. We know how to promote your center and keep data secure.

COMMON HIPAA VIOLATIONS

A HIPAA violation can lead to fines up to $1.5 million, sanctions, and potentially loss of license. Most health care or-

ganizations take HIPAA compliance very seriously and encourage compliance at all levels of their organizations.

CONSIDER THESE COMMON HIPAA VIOLATIONS:

• Marketing and Social Media While there have been notable intentional breaches of patient information in recent years, most HIPAA violations arise from carelessness, complacency or simple ignorance of the law. One culprit is technology. Sharing photos of work on social media, making comments about patients on social media profiles, and even private messaging with patients’ friends and loved ones can lead to HIPAA violations.

• Data Security Lost devices are another concern.

Many health care professionals can access patient information and other HIPAAprotected data using various devices.

Technology allows modern health care professionals to connect with and serve patients in various ways across multiple devices. However, losing a device can lead to a serious HIPAA violation if whoever finds the device can access patient information.

Health care professionals should use good judgment when it comes to internet safety and passwords. Anyone working in health care should never share a password with someone else, even another employee. Additionally, devices meant

for work should only be used for work.

Installing personal software or accessing potentially dangerous websites can lead to a data breach. Health care organizations are one of the ripest targets for hackers since patient information is so valuable.

• Illegal Disclosure In some instances, texting may seem like a great way to quickly relay patient information, but again can lead to common rehab HIPAA violations. While it may seem harmless and a quick way to get others up to speed on a patient’s condition, personal mobile devices are largely unsecured. This puts patient data at risk. Additionally, health care employees should never attempt to access patient information from a home or personal computer.

Some patients may need to see multiple doctors and specialists to receive treatment. In these situations, it’s vital for the primary care provider to obtain the patient’s consent to share his or her information with other health care professionals. The HIPAA Privacy Rule dictates that patients must willingly provide written consent for their health information to be shared with others.

PREVENTING HIPAA VIOLATIONS

One of the best ways to prevent common rehab HIPAA violations in your workplace is to make HIPAA compliance a part of your company culture. Ensure employ-

ees understand the importance of information security and complying with HIPAA standards. Be clear about erring on the side of caution: If you are unsure whether an action would be a HIPAA violation, ask for clarification before continuing.

Network and device concerns vary from organization to organization, but a few best practices can help providers stay in compliance. Employ device monitoring so units can be quickly found or remotely disabled if lost or stolen. Additionally, encourage employees to use complex passwords and change them regularly. Finally, offer regular training to employees about HIPAA compliance.

STAYING EDUCATED ON HIPAA REGULATIONS

Even a seemingly harmless misstep can lead to loss of license, hefty lawsuit damages, or worse. At Addiction-Rep, we understand compliance because we are focused on lead generation specifically for treatment centers. We understand the price of costly common rehab HIPAA violations, and we take that into consideration in our marketing so treatment centers can continue providing patients with the best care possible.

Traditional firms don’t understand the unique considerations of treatment facilities, but we do. We’ve dedicated our resources to helping treatment facilities and clients find each other.

Jim Peake is president of Addiction-Rep. Visit www.addiction-rep.com.

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GrandRounds Florida Cancer Specialists Partners with UnitedHealthcare Implementing Innovative Cancer Care Model Florida Cancer Specialists & Research Institute (FCS), the largest independent hematology/medical oncology practice in the United States, has partnered with UnitedHealthcare to implement a cancer care model focused on quality patient care, best treatment practices and health outcomes.

The episode payment model shifts reimbursement away from the current “fee-for-service” approach that emphasizes volume of care delivered.

Similar payment models have shown to enhance care coordination and improve health outcomes for patients, while reducing overall costs.

Sarah Cevallos, FCS’ Chief Revenue Cycle Officer, said, “Our collaboration with UnitedHealthcare to expand enhanced oncology services provides the growing population of Florida’s oncology patients access to additional services to support their health care needs.”

In a study published in the UnitedHealthcare’s episode of cancer care payment initiative (EOC) reduced overall cancer expenses by more than a third while improving quality outcomes. The program rewards participating medical oncologists if they demonstrate superior clinical results and reduce the total cost of care.

FCS President and Founder Dr. William Harwin said: “Identifying best practices in the treatment of this

very complex disease, coupled with a streamlined payment process, will result in reduced health care costs for patients and their families. The EOC payment program from UnitedHealthcare is consistent with our priority of putting patients’ interests at the forefront of cancer treatment.”

“We welcome the opportunity to work with UnitedHealthcare through this initiative, which is designed to improve the effectiveness and efficiency of oncology care,” said Florida Cancer Specialists CEO Brad Prechtl. “At FCS, we have developed various programs, such as Care Management and our Survivorship initiative that focus on accountability, while ensuring clinically excellent, compassionate and costeffective care in a community setting.”

UnitedHealthcare piloted its episode payment program between October 2009 and December 2012 with over 500 oncologists nationwide. The results showed a significant reduction in hospitalizations for patients and a 34 percent reduction in total costs while improving quality. Since then, the program has been expanded to an additional six sites. Florida Cancer Specialists joins other prominent oncology practices in a growing national movement to explore care and payment models that deliver quality, cost-effective care.

AMA Launches New Podcast Series to Tackle the Most Salient Issues in Medicine The American Medical Association (AMA) today announced the launch of a new podcast series for physicians, residents and medical students. “AMA Doc Talk” is a lively, informative, conversation between physicians, ethicists, patients and academics, focused on relevant topics in medicine and packaged for quick consumption.

Season One, a six-episode run, focuses on the difficult discussions with patients that many physicians face as part of daily practice. The new podcast series features physicians’ eyeopening encounters with patients and their real-world solutions and insights.

Listeners will hear from peers who have struggled to comfort the sick or dying and agonized over word choice, and they can leave the podcast better equipped to handle even the most challenging conversation.

“In TV and in movies, doctors always seem to strike just the right tone in the most trying situation. But in real life, when it comes to telling a patient she is dying or that he has dangerous 15

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misconceptions about vaccines or antibiotics, delivering news delicately is not as simple as reading a script,” said AMA President David O. Barbe, M.D. “The AMA understands that these conversations are one of the many unique challenges facing physicians, and we are hopeful that this podcast series will help them feel better prepared when the moment comes.”

The first season of “AMA Doc Talk” is hosted by Rajesh S. Mangrulkar, M.D., associate dean for medical student education at the University of Michigan Medical School.

At Michigan, Dr. Mangrulkar leads the curriculum, student affairs and admissions units for the medical school.

The first two episodes of “AMA Doc Talk” were released today, and a new episode will be released each Tuesday for each of the next four weeks. Episodes are available on iTunes, Stitcher, and wherever you listen to podcasts. For more information, visit https://www.ama-assn.org/ ama-doc-talk-podcast-series.

Nasseam McPherson James Named Assistant Health Director At The Florida Department Of Health In Orange County Dr. Kevin Sherin, Health Officer of the Florida Department of Health in Orange County (DOH-Orange) has named Nasseam McPherson James the department’s new Assistant Health Director. Her first day on the job iwas February 8, 2018.

Dr. Sherin said, “We are excited to announce Nasseam McPherson James as our new Assistant Health Director.

She brings superb credentials and experience to help lead DOH-Orange into the future with successful public health programs and operations.

Ms. James comes to DOH-Orange from the Children’s Medical Services, a division of the Florida Department of Health, where she held the position of Regional Program Administrator of the Central Region that consisted of Brevard, Orange, Osceola and Seminole counties.

At the Children’s Medical Services (CMS), she served the region’s 109 employees faithfully and collaborated with community partners and leaders in the public, private, and faith based community to promote CMS’s mission of ensuring that children with special healthcare needs have access to resources that encourages healthy outcomes.

Her prior work experience included serving as an Operations and Management Consultant Manager/ Healthy Start Manager for the Florida Department of Health in Seminole County, and as a Social Services Man-

ager/Healthy Start and WIC Director at the Florida Department of Health in Highlands County. Before joining the public sector, Ms. James served as the Compliance and Quality Assurance Director for the Early Learning Coalition of Marion County.

“I’m honored to have the opportunity,” said Ms. James. “While I’ll miss the wonderful staff at Children’s Medical Services, I’m extremely excited to once again work within the county health structure.”

A graduate of the University of South Florida, Ms. James earned her bachelor’s degree in Social Work. In addition, Ms. James holds a Masters of Social Work – Social Policy and Administration from Florida State University in Tallahassee. She anticipates completing the Executive Masters of Business Administration program at the University of Central Florida in 2019.

Ms. James has served on the Seminole County Children’s Cabinet, as a board member on the Highlands County Children’s Services Council, and the Highlands County Healthy Families Advisory Council. She is a current board member for Central Florida Health Care, Inc., the Federally Qualified Health Center for Polk, Highlands, and Hardee counties. She is a past recipient of the Jane Mansfield Award for Outstanding Dedication to Leadership and Community Services and was named an Ocala and Marion County Top Forty Under 40 Leader.

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GrandRounds Corporate Law Boutique, Adds Specialty Healthcare Law Provider, Michael R. Lowe, P.A. To Form Forster Boughman Lefkowitz & Lowe Central Florida law firm continues expansion of boutique service in 2018 with the addition of Michael R. Lowe, P.A. “Michael allows us to expand our corporate, tax and asset protection practice with a full-service health law division. We can now handle any corporate, planning or litigation matter implicating the web of healthcare regulations,” said Managing Partner Gary Forster.

This brings together two extraordinary firms with practice strengths that are highly complementary. Michael R. Lowe said, “This enables us to provide a new and broader set of services. We will be able to handle a wider variety of legal matters for our clients.”

Eric Boughman, co-founder and head of the firm’s technology counsel and litigation division, noted the

synergies presented by the firm's experience. “We are well positioned to assist healthcare and medical professionals by providing sophisticated legal solutions efficiently and with the personal attention that our clients have come to expect. Michael’s experience with HIPAA, privacy regulations, and cyber security adds to the firm’s ability to service clients in the rapidly changing privacy arena.”

The mission of Forster Boughman Lefkowitz & Lowe, is to serve as a resource for complex domestic and international business transactions, tax, asset protection, technology and healthcare counsel, and related litigation. The firm is an approachable and economic alternative to large national and international law firms. For more information, visit www.FBL-Law.com

Health Care Leaders Collaborate to Streamline Prior Authorization and Improve Timely Access to Treatment

roles in improving prior authorization processes, which underscores the importance of this new effort.

As the first step in this collaboration, the American Hospital Association (AHA), America’s Health Insurance Plans (AHIP), American Medical Association (AMA), American Pharmacists Association (APhA), Blue Cross Blue Shield Association (BCBSA) and Medical Group Management Association (MGMA) have announced a Consensus Statement outlining their shared commitment to industry-wide improvements to prior authorization processes and patient-centered care.

According to the Consensus Statement, these health care leaders will work together to: Reduce the number of health care professionals subject to prior authorization requirements based on their performance, adherence to evidencebased medical practices, or participation in a value-based agreement with the health insurance provider.

Regularly review the services and medications that require prior authorization and eliminate requirements for therapies that no longer warrant them.

Improve channels of communications between health insurance providers, health care professionals, and patients to minimize care delays and ensure clarity on prior authorization requirements, rationale, and changes.

Protect continuity of care for patients who are on an ongoing, active treatment or a stable treatment regimen when there are changes in cov-

Physicians, pharmacists, medical groups, hospitals, and health insurance providers are working together to improve prior authorization processes for patients’ medical treatments, also known as pre-approval.

This will help patients have access to safe, timely, and affordable care, while reducing administrative burdens for both health care professionals, hospitals and health insurance providers.

If a treatment or prescription requires prior authorization, it must be approved by a health insurance provider beforehand. This is one way health insurance providers help ensure a treatment is safe and supported by scientific evidence. When applied appropriately, these processes help to maximize the value of every dollar spent on coverage and care.

Prior authorization approvals can be burdensome for health care professionals, hospitals, health insurance providers, and patients because the processes vary and can be repetitive.

Streamlining approval processes will enhance patient access to timely, appropriate care and minimize potential disruptions. Enhanced transparency and communication also play critical 16

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Announcing New Intern at Association of Independent Doctors We have welcomed our newest intern, Ena Strbac, to AID. A senior in health services administration at the University of Central Florida, Ena will work with AID through the spring. In addition to working with us while going to school, Ena also works for AID member Dr. Konrad Filutowski as an ophthalmic technician.

Born in Bosnia, Ena also lived in Croatia and Germany before coming to the United States at the age of eight. She came to her interview with a clear knowledge of issues independent doctors face and an excited appreciation for AID's cause.

"I've seen my own family get knocked around by the health sys-

erage, health insurance providers or prior authorization requirements.

Accelerate industry adoption of national electronic standards for prior authorization and improve transparency of formulary information and coverage restrictions at the point-of-care.

This group of health care leaders is committed to ongoing collaboration to improve the prior authorization process for health care professionals, health insurance providers, and, most importantly, patients. As experience is gained, these processes will be further refined to maximize efficiency and minimize care disruption for patients.

Bavarian Nordic Announces Initiation of Clinical Trial with Novel Cancer Immunotherapy Targeting Brachyury in Cancer Metastasis Bavarian Nordic A/S (OMX: BAVA, OTC: BVNRY) has announced the initiation of a clinical trial of BN-Brachyury, a novel cancer immunotherapy candidate designed to target brachyury, a key driver of cancer metastasis in several tumor types. The open-label Phase 1 trial will evaluate the safety and tolerability of the MVA-BN® Brachyury vaccine, followed by a Brachyury encoded fowlpox (FPV) booster in patients.

tem and wanted to be part of a cause that gives doctors and patients a voice," she said. Over the next several months, Ena will be helping create AID's "Independent Doctor Tool Kit," to help those doctors looking to break free from hospital employment and open their own practice. She will also work on outreach to medical schools to make sure students understand that independence is an option they should consider. Please join us in welcoming Ena to the association.

The trial will enroll up to 10 patients with metastatic or unresectable, locally advanced malignant solid tumors. Patients will receive two prime doses of MVA-BN Brachyury, followed by multiple booster doses with FPVBrachyury. The primary endpoint of the study is safety and tolerability, and secondary endpoints include immunologic responses as measured by an increase in brachyury-specific T-cells and other tumor-associated antigens, as well as evidence of clinical benefit such as progression-free survival (PFS) and objective response (OR).

The priming vaccine alone, MVA-BN Brachyury, was previously investigated in a Phase 1 study in 38 patients with chordoma or metastatic solid cancers, and was shown to be well-tolerated and to induce brachyury-specific T-cell immune responses in the vast majority of patients.

"The brachyury target represents an exciting new approach to attacking multiple cancers and deadly metastasis," commented Paul Chaplin, President and Chief Executive Officer of Bavarian Nordic. "Based on clinical results to date, we believe that BN-Brachyury may be a viable treatment option for patients with various forms of cancer.

We look forward to further expanding the program with a Phase 2 study later this year in patients with chordoma - a rare tumor of the spine known to overexpress brachyury, for which there are currently no systemic treatments of proven efficacy available."

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GrandRounds UCF College of Medicine/HCA North Florida Division Consortium Announces New General Surgery Residency Program UCF College of Medicine-Hospital Corporation of America North Florida Division Consortium has established a new General Surgery residency program that will begin at Osceola Regional Medical Center and the Orlando VA Medical Center this July and is seeking immediate applicants.

The Accreditation Council for Graduate Medical Education (ACGME) recently approved the new five-year program for a total of 15 residents. The new program is the consortium’s 19th in Central and North Central Florida.

“A new program allows us the rare opportunity to fuse the essentials of classical surgical education with the modern principles of surgical training to create something special,” said Dr. Philip Kondylis, residency program director. “Our program is devoted to excellence in surgical training and we are fully committed to graduating surgeons prepared to advance surgical care locally, and to lead the next generation of surgical thought nationally.”

The UCF-HCA North Florida Division partnership is designed to increase Florida’s number of residency programs – a key to solving the state’s physician shortage. Today the consortium has 250 residents and fellows training in HCA hospitals in Kissimmee, Ocala and Gainesville and the two parties expect to increase that number to 600 + by 2020.

Osceola Regional Medical Center has undergone major expansion of its services and facilities, doubling in size to about 400 beds over the past few years. The hospital is a Level 2 trauma center and includes a Comprehensive Stroke Center, Acute Physical Medicine Rehabilitation and programs for high-risk obstet-

rics and behavioral health. Osceola Regional has received accreditation with commendation from the American College of Surgeons Committee on Cancer and is Joint Commission disease-specific certified in breast, colorectal, lung cancer and sepsis.

“Residents training at our hospital are helping us serve one of Florida’s fastest growing, most diverse communities,” said Davide Carbone, CEO at Osceola Regional.

The Orlando VA Medical Center in Lake Nona is one of the nation’s largest healthcare facilities for veterans and includes a comprehensive outpatient multispecialty clinic and an extensive variety of surgical services. It houses the VA’s national simulation training facility.

Residents will also rotate at Nemours Children’s Hospital in Lake Nona to gain additional experience in more advanced/pediatric conditions.

All three training sites are devoted to minimally invasive surgical procedures (hand and stick laparoscopy, robotic assisted surgery and trans-orifice surgery). The new residency program has a vigorous academic schedule intended to foster self-review, continuous learning and to expedite evaluation and potential application of new innovative treatments. The program will also emphasize research, encouraging residents to publish and review the results of their scholarly activity on an ongoing basis.

Applications are now open for the 2018-2019 academic year and should be submitted through ERAS. Qualified applicants will be selected for interviews. Contacts for the surgery program are Ana Acevedo, program coordinator, ana.acevedo@hcahealthcare.com.

Florida Hospital opens first Neonatal Intensive Care Unit in Seminole County Florida Hospital Altamonte is providing an important new service in Seminole County that will allow its tiniest and most vulnerable patients to get care closer to home.

The hospital debuted its new 6,208-square-foot Level II Neonatal Intensive Care Unit (NICU), which features 10 private rooms, and meets a growing need for critical care in Central Florida.

The rooms are equipped with Draeger’s Babyleo TN500 IncuWarmer, which uses groundbreaking technology to regulate body heat, maximize efficiency for clinical staff and integrate families in their babies’ care.

The Babyleo also features low sound and light levels to create a womblike atmosphere, and has advanced safeguards against infection. Its “kangaroo mode” allows parents to more closely interact with their baby.

“We’re pleased to add neonatal intensive care services to our network of care for these tiny patients and their families,” said Dr. Rajan Wadhawan, chief medical officer and medical director of neonatology at Florida Hospital for Children.

“Having a child in the NICU can be a stressful time for families, and it’s important they have access to these services close to home.”

The new NICU is part of Florida Hospital’s neonatal network of care that includes 150 beds throughout Central Florida. The NICU network allows patients to receive the highest level of care, and includes a team of specialists who provide comprehensive diagnostic and therapeutic services, from minimally invasive surgery to highly complex cases, and innovative care and procedures.

Poinciana Medical Center Announces Plans To Expand Emergency Room In response to the growing healthcare needs of Osceola and Polk counties, Poinciana Medical Center will break ground on a $10.1 million expansion to its emergency room in 2018.

Expected to be complete by 2019, the 14,000 square-foot project will increase the capacity of the hospital’s ER from 22 beds to 31. The project will also include the renovation of the 17

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hospital’s lab, emergency department waiting room and entrance.

This will be the facility’s third expansion since its opening in 2013.

“At Poinciana Medical Center, we are dedicated to finding new ways to meet the needs of our community,” said CEO Chris Cosby. “The expansion of our emergency room will continue to drive down average ER wait

times and allow us to continue providing our patients with the quality care they deserve. Additionally, this project will further enhance the functionality of our lab.”

In January 2015, the hospital expanded its emergency room to 22 beds and 14,500 square feet, and in November 2015, completed a vertical expansion that more than doubled its

number of private patient beds.

Poinciana Medical Center employs more than 300 full-time staff members.

Additionally, the hospital has more than 280 credentialed physicians and advanced practice professionals as part of its medical staff.

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GrandRounds Ormond Beach Physician, Stephen A. Sevigny Announces Run for Congress Ormond Beach Physician, businessman, and philanthropist Dr. Stephen A. Sevigny MD announced his entrance to the District 6 Congressional Race. Dr. Sevigny, from Ormond Beach, has been a resident of the area for 18 years and is currently a partner of Radiology Associates Imaging where he has cared for patients from Deltona to St. Augustine. Dr. Sevigny has also been the medical director of Twin Lakes Imaging Center since 2005 and has privileges at Halifax Hospital in Daytona Beach. His wife, Dr. Gina Sevigny, is the owner of Ormond Beach Dermatology.

They have 3 children who attend/attended Volusia county's public schools and played local sports.

“As a physician, I have seen politicians try to manage health care with few positive results. Physicians do more paper work now than ever before, at the expense of what really matters – spending quality time with patients. As a practicing mammographer, I see the importance of continuous care and believe that in the richest country in the world, we all deserve access to affordable high quality health care.”

Steve brings hands on, significant experience from the financial sector as well. Steve served on the Board of Directors of Reunion Bank of Florida, and now serves as a Director at The National Bank of Commerce headquartered in Birmingham, AL. “As a director of a Community Bank, and now on the Board of a $3.1 Billion-dollar institution, I have seen governmental regulations in action, both effective and at times too restrictive. Community banks are the lifeblood of the economy and small business lending. Small businesses are the main job producers in this econo-

my. I have been very fortunate to serve alongside some excellent businesspeople and job creators. I hope to use this real-world experience to ‘right size’ regulations to allow small businesses to thrive while not allowing Wall Street executives to make risky bets with our money. “ Steve has been an active part of the east-central Florida community for many years. He is currently the Medical Director of Easter Seals of Northeast Central Florida. He is on the boards of Halifax Insurance Plan Inc., Daytona Chamber of Commerce, University of Florida Parent & Family Leadership Council, and is the current President of the Volusia County Medical Society. He is also active in the Phelan- Mcdermid Syndrome Foundation. His 18-year-old daughter is affected with this rare genetic syndrome which has made her physically and mentally disabled.

Steve was brought up with the importance of family values and working hard, following your passion and making a difference in people’s lives. He and his wife Gina now share those passions and values as they bring up their family of five.

“I have been a Radiologist in District 6 for 18 years. Gina and I raised our family here and love this area. I have been given the privilege of meeting and caring for thousands of patients throughout my career.

I promise if elected, I will work just as hard as your congressman as I have as a physician. I will work every day trying to make District 6 a better place to live for everyone.” For inquiries or to join our team, please visit www.sevignyforcongress.com or email steve@ sevignyforcongress.com

Interventional Radiologist Named Physician of the Quarter Florida Hospital Memorial Medical Center selected interventional radiologist Dr. Thomas Seale, from Radiology Specialists of Florida at Florida Hospital, as the physician of quarter.

“Dr. Seale embodies the qualities that make a really great physician,” said one colleague in his nomination. “He demonstrates compassion, competency and prudent judgement.

He explains everything to his patients and their families. He treats his coworkers with respect and is a great team player. He also has a wicked sense of humor!”

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Another colleague noted Seale’s work with Florida Hospital Memorial Medical Center’s Cancer Institute.

“Every one of our physicians are exceptional, but Dr. Seale embodies the true spirit of our mission and it shows,” the colleague wrote in a nomination. “When asked to go that extra mile, he is always willing to do what it takes to help get the answers we need… Our patients, staff and community are truly blessed by his dedication.”

(L-R) – former Board Member Pascale Vincent; current President/ CEO Margaret Brennan; Tim McKinney

(L-R) – Founders: Louis Kellom; Sister Ann Kendrick; Sister Teresa Gillespie; Sister Gail Grimes; Community Health Centers, current Board Chair Tim McKinney

Community Health Centers Celebrates 45 Years Community Health Centers, Inc. celebrates 45-year anniversary with team members, special guests and founders. On Friday, January 26, nearly 500 team members gathered for a celebration breakfast event at SeaWorld’s Ports of Call to honor their history and accomplishments.

Community Health Centers debuted a history video highlighting the journey of four catholic nuns working with community members to bring healthcare to farmworkers in south Apopka. In attendance for the event were Sister Ann Kendrick, Sister Therese Gillespie, Sister Gail Grimes and founding Board Member Louis Kellom.

Community Health Centers, currently, has 12 centers throughout Central Florida and is the medical and dental home to more than 66,000 patients. Community Health Centers accepts Medicaid, Medicare, Private Insurances and offers a Sliding Discount Program, based on family size and income, that assists patients with or without insurance.

During the event, Community Health Centers recognized 49 team members who have been with the organization 15 years or more. Delia Sanchez a dental assistant from the South Lake center in Groveland is celebrating her 39th year in the organization.

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GrandRounds Lead Architect at PONTE HEALTH Becomes New Chair at American Institute of Architects, Orlando Chapter Academy of Architecture for Health

Shepherd’s Hope Adds Six New Board Members, Elects New Board Chair for 2018

Orlando attorney Chirag Kabrawala, who hails from a family of more than fifteen physicians, has been elected the 2018 board chair for Shepherd’s Hope. In addition, six new members have joined the board for a three year term. They include: • Carlos F. Escobar, vice president and chief information officer, Florida Hospital Central Florida Division – South Region • Jean Florell, Community Volunteer • William R. McClusky, CPA and senior manager, WithumSmith+Brown, PC • Christina McGuirk, MSHA, BSN, NEA-BC, CENP; chief nursing officer; Health Central Hospital • Dr. Adalberto Torres, Jr.; chief of critical care; Nemours Children’s Hospital

• Brian L. Wagner, attorney and partner, Mateer Harbert “These new board members continue the two decade tradition of cultivating outstanding community leaders that are committed to furthering our mission and being the voice of the uninsured” said Marni Stahlman, president and CEO of Shepherd’s Hope.

“The caliber of our board has never been stronger as we embark on a major gifts campaign to fund our new healthcare facility in Winter Garden.

Our goal upon completion is to have

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increased our ability to meet the unrelenting need for access to high quality, compassionate medical care for the region’s uninsured and underinsured.”

Shepherd’s Hope provides free primary and secondary medical services to the one in four Central Floridians who are uninsured or underinsured, 11% of whom are children, at five health center locations in Central Florida. An estimated 850,000 Floridians remain in a gray area ─ the coverage “gap” in regards to insurance availability. They earn too much to qualify for some programs, but not enough to afford products offered on the Healthcare.gov exchange – even with federal subsidies, because of out-of-reach deductibles and co-payments.

Orlando Health Implements Nationreunification Program for International Patients

Orlando Health is releasing a white paper that outlines a new program designed to reunify international patients with their countries of origin. The need for the nation reunification program was identified in the aftermath of the Pulse tragedy when multiple consulates contacted the healthcare organization in an effort to determine if any of their nationals were impacted in the shooting. More than 80 foreign missions are based in the state of Florida, with many more being based outside the State which still have responsibility for the region.

Tabitha Ponte, AIA, ACHA Candidate, Lead Architect at PONTE HEALTH becomes new Chair at American Institute of Architects, Orlando Chapter - Academy of Architecture for Health.

The mission of AAH ORL is to improve the quality of healthcare through design by developing, documenting, and disseminating knowledge; educating healthcare architects and other related constituencies; advancing the practice of healthcare architecture; improving the design of health care environments; affiliating and advocating with others that share our vision and promoting research.

In January, PONTE HEALTH hosted with the support of AAH ORL the first Building Health Forum, #BuildHealth18, were professionals in Architecture, Engineering, Construction, and Healthcare gathered and discussed the current state and future of Healthcare Building Delivery. The event showcased a Panel of Experts including Jennifer Foley from Orlando Health, Eduardo Egea, AIA, Principal and Healthcare Architect at Stantec, and Justin Thompson, PhD, of 2Xalt; the event took place at the GuideWell Innovation Theater in Lake Nona, had a great turnout, and issued Continuing Education Credits to licensed professionals.

“Providing the information the consulates requested was a challenge.

We realized then that we needed a better system to help reunify international patients with representatives from their home countries, especially during mass casualty or mass fatality incidents,” said Eric Alberts, manager of emergency preparedness for Orlando Health. “During an extensive after-action review of our response to the Pulse tragedy, this issue rose to the top as one that needed our immediate attention.”

The emergency preparedness department and Orlando Health’s patient access department worked together to develop the program, which may be the only one of its kind in the United States. The program is active in Orlando Health hospitals located in Orange, Osceola and Seminole counties. Upon admission, international patients are provided with the contact information for their embassy or consulate-general.

If the patient wishes to contact their embassy or consulate-general, but is unable to do so, Orlando Health will make the connection for them. And with the patient’s consent, their nationality will be included in their medical record. Between September 2017 and early January 2018, the organization conducted a four-month long pilot of the program that reinforced the need for it.

During the pilot, more than 5,300 international patients were made aware of the nation-reunification program. More than 4,400 opted in to it while slightly over 950 patients declined. One hundred ten nations were represented by the patients who opted in to the program, ten of

which had 100 or more citizens who were patients in an Orlando Health hospital. In descending order, those nations were: 1

Haiti 827

2

Brazil 719

3

Venezuela 386

4

Mexico 339

5

Columbia 224

6

United Kingdom 162

7

Dominican Republic 144

8

Cuba 145

9

Honduras 116

10 Jamaica 110 “As one of the top tourism destinations in the world, Central Florida hosts millions of international visitors each year,” said David Strong, president and CEO, Orlando Health, “Should they become ill or injured during their stay, Orlando Health not only wants to provide them with the best medical care, we also want to help connect them to representatives of their home countries. We have seen, first-hand, the care and support consulates provide to their nationals overseas at a time when they need it most. We want to ensure all our patients, especially those who may be unfamiliar with U.S. processes, receive as much support as possible.”

The nation-reunification white paper is available for download by visiting www.OrlandoHealth.com/InternationalPatients.

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GrandRounds New AMA Studies Show Continued Cost Burden Of The Medical Liability System The American Medical Association (AMA) today released a new series of trend reports in its Policy Research Perspective series illustrating the price Americans pay for the nation’s broken medical liability system.

“Information in this new research paints a bleak picture of physicians’ experiences with medical liability claims and the associated cost burdens on the health system,” said AMA President David O. Barbe, M.D., M.H.A. “The reports validate the fact that preserving quality and access in medicine, while reducing cost, requires fairness in the civil justice system. Every dollar spent on the broken medical liability system is a dollar that cannot be used to improve patient care.”

The first report analyzes medical liability claims frequency among patient care physicians in the U.S. and finds that getting sued is virtually a matter of when, not if, for physicians.

Highlights in the report include: • Getting sued is not an uncommon event for physicians. More than a third of physicians (34 percent) have had a claim filed against them at some point in their careers.

• Because older physicians have been in practice for a longer time and thus have had more exposure, the probability of getting sued increases with age. Nearly half (49.2 percent) of physicians age 55 and over have been sued, compared to 8.2 percent of physicians under age 40.

• There is wide variation in the frequency of liability claims between specialties. General surgeons and obstetricians/gynecologists have the highest risk of being sued, more than 3½ to 4 times greater than pediatricians and psychiatrists, who have the lowest risk.

• Before they reach the age of 55, more than 50 percent of general surgeons and obstetricians/ gynecologists have already been sued.

“Even though the vast majority of claims are dropped, dismissed or withdrawn, the heavy cost associated with a litigious climate takes a significant financial toll on our health care system when the nation is working to reduce unnecessary health care costs,” Dr. Barbe said.

The second report analyzes indemnity payments, expenses, and claim disposition based on a sample of medical liability claims that closed between 2006 and 2015 aggregated 20

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by PIAA, the association representing the medical and health care professional liability insurance community.

The report’s key findings include: • The average expense incurred on medical liability claims that closed in 2015 was $54,165 – a substantial increase of 64.5 percent since 2006.

• In 2015, 68.2 percent of all closed claims were dropped, dismissed, or withdrawn; however, they are not cost-free. Each of these claims costs an average of $30,475 to defend, accounting for more than one-third (38.4 percent) of total expenses incurred.

• Only 7 percent of claims are decided by a trial verdict, and the vast majority (87.5 percent) were won by the defendants.

• In about 25 percent of claims, an indemnity payment was paid to the claimant. The average indemnity payment was $365,503 for claims that closed in 2015 – a notable increase of 11.5 percent from two years prior.

• The third report analyzes annual changes in medical liability insurance premiums for 2008-2017 from the Annual Rate Survey Issues of the Medical Liability Monitor. Highlights in the report include: • Despite increasing stability in liability premiums, the prospects for the near future are less than certain. Since 2015, more premiums increased than decreased, reversing the trend of the earlier part of the study period. In 2017, 13.4 percent of premiums were higher than those for 2016. Since 2010, 12 to 17 percent of premiums have increased from the previous year.

• The share of premiums that decreased from one year to the next has been falling since 2008, particularly in the last three years.

Only 12.4 percent of premiums decreased in 2017. This is substantially down from its peak in 2008, when almost 43 percent of premiums fell below their 2007 levels.

• Physicians continue to face high costs of insuring themselves against medical liability claims.

There is wide geographic variation in premiums. In some areas of New York, premiums for obstetricians/gynecologists reached $214,999 in 2017– while premiums for obstetricians/gynecologists in some areas of California

Florida Hospital Plans Emergency Departments in Waterford Lakes, Oviedo Florida Hospital is launching a major expansion of services on the east side of Orlando, with standalone emergency departments planned for Waterford Lakes and Oviedo.

The Waterford Lakes emergency department will be located at Colonial Drive and Lake Pickett Road.

Florida Hospital yesterday closed on the purchase of the 5-acre parcel where the emergency department will stand.

“We want to be where you live, with a complete network that’s easy to access. This will lead to steady growth in the coming years,” said Daryl Tol, president and CEO of Florida Hospital and the Central Florida Division of Adventist Health System.

“Our new centers in Oviedo and Waterford Lakes are just the next step in our aggressive multi-year plan.”

Both emergency departments are expected to include 24 beds, including observation beds allowing patients to stay close to home should they need advanced care not requiring admission to a hospital. Services offered will include: Diagnostic imaging (CT, MRI, X-ray), full-service laboratory and pharmacy services. The comprehensive clinical team at the

were $49,804.

Together with state and specialty medical associations and other stakeholders, the AMA is pursuing both traditional and innovative medical liability reforms to strike a reasonable balance between the needs of patients who have been harmed and the needs of millions of Americans who need affordable, accessible medical care. More information on AMA solutions to reshape the current medical

new EDs will include board-certified emergency physicians and emergency nurses trained in both adult and pediatric emergency medicine.

In Oviedo, the emergency department is slated to be built on Red Bug Lake Road near Oviedo Mall Boulevard, on a parcel already owned by Florida Hospital. The parcel also houses a Centra Care urgentcare office, which will remain on the site.

Final design decisions will be made after input from city government and residents.

“Many Oviedo residents are established patients in the Florida Hospital network and seek it out when they need emergency care, so having this option available closer to home will be a real benefit,” said Oviedo Councilwoman Megan Sladek. “We look forward to working with Florida Hospital to create a facility that’s a great fit for Oviedo.”

Groundbreaking for the Waterford Lakes location is expected in June of this year, with the ED opening in the second quarter of 2019.

Groundbreaking in Oviedo is set for this October, with the opening planned for the third quarter of 2019.

liability system to better serve both physicians and patients, please read Medical Liability Reform– Now! The new reports are the latest additions to the AMA's Policy Research Perspective series that support AMA federal, state and private sector advocacy agendas. For additional information from the new reports, go to the AMA website.

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BEST PRACTICES

EVIDENCE-BASED STANDARDS OF CARE

Venous Disease/Pearls and Pitfalls in Recognition and Treatment Venous disease is estimated to affect 25 million people in the United States.

Venous ulcers, the most significant complication, affect approximately 500 thousand people. More than 2 million working days are lost each year and approximately 3 billion dollars is spent treating venous disease. In addition, venous disease is estimated to account for 1 to 3 percent of the total healthcare budget. Although venous disease cannot be avoided, greater awareness in the general population and especially among physicians can diminish the impact.

Risk factors include heredity, age, gender (females > males), hormonal (estrogen and progesterone), Corona Phlebetatica pregnancy, obesity, jobs with prolonged standing, trauma, and previous superficial or deep vein thrombosis. Graduated compression stockings are the first line of therapy for spider telangiectasias, ankle edema and skin changes, pregnant women, or those who have jobs that entail standing for prolonged periods of time. Patients sometimes complain they are hot or hard to get on, but we must be firm and tell them about the problems that can follow. Insurance companies often insist on 3 to 6 months of conservative therapy with compression stockings prior to approving any treatment.

The majority of patients with advanced skin changes have superficial venous valvular insufficiency. Many will also have perforator or deep vein involvement. Patients with peripheral arterial disease and/or significant type 1 diabetes must be treated cautiously. If pulses can’t be detected, or the patient has ankle/arm index less than 0.5, compression is contraindicated. In patients with chronic swelling or pain in an extremity, obvious varicosities, or florid patterns of telangiectasia (spider vein), the vascular lab is the first step in the treatment algorithm. But, a word of warning, when a venous evaluation is ordered, most hospitals and diagnostic labs perform a test for venous thrombosis. One must specifically ask for an evaluation for venous insufficiency, and even then, most exams are inadequate. A study should be performed with the patient standing using valsalva and compression maneuvers to check for valvular reflux. The deep, superficial and perforator systems should be studied and reflux times should be noted along with the vein diameters. This exam reveals whether a patient has evidence of old deep vein thrombosis with scarring or obstruction. Therapy for superficial veins should not be undertaken if there is a significant obstructive component in the deep system. I see a large number of patients who have had a venous evaluation at an outside lab and 99% of these exams are inadequate for evaluation of venous insufficiency. Patients with severe type 1 diabetes or known arterial disease should have an arterial evaluation

to rule out significant disease, which might contraindicate compression or venous therapy.

Early skin changes consist of pink to red discoloration which may be blotchy and dry (stasis dermatitis).

The underlying tissue may be firm.

These areas should be lubricated and massaged at least two times a day. With time, a darker brown discoloration develops and the tissue becomes firmer. This is referred to as a lipodermatosclerosis. The cause is inflammation, secondary to metalloproteinases, lymphocytes, macrophages, and red cells that traverse the capillary membrane because of the Lipodermatosclerosis hydrostatic pressure of gravity. The brown discoloration is the result of red cell destruction with deposition of feratin. This tissue is very vulnerable to ulceration. Some patients will go on to develop lymphedema with swelling of the foot because the lymphatics in the lower legs are fibrosed by the inflammation. Flare ups of this tissue frequently occur with long periods of standing, and the tissue can become erythematous and even exude fluid. Sometimes this fluid has a scaly appearance or can even appear as a white exudare. It is important to recognize this as an exacerbation of stasis dermatitis, an inflammation, not cellulitis, an infection. In these times of concern about nosocomial and opportunistic infections, we must avoid using antibiotics for this condition.

The erythema will often persist for weeks, and if left on antibiotics for that period of time, patients are vulnerable to fungal infections, MRSA, and clostridia difficil colitis. The best treatment is to focus on the underlying veins, but this takes time. Use of hydrocortisone cream, elastic compression, and elevation are bridge maneuvers. Biopsy of the skin should never be an option.

The only place for a biopsy is at a site of long standing ulceration, or an ulcer, which is refractory to optimal therapy to rule out cancer.

We must be aware of patient’s complaints of aching, heaviness in the leg, and swelling as the day progresses. Varicose veins can lead to significant problems and should not treated as merely a cosmetic concern. Early attention can avoid later problems.

Venous Ulcer

Presented in Partnership by Orlando Medical News and Vascular Vein Centers

Dr. Hugo V. Hart Dr. Hugo V. Hart is a board certified general surgeon with over 29 years of experience. He has been practicing in the Central Florida area for over 23 years and is currently on staff at Orlando Regional Medical Center and Florida Hospital. Dr. Hart is an active member of the American College of Phlebology, the society for vein professionals. Dr. Hart is an active member of the Hispaniola Medical Charity, the medical mission organization that has been established to provide medical care to the impoverished people in the Dominican Republic.

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RADIOLOGY INSIGHTS

sponsored by

Heart Attack and Prevention The good news is that heart disease can often be prevented when we make healthier choices and manage existing health conditions. The major risk factors that can be controlled include tobacco use, high blood cholesterol, high blood pressure, physical inactivity, obesity, diabetes, and alcohol abuse.

A healthy diet is one of the best weapons to fight cardiovascular disease. The food we eat can affect other controllable risk factors: cholesterol, blood pressure, diabetes and overweight. It is important to emphasize intake of vegetables, fruits, and whole grains and limiting intake of sweets, sugar-sweetened beverages, and red meats. In addition, to maintain a healthy weight, coordinate a healthy diet with physical activity. The American Heart Association recommends at least 150 minutes per week of moderate exervice or 75 minutes per week of vigorous exercise to improve overall cardiovascular health.

The radiologists from Radiology Specialists of Florida at Florida Hospital are very well trained and experienced.

We have radiologists specifically trained in cardiovascular imaging who use imag-

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jkelly@orlandomedicalnews.com Leena Kamat, MD, is a board certified diagnostic radiologist, sub-specialized in breast imaging for Radiology Specialists of Florida at Florida Hospital. She earned her medical degree at the University of Florida, College of Medicine and following graduation completed her residency at the University of South Florida and a fellowship in breast imaging at the Moffitt Cancer Center. In her spare time, Dr. Kamat enjoys spending time with her family and friends, travel, fitness, and cooking.

Under the direction and guidance of Florida Hospital, Radiology Specialists of Florida is fully dedicated to providing our community with excellent medical imaging services.

Dedicated to Serve GY SPECIALISTS OF FLORIDA Dedicated to Under the direction and guidance of Florida Hospital, Radiology Specialists of Florida is fully dedicated to providing our community with excellent medical imaging services.

ing techniques such as x-rays, ultrasound, computed tomography (CT) scans, positron emission tomography (PET) scans, nuclear medicine scans, magnetic resonance angiography, and magnetic resonance imaging (MRI) to diagnose heart and blood vessel (vascular) disease. Using these diagnostic tests, we can screen for heart disease, determine what is causing patients’ symptoms, and monitor the effects of treatment. We keep up to date on the latest technology and information so that we can offer patients the best care.

The Florida Hospital Care Network delivers seamlessly connected healthcare services for all ages. Quality Imaging and Diagnostic starts today.

For more information visit Somedaystartstoday.com

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By LEENA KAMAT, MD

February is American Heart Month!

So we will focus this month’s article on heart disease and heart attack prevention.

Heart disease is the leading cause of death for men and women in the United States. It generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina), or stroke. Other heart conditions, which may affect the heart muscle, valves or rhythm, are considered other forms of heart disease.

A heart attack can occur at any age.

Heart attack occurs when the blood flow that brings oxygen to the heart muscle is severely reduced or cut off completely.

Your heart muscle needs oxygen to survive. This happens because coronary arteries that supply the heart muscle with blood flow can slowly become narrowed from a buildup of fat, cholesterol and other substances that together are called plaque. This slow process is known as atherosclerosis. When a plaque in a heart artery breaks, a blood clot forms around the plaque. This blood clot can block the blood flow through the heart muscle. When the heart muscle is starved for oxygen and nutrients, it is called ischemia. When damage or death of part of the heart muscle occurs because of ischemia, it is called a heart attack or myocardial infarction (MI). About every 40 seconds, someone in the United States has a heart attack!

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BEST PRACTICES

Surgeon Specializes in Robotic-Arm Assisted Joint Surgery Robotic-arm assisted hip and knee replacement has the ability to offer those suffering from osteoarthritis in their knees and hips almost immediate relief.

It is estimated that 15 million Americans suffer from osteoarthritis (OA) in their knees. The U.S. Census Bureau estimates that the 55 and older age group, who are peak knee replacement candidates, will reach 96 million by 2020. That age group is also the most susceptible to suffer from Degenerative Joint Disease (DJD) of the hip as well.

Abhijit Manaswi, MD, a specialist in joint replacement surgery, knows his robotic-arm assisted hip and knee replacement offers a solution to OA and DJD sufferers.

Heart of Florida Regional Medical Center, where Dr. Manaswi is the director of the Joint Replacement Center, is the only hospital in Polk County where the robotic arm joint replacement surgery is performed.

Dr. Manaswi uses a robotic arm interactive orthopedic system to map the area that will be operated on. Using a computer guided robotic arm, Dr. Manaswi can easily and quickly remove the osteoarthritis from the healthy bone and replace the knee or hip joint with the new joint.

“There is a smaller, less invasive incision than traditional surgery, and only the arthritic portion of the joint is removed, preserving the healthy bone and tissue,’’ Dr. Manaswi said. “There is less scarring, minimal hospitalization time and a more rapid recovery time.’’

When patients start having symptoms of DJD in the hip, for example, they notice they start limping to avoid putting weight on the affected hip, and that pain radiates down to the lower back, or thigh to knee. They also notice that pain medication is also no longer helping.

That is when the robotic arm joint replacement surgery provides the most relief.

“By using the robotic arm system to remove the damaged bone, I can reduce the risk of leg length discrepancy and improve the post-operative range of motion. There is also a rapid relief of pain and a quicker return to daily activities,’’ Dr. Manaswi said.

How It Works It all starts with a personalized plan. After a CT scan of the joint is taken a 3-D virtual model of area is generated. That model is loaded into the robotic arm system software and a personalized pre-operative plan is created.

During surgery, Dr. Manaswi uses that plan to

Robotic-arm joint replacement.

Original knee.

3-D map of hip for robotic-arm hip replacement surgery.

3-D map of knee for robotic-arm joint replacement surgery.

prepare the bone for the implant and the system guides him within the pre-defined arthritic area and keeps the machine from moving outside of the defined area for treatment. This helps provide a more accurate placement and alignment of the implant.

After surgery, the goal is to get the patient back up and moving around as soon as possible. At the Joint Replacement Center at Heart of Florida, the patients will be up and doing physical therapy within a few hours of the surgery. They also participate in group therapy with others who have had the surgery as well.

Patients also return home sooner than after traditional knee and hip replacement surgery.

Potential Benefits Improved surgical outcomes Optimal implant positioning Smaller incision, less invasive Minimal hospitalization Less scarring More rapid recovery Ligaments remain intact for a more natural feeling knee and hip • Ability to return to an active lifestyle quickly Dr. Manaswi offers several procedures including: robotic arm assisted total hip replacement, computer assisted total knee replacement, robotic arm assisted partial knee replacement, revision knee replacement, and revi-

sion hip replacement.

To find out more about the robotic arm joint replacement surgery, call Dr. Manaswi’s office today to make an appointment and come see how the robotic-arm assisted joint surgery can help your patients get their active lives back. For patients who would like to learn more about the surgery, please call Dr. Manaswi’s office at 863-419-8922.

Disclaimer: Before you decide on surgery, discuss treatment options with your doctor. Understanding the risks and benefits of each treatment can help you make the best decision for your individual situation.

Member of the medical staff at Heart of Florida Regional Medical Center. Heart of Florida Regional Medical Center is owned in part by physicians.

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Hip presentation

Abhijit Manaswi, MD, MS, FCPS, DNB, MNAMS, FRCS Board Certified | Fellowship Trained Total joint Surgeon Director, Joint Replacement Center

Robotic-Arm Hip Replacement