February 2020 > $5 PROUDLY SERVING CENTRAL FLORIDA, NORTH CENTRAL FLORIDA & VOLUSIA-BREVARD
First Dementia-Friendly Dining Option Now Available in Orlando The Meatball Stoppe becomes first restaurant in Central Florida to offer specialized service The Meatball Stoppe owners and chefs Isabella and Jeff Morgia personally know the difficulties faced by caregivers and families who struggle with the challenges of dementia. One can be the difficulty in eating out at restaurants. So, when the Morgias were approached with the idea of creating Central Florida’s first dementia-friendly dining option each Thursday, they were all in. “We have had three family members
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who have suffered and/or are currently suffering through this terrible disease of Alzheimer’s, so we personally know firsthand how this condition impacts the patients and their families,” Isabella said. “That’s why we want to make The Meatball Stoppe a place of comfort, a place that perhaps will remind them of home while feeding them a wonderful meal at the same time.” The Morgias were lead in establishing
Chef Isabella (standing), owner of The Meatball Stoppe, welcomes the first DfD patrons, Pat and Ron Strasburg (left) and Lisa and Bill Warren (right). the offering by Dennis Dulniak, EdD, a retired University of Central Florida Registrar, the care partner for his wife, Nancy, who has early-onset Alzheimer’s and was placed in a memory care community a year ago. Dulniak had been visiting The Meatball Stoppe for several years, and Isabella knew that Nancy has Alzheimer’s.
“She and Jeff are just the most heartwarming welcome, loving owners of a neighborhood restaurant that I’ve ever met,” Dulniak said. “I learned their family has had members who had passed on from Alzheimer’s and they’re currently a caregiver for one (CONTINUED ON PAGE 2)
Medical Cannabis in Nursing Homes: A battle between Federal and State law By MICHAEL PATTERSON
As more states legalize the use of medical cannabis, the stigma around cannabis for medical purposes continues to decline. However, since cannabis is still illegal under federal law, it creates a tremendous amount of challenges for access to medical cannabis for patients in Skilled Nursing Facilities (SNF). In the state of Florida, medical marijuana has been legal for physicians to recommend via a physician “certification” since 2015. There are currently over 300,000 qualified medical cannabis patients in the state. These numbers continue to increase 3,000-5,000 per week and the most common diagnosis prescribed is chronic nonmalignant pain. However, there is no data
available regarding qualified patients who are receiving medical cannabis residing in SNFs. Most patients who live in SNFs have diagnoses which would qualify under the Florida Medical Marijuana law (f.s.381.986) http://www.leg.state.fl.us/statutes/index.cfm?App_ mode=Display_Statute&URL=0300-0399/0381/Sections/0381.986.html
SNFs in Florida and the United States receive a majority of their funding through Federal insurance programs such as Medicare and Medicaid. In order for these SNFs to receive this funding, they must not violate federal law. If the SNFs were to purchase medical cannabis for patients or dispense, hold, or somehow contribute to the use of medical cannabis for patients, they could be at risk of violating federal law and losing their federal insurance payments.
However, all states have a list of resident rights in which each SNF must grant or face citations and/or fines. One of the most common rights of residents is the right to selfmedicate. SNFs are required (by state law) to allow residents who are deemed physically and mentally capable of self-medicating a system to do so. SNFs must provide a lock box for the patient to put the medication in for safe keeping. If the patient is physically (CONTINUED ON PAGE 3)
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First Dementia-Friendly Dining Option Now Available in Orlando, continued from page 1 The Meatball Stoppe is open for Dementia-Friendly Dining from 11:30 a.m. to 6 p.m. at the restaurant located at 7325 Lake Underhill Road at Goldenrod. For the menu visit: The Meatball Stoppe.com/menu.
family member. When my son shared a story out of the Washington Post about a restaurant in Huntington, W.Va., that became dementia-friendly, it all clicked. Why couldn’t we bring this to Orlando and why couldn’t it start with The Meatball Stoppe? I am absolutely astounded at their attitude of being able to make this happen in Orlando and to be the first restaurant. I am very, very proud of them and I wish them great success.” Dulniak, the founder of Central Florida Dementia-Friendly Dining, teamed up with Toni Gitles, Certified Caregiving Consultant and Educator with Heart Light Enterprises and Edith Gendron, Chief of Operations with the Alzheimer’s and Dementia Resource Center to help provide personnel training, schedule and publicizing. The group anticipates opening similar programs with other restaurants in upcoming months. Also vital to the effort, Dulniak said, has been the coordination and support with the Senior Resource Alliance (Area Agency on Aging of Central Florida) and the Dementia Care and Cure Initiative (Florida Department of Elder Affairs). These groups work toward creating enhanced dementia-friendly communities with services and support in place to make that community hospitable to people living with dementia, their care partners, and loved ones. “Edith is the key person who trained the personnel at The Meatball Stoppe,” Dulniak said. “Then she’s also going to be training Toni and me as future trainers of restaurant
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personnel. There are differences in terms of what services need to be delivered to families who have loved ones with dementia.” Ideally, restaurants that become labeled dementia-friendly will have a back room so they can have a more controlled environment away from the public. Another consideration is if the restaurant has a slow period of the week when they would be willing to set aside that back room that can become a dementia-friendly dining room. “I’m really interested in expanding this into as many communities as we can, not only in Orlando, but around Central Florida,” Dulniak said. “The dining doesn’t even have to be at night. It could just be a period of time between 2 and 5 p.m. when business is slow. But I want it to be a consistent day and time, whether it’s one day a month or one day a week. I want the managers to be willing to have us come in and train their personnel on the differences and what is important in serving customers with dementia and then treating their family with the respect that we need to have happen.” Another goal of the effort is to reduce the stigma of dementia and Alzheimer’s. He sees the program as not just creating awareness and compassion, but helping people understand that they need to be much more careful with their loved ones and create positive memories. Nancy was employed as a librarian at the Florida A&M University (FAMU) Law School when she started having memory issues that affected her job. She loved books but started
For more on dementia-friendly dining visit: https://www.soupedup.com/dementia-friendly-dining/
reading less and less. In 2014, she retired. “I didn’t get her mild cognitive impairment (MCI) checked out before retirement, and that was a major mistake,” Dulniak said. “I teach other people to do it if they’re having memory issues because MCI is a disability, and she could have gone on long-term disability and not retired from FAMU.” Dulniak retired at the same time when they were both 62. He felt their time together was more important than continuing to work. They wanted to have quality experiences and travel while they still could. During that time, they worked hard to get her some cognitive training by putting her in a brain fitness club and participating in eight different drug trials trying to hold off the disease that was coming. She was diagnosed with Alzheimer’s in February of 2015 when she was 63 years old. She is currently 68. Dulniak placed her in a memory care community because he felt even with hiring people to help, she was not getting the care she needed. “It was highly stressful,” he said. “That is why I decided it would be a great benefit if the family and caregivers of people with dementia could take their loved ones out in a friendly environment that’s safe. The idea is that there will be a controlled environment
where they can create quality memories again and can continue life in a positive manner with activities as simple as eating out.” Training employees includes providing quick tips on what’s necessary in serving these special needs. Dulniak has a passion to make this happen because he knows how important it is for him to take his wife out. “I know her levels of agitation and how that comes and I think it’s very, very helpful to have restaurants lined up that would be able to provide this kind of special needs service.” He has had family members of other special needs people come to him and ask, “Why can’t we do it for dyslexia? Why can’t we do it for autism?” While the Mediterranean diets are definitely favorable for brain health, that’s not necessarily the American way. And as a person progresses with dementia, it’s a matter of keeping adequate nutrition as weight loss can be a problem. “I’m interested in having them enjoy what they’re eating,” he said. There is interest in making Orlando a Blue Zone City, cities that have programs in place to enhance health and longevity. Dulniak said the dementia-friendly dining would fit in nicely with that effort.
If you would like to assist in the development and expansion of dementia-friendly dining throughout Orlando and Central Florida by volunteering your skills, services, resources or other means, please contact Dennis Dulniak EdD, ddulniak@ucf.edu, 407-592-6670 (mobile).
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Turnkey Project Management for Real Estate
What it is and why you need it! By FRANK RICCI
Today I would like to introduce you to the concept of “Turnkey Project Management (TPM) for Real Estate” and how it will simplify your life. Signing a lease or purchase agreement is only a thin slice of the work required to get your office up and running. The concept of TPM provides for a Single Source of responsibility through a Project Manager (PM) and encompasses all of the tasks necessary to get your facility ready to open, including these key elements: Due Diligence – Due diligence is the upfront work required to determine the best location within a geographical area to locate your practice and includes demographic analysis, a competitive market survey, space programming, budgets, traffic studies, zoning, lease/purchase analysis and other site specific studies. A PM will coordinate the performance of all of these activities. Lease/Purchase Negotiation and Execution – this is the work that brokers typically focus on and is an important part of the process. There are typically many deal points that must be negotiated to ensure the best possible outcome. A PM must be a broker with specialized knowledge of medical real estate. A PM must also be able to work with financial institutions to negotiate the best terms and conditions for your project financing. Design & Permitting – If there are going to be any construction or renovations performed, it is necessary to identify, compare and select the best architect, engineers, interior designer, consultants and equipment suppliers and installers for the project. A PM will have contacts within the industry in order to help select the firms best suited for your particular project based upon size, experience, quality, and availability. Value Engineering – A PM should have specialized knowledge of the construction industry in order to identify materials, methods and means to shorten the project timeline and/or to save costs without sacrificing quality. Construction – A PM will oversee the distribution of plans and specifications to various qualified contractors and oversee the bidding process. Working with the client and the architect, the PM will help select the winning bidder, determine the draw process, ensure that an adequate safety program is established, coordinate the various consultants and provide general supervision of the construction process including site visits and photographic/video evidence during each stage of construction. Cost Segregation – During the construction phase, an experienced PM will work with your architect, contractor and tax advisor to identify and separate costs
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for individual building components that will be used in a Cost Segregation Analysis. This analysis can be of enormous financial benefit and save you significant amounts of money for years to come. Move in & Grand Opening – Upon completion of the construction, there is now the enormous task of moving and installing equipment, furniture, interior design elements and personal touches. A PM will coordinate all of this work in preparation for your Grand Opening. Your PM can also coordinate with a public relations firm with medical expertise to get the word out and handle all of the event details for your eventual Grand Opening. As you can see, simply signing a lease or a purchase contract is just the tip of the iceberg. A PM, as a single point of contact, can relieve you of the many details, decisions, calls and trips necessary to get your office open and ready for business, on time and on budget. Frank Ricci is a principal with Healthcare Realty & Development Services, LLC a leading Total Project Management firm with over 35 years of experience based in Winter Park, Florida. Frank is a licensed real estate broker and licensed building contractor with extensive experience in “Turnkey Project Management.” For more information email Frank at Healthcare Realty & Development Services at FrankR@HealthCareRealtyOnline.com. Or visit www. healthcarerealtyonline.com
Medical Cannabis in Nursing Homes, continued from page 1
or mentally unable to perform self-medication, a family caregiver is allowed to administer the medication to the patient (if given proper permission legally via health care surrogate designation or through other legal means). However, most SNF operators are extremely hesitant to allow medical cannabis in their facilities for fear of losing their federal insurance payments. The only SNF in the United States to publicly admit they are allowing medical cannabis to be self-administered to their patients is in the Bronx, NY. A link to their medical cannabis program is below. file:///C:/Users/Michael%20Patterson/Docu-
ments/Nursing%20Home%20MMJ%20Study.pdf
The facility implemented a policy to allow residents to use medical cannabis under the following conditions: Patients must purchase the medical cannabis on their own with no payment coming from the SNF. Patients were provided with a lock box to store their medication and were required to self-administer the medication. The SNF was not allowed to record the use of the medication in the Medication Administration Record (MAR), and no staff were allowed to assist the resident in taking their medication. A copy of the resident’s medical cannabis state certification/ approval must be on file at the facility prior to self-administration of medical cannabis. Since smoking/vaping was against SNF policy, medical cannabis had to be in oil or pill form.
Once the policy was implemented, the SNF had 10 patients who became certified and approved through the state of New York to use medical cannabis. Once approved, the residents started to use medical cannabis within the facility. Most of the residents reported using the medicine and having a decrease in severity of symptoms such as chronic pain and tremors. There were no reports of any issues with government funding to the SNF (Medicare/Medicaid) during or after the residents were using medical cannabis. The issue of medical cannabis in SNFs is not going away. As more Florida citizens use medical cannabis, they will become accustomed to it. If they require short-term rehabilitation at a SNF and have been using medical cannabis for many years to control their diagnoses, they will be very reluctant to enter a SNF that does not allow medical cannabis use. The SNFs who begin to allow use of medical cannabis in their facilities will see an increase in revenue via increased census and increased patient satisfaction, which will lead to decreased facility citations. Michael C. Patterson, founder and CEO of U.S. Cannabis Pharmaceutical Research & Development of Melbourne, is a consultant for the development of the medical marijuana industry nationwide and in Florida. He serves as a consultant to Gerson Lehrman Group, New York and helps educate GLG partners on specific investment strategies and public policy regarding Medical Marijuana in the U.S. and Internationally. He can be reached at mpatterson@uscprd.com
CONTACT JAY BEST 904-834-5558, jbest@nahakama.com
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Questions to Ask When Upgrading/Building MRI or Radiology Facilities: Part Four By MARK BAY
In our final article of this series, we can delve a little deeper into some of the questions that affect cost and efficiency of the finished facility; layout, construction materials, safety concerns during construction and after construction for both patients and employees alike. In other words, proper site planning is essential to an efficient, high quality facility that brings both patient and staff into the equation. As most already know, MRI is an acronym for Magnetic Resonance Imaging. The technology was first successfully used in 1973 and then further developed for use on humans in 1977. An MRI creates a very powerful magnetic field and radio waves to produce an image of various parts and systems of the human body. The magnetic field created by an MRI is many hundreds of times greater than the Earth’s magnetic field. While this technology allows creation of valuable images that detect disease, this technology creates some unique issues for the environment surrounding the magnet itself as well as internally as to the image acuity. Since radio waves are essential in creating the image, careful planning is essential. Quite often, the details required in constructing the RF enclosure itself is overlooked by some members of the design and construction team. The RF shield is a support component of the MRI and not a building material. The slightest error in construction of the RF shield will result in poor imaging. Having to correct an error in RF construction once initial testing has begun can be catastrophically expensive depending on the severity of the error and whether it can be identified easily. Amongst the many decisions to be made early in the planning process is deciding on the material that will be used for the RF Shield enclosure. There are four common materials that are used most frequently for RF Shielding; copper, aluminum, steel and galvanized steel. All have their own advantages and drawbacks. Careful planning and choices are essential, and the many variables to look at when making this decision become a team effort. Shielding needs based on the equipment (strength of the magnet) and its location is first and foremost. RF shielding protects the image quality, as well as the surrounding environment. What electronic equipment will be in proximity to the MRI room and its support equipment? Are the operator and other personnel passing by the MRI being considered? A strong magnetic field can adversely affect pacemakers and some metallic implants. Another consideration is whether the technicians installing the shield are experienced in the material chosen. Welding seams on copper is very different than welding seams on steel. Each metal has different conductive properties as well 4
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as different corrosive properties. Knowing the type of shield that will be installed prior to contractor selection, will contribute to the success of the installation and perhaps the quality of the imaging once installed. Another consideration one must include in careful planning of a project is the actual layout of the facility. If one is considering a leased space where other businesses are located, what type of businesses are adjacent becomes an important factor to be taken into consideration with the size Magnet (MRI) being installed. Most common is a 1.5T MRI Scanner which will produce a smaller Gauss field than a 3T MRI. Ever larger MRI’s have been developed and may become more commonplace. The type of construction will also factor into the equation here as well. How well the walls are insulated for sound between businesses may also be a factor. Has a patient emergency been considered in the layout of equipment or accessibility if a patient must be removed quickly? Although many layouts for MRI facilities are similar, not all are created equal. Where is the defibrillator equipment? Is it far enough away to not be affected by the Gauss field and is it close enough to be accessible if an emergency happens? If a stretcher or gurney is required, can it easily reach the patient and is it of material that can enter the MRI room safely? What is the method of communication between the operator and the patient while the MRI is operating? Can the operator view the patient at all times during the MRI? How is access to the room controlled? Contractors or employees entering the room with unsecured tools or materials create dangerous and expensive circumstances. Entering the MRI room before removing credit cards, phones, and other items with magnetic strip information can result in all the information on those cards or phones being entirely erased. What is the advantage of having a construction team involved in the planning as well as the construction of an MRI facility? Utilizing the expertise of subcontractors with MRI installation experience in the planning stages is they have experienced the errors and/or missteps in previous projects which the designers may not yet have encountered. Subcontractors with MRI experience know the power of the magnetic field generated by MRI equipment and take the proper precautions when working in and around an MRI room both before and after the magnet is “active.” Au fait subcontractors are wary of the materials and the tools they use. Once the MRI is ramped up, entering the room with a pair of unsecured metal pliers, for example, can create a dangerous projectile and cause considerable damage to the MRI, not to mention the cost to remove the tools from the MRI.
In summary, careful systematic planning and building of a design and construction team is tantamount to a successful installation. More important perhaps, is being sure that your entire team has MRI experience and that that team is complete. We have covered some of the variables involved in such an endeavor and may have answered some of your questions and likely have generated additional ones. There are countless questions to ask, and a single person cannot answer all of them. My hope is that if you are considering an MRI project, be it a building from the ground up, a leased or rented space or upgrading your existing equipment, you will have more information
to work with after this series of articles. I would not climb a mountain without collaboration with those who have climbed that mountain before me or without careful systematic planning. Choose your team carefully and what you build, will last! Mark Bay is owner and CEO of Tri-Bay Construction LLC, a Commercial Contracting firm located in Oviedo. Mark is an alumnus of Columbia University and has over 30 years’ experience in the construction business including numerous MRI and radiology facilities throughout Florida. Tri-Bay Construction has partnered with an internationally renowned shielding company, radiology facility designers, equipment suppliers, equipment transporters and subcontractors offering a unique team approach to imaging facility construction. Visit www.tribay.com or email mark@ tribay.com
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PHYSICIANSPOTLIGHT
Early Diagnosis and Aggressive Treatment are Key to MS Amy Gutierrez, MD, FAANS This is how it usually starts. A patient appears in the office of Amy Gutierrez, MD; it’s almost always a woman, seemingly healthy, in her twenties. But something is wrong: She’s having strange tingling in one leg. The young woman adjusts her glasses and mentions that she remembers that a few years ago, she had a similar tingling, but that it had stopped, and she just chalked it up as a running injury. She never mentioned it to her doctor. Now, however, the tingling is back, and it’s harder for her to run because sometimes she seems uncoordinated. Her doctor was puzzled and referred her to Gutierrez, a neurologist at Orlando Health. Gutierrez asks her about her glasses. The woman smiles and says she needs a new prescription; her left eye feels a little blurry. When the radiology report comes back, it confirms what Gutierrez suspected. Lesions – little scars – on certain nerves, where the young woman’s immune system has begun to attack her own central nervous system (CNS). It’s the telltale sign of Multiple Sclerosis. She already has two dozen of these lesions, and now it’s a race against time to stop more from forming. If Gutierrez and her team at the Orlando Health Multiple Sclerosis Comprehensive Care Center can stop more lesions from developing, the young woman might be able to manage the disease and mitigate its worst symptoms. Without treatment, she might need to use a walker or a wheelchair by the age of 40. “Early recognition and diagnosis of MS, and early intervention and treatment are very important,” said Gutierrez. “Typical early symptoms include numbness, tingling, weakness, incoordination, loss of vision and poor balance.” MS causes inflammation that damages myelin — the fatty substance that surrounds and insulates the nerve fibers — as well as the nerve fibers themselves, and the specialized cells that make myelin. “The disease is always going to attack the central nervous system and that is composed of the optic nerves, the brain and the spinal cord,” said Gutierrez. “But no two patients are going to develop lesions in the same places. Each patient is unique.” It’s estimated by the MS Society that about a million people in the United States are living with the disease. It strikes women nearly three times as frequently as men, according to the Society, and it usually strikes them between the ages of 20 and 30. “The disease was described in the 1600s,” said Gutierrez. “So, we have known 5
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about demyelinating disorder for hundreds of years, but no effective treatment was available until 1993. As a result, we have natural history data available that shows that patients 10-15 years after diagnosis would need ambulatory assistance, such as a cane or a walker, or in some cases even be in wheelchairs.” But that changed in 1993 with the development of new treatments that manipulate the immune system in such a way that inflammation and subsequent demyelination around the nerves is stopped without destroying the system’s ability to ward off other diseases. “Now patients can go many years, 20 or 25 years without having an impairment in their gait,” said Gutierrez. “Now our medicines are much more sophisticated at manipulating the immune system so that our outcomes are much more successful.” Gutierrez was recruited by Orlando Health in 2018 to step into the leadership role created by Stephen Rosenberg, MD,
FAAN, who is transitioning into retirement. After 25 years as co-director of the Orlando Health Brain Injury Rehabilitation Center, Dr. Rosenberg and Victor Robert, MD, and Debbie Chandler, PhD, created what is now the Orlando Health Multiple Sclerosis Comprehensive Care Center, the only comprehensive MS Center in Central Florida as designated by the National MS Society. “The center is a multidisciplinary center where we have specialist occupational therapists, physical therapists and speech therapists that are all certified in treating patients with MS,” said Gutierrez. “I was recruited down from my previous life in New Orleans where I ran the MS Center there at Louisiana State University. So really my work here has been to grow the clinic, establish avenues of research for the clinic, and to recruit others with MS specialties. We probably have 2,500 patients, because we also serve as consultants to the community and to the hospital for patients who have complicated MS cases.”
One of the factors that attracted Gutierrez to the role is the opportunity to help teach new doctors about MS and how to spot early symptoms. “I’m passionate about teaching other physicians,” she said. “And the transition from academia to Orlando Health has been good, because OH is a very academically minded institution, with more than 200 residents being trained in the OH system, which is amazing. This is a very productive teaching institution for a lot of the residents coming out of Florida medical schools.” Growing up in New York and Miami, Gutierrez said she always knew she wanted to be a doctor, and she always knew she wanted to study and treat the brain. “I knew I was going to be either a psychiatrist or a neurologist and the nervous system has always been something that just fascinated me.”
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EAST ORLANDO CHAMBER OF COMMERCE
CALENDAR:
Misters & Sisters Great Lunch Adventures Tuesday, FEB 11 | 11:00 AM – 12:30 PM BUFFALO WILD WINGS #667
6819 S Semoran Blvd., Orlando, FL 32822
EOCC Connect 4 After Hours
Connecting Property Professionals & Ancillary Services Thursday, FEB 13 | 4:30 PM – 6:00 PM BONEFISH GRILL WATERFORD LAKES
12301 Lake Underhill Road, Orlando, FL 32828 REGISTRATION REQUIRED
OPTIC – Incident Response Tabletop Exercise Featuring Ean Meyer
Friday, FEB 14 | 8:00 AM – 12:30 PM FULL SAIL UNIVERSITY BLD. 3B
175 University Park Drive, Winter Park, FL 32792 REGISTRATION REQUIRED
February Chamber Luncheon
“Is Recession Looming in 2020?” with Sean Snaith, Ph.D. Wednesday, FEB 19 | 11:30 AM – 1:15 PM THE LAKEHOUSE LAKE NONA
13623 Sachs Avenue, Orlando, FL 32827
Feast in the East Mardi Gras 2020 Thursday, FEB 20 | 4:30 PM – 9:00 PM AVALON COMMUNITY CENTER
13401 Tanja King Blvd., Orlando, FL 32828 REGISTRATION OPEN TO THE PUBLIC- 21+ EVENT
Non-Profit Council Roundtable – Member Non-profit Benefit
Internships for Your Organizations (Hands-on Activity) Wednesday, FEB 26 | 8:30 – 10:00 AM EAST ORLANDO CHAMBER
12301 Lake Underhill Rd., Ste. 245, Orlando, FL 32828 REGISTRATION REQUESTED
Latte with Leaders – Member Benefit
(4th Friday of the month) Intimate conversation with your Orange County Political leaders Friday, JAN 24 | 8:00 – 10:00 AM EAST ORLANDO CHAMBER
12301 Lake Underhill Rd., Ste. 245, Orlando, FL 32828 REGISTRATION REQUIRED
Please visit www.EOCC.org for a complete listing of February’s events 6
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EOCC MEDICAL CITY
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The Science Behind Patient Referrals By DOROTHY HARDEE
For Americans to enjoy optimal health they must have the benefit of high-quality health care services effectively coordinated within a strong public health system. For the independent physician seeking to expand their practice, it’s important to know how patients are selecting a provider, ways in which to capitalize on this trend and how to cultivate a warm handoff for patient referrals. According to a study done by the University of Michigan, patients age 50 to 80 are becoming more computer savvy using the internet to find a physician, though it is still not the most common way they determine to schedule an appointment. More than 50 percent of older patients reviewed online physician ratings with 71 percent considering a doctor with positive feedback despite some negative reviews. In addition, many still implore the tried and true methods of recommendations by family, friends and other doctors, as well as how long it takes to get an appointment, the doctor’s years of experience and ability to interact with the patient online for scheduling and refills. Of course, location is also a significant factor when considering a health care provider, not to mention health insurance plans and affiliated hospital. Juggling the ever-changing landscape of insurance, reviews and convenience for patients, developing strong relationship within your referral network is equally important. Cultivating a relationship between physicians offering a warm handoff for patient referrals reinforcing the patients trust in the doctor’s judgement, helps build the patient’s relationship with the referring physician and sets the stage for more effective care according to FPM Journal. To make sure the warm handoff is most effective, it is important to focus on three key elements: The shared relationship between colleagues must be strong enough that the potential for conversation always exists despite busy schedules, especially regarding patients with complicated history. The transfer of information between physicians must be easy, accurate and the most relevant data provided in a timely manner.
Finally, staff helping to facilitate referrals must be keenly aware of the physician’s referral relationship and service expectations. Without an organized support system, this process could unravel quickly. Creating a service agreement requires a conversation to determine that each practice can agree on a somewhat unified approach to referrals which can often be difficult given the differences and willingness to closely manage certain conditions. Including the practice manager or another trusted person to document the key points of the agreement will help in implementing it as part of the practice’s workflow. The major advantage of establishing the agreement early helps to address future complexities. It is also important to remember to keep a good line of communication with scheduled follow-up meetings to ensure a smooth process throughout. With all that said, how do we get the conversation started? The East Orlando Chamber Health Council Collaborative offers physicians, referral coordinators and practice administrators an opportunity for peer-to-peer networking, starting the conversation to increased referrals for your practice. This stress-free, leads-focused opportunity serves as a resource for independent practices and companies new to the industry, identifying issues and establishing
a healthcare legislative agenda. Also, to facilitate peer-to-peer connections, as well as practice to community interaction to help grow your practice through referrals, community outreach and new opportunities with increased revenue potential. Physicians, practice administrators and referral coordinators are invited and encourage to attend our first quarterly event Thursday, February 27, 2020 from 8:30 – 9:30 AM at CERTUS of Waterford Lakes. This Meet & Greet will introduce your neighboring physicians, more about the Healthcare Collaborative and how the EOCC is helping grow your practice through referrals, community outreach and new opportunities with increased revenue potential. If you are a physician or healthcare professional, register today. A continental breakfast will be provided. RSVP is requested. Want to know how else the Chamber can work with you to elevate your business? Give us a call at 407-277-5951. Let’s meet to discuss your business objectives and how the EOCC helps drive results making you a long-term member of one of the oldest established chambers in Central Florida. Dorothy Hardee is Chamber Administrator for East Orlando Chamber of Commerce
(CONTINUED ON PAGE 7)
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Did you know the percentage of Americans who can correctly answer basic money questions is declining, but the fraction who think they know what they’re talking about is increasing? A recent FINRA study found that over the past nine years, the grasp of financial literacy among Americans ages 18-34 has dropped while the percentage who overestimate their knowledge prior to taking the quiz has gone up. The study – which is based on data collected around a five-question quiz – revealed that more than three-quarters of those quizzed considered themselves to be highly financially literate, while in reality, only about a third of those surveyed achieved a high equivalency score. THE RULE OF 72: How long does it take for your money to double? The Rule of 72 is an easy way to calculate that. Just take the number 72 and divide it by the interest rate you hope to earn. That answer gives you the approximate number of years it will take for your savings to double. DIVERSIFICATION: On Wall Street, diversifying means spreading your dollars across different types of investments based on your goals, needs and risk tolerance. This strategy may reduce risk, as your eggs aren’t all in one basket. Diversification does not ensure a profit or protect against loss. MORTGAGE 101: If you were offered the same interest
rate on a 15-year loan as you would be offered with a 30-year loan, you would end up paying less interest on a 15-year loan although your monthly payments would be higher. INFLATION: Inflation is a rise in the general level of prices over time which can erode your money’s purchasing power. It may also refer to a rise in the prices of a specific set of goods or services. For instance, the average price of a first-class U.S. stamp in 1976 was 13 cents. Today, a stamp will cost you more than four times that price. COMPOUND INTEREST: When you earn interest on savings, that interest then earns interest on itself and this amount is compounded over time. The higher the interest, the more your money grows. WHEN IT COMES TO YOUR FINANCES, DO YOU KNOW WHAT YOU DON’T KNOW? Martino Siciliano is a Senior Vice President and OSJ Advisor with 40+ years of Financial Services experience and has been with Primerica since 1981. He holds State Life, Health, Property Casualty, FINRA Securities Series 6, 26, 63, SEC Series 65 and Federal NMLS Mortgage Licenses. He is a PFS Investments Inc. registered representative, as well as for life insurance and investment advisor. He can be reached at mjspfs@yahoo.com Eric Perlman is a Senior Regional Leader with Primerica who brings over 20 years of investment experience. He holds FINRA Series 6, 26, 63 and 65 licenses. Eric is an American Veteran who spent four years in the Air Force serving a one-year tour in Vietnam. Eric is a graduate of Long Island University with an MBA in Finance and Economics. He currently lives in The Villages, Florida with his wife of over forty years and has a grown son who lives in Danbury, Connecticut. He can be reached at eperlman50@gmail.com
Marty Siciliano, 201-657-2317 msicliano57002@primerica.com Primerica, Inc. is a public company listed on the New York Stock Exchange (PRI). Primerica, Inc. is a leading distributor of financial service products to middle income households in North America, assisting clients in meeting their needs for term life insurance, mutual funds, annuities, segregated funds (in Canada) and other financial service products. Most of these products are distributed on behalf of third-party companies. Primerica, Inc. conducts its core business activities through companies in the United States and Canada that are subsidiaries of Primerica, Inc. (the subsidiaries together with Primerica, Inc., collectively referred to as “Primerica”). Primerica markets its financial service products in the United States and Canada through its independent contractor representatives. Each subsidiary of Primerica, Inc., and not Primerica, Inc., is responsible for its own obligations to its customers.
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VOLUNTARYBENEFITS: NOT SO VOLUNTARY
SPONSORED BY
Voluntary Wellness Benefits: Cash in Your Pocket and Peace in Your Mind Voluntary Benefit plans such as Accident, Cancer, Critical Illness, and Hospital Confinement Coverages often have ‘Wellness Benefit’ riders built into the coverage. WHAT ARE WELLNESS BENEFITS? Wellness Benefits pay the policyholder cash for preventative doctor visits or tests such as annual physicals, blood tests, mammograms, colonoscopys, etc. Note: Allstate is one of the only voluntary benefit carriers that will pay wellness benefits for dental cleanings! WELLNESS BENEFIT EXAMPLE: Sandra, the office manager at ABC Dental, has an Allstate Benefits Accident plan for her family and a Critical Illness plan for herself. During Open Enrollment her agent reminded her that she can get cash back on both of her Allstate policies. So, Sandra started by booking her annual physical the next week for her and the rest of her family. • During her annual check-up, Sandra discovers they she has high blood pressure and is showing symptoms of potential heart problems • The Doctor recommends immediate diet and lifestyle changes and sends her for an EKG • Sandra agrees to implement changes and sets a follow up appointment for two weeks later WELLNESS BENEFIT BREAKDOWN $50 – Accident Plan: Wellness payout for initial doctor visit $50 – Critical Illness: Wellness payout for EKG $50 – Accident Plan: Wellness payout for EKG TOTAL OF $150 IN CASH BENEFITS FOR ONLY 2 APPOINTMENTS *Sandra will also get an additional $100 cash back for her family wellness visits* HOW DO WELLNESS BENEFITS HELP LOWER MY MAJOR MEDICAL COSTS? Wellness Benefits incentivize employees to take advantage of preventative medicine. The concept behind preventative wellness is to catch potentially dangerous illnesses early. Not only will this benefit the employees’ health, but it also benefits the employer’s health plan from a claims cost perspective. For example, if Sandra had not had her annual physical, she may have succumbed to a heart attack or another catastrophic illness. This would have been devastating to both Sandra’s family and ABC Dental. It could also negatively impact the renewal for the major medical insurance as a large claim can be detrimental for a small business. In summary, you do not need to have an accident or an illness to use your voluntary benefits! Wellness Benefits are built in to incentivize employees to stay healthy. This in turn benefits employers from an employee health/productivity perspective and claim containment strategy for major medical programs. As outlined above, there is a lot to gain for offering benefits that do not cost you, the business, a penny. Dale McMindes DALEMCMINDES@allstate.com https://agents.allstate.com/dale-mcmindes-orlando-fl.html 407-290-5000 Chelsea Whalley chelsea@jdonovan.financial www.jdonovan.financial 407-840-4042
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CompleteDecongestive Therapy The Gold Standard for Lymphedema Management By DR. NILMA ELIAS SANTIAGO
In several conversations with different physicians, there is a question that always seems to arise: What can you do to help a patient with lymphedema? I have been asked the same question by patients and caretakers diagnosed with this chronic condition. My reply is always the same: Complete Decongestive Therapy, the gold standard treatment for lymphedema. Lymphedema is a chronic condition where abnormal accumulation of proteinrich fluid occurs in the subcutaneous tissue. It may present in the extremities, face, neck, trunk, abdomen, genitalia, and internal organs following surgery and different types of cancers (breast, prostate, bladder, uterus, lymphomas, melanomas). Patients with morbid obesity, diabetes, cardiac, renal, hepatic, vascular, and pulmonary conditions can also develop lymphedema. There are two types of lymphedema: primary and secondary. Primary lymphedema is associated with congenital malformations of the lymphatic system, and secondary lymphedema develops from known etiologies. In the United States, secondary lymphedema can result from breast cancer and the medical conditions mentioned above. Filariasis is the main cause of secondary lymphedema globally, where the parasite Wuchereria bancrofti infects the lymph nodes following a mosquito bite. There are four stages of lymphedema: Stage 0 or Latency where there is no swelling or skin changes but, the potential to develop lymphedema due to comorbidities. Stage 1 is the Reversible Stage where soft and minimal
edema occurs but subsides with elevation of the affected limb. Stage 2 is the Spontaneous Irreversible stage. There is fibrotic tissue, nopitting edema, and frequent skin infections. Stage 3 or Lymphostatic Elephantiasis presents with extreme limb volume, skin fibrosis with papillomas, deep skin folds, and possibly Elephantiasis nostras verrucosa (ENV) where there is cutaneous hypertrophy. Lymphedema affects approximately 0.1 percent of Americans and 70 percent of breast and prostate cancer patients. If left untreated, lymphedema progresses into skin changes such as fibrosis, dermal hyperplasia, recurrent skin inflammation and edema, papillomatosis, hyperkeratosis, and telangiectatic (thickened wall in dermal vessels); all of which can cause cellulitis, bacteremia, and sepsis; not to mention the psychological and debilitating functional impairments the patient develops. Lymphedema is incurable but can be managed with Complete Decongestive Therapy (CDT), also known as Complex Decongestive Therapy – the gold standard treatment in lymphedema management. CDT is an intensive therapy program consisting of two phases: I-DECONGESTION AND PHASE II-MAINTENANCE. PHASE I The goal in Phase I is to decrease limb swelling and improve skin integrity. There are four components: skincare, manual lymph drainage, compression therapy, and exercises. Skincare is crucial to prevent further skin changes. The products used are acidic soaps and lotions to maintain the low ph that
normal skin presents. Manual lymph drainage is a type of light massage that stimulates lymph flow in the lymph vessels and collectors. Compression therapy includes the use of short-stretch bandages along with soft materials such as cotton and foam-based products to create padding and prevent skin breakdown. Lymphedema exercises include ankle pumps, deep breathing, upper and lower extremity strength, range of motion and functional mobility. Lymphedema patients are recommended to exercise when compression is used in the affected limb to prevent additional lymphatic fluid from accumulating in the interstitial spaces of the skin. Under normal circumstances, blood flow will increase to supply oxygen and nutrients to the working muscle but with lymphedema, this leads to increase swelling. Thus, the patient should exercise while wearing compression bandages or garments. PHASE II The goal in Phase II is to maintain the limb size achieved during Phase I and prevent exacerbation of swelling. To accomplish this goal, the patient is instructed in skincare, self-MLD, and to wear a special compression garment such as compression stockings or socks and/or velcro wraps. Also, the patient is encouraged to continue with the exercise routine prescribed during Phase I. During Phase II, an intermittent pneumatic compression pump (also known as a lymphedema pump), is recommended. The pump facilitates lymphatic flow but should not be used as a stand-alone treatment but along with the components of CDT. It is imperative to remark that the patient receiving CDT must be treated by a Certified
Lymphedema Therapist or CLT. CLTs have completed specialized training and board certifications to treat lymphedema. Patient safety, limb compromise, circulation problems, skin breakdown, pressure injuries, throbbing pain, the spread of infections, among other complications can arise from untrained individuals performing CDT. Adherence to the program is necessary for lymphedema management to achieve positive Outcomes, including the prevention and reoccurrence of swelling. However, it is important to mention that even with good adherence, an exacerbation of comorbidities can lead to re-swelling of the affected limb. Therefore, lymphedema management must include patient education, not only about their lymphedema but their comorbidities as well. Also, it is our duty as clinicians to advocate for the patient when there are limited resources to manage the patient’s condition. The Florida Breast Cancer Foundation, the National Lymphedema Network, the Academy of Lymphatic Studies, Norton School, and the Lymphology Association of North America (LANA), among others, are available resources for lymphedema management. Lymphedema doesn’t need to be a debilitating condition. With proper care, education and advocacy, it can be managed. The patient has the right to quality of life and with the help of a Certified Lymphedema Therapist. Lymphedema doesn’t have to take that away from them. Dr. Nilma Elias Santiago is a Doctor in Physical Therapy, Certified Lymphedema Therapist, Wound Care Certified, and Ostomy Management Specialist. She is the owner of the Integumentary Physiotherapy Clinic in Altamonte Springs, FL. For more information contact her at nelias@integumentarypt.com
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Your Local American Lung Association: When You Can’t Breathe, Nothing Else Matters By JANELLE HOM, Executive Director
The American Lung Association…it’s an organization you’ve heard of and know it is a trusted name. This organization has been around for more than 100 years but the true breadth of our work impacts everyone breathing. My career started with the American Lung Association in May of 2008 as an intern. My job at the time was to plan what has become our signature nationwide events, the Fight For Air Climb and LUNG FORCE Run/Walk. I can say honestly at that time I did not know much about the American Lung Association but learned quickly just how impactful the mission and how far of a reach it has. Fundraising events such as those are helping to fund lifesaving research and provide education for all impacted by lung disease. The American Lung Association, formerly the National Association for the Study and Prevention of Tuberculosis, was founded in 1904 with the purpose of fighting tuberculosis, a disease that was not controlled in the United States or globally. Through the power of volunteers coming together to raise funds and awareness around this devasting disease, tuberculosis was nearly eradicated by the 1950’s. The American Lung Association today fights 28 different lung diseases, are focused on eliminating tobacco use and related lung disease, improving air quality for all and reducing the burden of lung disease on patients and families. The mission of the American Lung Association is to save lives by improving lung health and preventing lung disease through education, advocacy, and research. Can you imagine a world free of lung disease? We are focused on accomplishing this mission through four key areas: defeating lung cancer, improving the air we breathe, reducing the burden of lung disease on individuals and their families, and eliminating tobacco use and tobacco-related diseases. All of that sounds noble and great, but what does that mean for the people living in Central Florida? Your local American Lung Association staff are working hard every day for patients, caregivers, healthcare providers, and everyone in the region to bring this mission to life. From our first breath to our last, every breath counts. Here are just a few of
the local activities and resources happening in Central Florida: TOBACCO CONTROL: Perhaps when you think of the American Lung Association, you may think that is the organization that tells people to quit smoking. We know that tobacco use is the leading cause of preventable death and disease in the United States. For 35 years Freedom From Smoking has been a resource to help smokers quit; it is ranked as one of the most effective cessation programs in the country. More recently, the American Lung Association launched INDEPTH, an alternative to suspension or citation that helps schools and communities address the teen vaping problem in a more supportive way. We are proud to offer INDEPTH at no cost to schools and are always looking to connect with teachers and administrators. LUNG CANCER: Lung cancer is the number one cancer killer of women in the United States. Consider these eye-opening facts: every five minutes, a woman in the U.S. is told she has lung cancer; in the last 41 years, the rate of new lung cancer cases has fallen 35% among men while increasing 87 percent among women. We are working to change perceptions around lung cancer and that anyone can develop it. The American Lung Association launched LUNG FORCE in 2015 to educate men and women on lung cancer and advocate for increased research funding for better detection and treatment methods, and ultimately to find a cure. Locally, you can get involved in a local walk (the LUNG FORCE Run/Walk will take place on May 2nd in Baldwin Park), attend the LUNG FORCE Expo during Lung Cancer Awareness Month in November, or engage in a number of opportunities year-round to share your voice. We are also proud to offer a local Lung Cancer Support Group which meets the second Tuesday of every month at the American Lung Association’s Central Florida office. COPD: Chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema, is a longterm lung disease that makes it hard to breathe. This disease affects millions of Americans and is the third leading cause
of disease-related death in the U.S. The American Lung Association offers a variety of resources for patients including Better Breathers Clubs, an educational and support program. Better Breather’s Clubs are open to lung conditions including COPD, pulmonary fibrosis, and asthma. A full list of these program locations are available on our website at lung.org/support-andcommunity/better-breathers-club/. These are only a few of the examples of how the American Lung Association is impacting the lives of those living in Central Florida. There are countless opportunities for volunteerism, philanthropy, advocacy, and
receiving the benefits of these lung health programs. Take a moment to think about who you may know that has been impacted by lung disease; chances are you’ll think of several examples. At the end of the day, when you can’t breathe, nothing else matters, and that drives your local dedicated staff to serve Central Florida and fulfill our mission. Janelle Hom is the Executive Director of the American Lung Association in Florida. Email her at Janelle.Hom@lung.org. Visit Lung.org
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Understanding the Difference Between Usable Square Footage and Rentable Square Footage By DOUG PRICE
A monumental decision for your healthcare practice is choosing where it will be located and how much space you need. As you consider your top property options, you will encounter layers of information and definitions that can have a significant impact on both your success and budget. When it comes to the size of your space, there are a few items and definitions that often confuse even savvy tenants to the point of making costly mistakes. One of those items, is understanding the difference between Usable Square Footage and Rentable Square Footage. USABLE SQUARE FOOTAGE Usable Square Footage or USF is the total usable floor area of a space or building. Usable Square Footage is measured from the outside or outer surface of any exterior walls and windows, including the middle of any interior walls that are adjacent to other spaces, hallways or common areas. Similar to how homes are assessed, the measurements are from the outside of the exterior walls, not by measuring from the inside of the walls. Usable Square Footage is the space the tenant will actually occupy, as compared to the Rentable Square Footage the tenant will pay rent on. Usable Square Footage can sometimes also be called Leasable Square Footage. Architects and Tenants will often measure a space from the inside of all the walls of a space, and in doing so, will calculate a square footage that is lower than the landlord’s calculation of the Leasable or Usable Square Footage. Although this is both helpful and needed when designing a space and getting budgetary numbers, this is not the same as Usable or Leasable Square Footage. Measuring the interior walls of a space will not get you to an accurate measurement of USF. When measuring a space, it’s important to understand the location of the measurements as well as even the thickness of the
walls to calculate the correct size. An architect or space planner can help ensure a more accurate measurement than most individuals trying to use a tape measure or laser. Additionally, comparing in-person or field measurements to a verified CAD document can also decrease the margin of error. Usable Square Footage should not include any common areas of the building such as public corridors, hallways, common areas, restrooms, etc. Again, the definition of Usable Square Footage is the official measurement of the space or square footage you will actually occupy. RENTABLE SQUARE FOOTAGE Rentable Square Footage or RSF is the total square footage that tenants pay rent on and equals the Usable Square Footage plus the tenant’s pro-rata share of the Building Common Areas; such as: lobbies, public corridors, hallways, restrooms, utility closets, fire-sprinkler rooms, etc. When it comes to Building Common Areas, an example would be an office complex that has ten tenants utilizing a common area, where the ten tenants would share the proportionate amount of square footage based upon their percentage of the Usable Square Footage they occupy of the building. The same concept is typically the case when also dividing the cost of maintaining any common space; it is divided on a prorate scale. The square footage and cost would be included as a part of the Rentable Square Footage. Rentable Square Footage differs from Usable Square Footage in that Usable Square Footage is the tenant’s specific space they occupy whereas Rentable Square Footage also includes a portion or percentage of the property’s common areas. The pro-rata share has many synonyms and is often referred to as the Rentable/Usable (R/U) Factor, the Core Factor, the Loss Factor or the Common Area Factor. Regard-
less of what title it receives, the amount will typically fall in a range of 1.10 to 1.20 percent of the Usable Square Footage, depending on the particular building. Typically, a tenant who occupies an entire floor of an office building will have a lower R/U Factor compared to a tenant who occupies only a portion of a floor. To show the math on this as an example, if the Usable Square footage is 3,000 square feet, and the R/U Factor or Common Area Factor is 1.20 percent or 20%, you take: 3,000 square feet x 1.20 = 3,600 Rentable Square Feet. Buildings or properties that offer additional amenities such as conference room facilities, fitness gyms or other property benefits will often include those square footages into the common areas as well, which can increase both the R/U Factor and the overall Rentable Square Footage. Properties such as Retail buildings or single-story office or industrial buildings that don’t have any noticeable common areas or interior public corridors may still have a very small or minor additional R/U Factor which increases the Rentable Square Footage to them, in the form of a common building utility closet or fire alarm room or fire-sprinkler riser room. When evaluating the Rentable Square Footage of a property, it’s important to understand that you are paying for additional square footage as part of your pro-rata share of the common areas in addition to your Usable Square Footage. You will then also pay your pro-rata share of the expenses to maintain the common areas and overall property. A COMMON MISTAKE One of the most common mistakes that tenants make is basing their actual square footage needs on the Rentable Square Footage number they see advertised. A tenant will often speak with an architect to determine the approximate size of space they need, but
won’t realize that there could be a substantial difference in the size space they need vs. the final Rentable Square Footage, especially if they are considering an office building. In the example we used above, if a tenant believes they need 3,000 Usable or Buildable Square Feet for their space, and doesn’t understand the difference between usable and rentable, they will go search for 3,000 square feet, instead of a space that is actually 3,600 Rentable Square Feet with 3,000 Usable Square Feet or 3,000 Square Feet they can actually build out and occupy. This mistake can result in a number of issues, including wasting weeks or months of time evaluating spaces that are the wrong size; or, if a lease is signed prior to the tenant fully realizing the mistake, you can get committed to a space for five to ten years in a lease agreement for a space that is too small from day one. Overall, understanding the difference between Usable and Rentable Square Footage is a small but important step in mastering commercial real estate concepts that can help you maximize every opportunity you have, and ultimately, maximize your profitability through real estate. Doug Price is an agent with CARR Healthcare, the nation’s leading provider of commercial real estate services for healthcare tenants and buyers. Every year, thousands of healthcare practices trust CARR to achieve the most favorable terms on their lease and purchase negotiations. CARR’s team of experts assist with start-ups, lease renewals, expansions, relocations, additional offices, purchases, and practice transitions. Healthcare practices choose CARR to save them a substantial amount of time and money; while ensuring their interests are always first. Contact Doug at Doug.Price@carr.us
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When a Back Surgeon Hurts His Back By RAVI H. GANDHI, MD
As physicians, we are all invisible until we aren’t. I recently realized my weakness. In a simple moving of a box, I discovered what 1000s of patients have been describing to me for years. Horrific back pain to the point of being unable to stand. I walked hunched over for a day and dealt with all of my colleagues and patients offering up solutions. I then started to realize that I was my own patient. I started NSAIDs and inched through the first night. The second day was worse and now the pain had started to radiate down the lateral aspect of my thigh (An L5 radiculopathy). I immediately checked my plantar flexion and dorsiflexion strength. I was neurologically intact with back and leg pain. At that time, I was in denial. I underwent an MRI while hoping and praying for it to be negative. Unfortunately, I had a large L5 disc extrusion, ligamentous sprain, and collapse of my disc space. I was shocked and scared. Just like my patients, I wanted to feel better, but I was scared of the idea of having surgery. However, just like I would for my patients, surgery was far from the next step. I started a muscle relaxant, physical therapy and lifestyle modifications. Dietary changes to lose weight, pilates and yoga to
strengthen my core, and anti-inflammatory medications when needed. I am now two weeks into this episode and doing well. I have lost some weight, continue to work long hours but have limited improper lifting techniques. I am now able to sleep through the night. If my pain persists or returns, then my next step would be an epidural steroid injection and/or facet blocks. Finally, if this conservative management fails, I would undergo a simple microdiscectomy. Luckily, I have direct access to the best neurosurgeons in the country in my own office and hopefully I won’t have to utilize any of them. This is the same regimen I prescribe for any patient undergoing what I am. The incidence of disc herniations is estimated to be up to 50 percent in at risk populations. The natural history of this disorder has been well characterized. Ninety percent of patients will have resolution of their symptoms without significant medical intervention. Ravi H. Gandhi, MD, is a board-certified neurosurgeon who is fellowship trained in Cerebrovascular, Endovascular, and Skull Base Neurosurgery. Current areas of interests include traditional and minimally invasive methods of treating complex brain and skull base diseases such as brain tumors, trigeminal neuralgia, and acoustic neuromas. Dr. Gandhi practices at Orlando Neurosurgery. Dr. Gandhi is a medical director and part of the neurosurgical team at the AdventHealth Neuroscience Institute.
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Doctors: How to Talk to Patients About Nutrition and Diet By KERIN TORPEY BASHAW
No more powerful an approach exists to preventing or even reversing heart disease than improving lifestyle, especially nutrition and diet. The challenge for physicians is finding an effective way to talk about nutrition with their patients, because the usual admonitions to eat better and exercise often do not work. The American Heart Association estimates that 46 percent of U.S. adults have hypertension and, on average, someone dies of cardiovascular disease every 38 seconds. A 2018 report by the Centers for Disease Control and Prevention (CDC) showed the average U.S. adult is nearly obese. A 2017 study revealed that about 45 percent of deaths from cardiometabolic conditions were due to dietary factors. Andrew M. Freeman, MD, FACC, co-chair of the Lifestyle and Nutrition Workgroup with the American College of Cardiology, explains that the drugs we use to treat heart disease can be wonderful tools, but they don’t really focus on a cure or reversal—they only control the disease. But drugs aren’t the only option. Stephen Devries, MD, executive director of the Gaples Institute for Integrative Cardiology, stresses the wealth of research focusing on lifestyle and nutrition as the key component for curing or reversing heart disease. The data suggest that a diet filled with vegetables, fruit, whole grains, and predominantly plant-sourced protein offers the best chance for both prevention and treatment of heart disease, as well as benefits for reducing the risk of certain cancers. Dr. Devries points to one landmark study, which found that a Mediterraneanstyle diet emphasizing more fish, vegetables, nuts, and whole grains yielded a 72 percent reduction in the occurrence of nonfatal myocardial infarction and death, compared to a control group. A more recent study of the Mediterranean-style diet found a 28 percent reduction in nonfatal myocardial infarction, cardiac death, and stroke, Dr. Devries notes. The results that are possible with changes in nutrition and other lifestyle improvements make every drug and procedure pale in comparison, Dr. Freeman says. The Dietary Approaches to Stop Hypertension (DASH) trial showed that a diet rich in vegetables, fruit, and low-fat dairy prompted a significant drop in blood pressure in only two weeks. Dr. Devries explains the compelling results of this research in a four-hour, selfpaced CME program called Nutrition Science for Health and Longevity: What Every Physician Needs to Know, recommended by The Doctors Company. Dr. Freeman believes there is no doubt we can significantly improve the quality of life for patients with heart disease through better nutrition, which promises benefits several magnitudes larger than nearly any medication. 13
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The science is solid, but applying it is the challenge, he says. Unfortunately, cardiologists have almost no training in lifestyle approaches to disease. A survey of 646 cardiologists revealed that cardiologists are unprepared to talk to patients about the effect of nutrition on heart disease, with 90 percent receiving no or minimal nutrition education during fellowship training, 59 percent receiving little or no nutrition education during internal medicine training, and 31 percent receiving no nutrition education in medical school. That means physicians face a significant challenge when trying to persuade patients to switch to a predominantly, if not totally, wholefood, plant-based diet. The switch is difficult for most patients, and physicians are not adequately prepared to talk about nutrition at all, much less such a daunting lifestyle change. Most physicians have only brief conversations in which they tell patients to change their diets, possibly with a few specific suggestions. So, one of the keys to making nutrition counseling work in a busy practice is making optimal use of the short period of time that physicians have available for nutrition counseling – a key component of the CME nutrition course. Even when patients are eager for nutritional advice, they may find it difficult to sort out competing messages from the media and may not know how to follow their physicians’ advice to improve nutrition. Effective communication requires a
more interactive approach that uses data to back up the recommended changes. For example, Dr. Freeman asks patients what they had for lunch that day, what they had for dinner the night before, and how active they were in the past week for a snapshot assessment of nutrition and lifestyle. He then asks permission to be critical about the diet, which indicates whether the patient is receptive to the changes that are necessary to reverse the course of heart disease. Dr. Freeman also assesses readiness for change through a technique called motivational interviewing, which helps identify what incentivizes a person to change behaviors. This approach recognizes how difficult it can be for some people to make lifestyle changes and helps them find successful strategies. This approach and further conversation may reveal, for example, that the patient has an unhealthy diet but is unhappy about how he or she feels on a daily basis and wants to be able to dance at a daughter’s upcoming wedding. Such circumstances and goals can become the basis for meaningful change, supported by resources such as recipes and online links to resources, as well as support groups that let patients meet people who have successfully transitioned to better nutrition. Clinical scenarios that provide tips for motivational interviewing are also included in the nutrition CME course.
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Patient Centric Post-acute Care with Remote Monitoring TOPICS 1. 30-Day Readmissions NOT Reimbursed & Soon Penalized?
When patients are at least minimally receptive to the idea, the physician can show how research proves the value of improving their nutrition, comparing their own nutrition to the ideal versions and discussing the incremental steps for improvement. Physicians also can support patients making healthy lifestyle changes through programs like Walk with a Doc, which encourage doctors and patients to take walks together. Dr. Freeman runs the regional program and regularly takes walks, and talks, and educates patients. Because the benefits of improved nutrition and lifestyle for heart disease are so compelling, clinicians must make a concerted effort to convey that information effectively and to work with patients to overcome any personal obstacles or hesitation. Simply telling patients to change their lifestyles does not work—a supporting hand through change is necessary. Kerin Torpey Bashaw, MPH, RN, is the Senior Vice President, Department of Patient Safety and Risk Management for The Doctors Company. The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.
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Not All CBD is Created the Same, So Florida Steps in to Regulate By DR. CORLISS OLIVER
In 1937, the U.S. government passed the Marijuana Tax Act which imposed heavy taxes on cannabis and hemp products. Prior to 1937, marijuana was widely used in the United States for medicinal purposes, while hemp was widely used for commercial production of commodities such as textiles, rope and paper. In 1970, the U.S. government created the Controlled Substance Act which declared all strains of cannabis including marijuana and hemp as Schedule I drugs with no accepted medical use and a high potential for abuse or misuse. The 2014 Farm Bill defined hemp as distinct from marijuana and legalized hemp for agricultural and academic research. The 2018 Farm Bill declared the hemp plant and all its components as legal if the products contained less than 0.3 percent THC. With these sweeping changes, there has been significant public interest in CBD.
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Subsequently, the use of CBD products has skyrocketed. And for good reason, as emerging research has shown CBD to have therapeutic benefits in the treatment of epilepsy, muscle spasms associated with multiple sclerosis, chemotherapy-induced neuropathy and cancer-related pain. Doctors are daily bombarded with questions by patients on the possible benefits of CBD for ailments that range from chronic pain to cancer treatment and prevention. CBD now appears in a wide variety of products such as oils, creams, ointments, tinctures, dietary supplements, veterinary products and cosmetics. In 2015, the FDA began laboratory analysis of CBD products sold online to determine the amount of CBD in products in comparison to the alleged amount on the label. Lab results revealed that many of the CBD products contained substantially less levels of CBD than the product label claimed and, in some cases, CBD was undetected. Subsequently the FDA issued warning letter to retailers of their findings and the need to address these discrepancies. And now, thanks to Governor Ron DeSantis and the Florida legislature, the State of Florida has made sweeping changes regarding CBD products to ensure industry standards of purity, quality and ultimately public safety. Effective January 1, 2020, the Florida Department of Agriculture has the authority to regulate and inspect ingestible CBD products that are produced and sold in the
State of Florida. This includes lab testing to determine if the product contains pesticides, harmful additives and the actual amount of CBD contained in the product compared to the alleged amount on the product label. Eventually, consumers will be able to scan a bar code to see lab results revealing all the ingredients contained in the product. In addition, manufacturers and retailers of CBD products now require a state permit. Unfortunately, these regulatory changes will not affect out of state CBD products sold online. Therefore, it remains important that we educate the public on the importance of obtaining CBD products from reliable and reputable sources. In June 2018, the FDA approved Epidiolex, the first plant-based CBD product for patients suffering from Dravet syndrome and Lennox-Gastaut syndrome, two types of severe pediatric seizures that typically do not respond to current anti-seizure medications. However, Epidiolex has also been shown to reduce seizures in those suffering from tuberous sclerosis complex, Sturge-Weber syndrome, febrile infection-related epilepsy and specific genetic disorders that cause epileptic encephalopathy. In addition, early research
has shown promising results with CBD for treating insomnia, anxiety, pain, dystonia and autism. Clearly more quality controlled clinical studies and randomized clinical trials are needed. Unfortunately, consumers will continue to self-medicate by purchasing online CBD products from unknown sources without any knowledge of exactly what the product contains. Furthermore, the potential adverse effects based on a myriad of factors such as age, weight, comorbidities and possible drug-drug interactions can be a challenge in preventing catastrophic outcomes despite the efforts of the new legislation by the State of Florida. Dr. C. Yvette Oliver, President and CEO of Optima Health Institute is a boardcertified Family Medicine physician with a focus on improving patient outcomes by addressing individual inhibiting factors such as lifestyle, comorbidities and potential drug-drug interactions. For more information please visit www.optimahealthinstitute.com
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Before You Sign – Understanding Agreements for Doctors By MATTHEW ROSENTHAL and JUSTIN MEYER
It is easy to get contract fatigue and sign anything placed in front of you, especially when you may be excited about a potential opportunity. This scenario is especially true in two situations: when you are working with a friend; and when you are starting a new job. However, it is in these times that you have to be even more vigilant – after all, deals that began with a handshake can end up in a courtroom, and handshakes are not admissible. If you are joining a practice as a partner or starting a new partnership, you need some form of an agreement – the name of the agreement may be different based upon the type of entity. For example, a PLLC might have an operating agreement, while a PA would have a shareholder or partnership agreement, but the essential points are still the same. A good agreement will lay out the roles and responsibilities of each partner and will talk about what happens when one partner wants to or has to leave, either through death, disability, or retirement. Some examples that may be addressed in
the agreement to avoid future conflict are: Can that partner pass her share of the practice on to her children or sell it to another doctor? Do the remaining partners have to buy her out? What happens if one partner is ready to quit and move to another area? The best time to negotiate a partnership agreement is when you are first getting started. Putting this off can lead to issues later, as it frequently means that you are trying to negotiate buyouts as things turn acrimonious. Business divorces can be even more difficult and stressful than a personal one – even for married spouses, the best course of action is to have a partnership agreement. As an employer, you may also want to have your employees sign employment agreements. The first thing that you need to be careful about is Florida’s at-will rule. This rule states that an employee can be fired for any or no reason (other than discriminatory ones) and can quit at any time with no notice. You want to draft employment agreements carefully to ensure they do not violate this rule without a good reason. It would be best to
have a clear understanding of why you want an employee to be guaranteed employment for a set term, before giving him one. A lot of employers both in medicine and in other industries like to look at restrictive covenants – non-compete agreements, nonsolicitation agreements, and non-disclosure agreements. While these are reliable tools for employers to protect their business interests, knowing when and how to use each one is important. The most commonly misused agreement is a non-compete agreement. While it can be a powerful agreement and very useful to protect your business interests, including patients, it is also the most difficult agreement to enforce. Florida law is very clear on what makes a non-compete enforceable, and it is not automatic. A big mistake that many employers make is giving every employee in the office, including receptionists and clerks, a non-compete agreement. The best strategy is to provide non-compete agreements only to key employees. Non-solicitation agreements, which prevent the employee from reaching out to patients or other employees and trying to get them to leave your practice, are one very ef-
fective tool to protect yourself from people who are leaving. Non-disclosure agreements are, for a medical practice, essential. They prevent your employees from sharing confidential information. This agreement not only includes information about your practice, such as patient lists and financial information, but confidential patient information as well. Every employee, from doctors to receptionists, billing clerks to janitors, should be signing a non-disclosure agreement. If you bring in outside contractors to clean your office, a non-disclosure agreement should be part of the contract. One common question is whether you can ask current employees to sign these agreements. The answer is: yes. There are several ways that you can have current employees sign these restrictive covenants when it is appropriate. As a doctor who is joining a practice as an employee, it is important that you read everything you are asked to sign. If you are given an employment agreement, you should make sure that you understand your rights and obligations, including whether you have the (CONTINUED ON PAGE 16)
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Physician Burnout: What Will Happen If This Trend Doesn’t Change? By NICOLE BRAMBLETT
Physicians are 15 times more likely to experience symptoms of burnout than professionals in any other field. This comes directly from a report by Allscripts, one of the leading electronic health record (EHR) developers in the industry. The study was conducted to see how their products were affecting the healthcare professionals using them on a daily basis and the numbers were staggering. Doctors—or all healthcare professionals for that matter—have taken on a heavy caseload since President Bush started a transformation with his Healthcare Information Technology Plan. Good intent was certainly there—reduced charting errors, increased patient safety—but at what expense? FEELING THE EFFECTS OF AN INCREASED WORKLOAD According to the National Center for Biotechnology Information, or NCBI, there is a strong correlation between physician burnout and medical error. Through their research, they have found that about 9% of
physicians who have experienced burnout have made at least one major medical error. Cases of burnout have increased significantly since the rise of EMR. Prior to electronic medical records (EMR), a provider’s day revolved around patient care. When the EMR was adopted in 2004, it brought on additional tasks to a clinician’s already heavy workload. Patient care was affected, and this trickled down to nursing and ancillary staff using the system as well. Clinicians throughout the country have felt the effects of their additional charting tasks and the learning curve associated. Some have—and continue to—struggle through their processes. Patient care is falling at the wayside and physicians and their staff are feeling even more pressure as their patient satisfaction drops. This isn’t only affecting patients, though. According to the same NCBI study mentioned above, suicide rates among doctors have now risen. The rates among male doctors is 1.41 times higher than males in the general population. For females, that number is 2.27 times higher.
PROVIDING RELIEF IS VITAL Many clinicians who feel the effects of burnout—stress, lack of energy, irritability—are too busy to act to cure themselves. Ironically enough, the life of a doctor is often too busy to leave availability for self-examination. Unfortunately, if this trend continues, clinicians themselves will be the ones feeling the medical effects of their workload. Those who enter the field of medicine typically do so because they want to care for patients. In order to restore the joy that was once shared, processes will need to change, and relief will need to be provided. To hinder the growth of this epidemic, several actions can be taken:
• Help the mindfulness of the clinician, possibly with monthly focus meetings • Provide scribes to decrease workload • Get them emotional support and treatment for burnout • Offload non-essential tasks to other staff members
DECREASE BURNOUT AND INCREASE PATIENT CARE If clinicians continue at their current
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pace, the effects of burnout will only get worse. It is important that all of us in the field of medicine act quickly to help preserve our clinicians and to bring them the documentation and emotional support they need to get back to what it is they do best: caring for patients. Nicole Bramblett is the Client Relationship Manager for Scrivas, LLC an industry leading medical scribe company servicing the state of Florida. Nicole has over 10 years’ experience in healthcare and earned her Masters in Healthcare Administration from Florida Atlantic University. For more information email nbramblett@scrivas.com or visit scrivas.com.
Before You Sign – Understanding Agreements for Doctors, continued from page 15 freedom to leave and join another practice. You should also know how salary is paid and calculated, and the other terms of the contract, including when you are expected to be on call. Another important term to look for is what you are responsible for paying – employers should be covering your malpractice insurance, but some will require that you pay for it yourself. Best practices include taking time to review the contract, instead of immediately signing it when they give it to you. It is not an unexpected request to ask that your trusted advisor(s) review the contract before final signing. Managing contracts is not why you went into medicine. However, in today’s business world – and medicine is a business – you cannot escape them. You must take the time to read what you’re being asked to sign or to ensure that you have contracts in place to protect yourself and your business. It is important that you have trusted advisers who can help you to negotiate and draft these agreements to protect yourself. No one gets into medicine to deal with contracts, but ignoring them can significantly impact your ability to stay in medicine. Rosenthal Meyer, PLLC was founded by attorneys Matthew Rosenthal and Justin Meyer, who share the same commitment to providing client-centric legal services, with a concentration in business law, wills & trusts, probate, and real estate. The multistate community law firm prides itself on its experience, approachability, caring about the outcome of the situation, and providing legal solutions that work. Their focus is on legally protecting clients through the evolution of their business, and through all stages of life. They take pride in getting involved with the communities they serve and building long-term relationships. For more information, visit https://rosenthalmeyer.com.
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GrandRounds Definitive Healthcare Acquires Florida’s PatientFinder Definitive Healthcare, the leading provider of data, insights, and analytics on the healthcare provider market, has announced the acquisition of PatientFinder, a Florida software analytics firm that helps life science companies and healthcare providers find patient clusters who would most benefit from their products and services. “We have always had the best data on healthcare organizations and professionals. We amplified the value of that data this year when we integrated Commercial Claims analytics. With today’s acquisition of PatientFinder, Definitive accelerates progress against its strategic roadmap – to provide end-to-end go to market solutions that bridge the gap between data and action. This is an industry milestone,” said Jason Krantz, Founder and CEO of Definitive Healthcare. “It’s demonstrative of our commitment to enabling client growth by integrating patient and provider insights directly into our clients’ existing processes for strategic analytics, go-to-market planning, and field execution.” The acquisition supports the Definitive vision to entrench contextual data and insights within a business’s end-to-end commercialization effort. PatientFinder technology allows clients to build highly customized cohorts of patients by analyzing their diagnosis and treatment history and align that intelligence with the physicians and facilities who provide care to those patient populations. “Uniting the PatientFinder solution with the accuracy and breadth of the Definitive Healthcare provider data and bestin-class all-payer claims data is a win-win for our combined clients and a game-changer in the market,” said Dave Thornton, CEO and Founder of PatientFinder. “We are incredibly enthusiastic about becoming a part of the innovative team that has made Definitive one of the industry’s fastest growing companies with the highest customer satisfaction and industry-leading retention rates.” Definitive’s clients – which include 9 of the top 10 pharmaceutical companies, 8 of the top 10 medical device firms and over 2,500 of the top healthcare providers, healthcare IT, healthcare staffing and consulting firms – utilize the Definitive platform to solve their most critical revenue generating objectives. Clients analyze referral patterns, patient leakage trends, total and average charges, patient outcomes, and population health trends to drive a complete end-to-end commercialization effort. This is the second acquisition for Definitive Healthcare in 2019, following the HIMSS Analytics data services division in January 2019. With this acquisition, and with continuing investments in new talent, Definitive Healthcare now employs a 400-person workforce and continues to grow quickly. In 2019, Definitive was recognized, for the third consecutive year, for rapid growth by INC. 5000 and Deloitte 500 in their respective lists of fastest-growing private companies in the U.S. Definitive Healthcare is the leading pro17
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vider of data and intelligence on hospitals, physicians, and other healthcare providers. Its product suite provides the most comprehensive and highest quality data available anywhere on 8,800 hospitals and IDNs; 148,000 physician groups; 1.7 million physicians, nurses, and allied health professionals; 11,200 ambulatory surgery centers; 14,600 imaging centers; 91,600 long-term care facilities; 40,000 clinics; 1,400 ACOs and HIEs; more than 4 billion commercial medical and Rx claims; 115,000 clinical trials; and 900 Canadian hospitals. The company’s data provides its 2,200+ clients with the analytics and insight needed to effectively segment and research the healthcare provider market. Definitive Healthcare is backed by 22C Capital, Advent International and Spectrum Equity. For more information, or to trial the service, visit https://www.definitivehc.com
Orlando Health Acquires Property on Pennsylvania Street Orlando Health successfully completed the purchase of a building located at 45 Pennsylvania Street. Orlando Health closed on the property Wednesday, January 15, 2020. The property is located one block west of the new Orlando Health Imaging Center, which is being built at 1800 S. Orange Avenue. The property includes a two-story, 7,100 square feet apartment building constructed in 1970 and a 13-space parking lot on approximately .33 acres. The purchase price was not disclosed. Orlando Health is in the process of planning for the future redevelopment of the property as part of a new pediatric comprehensive care center complex. Details will be shared at a future date.
Ocoee Named Healthy Community Champion by the Florida Department of Health ORLANDO – Congratulations to the Orange County community of Ocoee for being named a 2019 Healthy Community Champion by the Florida Department of Health. Ocoee was among 33 communities to receive the honor this past year. Ocoee was recognized for building a sustainable community and adopting planning and urban design best practices. These efforts will increase community connectivity, provide for different modes of travel, and increase access to facilities, services, and activities to improve overall health, physical activity and social interaction. The city is in the process of updating its parks, which includes the addition of interactive and stimulating play equipment and assessing bicycle and pedestrian connectivity to parks. Another highlight was Ocoee’s on-site health clinic that provides city employees with easy access to wellness facilities and services. (CONTINUED ON PAGE 18)
Justin Birmele Named CEO for AdventHealth Winter Park WINTER PARK — After an extensive search, AdventHealth has named Justin Birmele to the position of CEO for AdventHealth Winter Park. Birmele will assume leadership of the hospital effective immediately. Birmele replaces Jennifer Wandersleben, who recently transitioned to a new role as president/ CEO of acute care services for AdventHealth’s Central Florida Division – South Region. “It is an exciting time for AdventHealth Winter Park and I am confident Justin’s clinical and operational experience and collaborative leadership style will take this health care campus to new heights and provide whole-person health to even more people in this community,” said Terry Shaw, president/CEO for AdventHealth. Birmele most recently served as the vice president and chief operating officer for AdventHealth Winter Park, responsible for leading hospital operations, including ancillary and support service departments. Justin also oversaw the renovation and construction projects for the hospital, including the new Nicholson
Pavilion and the AdventHealth Oviedo ER. He has worked in health care for more than 18 years with the majority of those being at AdventHealth in both clinical and operational areas. “I care deeply for this community and I’m excited to share our ongoing vision with the AdventHealth Winter Park family,” Birmele said. “I am honored to work with the physicians, team members and community partners as we continue to deliver Christ-centered, whole-person care to Winter Park.” Birmele is no stranger to Winter Park as a graduate of Leadership Winter Park. In addition, he serves on multiple community boards, is a current member of Central Florida’s ACHE and a graduate of the inaugural AdventHealth Executive Leadership Program. Birmele and his wife, Lindsey, have a beautiful baby girl, Danika. In his free time, Birmele enjoys travel and dining, spending time with his family and friends, and being involved in the Winter Park and Oviedo communities.
New Health Officer Selected for Orange County The Florida Department of Health (Department) is pleased to announce Dr. Raul Pino as the Health Officer for the Department of Health in Orange County (DOH-Orange). He has been serving as interim Health Officer since May 2019. As the Health Officer for DOHOrange, Dr. Pino is responsible for overseeing all operations, including planning, directing, developing and coordinating public health programs and activities. He is also responsible for making sure that that DOH-Orange continues to address state and local public health priorities and provide population-based partnerships with community stakeholders. “Dr. Pino has an excellent and diverse background in all aspects of public health and has demonstrated his ability as a skilled leader,” said Lieutenant Governor Jeanette Nuñez. “I believe he will be an asset to the Florida Department of Health in Orange County as its new health officer.” “Dr. Pino’s educational background and leadership experience make him well-suited to providing oversight for Florida Department of Health in Orange County,” said Dr. Scott Rivkees, Florida Surgeon General. “His considerable experience in the public health, administrative and community health areas make him a valuable resource to the residents of Orange County.” “We welcome Dr. Raul Pino as the
Health Officer for Florida Department of Health in Orange County,” said Jerry L. Demmings, Orange County Mayor. “I look forward to working closely with such an accomplished professional to secure great health outcomes for all Orange County residents.” Dr. Pino was the Commissioner for the Connecticut Department of Public Health (CT DPH) for almost 4 years following his role as Deputy Commissioner. Prior to these appointments, he served the City of Hartford, Connecticut, as Director and Assistant Director of the city’s Department of Health & Human Services. In these positions, Dr. Pino managed the budget and oversaw labor relations, public health preparedness, code enforcement and the department’s management team. Dr. Pino was also an epidemiologist for CT DPH’s Sexually Transmitted Diseases Control Program and worked at the Institute for Community Research, Hispanic Health Council and Hartford Hospital. He holds a doctorate in Medicine from the University of Havana and a Master of Public Health from the University of Connecticut School of Medicine.
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GrandRounds “We congratulate the City of Ocoee for being named a Healthy Community Champion,” said Dr. Raul Pino, Health Officer for the Florida Department of Health in Orange County. “Ocoee is committed to improving the lives of their residents through policies and best practices that will increase the overall health of their community. We are committed to partnering with Ocoee to promote healthy lifestyles and empowering the residents to improve their health.” Since 2014, the Florida Department of Health has empowered communities to make policy, system and environmental changes in an effort to make healthy choices practical and available to all communities. Florida’s county and municipal governments play an important role in improving the health of all communities and people. Local governments have implemented a variety of policies that have been shown to increase physical activity and improve nutrition in support of obesity prevention and chronic disease prevention. Local governments submitted a compilation of best practices as part of the Healthy Community Champion criteria to highlight progress that has been made in their communities to ensure Floridians live healthier lives. The Healthy Community Champions Recognition Program is the department’s effort to take a Health in All Policies (HiAP) approach to comprehensive planning. According to the Centers for Disease Control and Prevention, HiAP is a collaborative approach to improving health by incorporating health considerations into decision-making across sectors and policy areas. The HiAP approach provides one way to achieve the National Prevention Strategy and Healthy People 2020 goals and enhance the potential for state, territorial, and local health departments to improve health outcomes. By implementing recommended policies, local governments can promote community environments where the healthy choice is the easier choice. To learn more about Healthy Community Champions and for a list of the 2019 Champion Communities and best practices, please visit the Healthy Community Champions 2019 Recognition Program website.
Complexities in Medicare Advantage Options May Discourage Seniors from Comparing Plans Many seniors miss out on savings and benefits because they are confused about how to shop for Medicare Advantage. Medicare Advantage Open Enrollment Period (MAOEP) is from January 1 – March 31. It’s a time when seniors can potentially save money and gain benefits. Unfortunately, many seniors will do neither. But why is the Open Enrollment Period ignored by seniors? As Dave RichCEO, Ensurem LLC, puts it, “The Medicare Advantage market is constantly changing making better plans available to seniors every year during the fall Annual Election Period. This is crunch time for most seniors, but
VISN 8 Announces Orlando VA Healthcare System Director
what they don’t usually realize is they also have a chance to make one additional change to their MA coverage for the year during the OEP. Additionally, insurance companies and brokers aren’t legally allowed to market this period or its benefits to consumers. So oftentimes, they’re left feeling stuck with the choices they made during a hectic AEP season.” The MAOEP is the time when a beneficiary with Medicare Advantage can either: Change from one Medicare Advantage plan to a different Medicare Advantage plan. Drop their Medicare Advantage plan and return to Original Medicare, Part A and Part B (and subsequently apply for Medigap or Part D, if they choose.) For those who do decide to drop their Medicare Advantage policy and return to Original Medicare they often don’t understand that there is an increase in patient medical costs for Original Medicare holders, while Medicare Advantage costs are on the decline. (1) Medicare Part A and Part B comprise Original Medicare. This covers the basic hospital and medical expenses that the government provides at age 65. It does not cover all healthcare expenses however (such as Prescription Drug Plans) and it leaves the senior with out-of-pocket expenses that can sometimes be crippling. The difference between Original Medicare and Medicare Advantage Medicare Advantage, or Medicare Part C, replaces Original Medicare. This coverage is provided by private insurance companies that contract with Medicare. These plans will sometimes include additional coverage for things like dental and vision care, prescription drugs, rehabilitation services, diagnostic services or even fitness programs. If a senior has Medicare Advantage (MA) they may want to shop during the MAOEP because the MA markets are getting more competitive as more entrants continue to break in. To stay competitive, insurance companies are always adding new services and benefits. For example, hundreds of Medicare Advantage companies are rolling out new homecare benefits in 2020. This is because the Centers for Medicare & Medicaid Services (CMS) is giving Medicare Advantage plans the most flexibility they’ve ever had in terms of covering non-medical, in-home supplemental benefits. Additionally, the steps the Trump Administration has taken to improve and drive competition in Medicare Advantage means more savings, more benefits, and lower costs for seniors. Nevertheless, many seniors will likely not take advantage of these benefits. Only 6-11 percent of seniors voluntarily switched from Original Medicare to Medicare Advantage during the 2006 to 2017 enrollment periods. In addition, more than one in three Medicare beneficiaries reported difficulty comparing the Medicare Advantage plan options. Seniors find it easier to confront a colonoscopy Another survey indicated that 23 per(CONTINUED ON PAGE 19)
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The Department of Veterans Affairs is pleased to announce the appointment of Mr. Timothy J. Cooke as the new director of the VA Medical Center in Orlando, Fla. “We are excited to bring Mr. Cooke on board as the new director of the Orlando VA Medical Center,” said Dr. Miguel LaPuz, Veterans Integrated Service Network (VISN) 8 Director. “His sound leadership qualities and proven experience will be valuable assets for the facility, the employees and volunteers, and most importantly, for the Veterans we are honored to serve. Mr. Cooke’s appointment will begin January 19, 2020.” Mr. Cooke previously served as the director of the Martinsburg VA Medical Center in Martinsburg, Va. since 2014 and has held progressive leadership positions at the facility over the last 14 years. Prior to that, he worked at the he worked at the VA Maryland Health Care System, before lending his expertise to the Southern Arizona VA Health Care System. He also served as Chief of Engineering at the Jamaica Plain Campus during the VA Boston Healthcare System integration. From 2003 to 2005, he was in the private health care sector as the Vice President of Facilities & Support Services at Caritas St. Elizabeth’s Medical Center in Brighton, Massachusetts. Mr. Cooke started his VA career as an engineering intern in 1990 and is the son of a U.S. Army World War II Veteran. He holds a Bachelor of Science degree in
Electrical Engineering and is a graduate of multiple executive leadership development programs to include VA Senior Executive Core Training, the VA Senior Executive Strategic Leadership Course, facility management and planning courses at Harvard University’s School of Design, and many others. “With a strong sense of governance structure and ability to focus on customer experience, I am certain Mr. Cooke will be an asset to our VISN, our employees and volunteers, our health care partners, the community, and most importantly, to the Veterans we are honored to serve,” Lapuz said. Established as a medical center in October 2006, the Orlando VA Medical Center is recognized as one of the Top 100 Companies in Central Florida for working families. The Orlando VA Medical Center includes a 120-bed community living center in Lake Nona, a 60-bed residential rehabilitation program (domiciliary), also in Lake Nona and a 56-bed residential rehabilitation program (domiciliary) located at Lake Baldwin. The facility also operates two large outpatient clinics in Lake Baldwin and Viera and four community based outpatient clinics located in Clermont, Kissimmee, Tavares, and Orange City.
Cushman & Wakefield Negotiates $24.3M Sale of Gardens Medical Pavilion PALM BEACH GARDENS — Cushman & Wakefield has negotiated the sale of Gardens Medical Pavilion, a ±75,424-square-foot, Class A medical office tower in Palm Beach County. The Cushman & Wakefield Capital Markets team of Scott O’Donnell, Michael Ciadella, Dominic Montazemi, Greg Miller and Miguel Alcivar, combined with Anthony Librizzi and Michael H. Feldman of Cushman & Wakefield’s Brokerage Services, represented Gardens Medical Pavilion, LLC in the disposition of the asset. Charlottesville, VA-based Anchor Health Properties acquired the building for $24.3 million ($322 per square foot). Gardens Medical Pavilion is a fivestory medical office tower developed in 1991 on a ±4.71-acre site at 3401 PGA Boulevard. The asset features a portecochère, an on-site Walgreens pharmacy and diagnostics lab, covered and underground parking for tenants, lushly landscaped grounds and prominent visibility along PGA Boulevard. Gardens Medical Pavilion is conveniently situated one-quarter mile east of Interstate 95 and less than three miles from Florida’s Turnpike along PGA Boulevard, providing easy access for all of Palm Beach County’s affluent population. The asset is strategically located within
minutes of Palm Beach Gardens Medical Center, Jupiter Medical Center and the North County Surgery Center, which creates steady demand from numerous doctors and medical practices. The property is also within walking distance to premium amenities such as the 1.4-million-squarefoot The Gardens Mall, Legacy Place and the District at the Gardens. The building was 84.3 percent leased at the time of sale. Occupancy increased nearly 15 percent in the 18 months preceding the sale under the guidance of Gardens Medical Pavilion, LLC. Notable tenants include Florida Cancer Specialists, the University of Miami, Gastro Group of the Palm Beaches and Pediatric Partners. “Gardens Medical Pavilion is widely considered one of the premier medical office buildings in North Palm Beach County and is the only medical office building along PGA Boulevard,” said O’Donnell. “The property provided investors with a rare, value-add, Class A medical office opportunity with excellent leasing momentum and requiring only minor orenovations one r l a n d o min ed i c aofl nPalm e w s Beach .com County’s strongest micromarkets.”
GrandRounds cent of seniors said they found reviewing their Medicare plan to be one of the most unpleasant tasks they do among a list provided to them by pollsters. Other choices they said they’d rather confront before Medicaid included “getting a colonoscopy” and “going to the dentist.” According to Rich of Ensurem, neither reviewing your Medicare program or shopping for a new Medicare Advantage program has to be confusing or painful. After years dealing in international insurance Rich became a passionate believer in the use of technology and the need to fundamentally change how insurance is sold so that more Americans can enjoy the benefits of these products. “What is needed,” claims Rich, “is a user-friendly online platform serving as an insurance broker on one side and a provider of tailored Medicare solutions information and purchasing opportunities on the other.” Ensurem has designed such a platform. It has carrier relationships with Aetna, Humana, Ameritas, and other major health insurers where the senior can go and fill out a few forms and get straight, non-complicated answers as to which Medicare Advantage plan will work best for him or her. Medicare Advantage beneficiaries still have a chance to make changes to their 2020 coverage during the Medicare Advantage Open Enrollment Period (January 1 – March 31.) According to Rich an investment of a few minutes of time to do so may be worth it for any senior. “The Ensurem solution provides an online consumer marketplace that educates visitors and rapidly matches them to MA programs through a simple application backed by a fully licensed Contact Center staffed with Medicare experts.” Ensurem, headquartered in Clearwater, FL, is a leading technology and product distribution company serving carriers and consumers within the massive U.S. senior market. For more information, please visit www.Ensurem.com
AdventHealth Acquires Top Cardiovascular Surgical Group, Expanding Services for Patients AdventHealth announces the acquisition of Cardiovascular Surgeons, P.A. (CVS), one of Central Florida’s leading cardiovascular surgery practices. The addition of the five-physician practice expands AdventHealth’s surgical services to fight cardiovascular disease and increases access to world-class cardiovascular care throughout Central Florida. Dr. Kevin Accola, Dr. Foster Bryan, Dr. Tomer Karas, Dr. George Palmer III, and Dr. Jorge Suarez-Cavelier are widely recognized for excellence in cardiovascular and thoracic surgical care. Serving Central
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Floridians for 50 years and performing more than 1,500 cardiac surgeries annually, these physicians specialize in open heart surgery, heart valve repair, aortic aneurysms, roboticassisted surgery and electrophysiology of the heart. AdventHealth and CVS have worked together for nearly half a century on leading innovation and new program development. The collaboration has helped with the evolution of AdventHealth’s cardiovascular program — which now treats more cardiovascular surgery patients than any other hospital in Florida, according to the American Health Care Association. “We are proud to serve our community, our patients and their families with dedication and exceptional patient care, focused on innovation and strong outcomes,” said Accola. “This strengthened partnership allows us to continue to provide that exceptional care while making it even easier for our patients to stay connected to resources within the area’s leading health care system.” This acquisition is the next step in AdventHealth’s effort to expand access to world-class cardiovascular care across Central Florida. Recent expansion of cardiac care includes a new open-heart surgery program at AdventHealth Celebration and the launch of percutaneous coronary intervention, a procedure to improve blood flow to the heart, at AdventHealth East Orlando. Additionally, in 2021, the Cardiovascular Institute will expand to include the Center for Living, which will feature a genomics clinic to identify, prevent and treat cardiovascular disease in patients at risk for inherited conditions. “We’re committed to bringing worldclass cardiovascular care to more residents in Central Florida,” said Mike Thompson, CEO of Integrated Health Services at AdventHealth. “Having these physicians as a part of AdventHealth gives their patients greater access to our network of care. This acquisition is part of a journey of growth over the next several years to meet the area’s heart health needs.”
Orlando Health Temporarily Suspends Outpatient Imaging Services at its Orange Avenue Location Due to Lease Expiration Orlando Health announced it has temporarily suspended outpatient imaging services at its Orange Ave. location effective January 24. The suspension is a result of the month-end lease expiration on the building which is located at 1751 S. Orange Ave. Patients impacted by the change are being notified and provided the opportunity for priority rescheduling at one of the organization’s five other Orlando Health Imag(CONTINUED ON PAGE 20)
High School Students Train with Trauma Experts Local high school students added important tools to their medical kits. More than 450 students from Boone High School’s Academy of Health Science, and Junior Reserve Officers’ Training Corps participated in hands-on training in bleeding control, distracted driving prevention, and burn safety. The full day of learning on January 14 was part of a community outreach event by Eastern Association for the Surgery of Trauma (EAST), Orlando Health, and Orange County Public Schools. EAST hosted its 33rd Annual Scientific Assembly in Orlando. “Trauma is the number one cause of death in young people,” said Hee Soo Jung, MD, EAST. “As trauma surgeons, we believe that in order to tackle these issues we must reach out to our youth and our communities. Our annual injury prevention outreach efforts are one way that we can build relationships with our host communities. We hope that students gained a better understanding of what they can do to keep themselves and their loved ones safe.” The training event brought together lecture and interactive lab experiences. “Being part of this hands-on training was an invaluable experience for our students. Our Academy of Health Science prides itself in providing students with real world educational opportunities that are transferable to their postsecondary education and employment,” said Dusty Johns, principal, Boone High School. “Plus, the distracted driving topic is an especially good reminder for today’s teens.”
Orlando Health provided instructors from its adult and pediatric Level One Trauma teams to lead the sessions with EAST members. In the bleeding control training students learned how to respond to bleeding emergencies using different techniques including a tourniquet. During the distracted driving session students learned the importance of focused driving, and the dangers of diversions. The burn safety class highlighted cooking safety, how to use a fire extinguisher and emergency first aid for burn injuries. In addition to participation in the community outreach event, Orlando Health Boone High School have a longstanding partnership. “For nearly 20 years Orlando Health has enjoyed partnering with the Boone High Academy of Health Sciences, providing opportunities for work-based learning experiences,” said Angie Laxton, RN, coordinator of academic programs, Student Services, Orlando Health Institute for Learning. “I am particularly excited students were able to hear and learn directly from trauma physicians and staff in this event. Some students from the academy identified with the need to learn and embrace some essential medical skills following the Pulse tragedy. I think they connected the dots regarding how they can contribute to their community and families with medical skills even if they explore non-clinical careers moving forward. What we introduced students to with this event are ‘life skills.’”
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GrandRounds ing Centers or at one of its hospital-based outpatient facilities located on its downtown campus. To support the continuum of care, established patients of Orlando Health Imaging Centers can receive imaging services at any Orlando Health facility with no additional out-of-pocket expense until the opening of the new Orange Avenue location. Orlando Health will resume its outpatient imaging services on Orange Avenue this spring in a new Orlando Health-owned facility located across the street from the previous center. “We understand this change might be inconvenient for some patients and for that, we apologize,” said Daniel Honerbrink, corporate director, Orlando Health Imaging Centers, Ambulatory Services Division. “We hope to make this transition as smooth as possible for patients, who can look forward to our new center opening up later this spring.” Scheduled for opening in May 2020, the new Orlando Health Imaging Centers – Downtown Orlando will be located at 1800 S. Orange Ave. The one-story, 6,800 square foot facility will be state-of-the-art and will include a 3T wide-bore MRI, a 1.2T high-field ‘open’ MRI, a 128-slice CT, 3D tomographic mammography (biopsy capable), advanced ultrasound, bone-density and digital X-ray capabilities. In addition to technologically-advanced equipment and services delivered in a welcoming setting, the center will also feature ample patient parking adjacent to the building. “We’re excited for the opening of this new flagship imaging center on the eastern edge of our downtown campus,” said Matt Taylor, AICP, vice president of asset strategy for Orlando Health. “This location will provide superior access and be very convenient for patients who may have multiple Orlando Health appointments downtown on the same day.” During the temporary suspension of services at the Orange Ave. facility, patients can continue to receive high-quality care and imaging services at other facilities on Orlando Health’s downtown campus or at any of the following locations, which have extended hours and added weekend appointments to accommodate patients: Altamonte Springs – 398 E. Altamonte Dr. Ocoee – 572 Ocoee Commerce Pkwy. Ocoee – 1193 Blackwood Ave. (open MRI) Lake Mary – 392 Rinehart Rd. Spring Lake – 7243 Della Dr., in the Dr. Phillips area
Additionally, to continue supporting the needs of the growing Central Florida community, Orlando Health will soon open two new imaging centers. The first, scheduled to open in February 2020, is in the Orlando Health Medical Pavilion – Summerport, which is located at 5151 Winter Garden Vineland Rd. in Windermere. The second, scheduled to open this spring, is located at 1111 W. Fairbanks Ave. in Winter Park. These latest additions will also feature state-of-the-art diagnostic imaging in a warm, welcoming environment.
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Demystifying Infertility: New Book Offers Guidance for a Challenging Medical Journey A new book from infertility expert Dr. Mark P. Trolice of Fertility CARE: The IVF Center tells patients what they need to know—and avoid—in their quest for parenthood. In January, The Fertility Doctor’s Guide to Overcoming Infertility: Discovering Your Reproductive Potential and Maximizing Your Odds of Having a Baby, by Dr. Mark P. Trolice, MD, FACOG, FACS, FACE, Director of Fertility CARE: The IVF Center, and Professor of Obstetrics and Gynecology at the University of Central Florida College of Medicine, was published by Harvard Common Press. In his new book, Dr. Trolice, one of the leading practitioners in his field, offers patients and their families a guide to the struggles and realities of the infertility treatment process, along with no holds barred advice about misinformation, exaggerated claims, and unnecessary and unhelpful treatments. The Fertility Doctor’s Guide to Overcoming Infertility begins with an overview of the possible causes of infertility, both in couples who have never been pregnant and those who have suffered multiple uncompleted pregnancies. Unlike prior fertility publications, Dr. Trolice’s book equally deals with infertility stemming from men’s issues—the underlying cause of about 40 percent of all infertility cases — as well as female issues. Written in clear and understandable language for the layperson, this resource describes and explains the significance of endometriosis, fibroids, polycystic ovarian syndrome, tubal factor, male factor, and other possible causes of infertility. The book then unfolds with a wealth of detailed information on treatment options, both in terms of medical interventions and of lifestyle changes such as sleep, diet and exercise. In discussing and evaluating treatment options, Dr. Trolice—who has battled with infertility in his own life as well as in those of thousands of patients—maintains a steady focus on the fact that infertility is an emotionally exhausting and frustrating condition, and that the desperate desire for a solution can make patients open to offers of highly costly treatments of questionable—or no— value. This is particularly true, he notes,
in the case of recurrent pregnancy loss (RPL), a devastating condition that leaves patients craving for an answer and for treatment. To help patients avoid the risk of exploitation with excessive testing and unsubstantiated therapy, The Fertility Doctor’s Guide takes the reader through the different causes of RPL, appropriate treatments, and the corresponding percentages of likelihood of attaining the long-sought happy ending: a full-term pregnancy and a healthy baby. “Infertility,” says Dr. Trolice, “is a painful, heart-wrenching diagnosis that brings with it both emotional and financial risk. On the financial side, it can expose patients to the sometimes-exag-
gerated offerings of what has become a sizeable IVF industry. On the emotional side, too often it makes patients feel guilty—as though they have failed in some fundamental way and are being punished for it. One of my reasons for writing this book was to help the reader, as I do every day with my patients, understand that this is not true. I counsel all to be proactive, be your own advocate and seek a Board-certified infertility specialist early in the process.” Fertility CARE (Center of Assisted Reproduction and Endocrinology): The IVF Center provides patient-centered, evidence-based, and individually customized reproductive care in a comfortable and compassionate setting. This
Central Florida IVF clinic is a comprehensive infertility center in the Orlando/ Winter Park area, and consistently earns 5-star patient ratings in online reviews. Established in 2003 by founder and director Dr. Mark P. Trolice, it is one of the only fertility clinics in the country to offer both male and female testing, evaluation, and treatment. Today, the practice encompasses the Center for Male Infertility, headed by a fellowshiptrained male reproductive specialist; the Mind/Body Institute, overseen by a licensed clinical reproductive psychologist; and the IVF Laboratory of Central Florida, led by a Board-certified bioanalyst. Fertility CARE: The IVF Center offers a full range of infertility tests and treatment options as well as genetic testing, egg freezing, surrogacy, and all advanced reproductive services. For full details, visit http://TheIVFCenter.com. Mark P. Trolice, MD, is the founder and Director of Fertility CARE - The IVF Center. He also serves as Professor of Obstetrics and Gynecology (OB/GYN) at the University of Central Florida College of Medicine in Orlando and Medical Director of the Egg Donor Program at Cryos International, the world’s largest sperm donor bank. Dr. Trolice is Board-certified in OB/GYN and reproductive endocrinology and infertility (REI), and he is a Fellow of the American Colleges of Obstetrics and Gynecology (FACOG), Surgeons (FACS), and Endocrinology (FACE). Nationally known, Dr. Trolice and his wife battled infertility for over 10 years before adopting their children. This journey gave him unique insights into patients’ struggles and is included in his forthcoming book, The Fertility Doctor’s Guide to Overcoming Infertility—Discovering Your Reproductive Potential and Maximizing Your Odds of Having a Baby from Harvard Common Press. Dr. Trolice is a sought-after expert with hundreds of broadcast and print appearances in addition to annual acclaim as one of America’s Top Doctors® and repeat recipient of the American Medical Association’s “Physician’s Recognition Award.” In January 2019, he launched his “Fertility Health” podcast interviewing nationally renowned experts on vital topics in reproductive medicine. Learn why he has earned the trust of patients and physicians alike: http://marktrolicemd.com.
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GrandRounds AMA Foundation Launches New Initiative to Address LGBTQ Health Disparities The American Medical Association Foundation (AMAF) today announced that John D. Evans, telecommunications pioneer, internationally-recognized business executive and philanthropist, will lead a unique and innovative initiative designed to dramatically shape the future of LGBTQ health. The new initiative will create a cadre of LGBTQ health specialists through the AMA Foundation LGBTQ Fellowship Program – a national fellowship program to promote best practices and shared outcomes, while exponentially improving the quality of LGBTQ health care across the nation. John D. Evans will serve as Chairman of the AMA Foundation Fellowship Commission for LGBTQ Health. The commission will consist of 13-15 LGBTQ thought leaders, educational specialists, physicians, and philanthropists who will be appointed by the AMA Foundation Board of Directors, under Evans’s leadership and direction. The AMAF LGBTQ Fellowship Commission will guide the fellowship program inception to ensure the health needs of the LGBTQ community are optimally considered. The Commission will provide guidance on ways to enhance the fellowship request for proposal and its framework, including, but not limited to, funding, program structure and other design elements with the approval of the AMAF Board of Directors. “It is critical we eliminate health care disparities facing the LGBTQ community,” Evans said. “Intersectional issues of discrimination, stigma, access to and quality of care are experienced at a higher rate by lesbian, gay, bisexual, and transgender individuals, and we believe this new initiative will improve the health of LGBTQ people across the country. The AMA has proven its commitment to improving the health of the nation, and It is
indeed a privilege to serve as chairman of this commission. Working with the AMAF, we will create a pipeline of LGBTQ health specialists who are able to serve the health care needs of the LGBTQ community while growing the pool of competent instructors able to pay it forward by passing on their knowledge to the next generation of LGBTQ providers.” “We are honored Mr. Evans will lead our LGBTQ Fellowship Commission, that will help address and alleviate the health disparities that members of the LGBTQ community face,” said AMAF President, Sarah A. Sanders, PharmD. “Through his vast networks in business and academia, he will bring a tremendous amount of leadership, knowledge, and experience to the Fellowship Commission, which will also further elevate the status of this crucially important and timely initiative to transform health care for the LGBTQ community.” “A key social determinant of health affecting sexual and gender minorities is a shortage of health care providers who are knowledgeable and culturally competent in LGBTQ health. This shortage underscores the immediate need for the AMA Foundation’s LGBTQ Fellowship Program which will train physicians to become LGBTQ Health Specialists,” said former AMAF president and founding donor of its LGBTQ endowment fund, Joshua M. Cohen, MD, MPH, FAHS. Moreover, policies that permit the denial of services to LGBTQ people are linked to a 46 percent increase in the proportion of gay, lesbian, and bisexual adults who report mental distress and gay men account for more than two thirds of all people diagnosed with HIV each year in the United States, despite comprising only 2 percent of the general population. Establishing a national network of LGBTQ health specialist physicians who are formally trained to serve sexual and gender minorities will have a dramatic and positive impact on this community. (CONTINUED ON PAGE 22)
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University of Central Florida/ HCA Healthcare Announce New Residency Program A new Physical Medicine and Rehabilitation (PM&R) Residency program, based at West Florida Hospital in Pensacola, FL, has received initial accreditation and is seeking immediate applicants to begin training in 2021. The program is part of a UCFHCA Healthcare consortium that is building residency programs across Central and North Central Florida. The residency is the consortium’s 26th program and is the first at West Florida Hospital. UCF and HCA currently are training more than 440 residents and fellows in greater Orlando, Gainesville and Ocala to help alleviate the state’s physician shortage. PM&R is an advanced training program so applicants will need to have completed 12 months of training in an approved residency program by July 1, 2021. Applications should be submitted through ERAS (the NRMP program code is 1587340A0). Qualified applicants will be selected for interviews and the program also plans to participate in the Match Week Supplemental Offer and Acceptance Program (SOAP) in March 2020. The program will accept four residents a year for a total of 12 accredited positions. Dr. K. Rao Poduri, FAAPMR, will direct the program. Dr. Poduri served as program director for the University of Rochester’s PM&R residency for two decades and also chaired the university’s
PM&R Department. “We are committed to training young physicians to learn, teach, lead and practice with humanism to become highly skilled physiatrists for the community,” Dr. Poduri said. As part of HCA Healthcare, the nation’s largest healthcare provider, West Florida Hospital provides Pensacola’s first Accredited Chest Pain Center and Breast Imaging Center of Excellence. It is also a 2018 Straight A Safety Hospital, according to the Leapfrog Group. The West Florida Healthcare campus includes the acute care hospital, the area’s only comprehensive, CARF-accredited physical rehabilitation hospital, and a behavioral health facility. “We are pleased to announce the addition of a Physical Medicine and Rehabilitation Residency at West Florida Hospital,” said Gay Nord, hospital President and CEO. “This is outstanding news for our community, our physicians and Graduate Medical Education as a whole. At West Florida Hospital we have a focus on clinical quality, patient safety, advanced technology and service excellence. We are excited about our partnership with University of Central Florida and look forward to providing an outstanding training experience to residents.” To learn more about the PM&R Program at West Florida Hospital, please contact Michelle Stevenson at Michelle. Stevenson@hcahealthcare.com
WeCare tlc Names New President WeCare tlc, the leading workplace healthcare company, is proud to announce the promotion of Raegan Le Douaron to president. Le Douaron will head the day-today operations of WeCare tlc, which manages company heath centers across the USA. Le Douaron has headed up business development efforts for WeCare tlc, which this year expanded into two new states and celebrated its onemillionth patient visit. “I’m so honored by WeCare tlc’s accomplishments and thrilled to lead the charge on the goal we are so passionate about – to change how healthcare is delivered across the United States,” Le Douaron said. “Together, we can help whole communities become healthier.” With Le Douaron’s help, the company also was pioneer in co-op health centers, which allowed more companies have on-site health services. The WeCare team have revolutionized health by cutting costs for employers all while promoting employee well-being.
“Raegan has been instrumental in building the foundation of and growing WeCare tlc,” said Judy Garber, former WeCare tlc president and new co-CEO. “She is a tremendous asset to the company and shares the same vision and principles WeCare tlc was founded on. I expect Raegan to keep pushing the company to new heights.” WeCare tlc manages 54 on or nearsite healthcare centers for companies around the nation. The goal is to deliver high-quality healthcare in order to cut down on costs for employers. Patients who visit employee health centers have access to primary care services, chronic disease management and a formulary. To learn more about WeCare tlc, visit https://www.wecaretlc.com
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The LGBTQ Fellowship cohort provides a transformative opportunity to:
• Decrease LGBTQ health disparities; • Increase cultural and clinical competence amongst physicians in LGBTQ health; • Build capacity of LGBTQ health services sector to better identify and address the unique health needs of the LGBTQ community, such as the effects of anesthesia on transgender patients undergoing gender affirming surgery due to medications; • Improve basic quality of life (health and well-being) of LGBTQ communities; • Understand and address social determinants of health faced by this community through the promotion of research and supporting the dissemination of research findings across mediums such as medical journals; and, Provide safe entry point to link individuals to broader health and wellness services. The new initiative builds on the work of the AMA Accelerating Change in Medical Education initiative launched in 2013 to create the medical schools of the future. The goal of the effort is to address the growing gap between how physicians are being trained and the skills they’ll need to practice in modern health systems. The AMA will continue its efforts to drive the future of medicine by reimagining medical education, training and lifelong learning—ensuring physicians are better equipped to provide care in the rapidly-evolving health care environment. Additionally, the launch of the LGBTQ Fellowship Program follows last year’s hiring of the AMA’s first chief health equity officer and subsequent launch of the AMA Center for Health Equity.
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Axiom Bank, Appoints Susan Maurer SVP, Market Executive Axiom Bank N.A., a Maitlandbased, leading community bank, recently named Susan Maurer as SVP, Market Executive. In this role, Maurer will develop relationships with Axiom’s commercial partners and create opportunities for growth in the Tampa Bay area. With over four decades of experience working in financial institutions, Maurer specializes in business and community leadership, corporate lending, commercial relationship development and financial management. “Susan has a passion for leadership, a keen business acumen and a huge amount of financial knowledge – and her stellar track record shows she can put her skills into action,” said Ted Sheppe, Executive Vice President, Commercial Banking of Axiom
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Bank. “That expertise will be a major advantage, not only for Axiom’s team, but also for the businesses we serve.” Maurer earned her bachelor’s degree in banking and finance at National University and is pursuing a master’s degree at Southeastern University. In 2017, Maurer was a finalist for Tampa Bay Business Journal’s “Business Woman of the Year.” For more information about Axiom Bank and to find the nearest location, visit AxiomBanking.com.
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Inducted into the Cable Television’s Industry’s Hall of Fame in 2016, Evans is best known as one of the co-founders of C-SPAN in 1977 and continues to serve on the C-SPAN Board. From 2002-2013, he served on the board of the International AIDS Vaccine Initiative; served on the University of Michigan’s Global Health Initiative Advisory Board and currently co-chairs the Advisory Board for Dr. Robert Gallo’s (co-discoverer of the HIV Virus) Institute of Human Virology at the University of Maryland. From 2011-2018 representing industry, he served on the
board of Internet2, a consortium of 321 universities operating one of the most advanced fiber optic networks for medical, educational and life sciences research. Since 1950, the AMA Foundation has been a leader in health care philanthropy with programs that advance public health and medical education. As the philanthropic arm of the world’s largest physician organization, the AMAF has awarded more than $121 million in grants and scholarships, demonstrating nationwide programmatic excellence.
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AdventHealth Expanding Network with ER & Health Park ER, primary and specialty services to fill local care gap in fast-growing Clermont CLERMONT – AdventHealth is making a $35 million investment in the health of Clermont residents. The organization plans to bring an extensive range of medical services, along with a freestanding emergency room, to serve the fast-growing city and surrounding area of south Lake County. Located adjacent to the intersection of State Road 50 and Citrus Tower Boulevard, the ER will be approximately 19,000 square feet, with 24 patient rooms (including two pediatric-friendly rooms); respiratory therapy; diagnostic imaging, including CT scans, X-ray and ultrasound; and a fullservice laboratory. The ER will be staffed by a comprehensive clinical team including board-certified emergency physicians and emergency nurses. “It is a privilege to expand our care network to better serve Clermont and the surrounding south Lake County community,” said Abel Biri, president and CEO of AdventHealth Waterman, who will also oversee the Clermont ER. “This growth
demonstrates our commitment to provide convenient, exceptional whole person care close to home.” Next door, AdventHealth will build a two-story, 36,000-square-foot health park that will include primary and specialty care practices, imaging, outpatient sports medicine and rehab, and lab services. “We’ve had a Centra Care in Clermont for a dozen years, and during that time the community has experienced extraordinary growth,” said Dr. Scott Brady, senior vice president of ambulatory services for the AdventHealth Central Florida Division. “The health care needs of the area have far outpaced the available services. That means people need to travel outside their area for the care they need. Our goal as an organization is to provide care close to home no matter where you live, so we are looking forward to coming in and meeting those pressing needs. We also see Clermont, being a center for athletic training and fitness, as a natural fit with the culture at AdventHealth, which
emphasizes prevention and healthy habits in ensuring long-term health. The health park will offer same-day appointments, expanded 7 a.m.-7 p.m. hours for patient convenience, and specially trained staff providing concierge-level service. The health park will give consumers a seamless experience, with a single checkin and a single bill for all services. In addition, all forms, registration and appointment scheduling can be completed online from home, or at an on-site kiosk, for a completely paperless experience. “Health parks represent a dramatic reimagining of the health-care experience,” said Brady. “The health park concept came out of asking consumers what they want in their health care experience. People prefer not to have to shuttle between doctor’s offices, sign in at each one, and then receive multiple bills. They want the experience to be as seamless and convenient as possible. We liken it to shopping at a department store – you may buy items from different departments, but ev-
erything you need is in that one store, and you only need to check out once. This is a new product for us – the Clermont health park will be only the second in our system (the first is under construction in Osceola County). It’s a great example of our drive to become a consumer-centric organization.” These new services will meet a significant need in Clermont, which suffers from a shortage of physicians in nearly every specialty, including primary care, cardiology, pediatrics, gastroenterology, oncology, obstetrics and gynecology. “The health park staff will be approximately 70, including physicians, other clinical roles and support staff. Our organization is always growing, and therefore we have a strong existing recruiting operation. As a national health-care company, AdventHealth is an attractive destination for candidates nationally and beyond,” said Brady. A construction timeline is being finalized. The ER and health park are expected to open in 2021.
Taking a Moment to Focus on Men’s Health Jamin V. Brahmbhatt, MD
For most men, no matter how old they are, paying attention to their overall health is typically not very high on their list of priorities. Many men simply don’t take care of themselves very well and, when they do, it’s more often because they want to look good by staying fit. And while that’s great, there are health issues that can occur that aren’t prevented by good fitness. As a result, they often wait too long before seeking medical attention for a problem. It’s kind of like waiting for the tires to get completely flat, damaging the rims to the point where the car can’t be driven anymore. They ignore the warning signs and don’t go to a doctor. This is, in part, why the life expectancy gap between men and women is about five years. Men wait too long to start focusing on preventive healthcare. When you look at major diseases – like cancer, heart disease, and diabetes, as well as mental health disorders and suicide rates – men are more likely to suffer from them and 23
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receive a poor prognosis. This is because men are often more reactive than proactive about their health, so they’re always on the defensive, and not the offensive, when it comes to seeking care. I recommend that men start getting screened as young adults, even as early as 20 years old. It’s an opportunity to discuss your family medical history with a physician, undergo a complete physical exam, and have blood drawn to screen for diabetes and other conditions. This gives us a baseline measure of health, while also catching any early-onset conditions, which may be highly treatable if the treatment is started early enough. This also gives us a chance to ask about high-risk sexual behavior. It’s important to emphasize that if you’re taking risks with unprotected sex or multiple partners, you should definitely discuss it with your physician so you can be screened for sexually-transmitted diseases, or STDs. Only then can your doctor provide the necessary treatment. As a urologist, I see a lot of male patients when there is something going on with their
genitourinary tracts or their reproductive organs, the most common of which is erectile dysfunction. They may be asking questions like, “why me?” Or they’ll want to know, “what’s wrong with me, and how can it be treated?” That tends to lead to honest, open discussions about their health. Sometimes, issues with erections can be solved just by talking things out with the patient and letting them know what’s realistic, as opposed to what they may see on adult films or hear their friends talking about. At the same time, if I see a young guy with erectile dysfunction and I don’t think it’s the result of emotional or social causes, there may be an underlying health issue causing the problem. At that point, I do a full workup on their heart to make sure that it’s not a sign of early heart disease. The other main issue male patients talk to me about is their testosterone levels. That sometimes leads to screenings for prostate cancer, testicular cancer and bladder cancer,
hopefully to rule it out or catch it early enough to treat it effectively. There’s really only one way we can help men maintain good health, though, and that’s if they come in to see us. I encourage all men, starting in their early 20s, to pick a physician and go for a physical exam. It’s an important decision that could lead to a lifetime of good health. Dr. Brahmbhatt is a board-certified urologist specializing in chronic testicular pain and infertility. He completed his urology residency at the University of Tennessee followed by a fellowship in robotic microsurgery at the University of Florida. He is now co-director of PUR Clinic (Personalized Urology & Robotics) at South Lake Hospital & Orlando Health. He is an active member of several professional organizations including the American Urological Association, SMSNA, CAPI, and Florida Urological Society where serves on the executive committee. He is a TEDx speaker and winner of numerous awards including 40 under 40, most influential health care provider in the region, and Top Doctor. He is frequently seen offering expert medical opinions on national media platforms and his own social media channels. He is co-founder of the Drive 4 Men’s Health, an annual non-profit public engagement campaign that continues to encourage millions of men to eat better, get active, and engage in preventative medical screenings.
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NorthCentralFlorida GrandRounds Florida Heart and Lung Institute Earns 3-Star Rating from STS OCALA - Ocala Health in partnership with Florida Heart and Lung Institute of Ocala and its Cardiothoracic Surgical program has earned a distinguished three-star rating from The Society of Thoracic Surgeons (STS) for its patient care and outcomes in isolated coronary artery bypass grafting (CABG). The three-star rating, which denotes the highest category of quality, places Omeni Osian, MD among the elite for heart bypass surgery and aortic valve replacement in the United States and Canada. The STS star rating system is one of the most sophisticated and highly regarded overall measures of quality in health care, rating the benchmarked outcomes of cardiothoracic surgery programs across the United States and Canada. The star rating is calculated using a combination of quality measures for specific procedures performed by an STS Adult Cardiac Surgery Database participant. The latest analysis of data for CABG surgery covers a one-year period, from July 2018 to June 2019. Historically, only approximately 10-12 percent of participants receive the threestar rating for isolated CABG surgery. “Ocala Regional Medical Center achieved the highest rating in heart surgery compared to other cardiac programs nationwide. This achievement is a demonstration of the patient-focused approach adopted by our multi-disciplinary team in the care of patients
Ocala Health Holding Ribbon Cutting for Trailwinds Village ER On February 13, at noon, Ocala Health will hold a ribbon cutting ceremony for the Trailwinds Village ER at 6131 Seven Mile Drive in Wildwood. The new, 24/7 full service freestanding emergency department will feature 11 emergency room beds and will be capable of caring for all ages, including pediatrics. The 11,630-square-foot, one-story facility will
UF Health The Villages® Hospital Cuts Ribbon for New Freestanding ER THE VILLAGES — UF Health is one step closer to opening its newest freestanding emergency room, which will soon provide convenient access to high-quality health care in Wildwood and surrounding communities as the demand for services continues to grow. Health officials and local community and government leaders celebrated Thursday with a ribboncutting and open house for the UF Health The Villages® Hospital Freestanding E.R., slated to open in early February. “This is a special day for UF Health and The Villages® and I am especially proud of the team of dedicated professionals and construction partners responsible for bringing our vision to fruition by making this center a reality for our community,” said Don Henderson, CEO of UF Health Central
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and families in need of heart surgery. We are motivated to continue the pursuit of excellence on behalf of our patients.” says Omeni Osian, MD, Cardiothoracic Surgery Medical Director, Ocala Health. “The Society of Thoracic Surgeons congratulates STS National Database participants who have received three-star ratings,” said David M. Shahian, MD, Chair of the STS Council on Quality, Research, and Patient Safety. “Participation in the Database and public reporting demonstrates a commitment to quality improvement in health care delivery and helps provide patients and their families with meaningful information to help them make informed decisions about health care.” The STS National Database was established in 1989 as an initiative for quality improvement and patient safety among cardiothoracic surgeons. The Database includes four components: the Adult Cardiac Surgery Database (ACSD), the Congenital Heart Surgery Database (CHSD), the General Thoracic Surgery Database (GTSD), and the mechanical circulatory support database (Intermacs). The STS ACSD houses approximately 6.8 million surgical records and gathers information from more than 3,800 participating physicians, including surgeons and anesthesiologists from more than 90% of groups that perform heart surgery in the US. STS Public Reporting Online enables STS ACSD participants to voluntarily report to each other and the public their heart surgery scores and star ratings. front 466A. The freestanding ER is expected to serve more than 11,500 patients a year. The $13 million project will employ approximately 30 full-time healthcare professionals. As a means to improve access to local high-quality care, this will be Ocala Health’s third freestanding emergency department. Ocala Health opened its first freestanding emergency department in Summerfield (Summerfield ER) in October 2016 and is currently building a second freestanding emergency department (Maricamp ER) on Maricamp Road in Ocala which will open later this year.
Florida. “Area residents will now have access to the fast, efficient, advanced medical care they need close to where they work and live.” The modern, 25,000 square-foot facility will be open 24/7 and will feature a full complement of staff, including physicians, nurses and patient care technicians, and will be equipped with 16 beds, two of which will be situated inside state-of-the-art trauma bays. To allow for future expansion, the facility contains additional space that eventually will accommodate eight more beds. The UF Health The Villages® Freestanding E.R. will feature laboratory, pharmacy and respiratory therapy services as well as the latest diagnostic imaging technologies. In 2019, more than 80,000 patients visited the emergency rooms at the facilities now known as UF Health The Villages® Hospital and UF Health Leesburg Hospital.
West Marion Community Hospital Appoints Gabe Bullaro as Chief Executive Officer HCA Healthcare, announces the appointment of Gabe Bullaro to the position of Chief Executive Officer at West Marion Community Hospital. Bullaro has most recently served as Chief Operating Officer at Ocala Health, a 430 bed two campus facility. During Gabe’s time at Ocala Health he has led the aggressive construction efforts happening across the Ocala Health campuses, adding 114 beds, 20 ED bays, six Operating Rooms, expanding the Summerfield Freestanding Emergency Department by eight bays, as well as the construction and opening of the Maricamp Freestanding Emergency Department in August of 2019. He has executed many initiatives resulting in program and hospital growth, operational enhancements and significant physician recruitment efforts most notably leading the establishment and certification of Ocala Regional Medical Center as a Comprehensive Stroke Center in 2019. “Gabe’s familiarity with West Marion,
established relationships with physicians in the community, and excitement related to the expansion of healthcare services offered in this community has West Marion well positioned for continued growth under his leadership,” said Chad Christianson, CEO, Ocala Health. “I am honored to have been selected to lead such an outstanding team. After having worked with West Marion for over two years, I’m confident that the team is top notch. They drive exceptional quality care and consistently offer an outstanding patient experience,” said Bullaro. Gabe earned a bachelor’s degree from Boston University and a Master’s Degree in Business Administration from Duke University. In between his time at Boston and Duke University, Gabe served as the Operations Officer for the US Navy Helicopter Squadron flying relief missions in response to Hurricane Katrina and the Indonesia Tsunami. Gabe and his wife, Jennifer, have three children, Grace, Gabe III, and Olivia.
AdventHealth Waterman Celebrates the Opening of New Inpatient Rehab Center
Caption Chester Lemon, 65, of Tavares, uses the ArmeoSpring system for the first time.
In January, the community joined AdventHealth Waterman to celebrate the opening of a new 12-bed Inpatient Rehabilitation Center. The was the final phase of a 111,000-square-foot, $85 million expansion. “We are excited to open this inpatient rehab facility. This is a whole new kind of service and is the only one in Lake County,” said J. Coomes, AdventHealth Waterman executive director of rehab services. Previously, patients and families had to travel to Orange or Sumter counties to access these services. Now, patients from Lake County can stay close to home and recover within the community. “The patients who come to inpatient rehab have had a major event,” Coomes said. “They’ve had a stroke or some other event that’s really changed their life and changed their family’s life. Keeping them close to home, where family can continue to be there for them, is essential to helping them recover.” The Inpatient Rehab Center at AdventHealth Waterman specializes in stroke and brain and spinal cord injuries, as well as patients with cardiac conditions, amputations, neurological disorders and respiratory difficulties. These patients need at least three hours of therapy per day and require multidisciplinary expertise to recover. All of the rooms in the Inpatient Rehab Center at AdventHealth Waterman are private. In addition, the new unit includes a bariatric room with a larger entryway and bathroom to more comfortably care for patients over 750 pounds. The Inpatient Rehab Center also provides residential-style spaces, allowing patients to relearn and practice real-life scenarios, such as cooking or doing laundry at-home, while they are still in the hospital. “A big part of inpatient rehab is helping patients practice the things that they did
at home,” Coomes said. “In our kitchen, they can practice making meals. In our suite, which is like an apartment, we have a washer and dryer and a bed that we can use to practice making the bed, doing laundry, and more, to help that patient be ready to return home.” This unit also offers patients the latest technology in rehabilitation. In the gym, there is a hydraulic car that adjusts to the exact height of the patient’s personal car so patients can practice the movement necessary to safely get in-and-out of their vehicle. For patients with limited arm and hand mobility, AdventHealth Waterman offers the ArmeoSpring system, the latest technology that provides arm and hand training for moderately-to-severely impaired patients. The 100-foot-long Vector Gait Bioness track system helps nursing and therapy staff safely assist patients out of bed. The track system also helps patients begin walking without the fear or risk of falling. “One of the exciting things for our staff is to be with patients as they go through their journey,” Coomes said. “Patients in this new unit will likely stay for a couple of weeks. Our staff really enjoy being able to see them progress over those weeks, from needing a lot of help, to being able to get back home.” This 111,000-square-foot, $85 million expansion project is the second largest investment in a healthcare facility in Lake County’s history – since AdventHealth Waterman’s Tavares campus was completed more than 15 years ago. The project was designed by Gresham, Smith and Partners of Jacksonville. Construction was completed by Robins & Morton of Orlando. o rthe l a opening n d o m e of d i this c a lnew new s . cAdom With unit, ventHealth Waterman has grown to a 299bed facility.
NorthCentralFlorida GrandRounds Florida Company, IRIS, Selected as a Microsoft AI for Health Grantee
Ocala Regional Medical Center Now Offers TCAR Procedure
PENSACOLA - Intelligent Retinal Imaging Systems (IRIS), the industry leader in telemedicine solutions for diabetic retinal evaluation, was announced as a grantee for the Microsoft AI for Health Initiative. AI for Health, Microsoft’s newest initiative under their AI for Good program, will encompass a $40 million, 5-year program that will leverage AI to empower organizations like IRIS, and other companies in the realm of improving health. “It has always troubled me when patients would come into my practice with severe latestage eye damage and I couldn’t do anything to save their eyesight,” said Dr. Sunil Gupta, Retinal Surgeon and Founder at IRIS. “The opportunity to work with some of the most talented people in the world at Microsoft means that together we will generate new ideas and insights that will ultimately improve access to care, improve our ability to find and treat retinal disease earlier, all the while allowing us to more successfully save eyesight.” CEO of IRIS, Steve Martin added, “We are honored to have been chosen to partner with Microsoft through this great initiative. The exciting part about this opportunity is working with Microsoft to explore new technologies that will accelerate the development of AI solutions at IRIS to save people’s vision.” Diabetic retinopathy is a leading cause of blindness across the world and 463 million people are currently at risk. Early detection and effective treatment can reduce the risk of blindness up to 95 percent. Microsoft’s collaboration with research and the development of an AI solution will empower IRIS to bring retinal evaluations to underserved populations across the globe in an effort to end preventable blindness. Through the AI for Health initiative, efforts will center on three key areas: Quest for Discovery, Global Health Insights, and Health Equity. IRIS is one of six initial grantees for the AI for Health initiative and is honored to be recognized with organizations like BRAC, Fred Hutchinson Cancer Research Center, Novartis Foundation, PATH, and Seattle Children’s Research Institute. Each organization will work with Microsoft to use AI to decipher tough issues like discovering the cause of SIDS, eliminating leprosy, and building an ecosystem that allows safe and secure sharing of biomedical data. The mission of the AI for Good program is to solve humanitarian issues and create a more sustainable and accessible world; this mission, combined with IRIS’ mission to eliminate preventable blindness shows a direct alignment and clearly demonstrates why this partnership will generate good for people. Intelligent Retinal Imaging Systems (IRIS) is a Pensacola, Fla.-based company founded in 2011, with a vision to end preventable blindness through the development and deployment of retinal diagnostic services. The company’s IRIS solution includes an FDA Class II cleared medical device that has improved quality, expanded access and reduced costs for diabetic retinopathy exams across the U.S. For additional information visit our website: www.retinalscreenings.com
OCALA - Ocala Regional Medical Center now offers a newer minimally invasive procedure, Trans Carotid Artery Revascularization (TCAR), to treat carotid artery disease and prevent future strokes in high surgical risk patients who need carotid artery treatment. Carotid artery disease is a form of atherosclerosis, or an accumulation of plaque, in the two main arteries in the neck that supply blood to the brain. Carotid artery disease, if left untreated, may ultimately result in the causation of a stroke or TIA (mini-stroke). It is estimated that 15 million people worldwide suffer a stroke each year. Prior to the development of TCAR, the main surgical treatment option for severe carotid disease was an open surgical procedure called a carotid endarterectomy, which removes the plaque from inside of the carotid artery to restore normal blood flow to the brain. However, the large incision leaves a visible scar the length of the neck and carries risk of surgical complications, including bleeding, infection, heart attack, etc. With the new availability of Trans Carotid Artery Revascularization (TCAR), Ocala Regional Medical Center can now offer patients who are at high surgical risk, a minimally invasive treatment option. In contrast to traditional open carotid surgery, TCAR involves accessing the carotid artery through a small incision above the collarbone. The vascular surgeon then delivers a stent directly into the artery to restore blood flow to the brain. The benefits of TCAR are the reduced risk of stroke and other complications associated with traditional stenting or surgical methods. “The addition of the TCAR procedure at Ocala Regional Medical Center is just another example of our commitment to provide comprehensive treatment options for even the most complex and high-risk patients suffering from vascular disease. TCAR is a less invasive and clinically proven alternative to surgery. The minimally invasive approach and unique flow reversal system allows us to achieve an equivalent result to open revascularization with less risk in the high-risk patient population”, says Alberto Gonzalez, MD, Board Certified General and Vascular Surgeon at Ocala Health. “In my practice, TCAR has shown to be truly beneficial to my patients. Through this minimally invasive procedure, patients recover faster and experience less complications than with traditional carotid surgery. Having this new technology available in Ocala allows patients to receive cutting edge care right here in own community”, says Ravi Chandra, MD, General and Vascular Surgeon at Ocala Health. Ocala Health encompasses Ocala Regional Medical Center, a 256-bed facility located in the heart of Ocala, and West Marion Community Hospital, a 174-bed hospital located in west Marion County, Summerfield ER, a freestanding emergency department located in southern Marion County, and Maricamp ER, a freestanding emergency department located on Maricamp Road in Ocala. Ocala Regional Medical Center is a Level II Trauma Center and a Comprehensive Stroke Center.
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Central Florida Regional Hospital Welcomes New Cardiovascular and Thoracic Surgeon Cardiovascular and thoracic surgeon Tuan Nguyenduy, M.D., has joined Florida Heart & Lung Institute of Central Florida and the medical staff at Central Florida Regional Hospital. “Just like every heart specialist at the Florida Heart & Lung Institute, Dr. Nguyenduy is committed to excellence,” said Trey Abshier, CEO, Central Florida Regional Hospital. “His expertise empowers us to continue delivering the highest level of cardiothoracic care available in Seminole and west Volusia counties with a focus on high quality, individualized care for each patient.” Dr. Nguyenduy has more than 25 years of experience treating patients with cardiac, thoracic and vascular problems. A graduate of the Albert Einstein College of Medicine in New York City, he completed general surgery residencies at both Harvard Medical School’s Beth Israel Hospital and the State
University of New York at Buffalo. Dedicated to medical research and advancements in bloodless surgery, Dr. Nguyenduy specializes in minimally invasive surgical approaches to cardiac and thoracic problems. Following a cardiothoracic surgery fellowship at George Washington University in D.C., he helped build the facility’s endovascular program to treat aortic aneurysms and the bloodless medicine program to minimize blood usage. “Medical problems, particularly those involving the heart, can feel overwhelming,” said Dr. Nguyenduy. “My philosophy is to treat a patient respectfully, as a whole person, and not just his or her cardiac, thoracic or vascular problem.” Florida Heart & Lung Institute of Central Florida is located at 305 N. Mangoustine Ave. in Sanford. For more information, visit www.centralflheartandlung.com.
Ocala Regional Medical Center Receives Comprehensive Stroke Center Certification from DNV GL Healthcare
Ocala Regional Medical Center has received certification from DNV GL Healthcare as a Comprehensive Stroke Center, a prestigious designation that reflects the highest level of competence for treatment of patients who have experienced a stroke. Scientific evidence shows that when a stroke, or also called brain attack occurs, immediate assessment and treatment will reduce the effects of stroke and lessen the chances of a permanent disability. Ocala Regional Medical Center is the only Comprehensive Stroke Center in Marion County and is also the closest Comprehensive Stroke Center to patients in Sumter, Citrus, and parts of Lake County. Patients no longer have to travel out of the area to receive the high-quality treatment that can result in more favorable outcomes for patients who have had a stroke. “With stroke care, you must have the best clinicians and resources, but also the ability to act organizationally with extreme efficiency because of the time-critical nature of these events,” says Chad Christianson, CEO, Ocala Health. “Earning national accreditation through a program such as DNV shows ORMC’s commitment to quality, process improvement and providing excellent healthcare.” The DNV GL - Healthcare Comprehensive Stroke Center Certification is based
on standards set forth by the Brain Attack Coalition and the American Stroke Association, and affirms that the medical center addresses the full spectrum of stroke care – diagnosis, treatment, rehabilitation and education – and establishes clear metrics to evaluate outcomes. “Achieving certification shows commitment to excellence,” says Patrick Horine, CEO of DNV GL - Healthcare. “And it helps demonstrate to your community that you are performing at the highest level.” Dr. Iraj Nikfarjam, a Neurointerventionalist at Ocala Health says “By achieving this certification, Ocala Regional Medical Center is being recognized for the care they provide to patients in Marion County as well as patients in Sumter, Citrus, and parts of Lake County. With this designation, patients suffering from all types of strokes such as large brain clots and hemorrhages, can now receive immediate care closer to home.” Comprehensive stroke centers are typically the largest and best-equipped hospitals in a given geographical area that can treat any kind of stroke or stroke complication. In a growing number of states, stroke center certification determines to which facility a patient should be taken for the most appropriate care when a stroke occurs.
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February 2020
AdventHealth Fish Memorial Celebrates the Topping Out Ceremony for the $100 Million Patient Tower Expansion AdventHealth Fish Memorial celebrated the topping out for the hospital’s four-story, $100 million patient tower. Led by general contractor Brasfield & Gorrie, construction workers and hospital staff gathered to celebrate that the patient tower has reached its maximum height. Following tradition, a crane hoisted an American flag and tree to the top of the construction site. However, instead of the traditional evergreen tree, an orange tree was used in honor of Orange City’s history. Named for the thousands of acres of orange groves planted in and around the area, Orange City was incorporated as a city in August 1882. “This is a great milestone in this project, and we are so excited to see the progress. This is something that will stand here on this ground
for decades to come,” said AdventHealth Fish Memorial CEO Rob Deininger to the Brasfield & Gorrie workers during the event. The patient tower’s construction crew consists of nearly 150 people, of which approximately 50 percent are local residents. When construction is completed, the patient tower will include a state-of-the-art 20-bed labor and delivery unit, as well as enhanced cardiac, intensive care and surgical services. This construction project will also fully privatize all patient rooms at AdventHealth Fish Memorial, while increasing the number of licensed beds from 175 to 225. Furthermore, the expansion will significantly increase the size of AdventHealth Fish Memorial’s emergency department, while also adding pediatric emergency care.
The new construction will add 120,000 square feet to the hospital’s footprint, growing the facility to a total of 384,839 square feet when completed. “With an investment of this size, and the services we are bringing, it will transform the level of care available locally,” Deininger said. “The impact that this investment will have on this community, I think it will well-outlive any of our lifetimes.” The architect is Orlando-based RLF Architects. Construction is expected to be completed by April 2021. To learn more about this construction project, visit www.YourPatientTower.com.
AdventHealth Fish Memorial celebrated the topping out for the hospital’s four-story, $100 million patient tower. Led by general contractor Brasfield & Gorrie, construction workers and hospital staff gathered to celebrate that the patient tower has reached its maximum height. Following tradition, a crane hoisted an American flag and tree to the top of the construction site. However, instead of the traditional evergreen tree, an orange tree was used in honor of Orange City’s history. Named for the thousands of acres of orange groves planted in and around the area, Orange City was incorporated as a city in August 1882.
Wet-to-Dry Dressings: the “Best” Wound Dressing? By DR. NILMA ELIAS SANTIAGO
Let’s begin with the following questions: Is wet-to-dry the best choice of dressing to facilitate moist wound healing? Should wetto-dry be used to treat chronic wounds regardless of the phase of healing they are at? If a wound needs debridement, is wet-to-dry the best choice? Is wet-to-dry more cost-effective for treating chronic wounds than any other type of dressing? Interesting enough, the answer to all of these questions is “No.” Wet-to-dry dressings are a type of mechanical debridement that consists of damping a sterile gauze with normal saline, usually 0.9 percent and applying it to the wound bed. Once the gauze is dried up, the clinician forcibly removes the gauze along with devitalized tissue. The wound must be in the inflammatory phase should a wet-todry dressing is selected because its purpose is the removal of necrotic tissue. Unfortunately, many clinicians choose to moisten the dressing before removing the gauze in order to decrease the amount of pain and tissue damage dealt with the patient. This defeats the purpose of mechanical debridement. In addition, wet-to-dry dressings do not facilitate moist wound healing because as the saline evaporates, wound 26
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drainage is trapped in the gauze, desiccating the tissue which impedes cell migration and proliferation. Not to mention that the dry gauze removal disperses a significant amount of bacteria into the air, increasing the risk for wound infection. With the use of wet-to-dry wound healing is also delayed. On each dressing removal, healthy tissue is damaged which causes trauma and pain. Furthermore, the frequency of dressing change, which is as often as much as 3-4 times daily, causes a decrease in wound temperature which leads to vasoconstriction. Because of the decrease in blood perfusion, lack of oxygen impairs the ability of bacterial clearance from the wound bed, leading to a higher risk of tissue infectability. Another important point of discussion is the cost-effectiveness of using wet-to-dry dressings in the current wound care practice. In many cases, clinicians believe that using a moistened gauze to treat a chronic wound is less expensive than advanced wound dressings such as foams, hydrocolloids or alginates. This cannot be further from the truth. Coyne[1] researched the cost-effectiveness of using a polyacrylate moist wound dressing in comparison with wet-to-dry. He found a 26 percent savings annually in a 65-nationwide home care agency and
remarked that wet-to-dry dressings increase pain, slowed wound healing and increased infection rate. Colwell et al.[2] found that the use of a more expensive semi-occlusive dressing requiring less frequent dressing changes had a faster healing outcome than wet-to-dry dressings. In spite of all the scientific evidence discouraging the use of wet-to-dry dressings in the current wound management practice, these continue to be ordered. Cowan & Stechmiller[3] indicated that wet-to-dry dressings were improperly selected to treat chronic wounds 78 percent of the time. They are considered a “default” dressing, even when the wound is in the proliferative phase when no debridement is indicated. Cowan & Stechmiller indicated that wetto-dry dressings can be appropriate only if
the risk of destructing the healthy tissue is outweighed by the benefit of removing devitalized tissue, such as when the wound bed presents with 50 percent or more of necrotic tissue. However, clinicians were ordering this dressing for proliferating wounds with more than 75 percent of granulation tissue. There are other types of debridement such as enzymatic, sharps, hydrotherapy, among others, that facilitate the removal of necrotic tissue without the challenges a wetto-dry dressing cause in the wound bed. If the use of wet-to-dry dressing is being challenged in the current wound practice, why its continued use? The main reasons are unfamiliarity with advanced wound dressings and their use; lack of time to learn about advanced wound dressings; clinician’s training and personal experience using wetorlandomedicalnews
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Volusia/Brevard GrandRounds Gifts of Encouragement Help Patients Stay Warm During Treatment When dealing with a disease that knows no boundaries, every little bit of comfort helps. A sense of warmth and encouragement contribute to the support Tammi needs when receiving her infusions at the Health First Cancer Institute. Tammi, and others just like her who are battling cancer, received blankets courtesy of Subaru of Melbourne and the Leukemia and Lymphoma Society when they distributed the little tokens of love, hope and warmth to the Health First Cancer Institute Hickory Infusion Suite. “I have been receiving treatment for numerous years at the Hickory Street infusion center and have always felt welcomed, cared for and like I’m part of the Health First family,” Tammi said. Since 2015, donations of blankets have been a constant act of kindness Subaru of Melbourne and the Leukemia and Lymphoma Society have provided together. They have donated more than 100,000 blankets and 12,000 arts and crafts kits to hospitals and cancer treatment centers across the country. Each blanket given to Health First cancer patients was specially crafted with
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messages of bravery, written by Subaru employees. For years, patients have received these gifts of encouragement, which they can cherish forever. “While the blanket was a wonderful surprise, the thought behind it was even more meaningful,” Tammi said. The caring gift also reminded Tammi that she is not alone in the fight against cancer. It truly is a friendly gesture showing that an entire community supports her, and that a small act of giving can have a long-lasting, positive impact on treatment. “It made me feel thought of and cared for, just as I always do,” Tammi said.
Family Turns Devastating Loss into an Opportunity to Help the Heartbroken Paula knew that something wasn’t right. Her son, three-month-old Maxwell, had been miserable for days. A doctor visit and multiple tests revealed nothing. But the day after Christmas 2017, Max was suddenly struggling to breathe. He was rushed to the emergency room at Health First’s Holmes Regional Medical Center. Her husband was still parking the car when Max’s heart stopped. Despite 45 minutes of trying to revive him, Max was gone. “He was the most jubilant baby ever,” Paula said. “It was almost like he knew he didn’t have a lot of time.” The devastation hit Paula, her husband, Todd, and their eldest son, Jackson, hard. Eventually, they learned Max had neuroblastoma, a rare childhood cancer. There was nothing more the medical staff could do for Max. Yet, Paula knew that her experience could provide comfort to others undergoing a similar, unexpected loss. On what would have been Max’s first birthday, an emergent loss bereavement program was introduced at all four Health First hospital emergency rooms.
AdventHealth Names Chief Financial Officer for the Central Florida Division – North Region AdventHealth has selected Brent Davis to serve as vice president and chief financial officer for the company’s Central Florida Division – North Region, effective Feb. 3. Davis will provide strategy development support and executive oversight for the chief financial officers for the AdventHealth op27
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to-dry dressings; and the belief that wetto-dry dressings are more cost-effective than other dressings.[1] The use of advanced wound dressings for chronic wounds is well-documented in the literature. A clinician treating patients with wounds must rely on evidenced-based medicine for their clinical decision making to improve patient care, facilitate positive outcomes and cost-effective treatments. Therefore, the best way to improve the current wound practice and limit the use of wet-to-dry dressings is education. Clinicians must follow wound management guidelines from white papers and expert panels such as the National Pressure Ulcer Advisory Panel, the Wound Healing Society, the Academy of Clinical Electrophysiology and Wound Management; and the American Professional Wound Care Association, among others.
Gastroenterologist of 22 Years Joins Melbourne Regional, Steward Health Care
“If we can help other families not feel the pain we felt, then we’re all for it,” Paula said. Ceramic necklaces made of a tiny heart - for the patient - that fits inside a bigger one - for the family - are provided, as well as a memory box for families of the littlest patients. That way, they may save locks of hair and preserve handprints and footprints. Within 48 hours of any ER patient’s death, a bereavement counselor calls. Within five days, a sympathy card signed by the care team is sent. Within two weeks, bereavement resources are offered. “No family will ever feel like they’re going through the most difficult time of their lives alone,” Paula said. “It’s bittersweet at best, but it’s an amazing thing.”
Melbourne Regional Medical Center, a member of Steward Health Care family, is pleased to welcome Mahboob M. Alikhan, MD, FACP. Board-certified in gastroenterology, Dr. Alikhan specializes in diagnosing, treating and preventing many problems of the digestive tract and related organs. “The GI tract is a very fascinating and diverse organ,” said Dr. Alikhan. “It’s interrelated with the brain and nervous system, with hormones and the immune system. There’s a lot of complexity related to this organ, which makes it all extremely interesting.” Dr. Alikhan earned his medical degree from Loyola University of Chicago, Stritch School of Medicine. He did his internal medicine residency at Loyola University Medical Center in Maywood, IL, and completed his gastroenterology fellowship at Indiana University Medical Center under renowned physicians in the field, such as Douglas Rex, MD; Glen A. Lehman, MD; and Stuart Sherman, MD. Fluent in multiple languages, including Hindi and Urdu, the Chicago native has been a physician for 22 years, serving in Port St. Lucie, Merritt Island and Melbourne.
erations in Flagler, Lake and Volusia counties. Davis replaces Debbie Thomas who was recently promoted to serve as the senior executive officer for system transformation for the AdventHealth Central Florida Division, which encompasses Flagler, Lake, Orange, Osceola, Seminole and Volusia counties. He most recently served as chief financial officer for Kettering Medical Center
System in Kettering, Ohio. Comprised of three hospitals, one behavioral health hospital, an allied health college, and multiple freestanding assets, Kettering Medical Center System is the largest division of Kettering Health Network, a non-profit, faith-based health care system. In addition, he has worked with Centura Health, a healthcare system formed in 1996 as a joint operating agreement between CommonSpirit Health and AdventHealth. At Centura Health, he served as chief finan-
Most importantly, there needs to be a collaboration with wound clinicians and board-certified wound specialists who have studied and researched the area of wound management and can make the best recommendations to treat a chronic wound and facilitate healing. Not only this will benefit the patient but healthcare as a whole. Wound care is a science, is an art, is a love; with collaboration and expertise, wounds can heal. Dr. Nilma Elias Santiago is a physical therapist with 15 years of experience. She is certified in wound care and ostomy specialist through the National Alliance of Wound Care and Ostomy. She is the owner of the Integumentary Physiotherapy Clinic in Altamonte Springs, FL. For more information, you can reach her at nelias@integumentarypt.com.
One of his primary career objectives is educating the community about colorectal cancer prevention. Dr. Alikhan treats GERD/Barrett’s disease, colon cancer and polyps, among many other conditions of the digestive tract. The Consumers’ Research Council of America rated Dr. Alikhan as a top physician in the 2009-2010 list of America’s Top Gastroenterologists List. The American College of Physicians has named him a fellow. Dr. Alikhan has written a number of articles, case reports and abstracts for such pubs as the American Journal of Gastroenterology and Gastrointestinal Endoscopy. He said that treating patients with GI problems gives him an opportunity to improve their quality of life, which he finds deeply satisfying. “It’s the impact I’m able to make on the lives of patients who come to us in times of distress: That makes it all worthwhile when we can ease pain, comfort patients, offer moral support and compassion,” Dr. Alikhan said. “Medicine gives us an opportunity to make the world a better place.” Dr. Alikhan is now accepting new patients at his practice at 240 North Wickham Road, Suite 309, Melbourne, FL 32935. Anyone wishing to schedule an appointment may call the practice at (321) 752-1630.
cial officer for Avista Adventist Hospital in Louisville, Colorado, and St. Anthony North Health Campus in Westminster, Colorado. Davis earned a Master of Business Administration with an emphasis in IT from California Lutheran University and a Bachelor of Business Administration with a concentration in accounting from Walla Walla University in Washington. He is a Certified Public Accountant and is a Fellow of the American College of Healthcare Executives (FACHE). orlandomedicalnews
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Volusia/Brevard GrandRounds AdventHealth Medical Group Gastroenterologist Relocates to Volusia County AdventHealth Medical Group gastroenterologist Dr. Harsh Duphare has relocated from Lake County to serve the Volusia County community. AdventHealth Medical Group is the healthcare system’s employed group of physicians. In Volusia, Flagler and Lake counties, there are more than 300 AdventHealth Medical Group providers, including 160 primary care doctors and specialists. Duphare is board-certified and specializes in diagnosing and treating conditions that impact the digestive or gastrointestinal tract. He also performs a variety of endoscopic treatments, such as endoscopic ultrasounds (EUS), a minimally invasive procedure to assess digestive and lung diseases, and endoscopic retrograde cholangiopancreatography (ERCP), a procedure to diagnose and treat problems in the liver, gall-
AdventHealth Hospitals Earn Top Awards for Outstanding Quality and Safety Highlighting its nationally recognized achievements in patient safety and quality, AdventHealth Daytona Beach and AdventHealth Palm Coast were both named a Top General Hospital by The Leapfrog Group. The Leapfrog Top Hospital award is widely acknowledged as one of the most competitive honors American hospitals can receive and this accolade comes following AdventHealth Daytona Beach and AdventHealth Palm Coast’s “A” Hospital Safety Grade in the fall of 2019. This designation is awarded by The Leapfrog Group, a national watchdog organization of employers and other purchasers focused on health care safety and quality. Approximately 2,100 hospitals were considered for this award. Among those, AdventHealth Daytona Beach and AdventHealth Palm Coast were among 37 hospitals in the nation to earn a Top General Hospital distinction. Performance across many areas of
bladder, bile ducts and pancreas. Duphare also performs Barrett’s Esophagus ablation therapy, a treatment that targets tissue in the esophagus that is potentially cancerous. Duphare and earned his medical degree from All India Institute of Medical Sciences in New Delhi, India. He completed his residency at Michigan State University College of Human Medicine in East Lansing, Michigan, and his fellowship at the University of Wisconsin Hospitals and Clinics in Madison, Wisconsin. He has two office locations: AdventHealth Daytona Beach, 305 Memorial Medical Pkwy., suite 307, Daytona Beach and 125 Memorial Medical Pkwy., suite 2200, New Smyrna Beach. However, Duphare will relocate his New Smyrna Beach office by March to 501 Live Oak Street, Suite B, New Smyrna Beach. His practice accepts new patients and most insurance plans and can be reached at Call386-424-5248.
hospital care is considered in establishing the qualifications for the award, including infection rates, practices for safer surgery, maternity care, and the hospital’s capacity to prevent medication errors. The rigorous standards are defined in each year’s Top Hospital Methodology. “We are pleased to recognize both AdventHealth Daytona Beach and AdventHealth Palm Coast as 2019 Leapfrog Top Hospitals,” said Leah Binder, president and CEO of The Leapfrog Group. “This demonstrates extraordinary dedication to patients and to the community. We congratulate the board, staff and clinicians whose efforts made this honor possible and know they share pride in this achievement.” To qualify for the Top Hospitals distinction, hospitals must rank top among peers in the 2019 Leapfrog Hospital Survey, which assesses hospital performance on the highest known standards for quality and patient safety, and achieve top performance in its category. To see the full list of institutions honored as 2019 Top Hospitals, visit www. leapfroggroup.org/tophospitals.
AdventHealth Daytona Beach was one of 37 hospitals in the nation to earn a Top General Hospital distinction by The Leapfrog Group. Approximately 2,100 hospitals were considered for this designation that highlights achievements in patient safety and quality. In addition, AdventHealth Daytona Beach has also received consecutive “A” grades from The Leapfrog Group for quality and safety since the ranking’s inception in 2012. Pictured here from left to right: Shawn Bishop, director of emergency services; April Chilson, vice president of ancillary services; Joy Fritts, regulatory and quality manager, Tara Swank, emergency department nurse; Amber Gallagher, executive director inpatient services; Dr. Christopher Riccard, hospitalist; Michele Goeb-Burkett, chief nursing officer; Ed Noseworthy, CEO; and Dr. Utpal Desai, cardiothoracic surgeon.
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AdventHealth Grows Partnership with Chip Ganassi Racing and Kyle Larson; Adds Ross Chastain for Two Races With an AdventHealth show car on display in the Gatorade Victory Lane at Daytona International Speedway today, AdventHealth announced it is expanding its relationship with Chip Ganassi Racing (CGR) by teaming up with both Kyle Larson and Ross Chastain. During the 2020 season, Kyle Larson will pilot the No. 42 AdventHealth Chevrolet Camaro ZL1 1LE for the Clash at Daytona, as well as the NASCAR Cup Series playoff race at Kansas Speedway in the fall. In addition, Florida-native Ross Chastain will drive the No. 77 AdventHealth Chevrolet Camaro ZL1 1LE, prepared by CGR, for starts at the DAYTONA 500 in Florida and the Coca-Cola 600 at Charlotte Motor Speedway in North Carolina. “We’ve been a proud supporter of Chip Ganassi Racing since 2016, and I’m really excited to further expand our winning partnership by teaming up with both Kyle and Ross,” said David Banks, AdventHealth chief strategy officer. “This collaboration is something all of our employees across the nation can get excited about.” As one of the country’s largest faith-based health systems, AdventHealth has 50 hospitals in almost a dozen states. Iconic racetracks like Daytona International Speedway, Charlotte Motor Speedway, Kansas Speedway, Atlanta Motor Speedway and Texas Motor Speedway, are all located in close proximity to an AdventHealth market. AdventHealth has previously had a presence on the No. 1 car, racing in the 2019 Clash at Daytona with Jamie McMurray, and with Kurt Busch’s entry in the 2019 fall race at Kansas, in addition to sponsoring Larson’s All-Star Race winning ride. “We had a great run with Kyle last year and are excited about the 2020 season,” Banks said. “In our first race on Kyle’s car, he not only raced his way into the NASCAR All-Star race, but also went on to win it! We are looking forward to continuing that momentum and success together in 2020.” “It’s great to have AdventHealth back with the No. 42 team for some races in 2020,” Larson said. “It was awesome to win with AdventHealth on our car at the All-Star Race, in their first race with the 42 team, and I hope we can have more exciting races with them this year. They have been a great partner, on and off the track, and I’m glad to see our relationship continue.” AdventHealth will also support Chastain, who continues to be a CGR development driver, in a Spire Motorsports entry as he makes his second career DAYTONA 500 start, following a 10th place finish in last year’s race. Chastain will run the No. 77 AdventHealth Chevrolet in Charlotte for the Coca-Cola 600, while juggling full-time duties in the NASCAR Xfinity Series in 2020. Nicknamed “Melon Man,” Chastain is an eighth-generation planter and fourth-generation watermelon farmer from Alva, Florida. Chastain
made his NASCAR debut in 2011 at the age of 18, competing in five NASCAR Gander RV and Outdoors Truck Series events before transforming the opportunity into a full-time ride in 2012. In 2019, Chastain earned a second Xfinity Series win while competing for championship honors in the Gander RV and Outdoors Truck Series. By season’s end, Chastain led 591 laps, earned one pole, three wins, 10 top-five finishes and 19 top-10 finishes. When the checkered flag waved at Homestead Miami Speedway, signaling the end of the 2019 campaign, Chastain came home fourth, missing out on the title by a mere two points. The “Melon Man” was bestowed with the series Most Popular Driver Award in 2019, bringing his career full circle from once very humble beginnings. “To have the opportunity to run the DAYTONA 500 is awesome, and it’s great to do it this year with AdventHealth on board my car. I’ve only had one start in the DAYTONA 500, and can’t wait to run that race again in what I know will be a competitive car,” Chastain said. “I’m also looking forward to racing the CocaCola 600. That’s another iconic race that all of us want to win.” AdventHealth continues to support the Human Innovation and Development Lab (HIDL) at CGR. The HIDL features tools, technology and unique training to improve the performance of CGR’s pit crews and drivers and help them prepare for upcoming races both mentally and physically. Headed by Josh Wise, both Larson and Chastain utilize the resources made available in the HIDL. Locally, AdventHealth has been a Founding Partner of Daytona International Speedway since 2014. As the Official Healthcare Partner of Daytona International Speedway, AdventHealth cares for more than 1,000 patients each year on-site. In the event of an emergency, there are 11 AdventHealth ambulances, two care centers and nine first aid stations standing ready to care for drivers and fans alike. The AdventHealth injector– or gate entrance – at the Daytona Beach, Florida, track is a 20,000-plus-square-foot oasis. “With our injector at the Daytona International Speedway, we’ve been able to engage with the hundreds of thousands of race fans that attend Speedweeks, but are beyond thrilled to have an AdventHealth car racing in the DAYTONA 500 for the first time ever,” Banks said. “I can’t wait to watch Florida’s own ‘Melon Man’ race on the track this year in our watermelon-themed AdventHealth Chevy.” “We are thrilled to be continuing our partnership with AdventHealth for a fifth year,” said Doug Duchardt, CGR chief operating officer. “The partnership has generated some exciting moments on track, like Kyle’s All-Star win. Additionally, AdventHealth’s dedication to helping people feel whole has aided the growth of our drivers and pit crews off the track through the Human Innovation and Development Lab. We’re looking forward to another exciting year orlandomedicalnews.com of the partnership.”
Volusia/Brevard GrandRounds Neurosurgeon Joins AdventHealth’s Employed Physician Group Board-certified neurosurgeon Dr. Federico Vinas has joined AdventHealth Medical Group. As an AdventHealth Medical Group physician, Vinas joins AdventHealth’s employed group of physicians with more than 300 providers, including 160 primary care doctors and specialists in Volusia, Flagler and Lake counties. Vinas has cared for the Daytona Beach community for nearly two decades. He specializes in the diagnosis and surgical treat-
ment of patients with injuries or disorders of the brain, spinal cord, spinal column and peripheral nervous system. He also performs minimally invasive surgery and cervical arthroplasty, a type of joint replacement procedure to replace a cervical disc in the spine. In Detroit, Michigan, Vinas earned his medical degree from Wayne State University and completed his residency at Henry Ford Hospital. His practice accepts new patients and most insurance plans. His office is located at 305 Memorial Medical Pkwy., suite 505, Daytona Beach and can be reached at Call386-231-3540.
AdventHealth DeLand Recognizes Nurse with DAISY Award AdventHealth DeLand recognized registered nurse Delaney Rodriguez with the DAISY award. The DAISY Award is an international program that rewards and celebrates extraordinary clinical skill and compassionate care provided by nurses. Rodriguez works in the intensive care unit and received nominations from both patients and colleagues. “Delaney’s calm and gentle demeanor helped ease my nerves. Her sincere humbleness and sincerity took away my fear and anxiety and brought me to a place of peace,” a patient wrote in nomination of Rodriguez. “Once I saw how confident and poised she was, I was able to totally relax. Her care helped to holistically heal my mind, body and spirit.” Rodriguez’s colleague recounted occasions she had gone above and beyond in providing uncommon compassion. “She spent a lot of time with a patient and his wife, discussing his cardiac condition and explaining his treatment in laymen terms. She was so patient and kind,” her coworker wrote. “Delaney truly exemplifies AdventHealth’s service standards and our mission of extending the healing ministry of Christ.” Created in 1999, more than 2,500
AdventHealth Daytona Beach Nurses Receive Awards AdventHealth Daytona Beach recognized registered nurses Julie Cupp and Rebekah Groover with the DAISY Award. The DAISY Award is an international program that rewards and celebrates extraordinary clinical skill and compassionate care provided by nurses. Cupp works in the medical care unit and was nominated by a patient’s family member. “From the moment she started taking care of my father, she showed a warmth that was felt by both of us,” the patient’s family member wrote. “She exuded professionalism in all that she did and always had a smile on her face. She even stopped by to see my dad on a day she was covering for another nurse. 29
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DeLand Daisy Award_Delaney Rodriguez: AdventHealth DeLand recognized registered nurse Delaney Rodriguez with the DAISY award. Rodriguez works in the hospital’s intensive care unit and was nominated for this recognition by a patient and a coworker. Pictured here, Craig Lindsey, AdventHealth DeLand chief nursing officer, presents the DAISY award to Rodriguez.
healthcare facilities in all 50 states, as well as 15 other countries, use the DAISY Award to honor nurses. In recognition of this honor, Rodriguez received a DAISY pin, a certificate, a tote bag and a hand-carved stone sculpture of the “Healer’s Touch” by an artist of the Shona Tribe in Zimbabwe. Her unit, the AdventHealth DeLand intensive care unit, also received cake, cinnamon rolls and a DAISY banner to display.
Julie is really an exceptional nurse.” Groover works in the medical progressive care unit and was nominated by a patient. “When I first found out that I was diagnosed with cancer, my nurse Rebekah came to my rescue. My family and I were all shocked, but Rebekah took the time to answer all of our questions and made sure that we understood everything that was going on,” the patient recalled. “She always had a wonderful and friendly attitude and worked hard to ensure that I was well taken care of. She is an extraordinary nurse who deserves the DAISY award and so much more! She went above and beyond in her care and treatment of me and I could not be more grateful, appreciative and happy to have met her and make a new friend!” In recognition of this honor, both Cupp and Groover received an award pin, a bou-
AdventHealth DeLand Names New Director of Food and Nutrition AdventHealth DeLand has selected Gregory Neumann to serve as the director of food and nutrition. In his new role, Neumann is responsible for providing leadership and overseeing the effective operations of the food and nutrition department at AdventHealth DeLand. With over 30 years of experience in food and nutrition, Neumann joins AdventHealth DeLand from the Atrium Medical
Center in Middletown, Ohio. In his previous role, Neumann served as the director of operations, where he managed the daily functions of the nutritional services department, the campus police and the plant services and engineering team. A Palm Coast resident, Neumann earned a bachelor’s degree in food and administration from Morehead State University and a Master of Business Administration from Indiana Wesleyan University.
Atlantic Center for the Arts Partners with AdventHealth New Smyrna Beach to Connect the Arts & Healing Atlantic Center for the Arts (ACA) and AdventHealth New Smyrna Beach have developed a formal partnership to instill the arts into the healthcare continuum. AdventHealth New Smyrna Beach recently donated $5,000 to support ACA’s programs within the arts and wellness initiative, funding two programs each month during the 2020 season, including Soundwalks, creative writing and expressive art journaling. In addition, ACA Art Ambassadors will lead programs with four of the hospital’s support groups in 2020. “We are really excited about our partnership with Atlantic Center for the Arts and their program that enriches our community with the arts,” said Dr. Dennis Hernandez, AdventHealth New Smyrna Beach CEO. “With a focus on wellness, programs like this allow for creative expression and provide therapeutic remedies. They align well with our mission at AdventHealth New Smyrna Beach to provide care that is centered on the whole person.” “The ACA Arts & Wellness initiative is an integral part of connecting the arts to community health, and the support of AdventHealth brings this goal directly into the fabric of society,” said Eve Payor, ACA director of community programs. In 2012, ACA began to integrate various forms of the arts into its community programs and in healthcare settings. The ACA staff work with a team of professional artists
to create programs that increase the health and wellness of elders, caregivers, veterans, active adults and students. These programs support healthy living and reach thousands of residents throughout the Southeast Volusia community. In addition to its internationally acclaimed artist residency program, ACA offers more than 200 free community programs each year, engaging over 70,000 people annually. For more information about Atlantic Center for the Arts, visit atlanticcenterforthearts.org.
quet of flowers, a tote bag, and a handcarved stone sculpture of the Healers Touch by artists of the Shona Tribe in Zimbabwe. Both of their units also received cinnamon rolls and a DAISY banner to display.
AdventHealth Daytona Beach recognized registered nurses (left to right) Julie Cupp and Rebekah Groover with the DAISY award. The DAISY Award is an international program that rewards and celebrates extraordinary clinical skill and compassionate care provided by nurses.
The Atlantic Center for the Arts (ACA) and AdventHealth New Smyrna Beach have developed a formal partnership to engrain the arts into the healthcare continuum. From left to right: Dr. Dennis Hernandez, AdventHealth New Smyrna Beach CEO, and Eve Payor, ACA director of community programs.
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Volusia/Brevard GrandRounds Volusia County Schools Recognize AdventHealth with the Jack Schoep Award In January, the Volusia Association of School Administrators (VASA) presented AdventHealth with the 2020 VASA Jack Schoep Award during the annual Phi Delta Kappa and VASA Night at the LPGA Clubhouse in Daytona Beach. Named in honor of a Volusia County Schools administrator who solved problems and cared about people, VASA presents the Jack Schoep Award annually to a person or organization that elevates public education through community service, leadership, and generous support. In 2018, AdventHealth and the Volusia County School Board entered into a historic, first-of-its-kind partnership, establishing the AdventHealth Healthy Futures Program of Volusia County Schools. As one of the nation’s largest faithbased healthcare systems, AdventHealth is the largest hospital system in Volusia County with facilities in Daytona Beach, DeLand, Orange City and New Smyrna Beach. AdventHealth’s involvement with the school district not only expands the care available to students and athletes, but also develops and enhances career opportunities. Through this program, AdventHealth strives to address three key issues impacting local schools: 1) career development in the healthcare industry; 2) student athlete health; and 3) chronic absenteeism. “At AdventHealth, our mission extends beyond the walls of our hospitals and into
Parrish Medical Center Offers Free Community Support Groups Parrish Medical Center is offering free support groups for community members living with various health issues. See the upcoming February 2020 support groups listed below: • AWAKE Sleep Disorders Support Group Celebration: Monday, February 10, 6-8 p.m., Parrish Healthcare Center, 5005 Port St. John Parkway, Port St. John • Caregiver Support Group: Thursday, February 6 and 20, 9:30-11:30 a.m., Heritage Hall, 931 N. Washington Ave., Titusville • Caregiver Academy: Thursday, February 13, 10-11 a.m., Heritage Hall, 931 N. Washington Ave., Titusville • Diabetes Support Group: Thursday, February 13, 3:30-5 p.m., Heritage Hall, 931 N. Washington Ave., Titusville
On Jan. 22, the Volusia Association of School Administrators (VASA) presented AdventHealth with the 2020 VASA Jack Schoep Award. Pictured here, Anna Donaldson (left), AdventHealth director of sports marketing and strategic partnerships for Volusia and Flagler counties, and Kelly Amy (right), Volusia County Schools manager of strategic partnerships, during the annual Phi Delta Kappa and VASA Night at the LPGA Clubhouse in Daytona Beach.
the communities where we live, work and, in this case, learn,” said Anna Donaldson, AdventHealth director of sports marketing and strategic partnerships for Volusia and Flagler counties. “These students represent our future, and AdventHealth is committed to improving the health of the communities we serve at every stage of life, in every stage of health.”
• MAK Gathering (Moms and Kidz) Support Group: Mondays and Wednesdays (February 3, 5, 10, 12, 17, 19, 24 and 26), 10-11:30 a.m., The Children’s Center, 5650 S. Washington Ave., Titusville • Parkinson’s Support Group of North Brevard: Thursday, February 20, 2-4 p.m., Heritage Hall, 931 N. Washington Ave., Titusville • Pulmonary Hypertension Support Group: Tuesday, February 11, 3-5 p.m., Grace United Methodist Church, Merritt Island • Stroke-Heart Survivors Group: Tuesday, February 18, 2-4 p.m., Heritage Hall, 931 N. Washington Ave., Titusville • Parrish Partners Cancer Support Group: Monday, February 17, 4-5:30 p.m., Parrish Medical Center, 951 N. Washington Ave., Titusville
• NAMI Family Support Group: Wednesday, February 5, 6-7:30 p.m., Palm Point Behavioral Health, 2355 Truman Scarborough Way, Titusville The support groups are free, but • Fearless Café: Wednesday, February 5, space is limited. For more information, 10-11 a.m., Heritage Hall, 931 N. Wash- and to preregister, visit https://www.parington Ave., Titusville rishhealthcare.com/events/. • Diabetes Community Education Class: Thursday, February 20, 3-5 p.m., Parrish Medical Center, 951 N. Washington Ave., Titusville
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Publix to Open Retail Pharmacy at Halifax Health Medical Center Publix and Halifax Health broke ground this morning on the construction of a fullservice Publix Pharmacy at Halifax Health Medical Center in Daytona Beach, Florida. The pharmacy will provide prescription and over-the-counter medications for patients, visitors and employees of Halifax Health and is expected to open in August 2020. “As patients are discharged from the hospital, they are often prescribed medications to continue their care. Through our collaboration with Halifax Health, we’re able to bring the convenience of bedside delivery to the medical center’s patients and eliminate an extra stop on their way home,” said Publix Vice President of Pharmacy Dain Rusk. “We also look forward to providing premier service to Halifax Health employees as we become their exclusive innetwork pharmacy.”
Halifax Health|UF Health Medical Center of Deltona Holds Community Grand Opening Event Halifax Health hosted a community grand opening event for the health system’s third hospital, Halifax Health|UF Health Medical Center of Deltona. The medical center, is Deltona’s first full-service hospital and opened to serve patients on February 4, with 43 licensed beds. In April 2017, Halifax Health celebrated the grand opening of Halifax Health Emergency Department of Deltona – Volusia and Flagler counties’ first freestanding emergency department. In December of that year, the community health system hosted a groundbreaking ceremony near the site of the emergency department to celebrate the start of construction on Halifax Health Medical Center of Deltona – the city’s first hospital. In 2018, the Halifax Health Board of Commissioners voted unanimously to approve a Letter of Intent
“We are pleased to collaborate with Publix Super Markets to provide our patients access to their medications in the most efficient and timely manner,” said Halifax Health President and Chief Executive Officer Jeff Feasel. “Now, when patients leave the hospital or emergency department, they will easily be able to obtain their medication. We know convenience helps drive better health outcomes, and this pharmacy program provides that convenience.” Patients at Halifax Health Medical Center not only benefit from the convenience of having new prescriptions delivered upon discharge, they can also refill those prescriptions at their neighborhood Publix Pharmacy. There are 26 Publix Pharmacies in the communities served by Halifax Health. Publix Pharmacy currently operates 12 in-hospital pharmacies in the state of Florida. The company continues to look for collaboration opportunities throughout its seven-state operating area.
to form a joint venture with University of Florida Health Shands to develop and operate the Deltona hospital. The $153 million, state-of-the-art, sixstory medical facility is 202,242 square feet. The medical center features four operating rooms, three multipurpose special procedure rooms, 13 intensive care rooms and 30 medical/surgical rooms. Services offered by the medical center will include anesthesiology, cardiology, emergency care, gastroenterology, general surgery, nephrology, neurology, orthopedic surgery, pathology, vascular surgery, radiology and urology. Hospitalists and intensivists will be on staff. In its first year, the hospital will employ 211 full-time employees. The overall economic impact of the medical center once complete is estimated to be $133 million. A two-story, 53,000-square-foot medical office annex is currently under construction beside the hospital and is expected to open in March 2020.
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