January 2019 Orlando Medical News

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Making Value-based Care Work A look ahead with predictive analytics The healthcare industry is one of the fastest growing industries in the world, having a direct impact on a patient’s quality of life.

Global healthcare systems are struggling to manage and treat chronic diseases associated with an aging population. Diabetes, chronic heart disease, cancer and Alzheimer’s are just some of the illnesses placing a strain on financial resources of both the private and public health sectors, creating added stress and having a detrimental effect on patient outcomes.

As pressure mounts, an increasing number of healthcare service providers are looking for innovative, cost-effective methods to deliver technology-centric services. Predic-

ON ROUNDS

PHYSICIAN SPOTLIGHT Dr. Harold Neyra ... 3

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Proper Incident-To Billing: Avoiding Pitfalls That Could Paralyze Your Practice ... 2

EAST ORLANDO CHAMBER OF COMMERCE Innovation Through Collaboration ... 5

HEALTH INNOVATORS

19 Curiosities of Medicine ... 17 Prescription for Buying and/or Selling a Practice ... 18

tive analytics is standing out as a solution of choice. According to Grand View Research Inc., the global healthcare analytics market is forecast to reach $53 billion worldwide by 2025. Driven by the need to achieve costeffective solutions and adapt to a population with a longer life expectancy, predictive analytics promises to use data and machine learning algorithms to deliver efficient and accurate personalized care.

Several key factors are contributing to a transformation within healthcare.

The digitalization of healthcare has resulted in the creation of an enormous amount of new data, which is transmitted to

healthcare service providers on a daily basis.

These massive quantities of “big data” have the potential to support a wide range of medical and healthcare functions, including clinical decision-making, disease monitoring and health management.

As “value-based care” has emerged, focusing on healthcare quality over quantity, predictive analytics is already playing a substantial role.

Predictive analytics examines historical data in order to predict future outcomes.

These analytics have come a long way from their initial introduction to the healthcare system. Today’s AI systems are highly im-

proved, predicting likely patterns by merging technology with statistical methods and machine learning algorithms. The ability to predict such patterns provides invaluable support to physicians during the decisionmaking process, thus improving the accuracy and speed of diagnoses.

How predictive analytics changes healthcare?

Shifting from volume-based healthcare to value-based healthcare is almost impossible to achieve without the use of predictive analytics, which requires data warehousing and integration from all available sources. Once (CONTINUED ON PAGE 4)

HEALTHCARELEADER

A Third-generation Surgeon Looks to the Future Matthew Johnston, MD continues the family tradition of leadership Somewhere in the home of Matthew A. Johnston, MD, is a photograph taken in an operating room of Orlando Regional Medical Center more than 30 years ago. You would be forgiven if you looked at Dr. Johnston and thought there is something familiar about the doctors and nurses in that picture. Not just familiar, but familial.

In the photograph, Johnston’s grandfather is the lead surgeon, his father is the intern, his uncle, who is also a surgeon is there, and one of the nurses is his aunt. His mother, also a nurse, is in the room, too, although she is behind the photographer.

“I grew up in medicine,” Johnston said.

“I guess you could call it the family business.

Almost everybody in my family is in medicine in one way or another. Besides my grandfather, father and uncle, who were all surgeons, my grandmother was a nurse, my mother a nurse, and my aunts were nurses.”

ORMC is not only the same hospital where his grandfather and father were both thoracic surgeons, it is the place where Matthew was born, and where nurses and staff still remember him as a boy coming to see his father or to tag along on weekend rounds.

With a family full of medical professionals, family gatherings and holiday dinners were a little different from non-medical families. “I

“My dad always told me that a good surgeon knows when to operate, and a great surgeon knows when not to operate.” remember lots of conversations about various cases, new diagnostic modalities, and things going on at the hospital,” he said. “I was attracted to a career in medicine in part because I got to see the impact that medicine had on people’s lives and the community.”

Today, Johnston is a fellowship-trained thoracic surgeon at Orlando Health UF Health Cancer Center. Thoracic surgery involves the organs inside the chest. He is certified in lapa(CONTINUED ON PAGE 4)

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Proper Incident-To Billing: Avoiding Pitfalls That Could Paralyze Your Practice

By MICHAEL R. LOWE, ESQ.

Incident-to billing presents one of the last remaining opportunities for physicians to multiply their services and increase their income without having to work harder. However, the regulations which govern this practice under both the federal Medicare program and the various state Medicaid programs can present pitfalls to unwary physicians and their staffs who fail to properly understand and apply them. These mistakes can lead to government intrusion, overpayment demands, audits and false claim allegations.

Both Medicare Part B and many state Medicaid programs include coverage of services that are rendered “incident-to” a physician’s services. Unraveling the requirements will help ensure that non-physician practitioner (NPP) billing is handled correctly. When such services are properly provided incident-to a physician’s services, an NPP’s services may be billed using the physician’s provider number and are allowed to be reimbursed at 100 percent of the Medicare and Medicaid physician fee schedules. Otherwise, NPP services must be billed at their Medicare or Medicaid program fee schedule which is typically 85 percent of the applicable physician fee schedule. Either way, the NPP must have his or her own active, valid Medicare or Medicaid provider number.

KEY CRITERIA In order to qualify as “incident-to” services for billing purposes, an NPP’s services must meet several criteria. These include: (1) the NPP must be licensed or certified to provide professional health care services in the state where the physician practice is located; (2) generally, the NPP must be a full-time, part-time or leased employee of the physician or physician group practice (although in limited cases, the NPP may be an independent contractor of the physician or physician group practice); (3) the NPP must provide services as an integral part of and incident-to the physician’s services; and (4) the NPP must provide such services under the direct supervision of the physician.

AN INTEGRAL PART OF THE PHYSICIAN’S SERVICES The foundation of proper incident-to billing is that the incident-to services must be an integral part of the physician’s services. The physician must have initially provided health care services to the patient whom the NPP is treating “incident-to” the physician’s services. This requirement does not mean that there must have been a service rendered by a physician for each visit by a patient. Rather, an ongoing course of treatment initiated by a physician with the physician seeing the patient at the first visit will qualify under the

incident-to billing guidelines. In other words, a physician must see a patient at the first visit but would not necessarily have to see the patient for subsequent, related visits. However, if the same established patient reported a new chief complaint or problem, the physician would have to see that patient again for the new issue before an NPP saw the patient in order to be able to bill for the NPP’s services as incident-to the physician’s services.

Physicians and physician group practices often overlook this second point when treating patients for ongoing, related visits which also involve new chief complaints. This is an issue which both the Medicare and Medicaid programs focus on when auditing and reviewing claims. As a result, physicians and their group practices should develop policies and procedures for ensuring that they only bill incident-to services for those chief complaints and problems for which one of their physicians has seen a patient prior to services being rendered by an NPP.

LOWE & EVANDER, P.A. Florida-based Law Practice Representing PHYSICIANS & PHYSICIAN GROUP PRACTICES Business, Transactional, Litigation, Professional Licensure, Regulatory, Operational & Administrative Matters Helping Our Clients Navigate Today’s Healthcare Challenges

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DIRECT PHYSICIAN SUPERVISION Perhaps one of the most misunderstood aspects of the incident-to billing rules is the requirement for direct physician supervision of an NPP providing incident-to services. Many state laws permit advanced registered nurse practitioners (ARNPs) and physician assistants (PAs) to furnish health care services to patients without a physician’s on-site presence or direct supervision. Many of these state laws permit “general” physician supervision.

However, incident-to services must be furnished under a physician’s direct supervision under both Medicare and many states’ Medicaid program regulations. Direct supervision means that a physician must be immediately available to provide assistance and direction while an NPP is providing services that the physician plans to bill as incident-to. While the physician does not have to be in the same room as the NPP, the physician must be in the same office suite. By far, this is the incident-to billing requirement which physicians and their group practices misunderstand and fail to comply with. Unfortunately, they often confuse the direct supervision requirements for incident-to billing with their state law supervision requirements. This is particularly true, for example, in Florida where ARNPs and PAs can practice under the general supervision of a physician.

Thus, physicians and their office staff need to understand the difference between general supervision and direct supervision. They also must understand that the general supervision requirements for ARNPs or PAs under Florida law (and most likely in many other states as well) will not satisfy the direct supervision requirements for incident-to billing under either the Medicare program or perhaps the applicable state Medicaid program.

STATE LICENSING REQUIREMENT Another common misunderstanding physicians face when billing incident-to services is their misperception that an NPP may be licensed in another state and provide services to their patients in the state in which the physician’s practice is listed. However, both the Medicare and Medicaid program incident-to billing regulations require that the NPP be licensed or certified to practice in the applicable state before a physician can bill their services incident-to.

Failing to ensure that an NPP is properly licensed or certified to practice in the applicable state will result in an improper and potentially false claim for incident-to services.

Moreover, allowing an NPP to perform services when the NPP is not licensed or certified to practice in the applicable state can result in allegations by the Department of Health (CONTINUED ON PAGE 5)

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PHYSICIANSPOTLIGHT

A Promise Fulfilled

Harold Neyra, general surgeon Born in Lima, Peru, Harold Neyra dreamed of being a doctor one day. He never knew about the many turns his career would take on the way to becoming a general surgeon at Oviedo Medical Center.

After immigrating to the United States with his parents and two brothers in 1993, he graduated from high school and enrolled at the University of Colorado at Boulder.

He thought he’d enter premed but soon gravitated toward biology and environmental science, becoming the second member of his family to graduate college.

Afterward, he worked as a biologist in Denver for four years.

Then came a moment that changed his life.

“My parents made big sacrifices to bring us to America, and they wanted the best for us,” Neyra said. “My mom wanted me to achieve my dream of becoming a doctor, and I always told her I would go back to medical school. She died in a car accident, and that made me fulfill my promise.”

A NEW PURPOSE Driven by a new purpose, Neyra threw himself into his studies at the New York College of Osteopathic Medicine.

He planned to become a pediatrician, because he enjoys working with children.

“I never thought about other specialties, but I fell in love with surgery during my rotations at St. Barnabas Hospital in New York,” he shared. “I was drawn to the possibility of immediately helping people using my hands, skills and training.”

He switched tracks into general surgery, and his training confirmed he was on the right path.

“People from all over the world live in New York City, so we got to see pathologies you don’t see anywhere else,” he said.

“Choosing that path, and learning from those doctors, is the luckiest thing that could have happened to me.”

At one point during his residency, he was on call around the clock in the event of trauma cases at the hospital.

“The highlight of my residency was performing an open thoracotomy for a young man with a stab wound to the heart,” he says. “The mortality rate for that type of wound is around 90 percent, but I was able to save him, and he went home two weeks later.”

DEMANDING THE BEST When Neyra decided to pursue general surgery, some people said his personality was “too nice,” he recalled. “Surgery 3

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is a hierarchical field, with a reputation for being harsh and mentally challenging.

When I’m in the operating room, I try to keep my cool and put myself in the other person’s shoes. I think back to my mom, who used to clean offices at a hospital in Colorado. Everyone deserves respect, but you also need to demand the best from your team. It’s ultimately about the patient.”

Neyra’s pursuit of excellence is most evident in his commitment to performing less-invasive surgeries with more painless recoveries. With that in mind, he is trained on the da Vinci robotic system and stays current on the latest surgical techniques.

He makes the smallest abdominal incision possible, using an optical bladeless trocar only 5 millimeters wide.

“There are so many advantages to the da Vinci robot,” he said. “We can do better dissection, achieve cleaner margins on surgical tumors, and use smaller incisions, which translates to less pain. It allows us to not damage any other organs, because the 3D camera allows us to feel like we’re inside the abdomen.”

Meanwhile, postoperative treatment continues to advance. Neyra is working with Dr. Esteban Varela and the anesthesia team at Oviedo Medical Center to implement an enhanced recovery protocol that helps to reduce the risk of painkiller addiction and return patients home sooner.

COMMUNITY-ORIENTED CARE As one of the hospital’s main general surgeons, Neyra performs a wide range of procedures. The most common are gallbladder removal, hernia repair, colon resections and appendix removal. He also treats reflux disease and small bowel obstructions.

In the future, he hopes to develop Oviedo Medical Center’s breast surgery program to perform more lumpectomies and mastectomies. In addition, he and Dr. Varela are trained in bariatric surgery and working toward developing a full weightloss surgery center at the hospital.

Married to an internist who works at another local hospital, Neyra has a young daughter and son. He enjoys playing soccer and traveling on medical mission trips to Haiti, Kenya and Ghana in his free time.

“I’m excited to be working at a community-oriented hospital, and I believe we can create something big here,” he said.

“We’re making sure patients know that they don’t have to travel far to find a surgeon they can trust.”

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Making Value-based Care Work, continued from page 1

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applying predictive analytics in tandem with clinical expertise, healthcare systems can develop predictive models that will drastically reduce avoidable readmissions. Such models can enable physicians to make pre-discharge decisions and determine if a patient is at low, medium or high risk for readmission.

These analytics assess the variables and have demonstrated how often flags such as socioeconomic factors, follow-up calls and appointments can drastically affect readmission rates. For instance, if a patient doesn’t progress as expected, an analytics flag can schedule a follow-up appointment long before any significant deterioration occurs.

Personalized care: Personalized treatment plans are at the center of attention in healthcare. By specifying genetic and lifestyle information and integrating it with big data, physicians can have clearer, more detailed analysis of their patients, allowing them to choose the best possible treatment and develop a customized care plan. This type of precision-based, personalized medicine can suggest alternatives otherwise overlooked, thereby minimizing side effects and avoiding unnecessary costs for both the patient and the facility. Focusing on highly individualized care not only improves patient outcomes, but also improves consumer engagement and enhances the patient experience.

Predictive analytics’ ability to turn massive amounts of data into actionable insights will help healthcare practitioners identify needs, improve services, predict and prevent crises, and improve patient care.

Dongmin Kim, PhD, is the CTO/Director of the AI R&D Center for JLK Inspection a Seoul, South Korea-based medical solutions provider specializing in AI-based technology. JKL’s universal AI platform is created by a combination of big data, experts, and our own unique engines and algorithms, providing on-site/real-time service, seamlessly connected to all systems.

HEALTHCARELEADER | Matthew Johnston, MD, continued from page 1

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fully implemented, predictive analytics offers foreseeable benefits.

Prevention: Preventive management is a valued advantage resulting from the implementation of predictive analytics because of its capacity to identify patients with potential, high-risk health issues. As lifestyle diseases are reaching endemic proportions, a more critical focus on prevention is mandatory.

Predictive analytics plays an important role in helping physicians detect and predict a wide variety of disorders and diseases, often years before a patient becomes symptomatic.

By pairing a patient’s medical history and symptoms with an elaborate databank that also conducts MRI, CT and X-Ray analysis, diagnoses can be accurately identified. Those patients suffering from serious illnesses such as cancer, heart disease and Alzheimer’s will greatly benefit from the use of predictive analysis technology, which offers earlier and more targeted treatments, helping eliminate unnecessary medications and enhance a patient’s quality of life.

Operational efficiency: Predictive analytics has the potential to significantly improve operational efficiency in a healthcare setting.

For instance, hospitals can predict a cold or flu season by using their own historical data and the use of external sources such as weather forecasts and social media, helping to prepare resources, inventory and improve staffing levels. Analytics are especially valuable in emergencies, where speed is of the essence, because of their ability to quickly gather medical data and inspect test results. In these types of situations, AI can move at speeds that physicians alone simply cannot match.

Improved patient care: When patient care is improved, hospital admissions, readmissions and overall costs are reduced. By

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roscopic surgery by the Society of American Gastrointestinal and Endoscopic Surgeons.

After graduating magna cum laude with a bachelor’s degree in chemistry from the University of South Florida Honors College, Johnston earned his medical degree from Florida State University College of Medicine in Tallahassee. He went on to complete a general surgery residency with Orlando Health and a cardiothoracic surgery fellowship at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina, where he has served as an instructor in thoracic surgery.

Some aspects of surgery – the technical ability to make smaller incisions and the precision of certain procedures have improved dramatically since when the earlier generations of Johnstons were operating. “They didn’t have the benefits of all the tools we have today,” he said.

But other things are timeless. “The number one quality that a surgeon must have is compassion for the patient and what that patient is going through,” said Johnston. Patients are often referred to him before their disease has been diagnosed. “Patients should come into the surgeon’s office with an open mind, expecting that we will listen to them.

Surgery is all about them, and they have a big say in what happens and how.

“My dad always told me that a good surgeon knows when to operate, and a great surgeon knows when not to operate.”

Even though he comes from a surgical heritage, Johnston said his family did not

pressure him to enter medicine or to become a surgeon. They let him decide, and that decision came early.

“Practicing medicine is one of those honorable professions,” he said. “And surgery is more of a hands-on way of treatment. You get to see some of that immediate impact you can have on a patient’s life and help them take care of what’s going on quickly as opposed to treating something with medication for months and then seeing how things respond. You can basically cure cancer in a matter of hours.”

It probably is not surprising that being hands-on is also how Johnston likes to relax.

He is an avid woodworker, who builds furniture. Several tables and a computer desk all are the products of his labor.

If he’s not sawing and sanding, chances are he might be crawling underneath an American-made muscle car, figuring out how to give it a little more muscle. “I still have my first car, a 1995 Mustang GT,” he admits a little sheepishly at first. And then he begins to list all of the things he has done to the car to make it even faster.

But, married with three daughters, age five and younger, Johnston has some more complex responsibilities, too. “I don’t know if any of them want to go into medicine, but it would be great,” he said. And just as it was with him, he doesn’t intend to push his children into medical careers. Yet, you cannot help but imagine what some of those family conversations might be like in the years ahead.

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MEDICAL CITY

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Innovation Through Collaboration

By Andrew Cole, President & CEO, EOCC

Since 1946, the East Orlando Chamber of Commerce (EOCC) has been committed to the growth and development of area businesses and the community. Serving an area more than 440 square miles, the EOCC serves communities East of the I-4 and along the Osceola County line encompassing the 650-acre health and life sciences park known as Lake Nona Medical City. The vision of Lake Nona’s Medical City aligns closely with that of the East Orlando Chamber: Accelerate innovation and growth among business and healthcare institutions.

Lake Nona Medical City has become the home of leading hospitals, universities, research facilities and health science companies, not only advancing healthcare but creating jobs and bolstering the economy in our region. Tremendous growth and increased regulations affecting the healthcare industry elevates the need to achieve security compliance and data security. It is essential for providers to keep a secure level of compliance and measures to combat ever-evolving threats.

Looking to support these measures and the professionals in the field, the East Orlando Chamber developed OPTIC, Orlando’s Professional Technology Innovative Collaborative, bringing together solution seekers and problem solvers to address the technology needs throughout Central Florida. Seeing the value of a strategically focused “tech-totech” council, Lake Nona Medical community partners, UCF, AdventHealth and Orlando Health quickly aligned to support the endeavor as founding members of the group.

Launching the first panel discussion early 2018, a distinguished panel of experts shed light on “Commercialization of Innovation,” the key to entrepreneurial success.

From there, the committee grew organically taking the focus to Cybersecurity with valuable information about the effects on the business, government, and healthcare community. As OPTIC evolves, we will expand Cybersecurity addressing Security Compliance from multiple aspects including auditing, regulations, and employee training to name a few. Now, you may ask, “How does this affect me and my practice?”

Compliance is the baseline that must be met, especially within a healthcare environment. Security and compliance must work hand in hand to ensure patient safety.

One example of a failed system was the WannaCry ransomware attack in 2017, causing many medical devices to become encrypted resulting in a loss of function and a critical issue to patient safety. Imagine conducting surgery or a procedure on a patient and the medical device fails due to a virus or cyber-attack.

Considering U.S. health systems knocked out by WannaCry, the U.S. Department of Health and Human Services (HHS) strongly recommended a protocol within systems to update patches and reimage all infected devices. With key medical and academic institutes in Lake Nona, not to mention a strong number of independent doctors practicing in the area, having a strong protocol in place is essential to protect not only patient data but your practice.

Healthcare continues to be a lucrative target for hackers and, as we saw in 2018, threats continue to get more creative despite awareness among healthcare organizations. It will need more funding from the executive levels to protect your organization. Do not think you are at risk? Tell

that to Missouri-based Blue Springs Family Care. They suffered a breach of 45,000 patient records after hackers hit them with a variety of malware including ransomware.

It is a sobering reminder that your practice must plan and prepare for cyberattacks.

According to Healthcare IT News, “Organizations that underinvest in cybersecurity will spend $408 per record from a data breach.” For Blue Springs Family Care, this equates to a costly $18,360,000.

On January 18, the East Orlando Chamber presents OPTIC, a Compliance Security Briefing. During the Compliance Security Briefing, our panel of experts from Core & Main, Darden, Full Sail University, Leidos, and SafeFirst Partners, LLC will address important factors to consider when designing new technology compliance function; partnering with non-technical teams to understand the technical areas of compliance; and much more. Visit eocc.org for more information or to register for the session.

The East Orlando Chamber is thinking differently for its members and the Lake Nona community offering Health Benefits, Discounts, and igniting a Spark in your business. Check us out at eocc.org or give us a call at 407-277-5951.

CALENDAR: JANUARY 16 Chamber Luncheon: Danielle Hollander Visit Orlando & Board Installation 11:30AM Bonefish Grill

JANUARY 18 OPTIC - Compliance Security Briefing 8:00AM Full Sail University

JANUARY 24 Coffee Club Lake Nona 8:30AM SAM’s Club Lake Nona Please visit www.EOCC.org for a complete listing of January’s 18+ Events

LOWEDOWN | Proper Incident-To Billing, continued from page 2 that a physician is aiding and abetting the unlicensed practice of medicine or nursing.

Physicians and their group practices need to ensure that their NPP’s are licensed or certified to practice in the applicable state before they permit them to render services to their patients and bill those services incident-to.

INSTITUTIONAL SETTINGS Finally, it is important to note that neither Medicare nor Medicaid incident-to billing regulations apply in institutional settings (i.e., hospitals or skilled nursing facilities). Physicians cannot bill Medicare Part B or many state Medicaid programs for services furnished by NPPs in an institutional setting even if they meet all of the other requirements such as direct supervision. Thus, physicians and their group practices must be very careful not to bill NPP services as incident-to when they are rendered in these settings.

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POLICIES, PROCEDURES & COMPLIANCE PLANS In order to prevent billing mistakes and problems with regard to incident-to services, physicians and physician group practices should develop specific policies and procedures for billing these services and make them part of their compliance plans. While the incident-to billing requirements appear to be simple and easy to comply with, many of the recent overpayment, audit, civil false claims act and even criminal cases instituted by the federal and state health care regulatory agencies tasked with overseeing the Medicare and Medicaid programs involve allegations of improper billing for incidentto services.

Michael R. Lowe, Esquire is a Florida board-certified health law attorney at Lowe & Evander, P.A. Mr. Lowe and our law firm regularly represent providers, physicians and other licensed health care professionals, and facilities in a wide variety of health care law matters. For more information regarding those health care law and such matters please visit our website http://www.lowehealthlaw.com.

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GrandRounds Osceola Regional Medical Center Receives Leapfrog ‘Top Hospital’ Award Osceola Regional Medical Center was recently named one of The Leapfrog Group’s 2018 Top Teaching Hospitals. The hospital is one of only four facilities in Florida to receive the award, and the only one in Osceola County. This recognition – which follows the hospital’s ‘A’ grade in The Leapfrog Group’s Hospital Safety Score awarded just last month – showcases Osceola Regional’s commitment to providing safe, high-quality healthcare.

The selection is based on the results of The Leapfrog Group’s annual hospital survey, which measures performance on patient safety and quality, focusing on three critical areas of care: how patients fare, resource use and management structures established to prevent errors. Performance across multiple areas of care is considered for the competitive award, including preventing infections, reducing C-sections, use of technology to prevent errors, surgical quality, and leadership policies and practices.

“Osceola Regional strives to continuously provide top-notch education to the next generation of physicians,” said Davide Carbone, CEO of Osceola Regional Medical Center. “This award, coupled with our ‘A’ grade, validates these efforts and reflects our entire team’s dedication to investing in the future of healthcare.”

Osceola Regional currently offers 7 Graduate Medical Education residencies and two fellowships as a part of a consortium with University of Central Florida’s College of Medicine.

Out of more than 5,500 hospitals, Osceola Regional was one of 53 facilities in the U.S. to receive this prestigious designation, and one of four in the state of Florida. To learn more visit, http://www.leapfroggroup.org/ ratings-reports/top-hospitals.

NetDirector Teams with DocPanel to Provide Rapid Integration and Data Consistency for Radiology Reads and Reports NetDirector, a cloud-based data exchange and integration platform, 6

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has expanded their healthcare datatrading ecosystem by partnering with DocPanel, a digital community of highly-skilled subspecialty radiologists who provide radiology interpretations for both healthcare providers and patients.

With a shared vision founded on providing exceptional patient care and leveraging technology to increase interoperability in healthcare organizations, DocPanel and NetDirector have moved forward with their partnership to increase the ease of deployment and level of integration available to both DocPanel, and the healthcare providers that they engage with.

DocPanel's network of over 300 board-certified, highly distinguished radiologists across 41 states and academic institutions provide unparalleled specialization. NetDirector's cloud-based integration-platformas-a-service (iPaaS) model will make specialty care more rapidly accessible and easier to leverage for the providers who are directly servicing the patients by handling the complex integrations and variety of systems that are ubiquitous in the world of modern day medical imaging data.

"DocPanel was built to make it possible for imaging providers to receive the best possible radiology interpretations available, no matter where they are," states Cate Lloyd, COO of DocPanel. "By partnering with NetDirector, together we will make that world-class service easier to access and more cost effective and interoperable for both the initial provider, and the participating radiologist, ensuring sustainability and availability for all participants," she continued.

DocPanel is initially utilizing NetDirector's HealthData Exchange to receive digital orders from customers and return diagnostic results back to its ecosystem of Imaging Centers. NetDirector allows them to fast-track onboarding of new trading partners and significantly reduce IT resource overhead to maintain a multitude of data interfaces. They are also looking to potentially expand services by utilizing NetDirector's new DICOM image converter to automate the inclusion of PDFs to DICOM directly into the radiologist's reading protocols and eliminate on-premise licensed software.

Additionally, NetDirector's new Health Data Monitor (HDM) makes the whole integration environment easier to monitor and maintain compliance than ever before. Network participants are notified of delays or connectivity concerns in real time through the HDM dashboard and

Alfred I. duPont Charitable Trust Donates $35,000 To Provide Free Medical Care for Uninsured in West Orange County duPont Check Presentation Photo A holiday gift arrived early for the uninsured in West Orange County and throughout the region in the form of $35,000 donation from the Alfred I. duPont Charitable Trust to Shepherd’s Hope. The funds will be used to build support for the buildout of the new West Orange Medical Clinic and Administrative Center in Winter Garden, Fla. A large check was presented during a brief ceremony held at

the clinic. Pictured (from left) are John S. Lord, trustee of the Alfred I. duPont Charitable Trust, board director of The Nemours Foundation, and retired Bank of America Orlando market president; Marni Stahlman, Shepherd’s Hope CEO/ president; Thomas G. Kuntz, trustee of the Alfred I. duPont Charitable Trust, chairman of the Florida Board of Governors, and retired SunTrust Banks/Florida CEO; and Chirag Kabrawala, chairman, Shepherd’s Hope Board of Directors and attorney at Kabrawala Law Group

Dr. Zakaria Razick, Hospitalist Medical Director and 2017-2018 Chief of Staff at Poinciana Medical Center, was recently named Medical Director of the Year for Alliance/Envision HealthCare.

Dr. Razick was selected from a pool of more than 260 physicians, and was recognized for his key performance metrics, leadership skills and successes at Poinciana Medical Center. Dr. Razick also recently pioneered the Hospitalist Program at our sister facility, Osceola Regional Medical Center.

Madeline Kraftchick Named Public Relations Coordinator for First Choice Pediatrics Madeline Kraftchick is a graduate of the University of Central Florida Nicholson School of Communication, graduating with a B.A. in Advertising/Public Relations. She is the first full-time public relations coordinator for First Choice Pediatrics in Orlando. The practice has seven locations across the greater Central Florida area, with locations in Winter Springs, Sanford, Metrowest, Semoran, Kissimmee, Alafaya and Oviedo.

She will be responsible for all the public relations efforts for the practice, including social media, media relations and community events

to promote the practice. Prior to this, she worked for public relations agencies for non-profits, startups, local businesses and luxury travel.

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GrandRounds can respond as needed or engage with their dedicated integration analyst who are domain experts in healthcare workflow and integration technologies.

"Partnering with DocPanel is very exciting – they are at the forefront of their industry, much like we are," said Harry Beisswenger, CEO of NetDirector. "Being able to provide a strong and secure integration solution, while simultaneously reducing costs, ensures that the amazing services provided by DocPanel's team of radiologists can be accessed in a simple and straight-forward way."

CMS Finalizes “Pathways to Success,” an Overhaul of Medicare’s National ACO Program The Centers for Medicare & Medicaid Services (CMS) issued a final rule that dramatically redesigns and sets a new direction for the Medicare Accountable Care Organizations or “ACOs.” ACOs are groups of healthcare providers that take responsibility for the total cost and quality of care for their patients, and in exchange they can receive a portion of the savings they achieve. To ensure the ACO program delivers the most value, Pathways to Success is designed to advance five goals: Accountability, Competition, Engagement, Integrity, and Quality.

The Medicare Shared Savings program (MSSP) launched in 2012 and currently over 10.4 million beneficiaries in Fee-for-Service Medicare (of the 38 million total Fee-for-Service beneficiaries) receive care from providers participating in a Medicare ACO. Most Medicare ACOs currently do not face financial consequences when costs increase, but Pathways to Success will change this. Having more Accountable Care Organizations take on real risk, while offering them the incentives and flexibility they need to coordinate care and innovate, is an important step forward in how Medicare pays for value. Data on ACO performance shows that over time ACOs taking accountability for costs perform better than those that do not. As a result of today’s changes, the projected savings to Medicare total $2.9 billion over ten years.

“Pathways to Success is a bold step towards quality healthcare at a lower cost through competition and beneficiary engagement,” said CMS Administrator Seema Verma. “The rule 7

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strikes a balance between encouraging participation in the ACO program and advancing the transition to value, ultimately protecting taxpayers and patients. Medicare can no longer afford to support programs with weak incentives that do not deliver value.

As we structure new payment arrangements, the impact on the overall market will be top of mind.”

The national program for ACOs in Medicare has been in operation for six years, and over time CMS has learned from these experiences.

Building on this experience, Pathways to Success overhauls the current program to put true accountability in Accountable Care Organizations and promote program-wide savings for Medicare’s ACOs. Pathways to Success implements bold changes including: • Accountability and Competition: The final rule reduces the amount of time that an ACO can remain in the program without taking accountability for healthcare spending from six years to two years for new ACOs and three years for new “low revenue” (physicianled) ACOs, including some rural ACOs. The rule also strengthens incentives by providing higher shared savings rates as ACOs transition and accept greater levels of risk.

• Quality: To increase flexibility for ACOs taking on risk, Pathways to Success expands access to highquality telehealth services that are convenient for patients, including telehealth services provided at a patient’s place of residence.

• Beneficiary Engagement: Pathways to Success promotes beneficiary engagement and improved health outcomes by allowing ACOs to offer new incentive payments to beneficiaries for taking steps to achieve good health, such as obtaining primary care services and necessary follow-up care. In addition, this rule requires ACOs to provide beneficiaries with a written explanation in person or via email or patient portal of what it means to be in an ACO to put patients in the driver seat.

Integrity: This rule establishes rigorous benchmarks by incorporating factors from regional Medicare spending to establish an ACO’s benchmark during all agreement periods, providing a more accurate point of comparison for evaluating ACO performance. In addition, ACOs that terminate their participation will be accountable for prorated shared losses.

In addition to the larger program in Medicare for ACOs that today’s rule

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GrandRounds will impact, CMS is releasing the financial and quality results for the second performance year of the Next Generation ACO Model. The Next Generation model requires participants to assume the highest level of risk out of all CMS ACO programs, and in exchange for this level of risk, Next Generation ACOs receive greater regulatory flexibility. The Next Generation ACO Model actuarial results show that net savings to the Medicare Trust Funds from the model in 2017 were more than $164 million across 44 ACOs. The Model is also showing strong performance on quality metrics.

In connection with the Medicare Shared Savings Program redesign, CMS will offer an application cycle for a special one-time new ACO agreement period start date of July 1, 2019.

Ninety percent of eligible ACOs with participation agreements expiring on December 31, 2018 have elected to extend their agreement for six months, so they have the option to renew their agreement under the new policies and continue to participate in the program uninterrupted. The Notice of Intent to Apply will be available January 2, 2019 through January 18, 2019. The application submission due dates will be posted on the Medicare Shared Savings Program website in the coming days. See the Application Types & Process webpage for eligibility requirements, key timelines, and detailed instructions on the submission process.

For more information regarding Medicare Shared Savings Program Notice of Final Rulemaking (CMS1701-F2), “Accountable Care Organizations‑‑Pathways to Success,” please visit https://www.federalregister.gov/public-inspection/ and https://www.cms. gov/newsroom/fact-sheets/final-rulecreates-pathways-success-medicareshared-savings-program.

Malissa M. Barbosa, DO, Leads as Area Medical Director at CleanSlate Outpatient Addiction Medicine As the number of deaths from synthetic opioids continue to climb across Florida, CleanSlate Outpatient Addiction Medicine helps those struggling with the disease of addiction in Orlando. CleanSlate is a national medical group which provides treatment for the chronic disease of addiction, primarily opioid and alcohol use disorders, through 8

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physician-led outpatient addiction treatment centers where patients receive medication-assisted treatment using the highest quality, evidencebased practices. Patients bear too much of the burden of finding treatment. We help solve this challenge by expanding access and outreach – co-locating with other providers, partnering with community organizations and payers, introducing new services, such as telehealth, to our centers and constantly enhancing our model to meet the evolving needs of patients.

Our Orlando efforts are led by Florida and Wisconsin Area Medical Director Malissa M. Barbosa, DO, a board-certified Family Physician and a fellowship-trained Addiction Medicine Specialist. Barbosa's medical education began at the Philadelphia College of Osteopathic Medicine. She continued her postdoctoral training at Nova Southeastern University/Larkin Community Hospital for residency and fellowship. Barbosa served as both chief resident and chief fellow for the Family Medicine and the Addiction Medicine programs, respectively.

Barbosa went on to serve as a physician leader and champion within the Penn Medicine/Lancaster General Health System and the Orlando Veterans Administration Medical Center before she joined CleanSlate as Center Medical Director in December 2017.

As a leader, Barbosa has worked on various committees addressing patient care needs in the areas of acute and chronic pain syndromes while working within the mental health community to advocate for the standardization of care for acute withdrawal syndromes within the hospital setting. Barbosa serves in the following capacities: Board of Trustee member for the American Osteopathic Academy of Addiction Medicine, Assistant Professor of Family Medicine at the University of Central Florida College of Medicine, and member of the Clinical Care Advisory Committee for CleanSlate.

In recognition of her leadership expertise, Dr. Barbosa was promoted to Area Medical Director within CleanSlate.

Barbosa is active in the Orlando community at-large through her participation on the Orange County Treatment Committee and Seminole County Drug Free Taskforce. She is also a public speaker and advocate providing education and information for professionals, patients, and families.

FAA Approves PONTE HEALTH's Vertical Medical City Development Tallest Building Height Approved for Downtown Orlando in 30 Years On Saturday December 22, 2018, the Federal Aviation Authority issued its Final Determination for Vertical Medical City, a new complex medical project for Downtown Orlando by developer Ponte Health Properties, LLC. FAA approved the larger portion of VMC ORL, a curved structure, to

a maximum of 2 points at 444 Feet AGL (Above Ground Level) and 2 points at 438 Feet AGL. Vertical Medical City, to be built in the northern portion of the Downtown Orlando Central Business District, will be moving forward with pre-construction testing during the early weeks of the first quarter of 2019 and is currently in the Master Planning Phase.

Ascent Audiology and Hearing Announces New Location in Waterford Lakes/Orlando, Florida Dr. Clifton, audiologist and clinic director of Ascent Audiology and Hearing, is excited to announce the opening of a new office in Orlando, Florida.

The new office will have the latest state-of-the-art technology and equipment to provide the best in hearing health care services, including hearing evaluations, video otoscopy, hearing instrument fittings, and aural rehabilitation. “I am very excited to open this new audiology clinic and provide hearing healthcare in my hometown.” - Dr. Clifton For more information or to set up an appointment with Dr. Clifton, please call 407-635-8497 or visit www.ascentaudiologywaterfordlakes.com.

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GrandRounds Women & Wine Benefiting Leukemia & Lymphoma Society - Student of the Year Please join us Wednesday January 30, at 5:30 pm for another awesome Women & Wine - if you haven't been - you are missing out!!

This month's event will be benefiting the Wolverine Heroes, a team running for Student of the Year for the Leukemia & Lymphoma Society of Central Florida. These two young ladies are dear to my heart - Hannah, my daughter, and her BFF, Maddy - have taken on this challenge in the hopes of winning a college scholarship.

Our friends at Breakthru Beverage will be providing a variety of wine selections. Fleming's will be doing the nibbles - all we need is you and your girlfriends to join us for the fun.

We’ll be at Fleming’s Prime Steakhouse & Wine Bar, 933 North Orlando Avenue,Winter Park.

We will be doing some awesome raffle baskets too! You can pre-purchase tickets along with your registration.

Tickets h t t p s : / / w w w. e v e n t b r i t e . c o m / e / women-wine-benefiting-leukemialymphoma-society-student-of-theyear-tickets-54097221245#tickets

Dr. Thomas Price Addresses Infant Mortality Crisis Orange County has an infant mortality crisis.

We now have the second highest infant mortality rate among the urban counties in Florida at 7.2 deaths per 1000 births. Imagine 110 first birthday celebrations not being held last year or 6 kindergarten classrooms sitting empty. What’s also alarming is that 69 of those non-birthdays belonged to African-American families. Our Black babies died at 4 times the rate (15.5) of White babies (3.8) last year in our county. As a medical community, we can do more to lower this poor outcome – and it begins with your support of Healthy Start. · As an OB, make sure EVERY prenatal patient, i.e. 100%, in your practice receives a Healthy Start risk screen. Any woman can be at risk of a poor outcome and Healthy Start’s professional nurses and counselors can offer evidenced-based services that complement your clinical prenatal care. Also, it’s the law that you complete a Healthy Start risk screen for every pregnant woman at her first prenatal visit. (FL Statute 383.14) 9

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· As a pediatrician or family practice physician, refer any infant you have concerns about to Healthy Start. · Dispel the myth that women and infants who need Healthy Start services are only poor, minority or Medicaid patients. Infant mortality affects every demographic and Healthy Start services are available to any patient. · Ensure your staff understands the importance of this risk screen as a tool in the assessment of the woman’s overall health status. Healthy Start staff can offer training on this screening form as well as how their program services can support your patient’s care. · Contact the Healthy Start Coalition for more information about their services at 407-228-1478.

Florida is the only state in the US with a universal risk screen and targeted services available to every woman and infant in every county.

Make sure it works for your patients and help eliminate Orange County’s infant mortality crisis.

Dr. Thomas Price Orange County Medical Society

Orlando Medical News Enters Partnership with Red Fang Marketing Orlando Medical News, in partnership with Red Fang Marketing announce the immediate availability of Reputation Management Services Red Fang Marketing, enabling groups and practices to take control of their reputation online.

"We live in a review-based sales world now," said John Singleton, CEO at Red Fang Marketing. "Modern day consumers have been trained by companies, like Amazon, to research a product and read online reviews before making a purchase decision. This has now carried over from an ecommerce environment into the overall service sector."

Positive Customer Impact Many customers have already benefited from deploying Red Fang Marketing. Orlando Medical News recently committed to deploying Red Fang Marketing and sees the tremendous value it can bring to its readership community.

"With the availability of so many providers competing for new patients, it's now more important than ever to make sure your reputation is on solid ground, especially where all of the eyeballs are, which is online," said John Kelly, Managing Partner & Publisher, Orlando Medical News.

Founded in 2015, Red Fang Mar-

St. Cloud Regional Medical Center Adds New 128-Slice CT Scanner St. Cloud Regional Medical Center has expanded imaging capabilities by adding a second Computed Tomography machine to the facility, a 128-slice Computed Tomography machine. The 128-Slice Computed Tomography (CT scanner) provides patients faster, safer and more accurate diagnosis.

A CT scan is commonly used by physicians to help see inside a patients’ body and to diagnose medical conditions utilizing computers and x-ray equipment to create images. By adding a 128-slice machine, St. Cloud Regional Medical Center is utilizing the latest advances in CT imaging technology to provide increased speed and more detailed information which will provide better diagnostic care and improved patient safety outcomes.

St Cloud Regional Medical Center is an accredited Computed Tomography facility by the American College of Radiology. This means St. Cloud Regional Medical Center meets all requirements for equipment, medical personnel and quality assurances as

surveyed by The American College of Radiology. Adding the 128-Slice CT scanner will assure patients the hospital is providing the highest level of image quality, the safest way possible.

“This addition to our Imaging Department will help support our mission of providing safe, personalized and accessible healthcare to St. Cloud and the surrounding communities,” said Brent Burish, CEO of St. Cloud Regional Medical Center.

The CT Scanner will be housed inside the facility’s newly expanded and renovated Emergency Department, which opened for operations in September of 2018. The ER expansion project added more than 14,000-square feet to the hospital, increased capacity to 20 private exam rooms and enhanced privacy, comfort, and technology in an emergency department that served more than 26,000 patients last year.

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by St. Cloud Regional Medical Center, visit StCloudRegional.com.

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For more information, press only: John Kelly 407-701-7424 jkelley@orlandomedicalnews.com For more information on Red Fang Marketing: https://redfangmarketing. com/

AdventHealth’s Translational Research Institute Participates in National Study You know exercise is good for you — but do you know why?

As it turns out, scientists don’t know either. So researchers are launching a major study to try and find out.

Known as MoTrPAC (Molecular Transducers of Physical Activity in Humans), the study’s goal is to discover why exercise helps the body’s cells and organs at the molecular level. It’s taking place at eleven sites around the country, including the Translational Research Institute for Metabolism and Diabetes at AdventHealth Orlando. Other sites include Duke University, the University of Pittsburgh, the University of Alabama and the University of California-Irvine.

The $170 million project, funded by NIH’s common fund, will involve 1,5002,000 participants nationwide over a period of three years. The TRI will pro-

vide 150-200 of those participants.

Bret Goodpaster, Ph.D., will serve as principal investigator for the TRI portion of the study. He has been involved in the planning for the study for the past few years, after publishing a white paper about science’s gaps in knowledge about the benefits of exercise.

“The study is not disease-specific, because we know exercise impacts all diseases,” Goodpaster said. “But we don’t know the answers to other basic questions: Why do we see variation?

Why doesn’t everyone respond in the same way? Why do some respond better to exercise than others?”

In the initial phase, investigators will track healthy but sedentary volunteers, ages 18-80, ranging from normal weight to moderately obese. The volunteers will take part in a 12-week exercise program, and researchers will collect blood and tissue samples before and after exercise. The study will take advantage of emerging fields of study such as genomics.

This first phase will also set the framework for future studies on populations with specific diseases and conditions.

The tissue samples will be sent to scientists at MoTrPAC Chemical Analysis Sites, who will analyze a variety of molecules that change following exercise, and may transmit the benefits of physical activity even to areas of the body not directly involved in exercise.

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

Central Florida Regional Hospital Announces New CEO Central Florida Regional Hospital, an HCA Healthcare North Florida Division facility, has named Trey Abshier, FACHE, as its new CEO. Abshier will begin his new role with the 221-bed Level II Trauma Center facility on Feb 4. He replaces Wendy Brandon, now CEO of UCF Lake Nona Medical Center, a partnership between HCA Healthcare and University of Central Florida.

Abshier rejoins HCA Healthcare with over 14 years of experience, most recently serving as Chief Executive Officer of Palm Beach Gardens Medical Center in Palm Beach Gardens, Florida. He also served as Chief Executive Officer of Florida Medical Center in Fort Lauderdale.

Trey began his career with HCA Healthcare in 2005 at Medical Center of Arlington in Texas and held several executive positions during his tenure.

"Trey is an accomplished leader who will partner with physicians and employees to carry on Central Florida Regional Hospital's legacy of quality and compassionate care, " said Michael P. Joyce, FACHE, President of HCA Healthcare's North Florida Division. "His experience will be critical in facilitating the continued growth of the hospital to meet the needs of the communities in Central Florida."

He earned his Bachelor's Degree in Human Resources Management from Louisiana State University and his Master's Degree in Healthcare Administration from Trinity University in San Antonio. He is a fellow of the American College of Healthcare Executives.

"I'm honored to join the dedicated team at Central Florida Regional Hospital as we serve Seminole and West Volusia counties and enter a new chapter of growth," Abshier said. "I look forward to getting immersed in this dynamic region as we create the future of healthcare for our community."

Osceola Regional Medical Center Hires New Chief Medical Officer Osceola Regional Medical Center recently announced the appointment of Dr. Joseph Mazzola to the position of Chief Medical Officer. Mazzola assumed his role Nov. 12, 2018.

With more than a decade of experience in healthcare leadership, Mazzola has spent the past eight years as Senior Vice President of Medical Affairs, Chief Medical Officer and Vice President of Medical Education of Carolinas HealthCare System Blue Ridge in Morganton, North Carolina. Previously, he held the roles of Family Medicine Residency Program Director and Chief Medical Information Officer at Floyd Medical Center in Rome, Georgia.

“Dr. Mazzola is a seasoned leader who is skilled in implementing and expanding physician programs, and we are excited to have him join

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Osceola Regional in this role,” said Davide Carbone, CEO of Osceola Regional Medical Center. “He also has more than 15 years of experience in medical education, and our graduate medical education program will greatly benefit from his knowledge.”

During his tenure at CHS Blue Ridge, Mazzola developed the healthcare system’s graduate medical education programs in Family Medicine, Internal Medicine, Gastroenterology and Geriatrics. He also redesigned CHS Blue Ridge’s physician professional review program, fully deployed its computerized physician order entry system and expanded the multispecialty medical group to include more than 40 practices serving three counties in western North Carolina.

“Osceola Regional Medical Center is an outstanding hospital with strong

ties to its community,” Mazzola said.

“The entire staff here is exceptional, and I look forward building on a rich history of top-notch care and leading this team of physicians into the future.”

Mazzola earned his Doctor of Osteopathic Medicine from Chicago College of Osteopathic Medicine at Midwestern University in Downers Grove, Illinois, and is board certified by the American Board of Family Medicine and the American Board of Osteopathic Family Physicians.

He is a Fellow in the American Academy of Family Physicians and American College of Osteopathic Family Physicians and was awarded the designation of Certified Physician Executive by the Certifying Commission in Medical Management in 2016.

Mazzola is currently completing his

Master of Business Administration through Fayetteville State University in Fayetteville, North Carolina.

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Majority of Physicians Unwilling to Recommend Medical Profession

By BILL FLEMING

Seven out of 10 physicians are unwilling to recommend their chosen profession to their children or other family members, according to the nationwide Future of Healthcare Survey of over 3,400 physicians released by The Doctors Company.

By comparison, Florida physicians’ responses fell slightly above the national average at eight out of 10 unwilling to recommend their chosen profession to their children or other family members.

The survey further showed that over half of physicians nationwide say they are contemplating retirement within the next five years, including a third of those under the age of 50.

The survey collected 2,291 written responses voicing physicians’ frustration at how electronic health records (EHRs) and value-based care and reimbursement (pay for performance) are compromising the traditional doctorpatient relationship, indicating their advocacy for preserving this relationship and providing high-quality care.

KEY FINDINGS OF THE SURVEY INCLUDED: • 54 percent of physicians believe EHRs have had a negative impact on the physician-patient relationship.

• Half of physicians believe value-based care and reimbursement will have a negative impact on overall patient care.

• 61 percent of physicians believe EHRs are having a negative impact on their workflow, with many suggesting that EHR requirements are a major cause of burnout.

• 62 percent of physicians say they don’t plan to change practice models, perhaps indicating that the pace of practice change seen in recent years may have run its course.

Watch the video on the Future of Healthcare Survey. The survey was conducted in partnership with Modern Healthcare Custom Media.

SEVEN OUT OF 10 PHYSICIANS UNWILLING TO RECOMMEND HEALTHCARE AS A PROFFESSION

Bill Fleming is the COO of The Doctors Company, that takes the mal out of malpractice insurance by helping hospitals and practices of all sizes manage the complexities of today’s healthcare environment—with expert guidance, resources, and coverage.

Source: The Doctors Company 2018 Future of Healthcare Survey

Visit www.thedoctors.com

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The Attraction of Working in the Medical Marijuana Industry

By MICHAEL PATTERSON

Currently in the United States there are 30 states in which medical marijuana is legal and widely available. There are 10 states in which marijuana is legal for adult use (over 21). Medical Marijuana has been legal in Florida since 2014. By 2020, Forbes magazine has projected that more than 250,000-300,000 jobs will be in the legal cannabis industry.

We are seeing people from all professions wanting to join this new, legal industry. But why? What is the lure of working in a marijuana business? After posing this question to hundreds of cannabis industry insiders, I have collected the most common answers given on why people want to work in legal cannabis: • It is the first time in the modern era where something illegal is now legal.

That is intriguing and exciting for most people. It is the lure of being a rebel, or doing something that you are not supposed to, and getting away with it that drives people to the cannabis space.

• The stigma of working in the marijuana field is starting to disappear. As more states legalize cannabis, the stigma continues to decrease. People start to look at cannabis with an objective and factual point of view, rather than an ideological view as something that is bad for people.

• The ability to start over or bring new skills to a profession that are needed. Some of us have been working in a profession for decades and are burnt out. Some of us have kids, and a mortgage, and other responsibilities that don’t allow a change in professional career. This new legal industry gives people a chance to start over, a chance to reinvent themselves, or a chance to be a part of history.

• Being able to move up quickly because you are not decades behind in experience. It creates a level playing field. The cannabis industry is unique because most people have no experience when applying for jobs. Most cannabis companies expect employees to have no experience and it is not considered a negative when applying.

TYPES OF JOBS IN LEGAL CANNABIS The types of jobs that are in the legal cannabis industry are classified into two categories; direct and indirect jobs. Direct jobs work in areas that actually touch the marijuana plant (jobs related to cultiva12

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tion and processing, working in a dispensary, transporting cannabis, etc.). Indirect jobs are ancillary jobs related to the cannabis industry, but never touch marijuana (accountant, lawyer, general contractor, human resources, software developer, plumber, insurance agent, etc.)

HOW DO I GET INTO THE CANNABIS PROFESSION? Most, if not all, of the medical marijuana companies are hiring in Florida.

However, competition is fierce. If you are interested in working in the cannabis space, I have a few suggestions to increase your chances of gaining employment: • Do your homework - If you apply for a cannabis job and know nothing about the cannabis industry, then you will show prospective employers that you are not serious, and you will not get hired. Read the Florida Medical Marijuana law (Florida Statute 381.986) It is approximately 60 pages. It will help you understand how the Florida Medical Marijuana system operates and allow you to ask educated questions in your interview.

• Network with people in the cannabis industry - Go to cannabis or CBD related conferences, reach out to industry executives on Facebook

and LinkedIn. Let people know your skill set, your background, and your capabilities. Ask people in the industry for advice on what you should work on to be a more attractive candidate. The cannabis industry is growing extremely fast and employers are always looking for talented people that can fill positions they know will be coming in the future.

• Know your worth - Just because you may not have experience in the cannabis industry, does not mean you do not bring expertise and knowledge to help a cannabis company. Explain to companies how your knowledge can bring value to their organization and how their company is much better with you on their team.

• Desperation never sells - When looking for any job, if you portray that you are desperate for a job, it shows a potential employer that you are not passionate about working in the cannabis industry. You are just showing that you want a paycheck, and you will be overlooked for someone who is truly passionate about cannabis and you will not be hired.

• Persistence, Persistence, Persistence

- Just because you met a cannabis executive once, doesn’t mean he or she will remember you when it comes time to hire for a position.

These people are busy and are being approached constantly for positions within their organization.

If you are in contact with people from the industry via social media or in person on a regular basis, they are more likely to remember you and notify you of a position prior to being announced. From my personal experience running many healthcare companies, the people who are the most persistent are the ones who eventually get hired.

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.

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Do You Know Donating Your Plasma Saves Lives?

By SHALYCE D. JACKSON, MBA

Plasma donors are needed to contribute to saving lives based on the donor’s plasma protein and the therapies for the patients it impacts. Plasma donation, (Source plasma) and whole blood donation are critically important activities that contribute to saving lives. Only a small number of people living in the United States who are eligible to donate source plasma or whole blood actually donate.

There are many with rare diseases that these are the only therapies available to treat the chronic condition(s). Plasmaderived therapies replace missing or deficient proteins that allow individuals to lead healthy and more productive lives. The patients that rely on these therapies generally require regular infusions or injections throughout their lives.

WHAT IS YOUR PLASMA USED FOR? • Clotting Factors—People with bleeding disorders are unable to clot blood properly. As a result, a minor injury may result in internal bleeding, organ damage and even death.

• Immunoglobulin or IVIG— There are more than 150 primary immune deficiency disorders (PID).

These individuals have improperly functioning immune systems and do not respond to traditional antibiotics.

Without IVIG, they are exposed to frequent and often serious infections.

• Alpha-1 Antitrypsin—Alpha-1 is more commonly known as genetic emphysema. It is a heredity condition that may result in serious lung disease in adults and lung and/or liver disease in both children and adults.

• Albumin—Albumin is used to treat burns, trauma patients and surgical patients.

• Hyperimmuneglobulins — These are used to treat rabies, tetanus, dialysis patients and organ transplant recipients. They are also used to treat pregnant women who have Rh incompatibility, a condition where the mother and fetus have incompatible blood that can lead to serious injury to the unborn child or even death.

• Alpha-1 Antitrypsin Deficiency — is one of the most common serious hereditary disorders in the world and can result in life-threatening liver disease in children and adults and lung disease in adults. It is often referred to as genetic emphysema.

• Hereditary Angioedema — is caused by a missing C1 esterase inhibitor protein (C1-INH), which helps regulate 13

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inflammation. Patients can experience edema (severe swelling) which can be fatal if the airway becomes obstructed.

• Hemophilia A — a heredity bleeding disorder that is caused by a lack of clotting factor VIII. As a result, individuals with this condition suffer from bleeding into joints and other complications. For the most part, men have hemophilia A as the defective gene is found on the X chromosome.

A woman who has the defective gene is considered a carrier and any male offspring have a 50% chance of having hemophilia A and female offspring a 50% chance of being a carrier. It affects one in 10,000 people. With treatment, individuals are able to lead relatively normal lives.

• Hemophilia B— a blood clotting disorder caused by a mutation of the Factor IX gene. It is rarer than hemophilia A and affected royal families in both Europe and Russia. It affects one in 25,000 men.

Replacement of Factor IX through recombinant therapy allows individuals to lead relatively normal lives.

• Von Willebrand Disease —the most common bleeding disorder, affects about 1.25 million men and women worldwide, although it is estimated that as many as 3 million are undiagnosed.

Common symptoms include excessive menstrual bleeding and nosebleeds.

There are several kinds of VWD and symptom severity varies. With proper treatment, individuals may live relatively normal lives.

• Antithrombin III — a protein that prevents blood clots from forming. It is caused by an abnormal gene that may lead to blood clots. Data on incidence is uncertain.

• Primary Immunodeficiency Disease (PID) — a genetic condition that prevents an individual’s immune system from functioning properly.

The World Health Organization (WHO) estimates that there may be as many as 150 PIDs. PID results a high susceptibility to infection and an inability to fight them with traditional antibiotics.

• Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) — is a rate autoimmune disorder that affects the peripheral nervous system of both children and adults. Nerves in the arms and legs may become weakened and lead to paralysis. It is sometimes referred to as Guillain-Barre Syndrome.

• Idiopathic Thrombocytpenic Purpura (ITP) — is an autoimmune blood

disorder that results in reduced blood platelet levels, essential for blood clotting.

• Kawasaki Disease— a condition that primarily affects children under the age of five and is the leading cause of acquired heart disease in children. If it is not detected, it can result in heart damage and death.

In addition to lifesaving therapies, Plasma Source is also used in everyday medicine and emergency and critical care situations and in preventive medicine for: Burns, Shock, Trauma, Major Surgery, RH Incompatibility, Cardiopulmonary Issues, Organ Transplants, Pediatric, HIV, Hepatitis, Liver Conditions, Animal Bites, and Auto-Immune Diseases.

Source plasma collection in the U.S. is regulated by the U.S. Food and Drug Administration (FDA) and, in Europe, by the European Medicines Agency (EMA) and national regulatory authorities. Source plasma collection centers are also certified by the International Quality Plasma Program (IQPP), a rigorous, voluntary program that goes beyond regulatory requirements to help ensure donor safety and further improve the quality of source plasma used for fractionation.

Source plasma is collected through a process called plasmapheresis. In more than 600 specialized donation centers located in the U.S. and Europe, individuals may donate plasma. Plasmapheresis is a sterile, self-contained, automated process that separates plasma from red blood cells and other cellular components which are then returned to the donor. The requirement To be a successful donor, verification and eligibility assessments are evaluated each visit.

• Be in good health, meaning you feel well and can do normal everyday activities.

• Drink plenty of water or juice to be fully hydrated • Be between the ages of 18 and 66.

• Have a healthy vein in your arm for drawing blood.

• The FDA sets the guidelines and the ranges for weight to be 110-400 pounds. Weigh at least 110 pounds.

• Must not have received ear piercings, body piercings, tattoos or permanent makeup in the past 4 months.

• Must pass a medical examination by on-site Medical Physicians Substitutes.

• Complete an extensive medical history screening.

• Test non-reactive for transmissible viruses including hepatitis and HIV. • You can expect to be voluntarily compensated anywhere from $20 to $50 per donation.

• Local facilities (BPL Plasma, 11601 E. Colonial Drive, 321-235-9100) provide additional promotions for consistent and committed donations.

• A donor can donate up to 2 times in a 7-day period, if there is 24 hours in between donations.

• Donor Eligibility is at the sole discretion of the plasma collection facility.

Because the need for plasma is so great, facilitates are looking for those committed donors. It is only after two satisfactory health screenings and negative test results within six months that you may receive Qualified Donor status. Until you meet the requirements, your plasma will not be used to manufacture therapies.

This is important to help ensure the quality and safety of the therapies that patients need to treat life-threatening diseases.

Visit BPL Plasma Center at 11601 E. Colonial Drive, Orlando, FL 32817, Monday – Friday 6am – 6pm and SaturdaySunday 8am-4pm.

(Source: https://www.donatingplasma.org) A recognized business leader known for implementing vision to achieve business goals, Shalyce Jackson, MBA, serves as a Sales, Marketing and Healthcare & Financial Services and Consultant to the healthcare industry for several Fortune 500 Corporations.

She holds a Florida License in Health & Life Insurance (including Annuities & Variable Contracts) and maintains membership in the National Black MBA Association, and an Advisory Board member of the National Sales Network, Orlando Chapter. She can be reached at shalyce.jackson@bplgroup.com

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U.S. Surgeon General Discusses the Opioid Epidemic From THE DOCTOR’S COMPANY

The Doctors Company 2018 Executive Advisory Board meeting—a gathering of some of the leading figures in medicine in the United States—featured a conversation between The Doctors Company Chairman and Chief Executive Officer, Richard Anderson, MD, FACP, and the United States Surgeon General, Vice Admiral Jerome Adams, MD, MPH. In this article highlighting key excerpts from the conversation, Dr. Anderson and Dr. Adams discuss the opioid epidemic’s huge impact on communities and health services in the United States.

DR. ANDERSON: Regarding the opioid epidemic, what are some of the programs that are available today that you find effective? What would you like to see us do as a nation to respond to the epidemic?

DR. ADAMS: Just yesterday, I was at a hospital in Alaska where they have implemented a neonatal abstinence syndrome protocol and program that is being looked at around the country—and others are attempting to replicate it.

We know that if you keep mom and baby together, baby does better, mom does better, hospital stays are shorter, costs go down, and you’re keeping that family unit intact. This prevents future problems for both the baby and the mother. That’s just one small example.

I’m also very happy to see that the prescribing of opioids is going down 20 to 25 percent across the country. And there are even larger decreases in the military and veteran communities. That’s really a testament to doctors and the medical profession finally waking up. And I say this as a physician myself, as an anesthesiologist, as someone who is involved in acute and chronic pain management.

Four out of five people with substance use disorder say they started with a prescription opioid. Many physicians will say, “those aren’t my patients,” but unfortunately when we look at the PDMP data across the country we do a poor job of predicting who is and who isn’t going to divert. It may not be your patient, but it could be their son or the babysitter who is diverting those overprescribed opioids.

One thing that I really think we need to lean into as healthcare practitioners is providing medication-assisted treatment, or MAT. We know that the gold standard for treatment and recovery is medicationassisted treatment of some form. But we also know it’s not nearly available enough and that there are barriers on the federal and state levels.

We need you to continue to talk to your congressional representatives and let 14

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them know which barriers you perceive because the data waiver comes directly from Congress.

Still, any ER can prescribe up to three days of MAT to someone. I’d much rather have our ER doctors putting patients on MAT and then connecting them to treatment, than sending them back out into the arms of a drug dealer after they put them into acute withdrawal with naloxone.

We also have too many pregnant women who want help but can’t find any treatment because no one out there will take care of pregnant moms. We need folks to step up to the plate and get that data waiver in our ob/gyn and primary care sectors.

Ultimately, we need hospitals and healthcare leaders to create an environment that makes providers feel comfortable providing that service by giving them the training and the support to be able to do it.

We also need to make sure we’re coprescribing naloxone for those who are at risk for opioid overdose.

DR. ANDERSON: So just so we are clear, are you in favor of regular prescribing of naloxone, along with prescriptions for opioids? Is that correct?

DR. ADAMS: I issued the first Surgeon General’s Advisory in over 10 years earlier this year to help folks understand that over half of our opioid overdoses occur in a home setting. We all know that an anoxic brain injury occurs in four to five minutes. We also know that most ambulances and first responders aren’t going to show up in four to five minutes.

If we want to make a dent in this overdose epidemic, we need everyone to consider themselves a first responder. We need to look at it the same as we look at CPR; we need everyone carrying naloxone. That was one of the big pushes from my Surgeon General’s advisory.

How can providers help? Well, they can co-prescribe naloxone to folks on high morphine milligram equivalents who are at risk. If grandma has naloxone at home and her grandson overdoses in the garage, then at least it’s in the same house. Naloxone is not the treatment for the opioid epidemic. But we can’t get someone who is dead into treatment.

I have no illusions that simply making naloxone available is going to turn the tide, but it certainly is an important part of it.

DR. ANDERSON: From your unique viewpoint, how much progress do you see in relation to the opioid epidemic? Do you think we’re approaching an inflection point or do you think there’s a long way to go before this starts to turn around?

DR. ADAMS: When I talk about the opioid epidemic, I have two angles. Number one, I want to raise awareness about the opioid epidemic—the severity of it, and how everyone can lean into it in their own way. Whether it’s community citizens, providers, law enforcement, the business community, whomever.

But in addition to raising awareness, I want to instill hope.

I was in Huntington, West Virginia, just a few weeks ago at the epicenter of the opioid epidemic.

They’ve been able to turn their opioid overdose rates around by providing peer recovery coaches to individuals and making sure naloxone is available throughout the community. You save the life and then you connect them to care.

We know that the folks who are at highest risk for overdose deaths are the ones that just overdosed. They come out of the ER where we’ve watched them for a few hours and then we send them right back out into the arms of the drug dealer to do exactly what we know they will do medically because we’ve thrown them into withdrawal and they try to get their next fix.

If we can partner with law enforcement, then we can turn our opioid overdose rates around.

A story of recovery that I want to share with you is about a guy named Jonathan, who I met when I was in Rhode Island.

Jonathan overdosed, but his roommate had access to naloxone, which he administered. Jonathan was taken to the ER and then connected with a peer recovery coach. He is now in recovery and has actually become a peer recovery coach himself. Saving this one life will now enable us to save many more.

Yet we still prescribe over 80 percent of the world’s opioids to less than five percent of the world’s population. So, we still have an over-prescribing epidemic, but we’ve surpassed the inflection point there.

Prescribing is coming down.

But another part of this epidemic was that we squeezed the balloon in one place and as prescribing opioids went down, lots of people switched over to heroin. That’s when we really first started to see overdose rates go up.

Well, it’s important for folks to know that through law enforcement, through partnerships with the public health community, through an increase in syringe service programs, and through other touch points, heroin use is now going down in most places.

Unfortunately, now we’re seeing the third wave of the epidemic, and that’s fentanyl and carfentanil.

Dr. Adams is the 20th Surgeon General of the United States, a post created in 1871. He holds degrees in both biochemistry and psychology from the University of Maryland. In addition, the Surgeon General has a master’s degree in public health from the University of California at Berkeley, and a medical degree from the Indiana University School of Medicine. Dr. Adams is a board-certified anesthesiologist and associate clinical professor of anesthesia at the University of Indiana. He has been active in a number of national medical organizations, including the American Society of Anesthesiologists and the American Medical Association.

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Top 8 Ways You’re Violating HIPAA … and You Don’t Even Know It

By MARA SHORR AND JAY A. SHORR

Today’s age of technology has brought about an incredible increase in communication and efficiency, making it easier than ever for practices to communicate with their current and prospective patients instantaneously.

However, we’re finding that more and more medical practices are violating the HIPAA rights of their patients without even knowing it. In the spirit of keeping as many doctors out of trouble as possible, here’s a list of the top tips to keep your medical practice HIPAA compliant.

1. Review the verbiage on all of your photo consents prior to sharing ANY of your patients’ Before and After photos. For instance, make sure that patients are consenting to allow the practice to use the photos and patient testimonials for your patients’ records, to show to other patients, on the practice’s website, print and on-air marketing AND digital marketing campaigns, including, but not limited to, social media. Include the option of the patient’s identifying features being blurred out, if this is an option. No patient photos should be published on ANY marketing channels without the patients’ express written consent! Don’t assume your staff has completed this process. Remember, YOU are ultimately the responsible party.

Confirm with the patient who is able to share these photos. For instance, are the patients’ photos able to be shared on the practice’s social media platforms only, or are your mid-level providers are able to share on their own Instagram account as well? Be sure to outline these policies, in writing, not only with your patients, but with your staff as well. This is two-fold process… your photo consents must outline where the photos can be shown, and by whom.

2. When responding to a patient complaint on any review site, such as Yelp or RealSelf, keep your response generic. If a patient were to outline, in detail, how horrible your staff treated them, refrain from describing your side of the account in detail. Instead, educate your staff with a generic response that does not share any patient-specific information. For example: Thank 15

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you for letting us know of your prior experience. We value every experience inside our practice, and would like to discuss this with you personally. Please call our office at 555-5555 and ask for Sue.” 3. Correspond via Email or text message with a patient only when you are certain you are using a HIPAA compliant platform.

Many email platforms, such as Office365, allow their account holders the option of securing their emails on a HIPAA-compliant platform... but only after you opt-in to this selection. (It’s not automatically done!). However, doing this is typically as simple as checking a box on the user’s end, and helps make sure your email stays secure. Although more and more practices are allowing their staff to correspond with their patients through text messages, beware that this is not-HIPAA compliant. Third party platforms can certainly be explored in order to remedy this.

4. Store patient photos and notes only on a secured platform or through a HIPAA compliant app or software, not on your smartphone’s “Photos” or “Notes” section. Consider this: what happens if you leave your phone unattended? (We can’t tell you how many phones we’ve found in the bathroom!). Even a password-protected phone can be easily broken into, and in a moment, all of your patients’ information is in the hands of a stranger.

5. Screen protect your reception desk’s computer monitor. A simple screen cover can keep private patient information away from curious eyes at checkout. When a passerby glances at the computer screen from anywhere but the perfect angle, all they’ll see is a black screen.

6. Don’t allow paper charts to be seen hanging on the entrance to the exam room. If you are so inclined to place the patient chart in a box or clear leucite cover on the wall, ensure that the patients name cannot be seen.

Finally, make sure you have a Business Associate’s Agreement signed by every vendor who either

deals with your patient information online OR in your office. Yes, it may seem like overkill, but all it takes is one person see a copy of your patient’s paper chart or electronic medical record open at the reception desk, to turn a “whoops” into a lawsuit.

In today’s world, it’s easier than ever before to accidentally violate your patients’ privacy. Simple precautions will make all the difference.

Mara Shorr, BS, CAC II-XIII serves as a partner, as well as the Vice President of Marketing and Business Development for Shorr Solutions, assisting medical practices with the operational, financial and administrative health of their business. She is a Level II - XIII Certified Aesthetic Consultant and program advisor, utilizing knowledge and experience to help clients achieve their potential.

A national speaker and writer, she can be contacted at marashorr@shorrsolutions.com.

Jay A. Shorr BA, MBM-C, CAC I-XIII is the founder and managing partner of Shorr Solutions. He is also a professional motivational speaker, an advisor to the Certified Aesthetic Consultant program and a certified medical business manager from Florida Atlantic University. He can be reached at jayshorr@shorrsolutions.com. More information on Shorr Solutions can be found at www.ShorrSolutions.com.

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Office Economics: Patient Experience Improved by Smart Lighting

By DAVID PARRETT

Lighting design for medical offices is no longer about choosing a fixture and flipping a switch on in the morning and off at night. New smart technologies are connecting lights with other essential building systems and sensors that can turn lighting into the brain of an office space. Smart lighting solutions can monitor occupancy levels, monitor heating and cooling, adjust lighting levels based on occupancy and daylight availability.

And, all of this can be controlled from a simple to use app.

Imagine an office space where the lights automatically turn on when the first employee arrives in the morning and turn off a short time after the last employee leaves at night without anyone putting any thought into it. Bathroom lights, exam room lights, lab lights, personal office lights all flick on the moment someone sets foot into a space. And, as the sun shines into the lobby or evening descends the lights dim or brighten based on the amount of natural light filtering into the space. All of this is now possible.

Connected lighting is turning on new opportunities for medical offices to reduce energy usage and costs while also improving aesthetics. Instead of lights remaining on all day or only at one lighting level sensors and schedules can be used to auto-adjust lighting. In the morning and evening, schedules can be set to raise or dim the lights based on the amount of daylight sensors detect filtering in through the windows. Dimming lights during the middle of the day can create compounding cost-savings over time. The color tone of lighting can be changed depending on the time of day or weather conditions. Customizing the lighting of an office by day or by hour based on the environment can make the space more appealing to patients increasing their comfort and potentially boosting their loyalty. The same effect can be had on employees.

In many common areas, connected lighting systems can eliminate the need for light switches. In medical offices this can be paticularly important in reducing the spread of germs. Motion sensors can be installed to automatically turn lights on and off as well as ventilation fans in areas like washrooms and kitchens.

Just like smart assistants and connected lighting systems are making home life more convenient, similar features adapted for office needs are achievable but before upgrading to a connected lighting system it is important to plan for 16

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the future. As new software is developed to improve system efficiency and safety, it is vital that a network of devices be able to upgrade and offer the latest features.

Think of it this way, no one would want to buy a new phone or computer every time a software update is issued. It is easier to just download the update, restart your system and continue with business as usual. While lighting and sensor updates may not be required as frequently as smartphone or computer updates, over time systems can become obsolete.

Having the ability to execute over-the-air updates can make it easier to improve system efficiency and keep systems in alignment with the latest features at all times.

Keeping connected lighting systems up-to-date can also be important for maintaining strong cyber security defenses. New internet-based security threats emerge daily, and many of these threats attempt to infiltrate and inflict harm on unprotected networks. Although lighting control networks are typically separated physically (and virtually) from a company’s Information Technology (IT) network, the threat of intrusion can-

not be underestimated or ignored. The ability to consistently update the lighting control system and all connected devices allows for the latest, most advanced security measures to be implemented as new threats are identified. While network security is normally not a concern for inspectors as more and more buildings incorporate IoT systems, and if future threats arise that compromise these systems, this could become a new area of regulation, especially since medical records are already a hot target for cyber criminals.

Another factor to consider when selecting a connected lighting system is whether to go with fixture-based or areabased controls. Generally, most medical offices will be best served by a blend of the two options. The area-based approach makes the most sense in a bigger and more heavily trafficked space such as a lobby or storage areas where large pools of light are perfectly acceptable, and where individual luminaire control is not needed. Fixture-based controls would be ideal for individual offices, exam rooms and other areas where being

able to isolate light fixtures individually is preferable. Different solutions within different spaces in a single building makes more sense and lessens the cost burden of investing in a connected lighting system.

In an age of smart homes and buildings, consumers will be more likely to frequent businesses where technology is an emphasis. Connected lighting is a smart decision for medical offices that are concerned about reducing energy usage, want the benefits of cost savings as a result, and who are interested in how technology can influence and even improve business, employee production and the overall customer experience. New advances are made in medicine every day, don’t leave your office in the dark ages by relying on old fashioned lighting when there is a better way to manage lighting.

David Parrett is Director of Product Marketing for Cortet, the leader in smart building IoT technologies, creating the industry standard for compatibility and performance, about how medical offices can benefit from smart lighting beyond simple cost savings and energy reduction. Visit www.cortet.com.

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HEALTH INNOVATORS

19 Curiosities of Medicine

By KELLI MURRAY, MedSpeaks

preventable chronic conditions such as obesity and diabetes. Back in 1987, Steven Gortmaker, a Harvard Chan researcher and study co-author, found that between 1963 and 1980, in children ages 6 to 11, there was a 54 percent increase in the prevalence of obesity and a 98 percent increase in what was then called super-obesity.

TVs, computers, and the “modern” food era has made the USA the ultraheavyweight contender to beat dollars per pound.

While I don’t carry the immeasurable responsibility of a doctor or surgeon, 2018 was an incredibly hectic year filled with exhilarating achievements, community-impact and, clearly not enough humor, wine, or exercise.

To mix things up, let’s kick into 2019 with 19 bite-sized facts that are at times a bit kitschy, mostly ingenious, and mixed with a pinch of folklore.

1.

2.

3.

4.

5.

6.

7.

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Why does room temperature coffee taste so bad? Certain taste bud receptors are most sensitive to food molecules that are at or just above room temperature. So hot coffee may seem less bitter because our bitter-detecting taste buds aren’t as sensitive (and at hot temperatures the aroma of coffee is at its peak which engages our nasal sensory cells).

By the age of 60, most people will have lost about half their taste buds which may explain why my mom seems to enjoy her cup of joe at room temp!

Scientific research confirmed that love is as potent as medicine when it is present and has an equally dramatic effect when it is withdrawn. A study of male patients in hospital cardiac units who, when asked “Do you feel loved?” are more likely to recover if their answer was positive over those patients who responded negatively.

Speaking of love, way back in 1859, the founder of nursing, Florence Nightingale, spoke of the positive effects of pet therapy, stating that a small animal “is often an excellent companion for the sick, for long chronic cases especially.”

At Stanford, one study demonstrated that women with breast cancer survived longer if they participated in group therapy sessions in conjunction with their chemical and surgical treatments.

An fMRI study revealed that for longterm couples there is an increased activation in the part of the brain that controls pain. A CDC report found in a study of more than 127,000 adults, that married people are less likely to complain of headaches and back pain. (Maybe it’s because the complaint falls on deaf ears?

The study didn’t say for sure.)

In 1960, the per capita cost of health care was $147 per person in America; adjusted for inflation, it would be $1,082 today; that means the US’s current per capita cost has grown over 660 percent above and beyond normal inflation.

Let’s fatten this up a bit more...75 percent of today’s healthcare spending is on patients with one or more mostly

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8.

9.

Physicians keep their patients waiting for an average of 38 minutes, according to a paper published in The American Journal of Managed Care. Maybe we should change waiting rooms to workout-while-you-wait rooms?

A recent Journal of Neuroscience study on laughter shows that laughing with others releases potent endorphins in the brain via opioid receptors. The more opioid receptors someone’s brain has, the more powerful the effect. Opioid drugs, such as heroin, bind to those same receptors which suggests that laughing induces a similar euphoria sans the negative side effects. :D

10. A Harvard dentist, Dr. George Franklin

Grant, joined the Department of Mechanical Dentistry in 1871 and became the university’s first black faculty member. By 1899, he invented and patented the wooden golf tee which replaced the need for golfers to carry sand buckets and place “their balls” on little sand piles.

11.

A doctor from Brazil, who was fed up with the burglars climbing over her property’s metal fence and stealing her belongings, reportedly taped HIV-infected syringes to the fence along with the warning, “Wall with HIV positive blood. NO Trespassing.”

12.

Born twice...pediatric surgeons Dr. Oluyinka Olutoye and Dr. Darrell Cass, removed a baby from the womb at 23-weeks to cut out a sacrococcygeal teratoma tumor then placed the baby back inside the womb until its healthy delivery at 36 weeks.

13. Surgeons wear green or blue-colored

scrubs because they are complementary colors to red (yes, think blood).

The color combination allows surgeons and their teams to better visualize the patient’s inside, lessens eye strain, loss of concentration and what’s known as the ‘after effect’ illusion.

14. Among Native American traditions,

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to pharmacological pills or tonics to treat or cure disease but rather to anything that has spiritual, physical, and emotional power. Healers recognize, however, a difference in “the diseases of civilization,” which often need what’s referred to as “white man’s medicine.”

15. A July 2006 report from the National

Academies of Science’s Institute of Medicine claimed that doctors’ illegible handwriting killed more than 7,000 people each year. Many errors were the result of - u n c l e a r - abbreviations and dosages.

Hopefully that problem has been cleared up with EMRs and common sense.

16. According to the biography of Chinese surgeon, Hua Tuo, Tuo created an anesthetic liquor which was a concoction of “cannabis boiling powder” dissolved in wine. Unfortunately, his prescription recipe was lost or destroyed, along with all of his medical writings after he was executed by a warlord, a patient whom Tuo no longer wished to treat.

17. Diabetes was first identified as early as

1500 BC, and in 600 BC when physicians recorded that ants were attracted to sugar in patients’ urine. During the Middle Ages doctors created a “Urine Flavor” chart which enabled physicians to accurately “taste test” a patient’s pee for diabetes. Um, no thanks. I’ll pass.

18.

At Carnegie Mellon University, researchers found that people with positive emotions are less likely to get sick after exposure to cold or flu viruses.

The study, published in Psychosomatic Medicine, compared people who were happy and calm with those who appeared anxious, hostile, or depressed.

I’m happy as can be! No flu shot for me!

19. Words are strong medicine. “A people

are as healthy and confident as the stories they tell themselves,” writes the Nigerian novelist Ben Okri. He adds, “Sick storytellers can make nations sick.” Given our country’s sensationalized and negative news, going on a media-free sabbatical may just be what the doctor ordered, eh?

Cheers to a positive, balanced, and loving 2019 with a twist of humor for good health!

——

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Prescription for Buying and/or Selling a Practice

By MICHELE NICHOLS

If trends continue, 2019 will be a year when many local physicians acquire or sell a practice. One of the factors is the change in the workforce. The State of Florida’s 2017 Physician Workforce Annual Report noted that up to 15 percent of physicians in Orange County plan to retire in the next five years. That report also noted that between 2012-13 and 2016-17, Orange County saw an increase of 13.7 percent in the number of practicing physicians.

What also continues to trend is the increasing number of established physicians who transition their businesses to hospitalowned practices. According to a report issued in March 2018 by the Physician Advocacy Institute, hospitals acquired 5,000 physician practices between July 2015 and July 2016. The southern region of the nation has seen a 125 percent increase in the number of hospital-owned practice locations between July 2012 and July 2016.

Below are five important actions to consider before buying or selling a practice:

TAKE A MULTI-DISCIPLINARY APPROACH

Physicians aren’t the only ones who offer referrals. As an experienced healthcare practice lender, I often advise on the importance of assembling a team who can help facilitate a sale and protect the buyer’s or seller’s interest.

In addition to a banker who specializes in the field, this can include an attorney, accountant and valuation expert, among others.

PREPARE FOR THE CHANGE

CREATE A FINANCIAL FORECAST

However, you cannot ignore the past/ potential revenue of the practice, which is difficult to gauge for several reasons not the least of which is the lack of metrics as the payment model shifts from fee for service to fee for value.

Of course, there is also pricing and billing challenges as the government or health plans typically set the price and remittance for a single invoice may come from a number of parties in various ways including from cash, checks, credit cards and health savings accounts.

Today, those getting their house in order to sell or physicians planning to acquire or launch a successful practice have technology on their side for revenue cycle management. At BankUnited we have the treasury management tools and solutions that allow

practices the ability to treat every financial encounter the same, despite the payer. The collections are then automatically posted to the bills with a lower error rate freeing the office staff from coding and data entry.

DUE DILIGENCE IS REQUIRED

In addition to a billing audit, a prospective buyer will review office and equipment leases, managed care contracts, other contractual agreements such as service agreements, medical records documentation and any legal issues or potential litigation.

In transitioning to a hospital-owned practice, it is important to understand how billing, coding and documentation may change as well as if the hospital will offer marketing support as it integrates the practice into its service lines.

To finance an acquisition or buy equipment, buyers may need medical office financing, working lines of credit or perhaps debt consolidations.

Just as you may plan renovations to sell or buy a home, there may be improvements that can be made in terms of instituting online and mobile banking solutions that offer access to account activity in real time and automate many bookkeeping functions.

Practices can improve velocity of cash flow, reduce errors and maximize efficiency when lockbox services that process deposits and transmit remittance data are combined with revenue cycle management platforms.

As in medicine, consult a specialist. Regardless of where you are in your medical career, we can assist in practice acquisition, partner buy-in or buy-out, expansion, refinance and start-ups.

With 14 years of industry experience, Michele Nichols is currently serving as Assistant Vice President in Business Banking with BankUnited. She is responsible for business development, portfolio administration, and client relations. A resident of Longwood, Michele supports the Florida Association of Veteran Owned Businesses, Feeding Children Everywhere and the Children’s Home Society of Florida, to name a few. She earned a bachelor’s degree from Rollins College in Winter Park. Michele is currently based at 189 South Orange Avenue, Orlando. For more information, please call Michele at 407-308-3514 or mailto:mnichols@ bankunited.com.

KNOW THE VALUE

BankUnited’s localized underwriting gives us a unique understanding of the marketplace and one of the most common questions I get asked is how we determine the value of the practice. Whether considering entering into a practice or exiting, the uncertainty remains of “What is it really worth?”

In terms of lending, the value of a medical practice is the price at which a subject practice would exchange hands between a willing buyer and a willing seller, when neither party is forced to buy or sell. It takes into account the special advantages of an established practice such as practice reputation, location, practice management and professional referrals which contribute to earning potential.

The value of a medical practice is determined by the likelihood of retaining existing patients and attracting new ones. The emphasis is on the amount of goodwill that can be transferred from one doctor to another. This differs from a non-medical business where the emphasis is on goodwill that stems from trademarks, product lines, brand name, etc. Often such factors as the personality or credentials of the new physician will determine whether a patient continues to seek treatment by the acquirer of the practice.

The most common way to assess the true value would be to obtain an independent appraisal for the practice. If an appraisal is obtained, the appraised value will typically supersede any average revenue methods of value.

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