Orlando Medical News January 2020

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Physicians Society of Central Florida Releases 2020 Legislative Agenda Session convenes January 14 As the 2020 Florida Legislature gets ready to convene, the Physicians Society of Central Florida (PSCF) is supporting a patient-focused healthcare agenda.

“There are a lot of issues related to access to treatment and care for patients that we serve, and we’ve launched some good patient protection initiatives,” said Fraser Cobbe, executive director of PSCF. Cobbe says that since it is an election year, historically it’s not unusual for some big-ticket items to fail, so physician support is important.

PRIORITIES FOR THIS SESSION Elements of the highest priority pieces of legislation for this session have been before the legislature previously and did not pass.

“Among the priorities for us are Senate Bill 820 and House Bill 373, which makes sure that patients have access to certain cancer treating drugs, especially related to stage 4 metastatic cancer medications that patients are reporting difficulty acquiring in (CONTINUED ON PAGE 2)

ON ROUNDS PHYSICIAN SPOTLIGHT Ajay Mangal, MD, MBA ... 5 EOCC MEDICAL CITY 2020 Focus for the New Year ... 6

Improving Return on Your Medical Office Investment ... 9 Cultural Diversity Creates Language Barriers: Reducing Claims with Multilingual Patients ... 10 Why Remote Patient Monitoring is Failing ... 15

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Jewett Orthopaedic Clinic and Orlando Health Partner for New Orthopedic Hospital

The expanded relationship makes Orlando Health’s orthopedic education program the most prominent in the Southeast ORLANDO, (January 6, 2020) – In a move that continues the trend of health system acquisitions, Jewett Orthopaedic Clinic and Orlando Health have announced the two

healthcare organizations have united. Under the arrangement, Jewett Orthopaedic became part of Orlando Health on December 31, 2019. Jewett Orthopaedic physicians and team

members will be fully integrated into Orlando Health. The current practices of Jewett (CONTINUED ON PAGE 4)

What’s in your Lobby?

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Physicians Society of Central Florida Releases 2020 Legislative Agenda, continued from page 1 a timely manner. As well, we are looking at retroactive denials. This legislation would prohibit health insurers, once they’ve given physicians the treatment authorization to perform a procedure, to later come back and deny that claim based on the patient not being eligible for those services. That’s something that we’ve tried to get passed the last three or four years and we’re going to try and do it again,” said Cobbe.

There’s also a new component of that bill that looks at surgical procedures, in particular, that is modeled after successful language that has moved legislation in Washington.

“We are seeing in our surgical specialties, situations where surgeons determine a necessary procedure based on diagnostic imaging or whatever, they’ll get that procedure authorized from the carrier and then when the physicians begin the procedure, they determine that the procedure they planned on performing should change slightly in the patient’s best interest. And then, of course, that gets reported with a different CPT code. We’ve been seeing the insurers deny these claims for years because the procedure that was ultimately performed is not the one that was originally authorized,” he said.

It starts an administrative nightmare trying to go back and get the ultimate procedure reimbursed.

“So, we do what we’re supposed to do and just perform the proper procedure, and then just try and chase the paperwork later on. We think there’s a common-sense

solution that if a surgical procedure is in a family of other common surgeries and you’ve got treatment authorization for one, and you’re treating that underlying condition, the carrier should not be able to deny payment, if what is ultimately performed changes slightly,” Cobbe said.

The second legislation on the list is Senate Bill 696 and House Bill 561. This one is also pro-patient to make sure that when patients sign up for an insurance, they can stay on the medications they need to be on and not switched off. That gives some protection for patients, and it’s something that’s going to impact the insurance industry.

“Potentially they’ll probably say that protection is going to increase premiums on patients. Whenever we get into that scenario where the carriers are saying premiums are going to go up if we implement this patient protection, that’s typically where we have difficulty getting those bills passed. We think it costs more money downstream by switching a patient off a drug that’s working and put them on something that is not working and causes their condition to deteriorate,” according to Cobbe.

In this legislation, there’s also a component addressing situations where patients really struggle to afford their medications.

There are cost sharing opportunities from foundations and other entities where patients receive either coupon codes or discounts from manufacturers to help pay for out-of-pocket costs to make sure they can purchase those medications.

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“Many of the carriers are not applying those third-party assistance programs to the patient’s out of pocket match they must reach before insurance kicks in. We don’t think that’s right. If a patient is able to find a foundation or other source of assistance to ensure they can meet their copay, the carrier should be obligated to accept that money as contribution to their copay rather than making the patient actually come up with the funding on their own,” he stressed.

Cobbe says the patient shouldn’t be penalized and be potentially limited in their access to a medication just because the money’s coming from a third-party source rather than direct from the patient.

As for society opposition, there is legislation – HB 607 and HB 389 – for expansion in scope of practice. The Speaker of the House has supported this concept and first hearings have already occurred. (See box for further information.)

Physician members are encouraged to join in lobbying legislators during two Physician Day visits to Tallahassee, February 10 and 11.

Meanwhile the PSCF will be offering, once again, its weekly webinars for physician members to be updated on current healthcare related legislation by registering at https://pscfl.org The group will also be sending newsletters and pushing alerts via emails.

BILLS SUPPORTED:

Health Insurance Prior Authorization

(SB 820 Harrell & HB 373 Massullo) Prohibiting health maintenance organizations from excluding coverage for certain cancer treatment drugs; prohibiting health insurers and health maintenance organizations from requiring, before providing prescription drug coverage for the treatment of stage 4 metastatic cancer and associated conditions, that treatment has failed with a different drug; requiring health insurers to provide and disclose procedures for insureds to request exceptions to step-therapy protocols; prohibiting health insurers, under certain circumstances, from retroactively denying a claim at any time because of insured ineligibility, etc.

IMPORTANCE TO PSCF

Insurance Carrier use of prior authorization processes and step therapy protocols has restricted access to certain medications and has created a major burden for physicians and patients securing medical necessary services. In addition to denied or delayed treatment, a report from the Annals of Internal Medicine revealed that for every hour a physician spent seeing patients, another two hours were spent on (CONTINUED ON PAGE 3)

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Physicians Society of Central Florida Releases 2020 Legislative Agenda, continued from page 2 paperwork and dealing with treatment protocols. This legislation will restore common sense to coverage decisions and step therapy protocols. It will also end the process of retroactive denials where physicians are financially harmed by acting on behalf of and with prior approval from insurance carriers. It will also enact a surgical exemption to make sure patients are not subjected to a second or unnecessary surgical procedure if a surgeon has to change the authorized procedure during the course of surgery.

Prescription Drug Coverage (SB 696

Mayfield & HB 561 Altman) Requires individual & group health insurers & HMOs to provide notice of prescription drug formulary changes; specifies requirements for notice of medical necessity submitted by treating physicians; specifies coverage requirement & restrictions on coverage modification by insurers & HMOs receiving such notice; requires insurers & HMOs to maintain record of formulary changes; requires small employer carriers to comply with requirements for prescription drug formulary changes; requires insurers & HMOs to apply reductions in out-of-pocket expenses for prescription drugs toward cost-sharing obligations.

IMPORTANCE TO PSCF

Cost and availability of drugs is becoming more of a critical consideration for patients, especially those in vulnerable patient populations.

This legislation requires carriers to provide adequate notice of formulary changes and provides treating physicians an opportunity to bypass the formulary change if it presents a danger to the patient. The bill also requires carriers to accept third party contributions as means for patients to meet their co-insurance and co-pays.

Peer-to-Peer Support for First Responders

(SB 160 Perry & HB 573 Casello and McClain) Prohibits certain persons who provide peer-to-peer support to first responders from testifying or divulging specified information; prohibits liability & cause of action.

IMPORTANCE TO PSCF

Given the nature of their duties, there is ample evidence that the burden of mental health disease and burnout in First Responders is extremely high. Often First Responders seek counsel and support from their peers who understand the unique pressures and realities of the profession. Early peer support is an important mechanism for First Responders to deal with burnout and mental health conditions. The PSCF supports this legislation that will make sure First Responders can seek counseling and support from their peers with the knowledge that those conversations are protected from discovery.

Keep our Graduates Working

(SB 356 Hutson & Diaz & HB 115 Duran) Prohibits state authority from denying or suspending or revoking person’s professional license, certificate, registration, or permit solely on basis of delinquency or default in payment of student loan.

IMPORTANCE TO PSCF

The burden of medical school loans for medical students has become a crisis. The average medical school debt in 2016 was $190,000 and 25% of medical school graduates are carrying debts over $200,000. While solutions to this crisis are explored, we need to make sure you’re young physicians do not face the threat of losing their ability to prac-

tice the profession if they are unable to meet a debt obligation. The State has a vested interest in not throwing away the investment in state resources we have made on a medical student that may have a temporary inability to satisfy their loan payment.

Prescription Drug Donation Repository Program (SB 58 Harrell & HB 177 Duran) Creates Prescription Drug Donation Repository Program within DOH; provides criteria & conditions for donation of prescription drugs & supplies from certain authorized entities for dispensing to eligible patients; authorizes Governor to waive program patient eligibility requirements during declared state of emergency.

IMPORTANCE TO PSCF

The ongoing impact of rising drug costs and an inability for many patients to afford their medications has been well documented. According to the Kaiser Family Foundation, “The groups most likely to report difficulties affording their medications include people with monthly drug costs of $100 or more (58 percent), in fair or poor health (49 percent), with annual incomes less than $40,000 (35 percent), or taking at least four drugs monthly (35 percent). Three in ten 50-64-year-olds report problems affording drugs.” We strongly support the creation of safe mechanism for patients to return unused medications that can be repurposed and made available to patients that are unable to afford the medications they need.

READ THE MONTHLY

DIGITAL EDITION

Prohibited Acts by Health Care Practitioners (SB 500 Harrell & HB 309 Massullo) Authorizes disciplinary action to be enforced by DoH for use of specified names or titles without valid license or certification to practice as such; provides penalties.

IMPORTANCE TO PSCF

Transparency and accuracy in qualifications is critically important for patients that are in need of medical care. Patients deserve to have a clear understanding of the level of training and expertise of the medical professionals in which they entrust their safety and well-being.

BILL OPPOSED:

Scope of Practice Expansions

(HB 607 Pigman & HB 389 Sirois) The PSCF is committed to a high-quality standard of care for all Floridians regardless of their economic status or health insurance coverage. We must protect the safety of Florida patients and ensure they receive care from the most qualified people trained to deliver that care. We firmly believe that high-quality care can only be achieved by a well-trained team of professionals under the supervision of a physician.

Non-physician practitioners are valuable members of the health care team but they are limited by their education and training. Physicians are the only members of the health care team who have the broad clinical experience and training to exercise independent judgment and provide overall direction of a patient’s care. House Bill 607 would enact autonomous practice for Advanced Practice Registered Nurses. House Bill 389 would enable pharmacists to test and treat Influenza and Streptococcus.

CONTACT JAY BEST 904-834-5558, jbest@nahakama.com

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Jewett Orthopaedic Clinic and Orlando Health Partner for New Orthopedic Hospital, continued from page 1

Orthopaedic Clinic and Orlando Health Orthopedic and Sports Medicine Group, formerly known as Level One Orthopedics, will begin working to leverage the strengths of both groups for the benefit of the region.

The partnership brings together three key elements in orthopedic care that set the program apart from others across the nation: a robust outpatient practice provided by recognized leaders in private orthopedic and sports medicine, an internationally known trauma program, and one of the nation’s top training programs for orthopedic physicians.

“This partnership brings together two organizations that have the vision to elevate care, training and innovation in orthopedics, said Mike Jablonski, MD, president of Jewett Orthopaedic Clinic. “We are excited to join an active, integrated, high-quality healthcare system like Orlando Health and help usher in the next generation of orthopedic care.”

“Orlando Health is thrilled and honored to partner with Jewett,” said David Strong, president and CEO, Orlando Health. “Jewett is recognized for providing extraordinary care to patients. We are pleased to welcome Jewett to the Orlando Health family.”

With an outpatient and clinical practice that cares for more than 250,000 patients annually across eight offices, Jewett brings to the relationship more than eight decades of innovation in orthopedic care, including the design and development of several total hip, knee and shoulder replacement systems used worldwide. Orlando Health is home to Central Florida’s only Level One Trauma Centers for adults and children that are among the busiest in the state; caring for thousands of people, the vast majority requiring some level of orthopedic care.

With more than 70-plus years of excellence in graduate medical education, the Journal of American Academy of Orthopedic Surgeons has ranked Orlando Health’s orthopedic residency program the fourth top academically productive orthopedic surgery program in the nation. In addition to 20 residents, which will expand to 25 by 2023, the program includes three fellowships, one each in orthopedic trauma, pediatric orthopedics and orthopedic sports medicine, making it one of the most extensive and advanced or-

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thopedic educational programs in the region.

“The expanded relationship makes Orlando Health’s orthopedic education program the most prominent in the Southeast,” said George Haidukewych, MD, director of orthopedic trauma and adult reconstruction and academic chairman for Orlando Health’s Orthopedic Faculty Practice. “We expect patients from across the region to seek us out for the latest and safest technologies in orthopedic care, as well as for the remarkable customer service we will provide.”

The combined strength of the new partnership is the catalyst for the creation of one of the premier destination orthopedic hospitals in the southeastern United States. The newly formed orthopedic group will lead the development of the Orlando Health Jewett Orthopedic Hospital, a 195,000-square-foot inpatient facility dedicated solely to the care of orthopedic patients.

As one of the only orthopedic-specific hospitals in the Southeast, it will offer unparalleled comfort and ease for patients – from arrival through departure. Designed to capitalize on efficiency of service, wait times for patients will be virtually eliminated. A centrally located diagnostic center will provide

immediate results for physicians and patients.

Patients on the go may view records, test results, schedules and provider communication through Orlando Health’s MyChart, a mobile customized application in the comprehensive health records platform that Orlando Health will launch in late summer of 2020.

In addition to being able to view health information, schedule appointments, and manage accounts, patients also can synchronize the MyChart app with their fitness device to update their medical record with daily health habits and physical activity.

“With all of the pieces in place – physician training, top quality providers and the busiest trauma program in the state – we expect the Orlando Health Jewett Orthopedic Hospital will care for more patients upon opening than any other orthopedic facility in the Southeast,” said Mr. Strong.

Orlando Health plans to break ground on the $250 million Orlando Health Jewett Orthopedic Hospital in late spring 2020.

When complete in 2023, the facility will include up to 75 inpatient rooms, 20 operating suites, 5 internationally virtually connected operating suites that can be used to train surgeons around the world and 167,000 square

feet of medical office space. It will be located on the southeast corner of Lucerne Terrace and Columbia Street on Orlando Health’s downtown campus.

Orlando Health is a $3.8 billion notfor-profit healthcare organization and a community-based network of hospitals, physician practices and outpatient care centers across Central Florida. The organization is home to the area’s only Level One Trauma Centers for adults and pediatrics, and is a statutory teaching hospital system that offers both specialty and community hospitals.

More than 3,100 physicians have privileges across the system, which is also one of the area’s largest employers with more than 20,200 employees who serve more than 167,000 inpatients, more than 2.7 million outpatients, and more than 20,000 international patients each year. Additionally, Orlando Health provides more than $620 million in total value to the community in the form of charity care, community benefit programs and services, community building activities and more.

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PHYSICIANSPOTLIGHT

The Noblest Cause Ajay Mangal, MD, MBA Ajay Mangal’s story began nearly halfway around the world. Growing up in New Delhi, India, he enjoyed his schoolwork and spending time with family and friends. As a young boy, he hadn’t thought much about his future – but that changed after a visit from a cousin, who was a family practice physician in Webster City, Iowa. Mangal loved listening to his motivational stories – and it sparked an interest in becoming a doctor.

“I enjoyed hearing how my cousin’s knowledge and expertise helped improve patients’ lives,” recalled Mangal. “To be able to dedicate your time to serving others seemed like the noblest cause.”

A few years later, Mangal, then 12, got closer to realizing his dream. In search of a better life and more opportunity, his parents decided to move to the U.S., settling in Iowa near their cousin and other family members. After graduating from his new American high school with high honors, Mangal began his undergraduate collegiate journey at the University of Iowa and was among the youngest in his class to graduate medical school. He was just 22 years old.

PURSUING OTOLARYNGOLOGY

“The toughest decision was choosing what specialty to pursue.” Mangal said. “I’d always been very good with my hands and wanted something procedure-oriented. Ultimately, otolaryngology was the most fascinating for me because of the microsurgery and complexities of treating issues around the face.”

Mangal completed his residency in 1989 at the University of Cincinnati. There he met his future wife, a fellow resident.

Following graduation, Mangal stayed local while his wife worked to complete her own studies. The couple settled down in Cincinnati, started a family and began building their careers. In 1998, Mangal went on to complete his MBA at Xavier University –

School of Business Administration. Then, from 2000 to 2009, he served as president and CEO of Prexus Health, a physicianowned developer and manager of imaging centers, surgical hospitals and ambulatory surgery centers.

While with Prexus, Mangal championed and helped raise awareness for lifechanging, outpatient ear, nose and throat (ENT) procedures, including myringotomy (a surgical incision into the eardrum to relieve pressure or drain fluid) and septoplasty (a corrective surgical procedure to straighten the nasal septum by removing nasal obstructions from patients with difficulty breathing).

By 2011, the Mangal family was ready for a change (and a warmer climate) – and they decided to move to Florida.

MEETING NEEDS IN OSCEOLA COUNTY

Upon relocating to the Sunshine State, Mangal continued practicing at several area hospitals. A Fellow of the American Academy of Otolaryngology - Head and Neck Surgery (FAAO-HNS), Mangal currently serves as an otolaryngologist at Allergy and ENT Specialists of Osceola, where he serves patients at Osceola Regional Medical Center. Working with people of all ages, from pediatric to geriatric, he specializes in disorders of the head and neck, including

difficulty swallowing, hearing loss, tumors and even cancer.

“Due to Florida’s weather patterns and tropical environment, I treat many patients with allergy and sinus problems – but that’s not all an ENT can do,” said Mangal. “Patients whose breathing, hearing or speaking has slowly deteriorated often accept it as their new way of life. Many don’t realize the conditions that affect the ear, nose or throat can often be addressed with minimally invasive procedures that have the capability to vastly improve their quality of life.”

PROCEDURAL ADVANCEMENTS

One such procedure is endoscopic sinus surgery which is used to remove blockages in the sinuses. If left unaddressed, these blockages can cause sinusitis, leading to drainage, pain and impaired breathing.

The procedure is usually performed on patients under general anesthesia using an endoscope. With a clear, magnified view of the sinus tissue, Mangal is able to safely and effectively remove blockages entirely through the nostril. And since there is no cutting involved, patients are able to go home the same day. “The most rewarding surgeries are those in which polyps or scar tissue are removed,” he said. “These procedures truly change a patient’s life, which makes the pro-

cess extremely gratifying.”

Another procedure Mangal performs regularly is called balloon sinuplasty (BSP), often referred to as the “smart sinus” procedure.

“We begin by inserting a slim, flexible balloon catheter into the sinus passage,” Mangal explains. “As the catheter is slowly inflated, the sinus opening expands, allowing us to flush chronic pus and mucus buildup using a saline solution. Once the balloon is removed, patients feel a dramatic decrease in sinus pressure.”

According to Mangal, very few patients will require another procedure or repeat surgeries. Results from a recent study support that claim, concluding that BSP patients still report significant improvement in sinus pressure and breathing two years post-op.

Throughout his career, Mangal has continued to promote innovative treatments like BSP with the goal of improving patients’ lives – and he looks forward to helping patients in Osceola County, while continuing to research ongoing advancements in the ENT field.

And to bring his life full circle: Just as his cousin inspired him to become a doctor all those years ago, Mangal has instilled the desire to serve in his own three children, who have gone on to study law, psychiatry and medicine.

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EAST ORLANDO CHAMBER OF COMMERCE

CALENDAR: EOCC Golf Outing

Benefiting the EOCC Foundation

Wednesday, Jan 8 | 7:00 AM – 2:00 PM RIO PINAR COUNTRY CLUB

8600 El Prado Avenue, Orlando, FL 32825

January Chamber Luncheon, Board Installation & 2019 Chamber Awards Featuring Candace Whiting, Great Life Unlimited

Wednesday, Jan 15 | 11:30 AM – 1:15 PM BONEFISH GRILL WATERFORD LAKES

12301 Lake Underhill Rd., Orlando, FL 32828

Chamber Luncheon – Board Installation & 2019 Chamber Awards Wednesday, Jan 15 | 11:30 AM – 1:15 PM BONEFISH GRILL WATERFORD LAKES

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

Coffee Club Nona

Sam’s Club Lake Nona (3rd Thursday of the month – NEW)

Thursday, Jan 16 | 8:30 – 9:30 AM SAM’S CLUB LAKE NONA

1920 Narcoossee Rd., Orlando, FL 32832

Non-Profit Council Roundtable

– Member Non-profit Benefit. Creating Your Marketing Calendar for 2020

Wednesday, Jan 22 | 8:30 – 10:00 AM EAST ORLANDO CHAMBER

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

Latte with Leaders

Member Benefit (4th Friday of the month) Intimate conversation with your Orange County Political leaders

Friday, Jan 24 | 8:00 – 10:00 AM EAST ORLANDO CHAMBER

12301 Lake Underhill Rd., Ste. 245, Orlando, FL 32828 Registration Required

NFL Pro Bowl Tailgate Party & Game Tickets

Includes Ticket to the Game, Tailgate Party, Food & Beverage

Sunday, Jan 26 | 11:00 AM – 7:00 PM Registration & payment required Does not include parking

Misters & Sisters Great Lunch Adventures Tuesday, Jan 28 | 11:00 AM – 12:30 PM SONNY’S BBQ ALAFAYA TRAIL

310 S Alafaya Trail, Orlando, FL 32825

EOCC & AACCCF Joint Chamber Mixer Complimentary hors d’oeuvres provided. Cash bar

Thursday, Jan 30 | 6:00 – 8:00 PM USTA NATIONAL CAMPUS

10000 USTA Blvd., Orlando, FL 32827 Registration requested

W.I.S.E. (Women in Successful Endeavors) Business Networking Brunch Wednesday, Feb 5 | 1:30 AM – 1:00 PM THE LEMON LILY TEA ROOM

1954 W State Road 426, Ste. 1106, Oviedo, FL 32765 Registration Required – Space is limited

February Chamber Luncheon

“Is Recession Looming in 2020?” with Sean Snaith, Ph.D.

Wednesday, Feb 19 | 11:30 AM – 1:15 PM THE LAKEHOUSE LAKE NONA

13623 Sachs Avenue, Orlando, FL 32827

Please visit www.EOCC.org for a complete listing of January's events.

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EOCC MEDICAL CITY

PRESENTED BY

2020 Focus for the New Year Established Chambers in Central Florida

By DOROTHY HARDEE

Lewis Carroll said, “If you don’t know where you’re going, any road will take you there.” As we dive into 2020, it is important to realize, if you don’t have a plan or have practice goals, you will move through the weeks and months blindly. The end of the year will be here before you know it with few objectives being achieved.

What are some of the strategies you will incorporate to help increase referrals to your practice? Physicians face numerous challenges including restrictive insurance rules, government regulations and declining compensation, as they try to balance patient care with business priorities. Mark Bennett mapped out five trends shaping the healthcare industry recommending administrators consider implementing them to potentially improve the practice outlook.

According to a 2018 report from Avalere Health and the Physicians Advocacy Institute fewer than half of all physicians now have an ownership stake in their practices, due to acquisitions by hospitals and insurance companies. But now all physicians are selling, but rather choosing to invest in technology and non-physician staff to increase efficiencies. Others are moving to a more concierge model focusing on personalized care with a smaller patient base or selling stakes to private equity firms to avoid being acquired by hospitals. This allows them to keep ownership and maintain their strong patient relationship.

To compete in this fast-paced environment, physicians must deliver a strong doctor-patient relationship offering a deeper understanding of the patient’s health history, something difficult to maintain in an urgent care setting. This growing medical consumerism moves some physicians to extend practice hours, opening emergency clinics, offering electronic health records and using outside clinics as referral sources to stay competitive and viable.

The Affordable Care Act has brought uncertainty for physicians and their practices, imposing regulations that have increased some reimbursements, but also penalties related to reporting quality standards and the use of EHRs. The political climate has added to the uncertainty as proponents seek to block any attempts to alter or eliminate the program, causing many physicians to postpone important decisions until the dust settles.

Finding skilled workers for a practice has become more competitive than ever driving Physician Assistants and Nurse Practitioners as the top 3 & 4 of the Best Jobs and the Best Health Care Jobs according to the 2018 US News & World Report. With difficulty filling a critical position, many are moving to healthcare services and technology to fill the gap, focusing on managing medical costs and quality, as well as increasing effectiveness and efficiencies in administrative functions. Using such services often allows the physician to choose their own hours and increasing their ability to provide healthcare services, while sometimes increasing profits for the practice.

The healthcare industry has evolved with a great deal of change driven by technology, from electronic health records allowing providers to streamline many aspects of patient care, to telehealth offering virtual healthcare bridging the divide between providers and their patients. Also, wearable technology, such as the Apple Watch, is able to detect signs of A-Fib, while also detecting irregular heartbeat at regular intervals and fall detection tools help create hyper-targeted, personalized health and wellness plans. It is fueling how to treat patients but can also create issues as practices select provider partners, integrate systems and train staff. Its important to be savvy and knowledgeable about technologies that are best for your practice.

With the growing trend of doctors launching their own practices or opting to stay independent after years of acquisitions by hospital groups, the East Orlando Chamber

(EOCC) asked what Central Florida’s independent physician practices need to help grow business. Referrals among peers and within the community went hand in hand. Limited time, staff and hours in a day make networking difficult, but not impossible if it means connecting with the right referral source.

The East Orlando Chamber Healthcare Collaborative is focused on the entire landscape with special attention to offering focused peer-to-peer networking to increase referral sources. Physicians, practice administrators and referral coordinators are invited and encourage to attend our first quarterly event Thursday, February 27, from 8:30 – 9:30 am at CERTUS of Waterford Lakes. This Meet & Greet will introduce your neighboring physicians, more about the Healthcare Collaborative and how the EOCC is helping grow your practice through referrals, community outreach and new opportunities with increased revenue potential. If you are a physician or healthcare professional, register today.

A continental breakfast will be provided.

RSVP is requested.

Want to know how else the Chamber can work with you to elevate your business?

Give us a call at 407-277-5951. Let’s meet to discuss your business objectives and how the EOCC helps drive results making you a long-term member of one of the oldest established chambers in Central Florida.

Dorothy Hardee is Chamber Administrator for East Orlando Chamber of Commerce

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Legalized Cannabis Linked to Lower Opioid Use and Death Rates

By MICHAEL C. PATTERSON

A MAIN STREET COMPANY FOR MAIN STREET FLORIDA

A new study published in the January 2020 issue of the Journal of Health Economics, analyzed over 1.5 billion opioid prescriptions given in the United States between 2011 and 2018. The researchers confirmed that states that legalize cannabis see sizeable drops in opioid consumption. https://www.sciencedirect.com/ science/article/pii/S0167629618309020?via percent3Dihub

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The study was conducted by Benjamin McMichael, law professor at University of Alabama, and R. Lawrence Van Horn and W. Kip Viscuzi, law professors at Vanderbilt University. The researchers analyzed prescription data from 90 percent of all outpatient pharmacies in the United States from 2011 and 2018. This data included over 1.5 billion individual opiate prescriptions. The research found that in states with medical cannabis laws, opiate prescriptions declined 11.8 percent. In states with recreational cannabis laws (adult-use cannabis), opiate prescriptions declined 4.2 percent.

The researchers also looked at previous studies to see if their findings were similar or contrary. They found similar results demonstrating access to legal cannabis can decrease opiate use. Bradford and Bradford (2016) did a study in which they analyzed a dataset of Medicare prescriptions between 2010 and 2013. They concluded that medical cannabis laws decrease the use of prescription drugs for which cannabis can serve as a clinical substitute. Bradford and Bradford did another study in 2017 which shows that declining overall prescription drug use can save over $1 billion annually for the Medicare program through the use of legalized cannabis.

The National Academies of Sciences, Engineering, and Medicine concluded after a comprehensive review of the clinical litera-

ture “there is conclusive evidence that cannabis is effective for the treatment of chronic pain in adults.” As of 2018, there were 72,000 deaths in the United States attributed to opiate overdose. However, there have been ZERO reported deaths attributed to cannabis consumption in human history. As we evolve into more states legalizing medical and recreational cannabis we are discovering, in certain cases, cannabis can be used as an extremely safe alternative to opiates.

We are moving into an era of cannabis use that is based on facts, and less on ideology and rumor. As health care professionals continue to see more positive data on the use of cannabis to treat multiple ailments, we will continue to see an increase of use of cannabis across the health care sector.

For 2020 and beyond, the healthcare industry must adapt to more change than ever. Accountable Care Organizations (ACOs) will become more powerful within the healthcare system, which will lead to even more emphasis on efficiencies and cost savings. Also, patients will have more choice than ever regarding health care services.

It is projected by the end of 2020, Florida will have over 600,000 medical marijuana patients, and a Constitutional Amendment to legalize recreational marijuana is expected on the 2020 Florida voting ballot. Cannabis in the healthcare system is not a fad, it is here to stay.

As a healthcare business owner/operator, start investigating ways that medical marijuana can benefit your patients, your business, and your bottom line. Reach out for advice and consultation from experts in the space.

If nothing else, find ways to be a resource of trusted information on cannabis for your (CONTINUED ON PAGE 8)

Listed on the NYSE under the symbol “PRI”

Marty Siciliano, 201-657-2317 msicliano57002@primerica.com Primerica, Inc. is a public company listed on the New York Stock Exchange (PRI). Primerica, Inc. is a leading distributor of financial service products to middle income households in North America, assisting clients in meeting their needs for term life insurance, mutual funds, annuities, segregated funds (in Canada) and other financial service products. Most of these products are distributed on behalf of third-party companies.

Primerica, Inc. conducts its core business activities through companies in the United States and Canada that are subsidiaries of Primerica, Inc. (the subsidiaries together with Primerica, Inc., collectively referred to as “Primerica”). Primerica markets its financial service products in the United States and Canada through its independent contractor representatives. Each subsidiary of Primerica, Inc., and not Primerica, Inc., is responsible for its own obligations to its customers.

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VOLUNTARYBENEFITS: NOT SO VOLUNTARY

SPONSORED BY

Voluntary Benefits are Becoming not so Voluntary in the Changing Landscape of Employee Benefits Dale McMindes

Chelsea Whalley

In a time when out of pocket expenses for healthcare are rising, many employers are turning to Voluntary Benefits as a way to both create cost containment and allow employees to customize their benefits during Open Enrollment.

Here are the 4 most frequently asked questions by employers.

What are the tax Implications of a Voluntary Benefit program?

Employees can pay pre-tax for their insurances saving them on average 22 percent. Employers can reduce their matching FICA to the same amount of pre-tax policies chosen.

How can a Voluntary Benefit offering help my staff?

Besides offering guaranteed issue insurance at a group rate with an additional tax benefit, Allstate rates do not change after issue. This allows employees to contain costs protected from the annual medical inflation and rising health insurance premiums.

How do Voluntary Benefits enhance my current benefits package?

By giving your employees access to Accident, Critical Illness, Cancer, Disability, Hospital Confinement plans, and Life Insurance, you allow them to customize their benefits based on the concerns and needs they have within their families, that you as the employer may or may not know about.

How can Voluntary Benefits potentially save my business money on our Major Medical program?

Due to the rising costs of healthcare, many businesses are opting for High Deductible Health Plans. By implementing an affordable voluntary GAP Insurance program, you can effectively reduce their deductible and out of pocket max.

This can be a very effective strategy in providing first dollar coverage for employees with expenses tied to their health insurance program, while allowing the employer to choose a more affordable high deductible health option as a base plan.

Legalized Cannabis Linked to Lower Opioid Use and Death Rates, continued from page 7 patients. Because we all know the only thing consistent in healthcare is change. As John F. Kennedy once said, “Change is the law of life.

And those who look only to the past or present are certain to miss the future.�

Michael C. Patterson, founder and CEO of U.S. Cannabis Pharmaceutical Research & Development of Melbourne, is a consultant for the development of the medical marijuana industry nationwide and in Florida. He serves as a consultant to Gerson Lehrman Group, New York and helps educate GLG partners on specific investment strategies and public policy regarding Medical Marijuana in the U.S. and Internationally. He can be reached at mpatterson@uscprd.com

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Improving Return on Your Medical Office Investment

By FRANK RICCI

Most physicians have one critically important asset in their investment portfolio that significantly impacts the amount of income they earn every year. They “invest” in this asset with a check monthly for as long as they continue to practice medicine, yet it is one of the least understood assets in the physician’s portfolio. What is it?

The answer, of course, is your medical office. Let me explain; your office represents one thing...a center of production. Just like a manufacturing plant, you produce income by seeing and treating patients in your “plant” and your income is directly tied to your production. You invest in your “plant” every month with your rent check or mortgage payment. Your “investment” provides you with the location, parking, services, signage, and physical space for the diagnosis and treatment of patients. All of these items will critically affect the “Return on your rent or mortgage investment dollar.”

Let us take a simple example...your location is inaccessible from one direction on a major road. One in four new patients is late getting to your office because of its inaccessibility. Of course, your staff has recognized this fact, perhaps subconsciously, and schedules flex time for this delay. This simple example may cost you the scheduling of one or more patients per day. Assume an average charge of $150 per patient per 250 workdays and you have lost $37,500 in one year.

This is just one example of how your office and location affect your income. All too often, physicians will focus too much attention on the cost to rent or purchase when these factors are not nearly as important considerations in choosing your office. In the example above, let’s assume this location was chosen because the rent was $24.00 per square foot per year and a better location was $26.00 per square foot per year. Assuming an average single physician office space to be 1,500 square feet, the rent savings amounted to a mere $3,000.00 while the lost opportunity cost was $37,500, resulting in a net lost opportunity cost of $34,500. The losses become even more staggering when you factor in lost income and increased costs due to an inefficiently designed or undersized office where you need more employees to produce the work or more space to produce additional work.

Here are some simple rules to follow in order to maximize the value of your office investment.

1. Treat your office like an income producing investment. Your office is a production facility, period. You get paid only for the amount of work you and your staff produce. Maximize your ability to produce income by adding extenders, enlarging your office, reno9

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vating your office to streamline operations, add services and procedures and eliminate or share with other physicians your non-income producing spaces.

2. Your office is a “practice” investment and its sole purpose is to allow you to maximize your income. Do not consider your office a real estate investment. If it inhibits your ability to grow and/or add services, move, sell it or lease it to someone else.

3. Do not become emotionally attached to your office. Too many physicians stay in an office because they like their location, the surroundings, proximity to services, their consultation office or due to familiarity. The moment you realize that you are losing opportunity to maximize your income due to your office size and/or location, make a change. This might involve a renovation, addition, or a move to a completely new location that will better support your practice.

nage, is clean, provides patient privacy, provides opportunity for growth, and does not limit the services which you can provide to your patients.

You can determine whether you are losing income due to your office layout and/ or its location by answering these questions: • Are there technologies or services you would provide if you had the space?

• Could you add a partner or extenders if you had more space?

• Could you share non income producing areas with others?

• Do you require additional personnel due to the layout of the office?

• Are you paying overtime frequently?

4. Recognize that the true value of your office lies in its ability to produce NET INCOME. An efficiently designed office will produce the highest possible return after expenses. Do not equate the lowest possible rent or mortgage payment with the resulting net income. In the example above, a lower rent actually “cost” the physician over $34,500.

• Is patient scheduling impacted by your office location and/or accessibility?

5. Enhance the value of your practice and your return on your monthly investment by selecting an office that is efficiently designed with identical exam rooms, has easy vehicular and pedestrian access, is visible with excellent sig-

• Are certain services prohibited due to your location, (i.e. hospital campus)?

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• Are your exam room sizes and layouts different?

• Do you ever wait for patients and/or nurses?

• Must you ever wait for medical supplies and/or patient records?

A “yes” answer to any of these questions indicates you may be losing income opportunities. In many cases, you can construct

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a simple cost/benefit analysis to determine the impact of possible office changes to your income. For a more in-depth analysis, you may be better served by hiring an expert to assist you in evaluating your options.

In summary, your office represents a significant “practice” investment. It is a tool that you use to complete your production cycle. By recognizing this fact, you are better able to evaluate and plan for the future growth of your practice and the services and procedures you will employ to enhance the return on your monthly investment. Oftentimes, we read about corporations that abandon huge manufacturing plants worth hundreds of millions of dollars and are amazed at the perceived waste. However, these firms determined that the sunk cost of remaining in a particular location was overshadowed by the opportunities to maximize their return on investment elsewhere. In today’s healthcare marketplace of declining reimbursement and competition, you too should critically evaluate opportunities to maximize the return on your office investment dollar.

Frank Ricci, managing partner, Healthcare Realty & Development Services, has over 30 years’ experience in real estate development, brokerage, facility design, construction and management of medical facilities, senior living centers, dental offices, diagnostic centers and other healthcare facilities. Contact him at 407.900.6003

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Improving Care for High Risk Seniors While Increasing Practice Revenue We need more game changers

By JOHN WHITMAN

Editor’s note: Author John Whitman is a professor in the Wharton MBA Health Care Management Program and is not vested in nor in any way does he benefit financially from the products mentioned.

Historically, our healthcare system has not made it easy for physicians to provide in-depth comprehensive care services for our nation’s seniors. Reimbursement (or lack thereof) has often been a significant barrier, especially for those physicians and nurse practitioners focused on the medically isolated senior population living in the community.

Adding to the challenge is the rapidly growing number of seniors, especially in the 85+ cohort who are the fastest growing segment of the U.S. population and are, of course, the greatest consumers of healthcare resources. Chronic conditions are one of the many challenges of caring for the senior population. The Centers for Disease Control estimate 85 percent of all seniors have at least one chronic condition and 60 percent have two or more.

The reality is clear: the number of high-risk seniors with diabetes, CHF, blood pressure and other chronic conditions continues to increase and they are living longer. Monitoring these high-risk seniors on a monthly basis through physician office visits, as we have historically done, is no longer adequate to assure their safety.

Through amazing advances in technology over recent years, high risk seniors can now be monitored daily in real time and their physician can be alerted any time their readings fall outside the specific guidelines they have set on a patient by patient basis. These alerts serve as an “early warning system” allowing the physician to provide an appropriate medical intervention to resolve the issue before it escalates to a medical crisis requiring an emergency room visit, hospitalization or worse.

One immediate solution to the growing number of high-risk seniors is a program I recently reviewed called the “Link+ Program” created and powered by a company called LiveCare in New York City. This progressive company has created the first twoway, real time video pendant that qualifies as a Personal Emergency Response System (PERS). Adding video capabilities is a milestone in PERS programs and the quality of the video on their business card sized pendent is amazing. Even more amazing is the fact that this PERS pendant can link to a wide range of FDA approved monitoring devices using Bluetooth technology. When

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a reading is taken by a senior, that reading is immediately Bluetoothed to the pendent.

The pendent immediately transmits that reading to the Remote Monitoring Platform where the readings are compared to the physician’s predetermined, patient specific ranges. If those ranges are violated, an alert is immediately sent to the physician so an appropriate medical intervention can take place.

The combination of the pendent and the remote monitoring devices working together is called the “Link+ Program” and is the Hub/ Gateway that links FDA approved remote monitoring devices that measure daily readings for hypertension, diabetes, obesity, SPO2 with heart rate, and temperature.

Linking the two-way video pendent with the remote monitoring devices by Bluetooth and then having the pendent transmit that information to the remote monitoring platform is brilliant. LiveCare has automated this process eliminating the need for a patient to use a smartphone, table and laptop to self-report their readings. This automation also eliminates any accidental and intentional inaccuracies being sent to the remote monitoring platform. Furthermore, no internet connection is required in the patient’s home because the pendent can transmit the information independently without a local internet connection. This too is a significant improvement over previous remote monitoring programs.

Last week I had the pleasure of interviewing Dr. Erik Ilyayev, an Associate Professor at Touro College of Medicine. Dr. Ilyayev also has a medical home practice and he and his staff of nurse practitioners visit medically isolated seniors in their homes in New York City. Dr. Ilyayev called the LiveCare Program a game changer because of the daily monitoring it offers for his high-risk patients, and the support it provides for clinicians allowing them to take even better care of their patients. He also commented on the added revenue he can generate for his practice using a range of CMS’s billing codes specific to remote monitoring.

He provided multiple examples where the LiveCare Program recognized serious changes in a patient’s medical condition while at home. Without the alert, and the added time it offers the practice to respond to the senior’s needs, many would have escalated into true medical emergencies.

One specific example he offered was an 86-year-old woman with a history of high blood pressure that was normally controlled by medications. She takes her blood pressure twice a day with a simple cuff device and her readings are immediately Bluetoothed

to the pendant. The pendant immediately sends the readings to the remote monitoring platform. If the readings fall outside the requirements established by the physician on a patient by patient basis, an alert is sent to the physician. A few weeks ago, Dr. Ilyayev received an alert on this patient because her blood pressure was significantly elevated. He immediately went on his tablet and was able to view not only the reading that generated the alert, but 30 days of data in a simple, easy to read graph. He was able to see a full month of readings and not just an individual reading at a moment in time. He called the patient on the pendant and had a meaningful face to face interchange. Based on his findings, he adjusted her medication in response to the immediate need and was then able to monitor the impact of the changed medication for several days making two additional adjustments as needed…something he would never have been able to do if the patient’s care were dependent upon traditional face to face office visits.

Bottom line, not only does this program provide additional protection for high risk patients, it allows clinicians to do a better job taking care of them while generating additional revenue for the physician practice.

In most states, the two-way video pendant is paid for my Medicaid as a PERS unit. The monthly billing potential for the physician depends on the number of remote monitoring devices recommended by the physician for his/her high-risk senior patients. For example, a senior with the Pendant and one remote monitoring device will be able to generate approximately $50 or more a month of net rev-

enue for the physician. For a senior with two remote monitoring devices plus the pendant, the net monthly revenue for the physician would likely be $75 to $100.

I recently had the pleasure of meeting the management team of LiveCare. Peri Avitan, the CEO and Founder was appropriately proud of the program his company has created and its ability to help improve care for high risk patients while at the same time helping physician practices generate significantly more and well-deserved revenue.

Peri offered to have his Director of Business Development, Eric Ditkowsky run a free, no cost evaluation for any physician practice interested in learning more about the program. Based on several practice specific statistics, Eric will be able to generate an estimate of the level of added reimbursement available for a given practice by offering the pendant and remote monitoring devices to their high-risk patients.

Bottom line, not only does this program provide additional protection for high risk patients, it also allows clinicians to do a better job caring for them while generating additional revenue for the practice. Better care, better revenue…yes, I would call that a game changer!

John Whitman is a faculty member at the Wharton MBA Health Care Management Program specializing in senior car services. John is the founder and Executive Director of The TRECS Institute and for the past five years he has been aggressively evaluating the ability of telemedicine and remote monitoring to improve care for high risk seniors, reduce costs for our health care system and improve revenue opportunities for those providers utilizing telemedicine and remote monitoring services.

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Cultural Diversity Creates Language Barriers:

Reducing Claims with Multilingual Patients

By RICH CAHILL and SUSAN SHEPARD

Ms. D., a naturalized U.S. citizen from Southeast Asia, presented to Dr. P. for a consultation regarding extensive acne scarring on her face and neck. The patient reported that she felt self-conscious about her appearance and sought advice on possible treatment options. According to the chart, Ms. D. spoke limited English.

Her reading proficiency was not noted.

Following an examination of the affected area, Dr. P. offered CO2 laser resurfacing. The benefits and potential disadvantages of the procedure were discussed, including the possibility that her complexion type posed an increased risk of scarring and changes in pigmentation.

Ms. D. subsequently agreed to undergo laser resurfacing and signed a written consent that specifically identified scarring and changes in skin color as possible postoperative outcomes.

The patient returned the following week. The treatment record reflects that Dr. P. performed the procedure under local anesthesia and conscious sedation.

The surgery was uneventful, and no intraoperative complications occurred.

Ms. D. presented on numerous occasions over the next several months. Hyperpigmentation was noted, and Solaquin Forte 4% and Pramosone lotion were prescribed. At one point, the patient complained of experiencing a burning sensation on her face. Approximately one year after the procedure, Ms. D. returned for further evaluation. The scarring was barely visible; the discoloration on her neck was noticeably improved. However, the patient expressed dissatisfaction with the result.

Ms. D. thereafter retained counsel and initiated suit alleging causes of action for medical malpractice and negligent infliction of emotional distress. In substance, the patient claimed that because of her limited proficiency with English and the failure by the physician to utilize any translation services, including for any

preoperative documentation, there was no informed consent.

PROVIDING LANGUAGE SERVICES: OBLIGATIONS AND BENEFITS Clear and unambiguous communication constitutes the key component of the physician-patient relationship. Misunderstandings often create frustration and distrust, especially when an adverse event occurs, and can result in professional liability litigation or reports to state medical boards and third-party payers by disgruntled patients and family members. Proactively implementing office procedures for both physicians and staff to promote optimum communication reduces the risk of surprise and the potential for expensive, protracted, and unpleasant disputes.

With our culturally diverse national population, including many who speak a language other than English at home, language barriers raise the risk for an adverse event. The Department of Health and Human Services (HHS) Revised Guidance Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient (LEP) Persons outlines the requirements for recipients of federal financial assistance from HHS to take reasonable steps to ensure LEP persons have access to language services.

(These recipients do not include providers who only receive Medicare Part B payments. However, providers that receive funding from any government program such as Medicaid or Medicare Advantage are subject to the requirements.)

To determine the extent of the obligation to provide language assistance, analyze the following four factors:

• Number: The greater the number or proportion of LEP persons served or encountered by your clinic, the more likely language services will be needed.

• Frequency: Even if unpredictable or infrequent, there must be a plan for providing language assistance for LEP persons.

• Nature: Determine whether a delay

in accessing your services could have serious or lifethreatening implications.

The more important the nature of the services you offer, or the greater the consequences of not accessing treatment, the more likely language services will be needed.

• Resources: Consider the resources available and the cost to provide them.

As a solo practitioner, you are not expected to provide the same level of service as a large, multispecialty group.

Investigate technological services or sharing resources with other providers.

It is not recommended to use a family member as an interpreter. Lay personnel are rarely familiar with medical terminology. Additionally, the patient may not want a family member to access their confidential health information.

An adult family member should serve as interpreter if a family member must be used—unless no adult is available, and care must be provided immediately to prevent harm. It is preferable to have a trained clinical staff member provide interpretation; alternately, your practice can use certified interpreter services. Consult your local hospital or the patient’s health plan for a list of qualified interpreters.

Other resources include a local nationality society, the Registry of Interpreters for the Deaf, or the local center for the deaf. Also, keep consent forms—especially for invasive procedures—translated into the applicable non-English languages by a certified translator.

The Agency for Healthcare Research and Quality (AHRQ) has prepared a guide, Improving Patient Safety Systems for Patients With Limited English Proficiency, which recommends that practices focus on the following: • Medication use: Understanding medication instructions is complicated for all patients, but even more difficult for LEP patients. Both patients and providers need to communicate accurately about mode of administration,

allergies, and side effects.

• Informed consent: Obtaining informed consent remains a hallmark of patient safety and a critical medical and legal responsibility. Achieving truly informed consent for LEP patients may require extra effort, but LEP patients should not be excluded from learning about choices that might affect their health and well-being.

• Follow-up instructions: Understanding discharge instructions is especially challenging for LEP patients. Speaking Together: National Language Services Network, a project funded by the Robert Wood Johnson Foundation, which created the Speaking Together Toolkit, found the need for greater use of interpreters at key moments of information exchange, such as at assessment and discharge—not just during the acute phase of treatment.

Relatively simple communication tools can provide some helpful solutions.

These include: • AskMe3™: Rx for Patient Safety: Ask Me 3 • The teach-back method: AHRQ: Use the Teach-Back Method: Tool #5 • The SHARE approach: AHRQ: The SHARE Approach—Using the Teach-Back Technique: A Reference Guide for Health Care Providers • Patient experience surveys: The Doctors Company: Patient Experience Surveys To protect your patients from harm resulting from their LEP, develop and implement a plan for language access in your practice. For more information, see the Centers for Medicare and Medicaid Services’ Guide to Developing a Language Access Plan.

Rich Cahill, JD, is Vice President and Associate General Counsel, and Susan Shepard, MSN, RN, is Senior Director, Patient Safety Education for The Doctors Company. Visit https://www.thedoctors.com/

Challenges of Cultural Diversity in Healthcare: Protect Your Patients and Yourself

By SUSAN SHEPARD

Physicians are increasingly faced with providing care to a multicultural society complicated by literacy issues.

Ensuring safe and quality healthcare for all patients requires physicians to under11

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stand how each patient’s sociocultural background affects his or her health beliefs and behavior.

Consider the following scenarios: A married 32-year-old Middle Eastern female with uterine fibroids presented at

the office of a gynecologist. After years of infertility and pain, a hysterectomy was recommended. She spoke English moderately well but with a heavy accent.

Offers of an interpreter were declined, (CONTINUED ON PAGE 12)

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Protect Your Patients and Yourself, continued from page 11 including translation of the surgical consent form. Eight weeks posthysterectomy, the patient asked the physician how soon she could expect to become pregnant.

An elderly female Asian patient was noncommunicative with the physicians and staff during the first three days of her hospitalization. She would not maintain eye contact or talk, even when an interpreter was provided. Communication regarding the patient’s care or concerns would occur only when a male family member was present. The staff and physicians—concerned with privacy issues—generally spoke with the patient when family members were not present. After several days of delayed treatment because consent for a necessary but nonemergent surgery could not be obtained from the patient, a visiting chaplain of the same nationality explained the cultural requirement that a male be present for a female’s care.

ADDRESSING THE PROBLEM The Doctors Company’s closed claims studies have shown that inadequate provider-patient communication is a frequent contributing factor to patient noncompliance, poor patient outcomes, and litigation. Effective provider-patient communication leads to an increase in patient satisfaction, better compliance, and improved outcomes. In multicultural and minority populations, the issue of communication may play an even larger

role because of behavioral, cognitive, linguistic, contextual, and cultural barriers that preclude effective patient-provider communication. Research has shown that services for minorities can be improved by removing language and cultural barriers.

When cultures and languages clash, physicians are unable to deliver the care they have been trained to provide. Culturally competent care depends on resolving systemic and individual cultural differences that can create conflicts and misunderstandings. If the provider is unable to elicit patient information and negotiate appropriate care, negative health consequences may occur.

How can physicians easily acquire and maintain the skills to provide culturally responsive and appropriate care to the increasingly diverse population of patients in the United States? Traditionally, training in cross-cultural medicine has focused on providing a list of common health beliefs, behaviors, and key “dos and don’ts.” This approach does not take into account acculturation and socioeconomic status and can lead to stereotyping.

An alternative approach, proposed

by Drs. Carrillo, Green, and Betancourt, helps physicians elicit a patient’s beliefs and preferences in order to identify and deal with the patient’s concepts, concerns, and expectations. This communication model is called ESFT (Explanatory model

of health and illness, Social and environmental factors, Fears and concerns, and Therapeutic contracting).

CASE EXAMPLE Consider this scenario with an example of the ESFT approach: A 62-yearold Dominican patient presented with hypertension. In the past two years, she had been seen by several physicians, had multiple tests to rule out any underlying etiology, and tried a variety of medications to control her blood pressure. Despite these efforts, her blood pressure remained poorly controlled. The patient, whose primary language was Spanish, had limited English skills but refused an interpreter at all clinic appointments. It appeared that the patient was nonadherent with taking the antihypertension medicine, taking it only periodically when she felt tense or stressed. Further inquiry by the physician revealed that the patient was illiterate and did not understand the complex medication regimen she had been given.

The physician was able to explore the patient’s explanatory model for hypertension using the ESFT approach. The patient strongly believed that her hypertension was episodic and related to stress. She didn’t take her daily antihypertension medication because it didn’t fit her explanatory model. The physician was able to reach a compromise by explaining that, although her blood pressure goes up during stressful

times, her arteries are under stress all the time, even though she didn’t feel it. Taking medications daily would relieve the arterial stress but would not help with her emotionally stressful episodes. The physician was able to negotiate with the patient to add relaxation techniques to her daily routine.

HEALTH LITERACY The Doctors Company supports the Agency for Healthcare Research and Quality (AHRQ) interventions to reduce the complexity of healthcare, increase patient understanding of health information, and enhance support for patients of all health literacy levels.

Studies have shown that people from all age, race, income, and education levels are challenged by an inability to obtain, process, and understand basic health information and services needed to make appropriate health decisions and to follow instructions for treatment. AHRQ has found that only 12 percent of the adult population has the skills to navigate and understand our complex health systems— skills reduced by stress and illness. We encourage you to explore the AHRQ Health Literacy Universal Precautions Toolkit.

STEPS YOU CAN TAKE Consider taking the following steps:

• Evaluate any personal attitudes, beliefs, biases, and behaviors that may (CONTINUED ON PAGE 13)

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Protect Your Patients and Yourself, continued from page 12 influence your care of patients.

• Conduct a self-assessment: Cultural and Linguistic Competence Health Practitioner Assessment available from the Georgetown University National Center for Cultural Competence.

• Use a communication model such as ESFT or LEARN: • Listen to the patient’s perception of the problem.

• Explain your perception of the problem.

• Acknowledge and discuss differences and similarities.

• Recommend treatment.

• Negotiate treatment.

• Ask the patient or interpreter to repeat back what you said during the informed consent process, during the discussion of the treatment plan, or after any patient educational session with you or your staff. The repeat-back process is a very effective way to determine the extent of the patient’s understanding.

• Use “Ask Me 3,” a tool that identifies three simple questions all physicians should be ready to answer—regardless of whether the patient asks. More information is available in our article, “Rx for Patient Safety: Ask Me 3,” and “Ask Me 3: Good Questions for Your Good Health” on the Institute for Healthcare Improvement’s website.

• Use language services for your limited English proficiency (LEP) patients.

• Partner with your health plans and hospitals to identify written and oral language services.

• Find out your state requirements. In some states, Medicaid plans may call for providing language access.

• Explain to patients who refuse interpreter services that it is very important to the patient’s care and safety that you

and the patient/family member understand each other. Suggest a referral to a physician who speaks the patient’s primary language. Be sure to document in the medical record the patient’s refusal and your explanation of the risks and benefits of an interpreter.

• Improve cultural competence: • Recognize that culture extends beyond skin color.

• Find out each patient’s cultural background.

• Determine your cultural effectiveness.

• Conduct culturally sensitive evaluations.

• Elicit patient expectations and preferences.

• Understand how your cultural identity affects your practice.

We Need Your Help!

Shepherd’s Hope, the largest free and charitable clinic in Florida, is seeking Urologists to provide volunteer care for our patients (one three hour shift per month) at one of our five convenient locations in Central Florida.

For volunteer information contact Abby Rice, Manager of Volunteer Programs (407) 876-6699, ext. 233 | abby.rice@shepherdshope.org or visit www.shepherdshope.org/volunteers.

OBTAIN MORE INFORMATION FROM THESE USEFUL WEBSITES:

• U.S. Department of Health and Human Services, Office of Minority Health, National Standards for Culturally and Linguistically Appropriate Services (CLAS) • U.S. Department of Health and Human Services, Think Cultural Health, A Physician’s Practical Guide to Culturally Competent Care • Agency for Healthcare Research and Quality, What Is Cultural and Linguistic Competence?

• Health Resources and Services Administration, Culture, Language, and Health Literacy Resources

SHARE YOUR PASSION: Help those in need of hope and healing in our community by joining our clinical and non-clinical volunteers at Shepherd’s Hope.

More volunteer doctors and nurses needed now more than ever to help fill the immense demand for healthcare services to the uninsured and under-insured men, women and children in Central Florida.

SUSAN SHEPARD, MSN, RN, IS Senior Director, Patient Safety and Risk Management Education for The Doctor’s Company. Visit https://www.thedoctors.com/

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Criticism is not Feedback

By WENDY SELLERS

Criticism assumes your way is the better way and inhibits the brain from learning.

Paying attention to weaknesses smothers the brain. Your brain responds to critical or negative feedback as a threat and narrows its activity. In a scientific study noted in “Nine Lies About Work” and “The Feedback Fallacy” (both by Marcus Buckingham and Ashley Goodall, Harvard Business Review) students hooked up to MRIs were asked what they were doing wrong and what needed to be fixed - their sympathetic nervous system lit up. The sympathetic nervous system prepares the body for intense physical activity and is often referred to as the fight-or-flight response. When students were asked about their dreams and how they might achieve them, their parasympathetic nervous system lit up. The parasympathetic nervous system has almost the exact opposite effect. This stimulates a sense of well-being, and even better immune system functioning.

So, it’s good for your health claims too!

The study also argues that disturbing the PEA is critical when creating or affirming a personal vision. The PEA is an

endogenous stimulant of the human brain that amplifies the activity of major neurotransmitters for multiple bodily reactions including a sense of well-being and higher performance of your body and brain. Again, all positives for your health insurance claims.

So now what? Focus on positive outcomes and experiences. Discuss scenarios or meetings that went well. Such as “here are three things that went really well.” Tell your team - “let’s do more of that! I want all of our meetings to look like that. That - yes, that!” Describe your experience when you catch them doing something good. Trust me, they already know how you felt when they screwed up. Say something like “that made me feel proud and excited.”

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Questions to Ask When Upgrading/Building MRI or Radiology Facilities: Part Three

By MARK BAY

Today, we bring you Part 3 in our series of articles about things to consider when retro-fitting an existing space for radiology equipment or when building new. With either scenario there are some things to consider very carefully before you commit to a contract of any kind. To reiterate the most important rule of thumb, every space is unique so not every rule fits all. Below we will discuss various cost saving measures that do not compromise quality; what is commonly called value engineering in the construction industry. We will also mention some typical cost over runs that can be avoided in most cases.

WHERE DO I SAVE AND WHERE DO I SPEND MORE? The first area that we want to address comes first because without it, the remainder of the project cannot happen. Which architect and engineering team do I select?

This can be a difficult question to answer.

The best-case scenario would be to have a general contractor to assist you with the selection process. The reason to do this may seem counterintuitive at first. Many general contractors who are knowledgeable about MRI and radiology construction also are privy to architects and engineers that they have worked with in the past that are knowledgeable about MRI/Radiology design.

The benefit here is that the contractor can work alongside the architects and engineers in the design phase and eliminate many issues prior to the construction phase. Often, the contractor is the best liaison between the designers and the owners. They often know what is affordable but more importantly what is necessary.

Quite often when you are thinking of opening an MRI/Radiology facility you would never think the radiology equipment can be purchased used. Yes, used equipment can save a bundle. A new MRI can typically cost over $1M if purchased new. A used piece of similar equipment can often be found for a fraction of the new equipment cost. Radiology equipment can be re-built and/or refurbished, then re-calibrated. It is imperative to deal with a reputable company. Be sure to check the credentials of whom you are buying from and know where your equipment was refurbished, who calibrated it, and does it have a warranty and what does the warranty cover?

Another significant cost saving can be found when purchasing a chiller for the MRI cooling system. This is where purchasing and installing a new chiller is likely going to be more economical in the long term. A new 15

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chiller will come straight from the manufacturer, likely be transported directly from its fabrication point and will have a warranty. A used chiller may appear “almost new” externally, but once connected and turned on, its flaws come to the surface (often). This poses a real threat to the entire operation. If the chiller becomes inoperable, an alternative method of cooling the MRI is required. Many places will have installed a city water bypass for just such a scenario. Others have not and that can spell disaster. One absolute is to have an alternate cooling (back-up) system ready to be activated at a moment’s notice. This is not a place to “save money” or to consider this something that is an option. A quenched system is very expensive. Multiple service calls, multiple shut-down of operations and waiting for spare parts is usually an expensive proposition every time it occurs and soon surpasses the cost of new equipment that would have been warranted. In this case “new” is more cost effective than used.

I have found that some design professionals “over-design.” There must be a balance between form, function and budget. We would all like a very polished elegant looking facility with nice floors, decorative acoustic ceilings and modern lighting. Not everyone can afford that. Finding a balance between form and function while also taking in to account a patient’s needs and an owner’s budget can be difficult. Typically, when the contrac-

tor has input on the specified products before the project is estimated the owner’s budget is known to the design team and can help in designing the facility and saving valuable time in the long run. (Time is money.)

Typically brand name products can be costlier. It is important to consider the function of an item and whether it will be seen by anyone. An example of this would be recessed can lights that are installed in an acoustic ceiling.

The body of these type lights are never seen.

What matters on these lights is the amount of light and the color of the emitted light. Another manufacturer that produces an equivalent product can provide cost savings that begin to add up. When substituting anything such as lighting, air conditioning equipment, sinks and faucets, flooring, cabinets, etc. a thorough comparison should be made with the item being replaced. Quite often people look at the cost of an item first and lose sight of the fact that the brand name may be an equal or better product, or you may also just be “paying for the name.” I have seen many designers specify fancy acoustic ceiling tiles and while this may look nice, one must ask if they are necessary or would a standard commercial ceiling tile perform the same way for half the cost?

Flooring can often be around 10-15 percent of one’s construction costs. Is it worth it to skimp on the flooring? In my opinion and experience, it is not. However, this is the one item that everyone who comes

to your facility will have contact with. Flooring needs to be durable and yet comfortable to stand on all day (Employees). This can be challenging. With the many new products on the commercial market, there is a better chance of finding a flooring product to meet your needs. My suggestion is to be practical and understand that not only can a floor enhance the beauty of an office, but it can provide long lasting function as well. Having multiple floor types in a facility may be practical, but this adds labor and coordination costs to the project.

In conclusion, one’s budget affects the project from beginning to end. Stay involved in the value engineering process. Educate yourself about the products and equipment being specified and ask questions about the equipment and alternatives. The more engaged and the more educated you are, the better the collaborative effort can be. Always bear in mind that cheapest is not always the best in the short term and the long term. Choose practically and utilize the ones around you that have more experience.

Mark Bay is owner and CEO of Tri-Bay Construction LLC, a Commercial Contracting firm located in Oviedo. Mark is an alumnus of Columbia University and has over 30 years’ experience in the construction business including numerous MRI and radiology facilities throughout Florida. Tri-Bay Construction has partnered with an internationally renowned shielding company, radiology facility designers, equipment suppliers, equipment transporters and subcontractors offering a unique team approach to imaging facility construction.

Visit www.tribay.com or email mark@tribay.com

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Why Remote Patient Monitoring is Failing

By JAY BEST

• An American Hospital Association Annual Survey conducted in 2018 revealed that over 60 percent of hospitals have implemented some level of remote patient monitoring program (American Hospital Association, 2019).

• 68 percent of physicians surveyed by the Consumer Technology Association, “strongly intend to use remote patient monitoring technology in the future” (Pennic, 2019).

• The Spyglass Trends in Remote Patient Monitoring 2019 report revealed that 88 percent of providers surveyed either desire to or have already invested in RPM technologies to manage readmission risk in their unstable chronic care management population (Spyglass Consulting, 2019).

• Three new CPT codes were released

by CMS in January 2019 that enable reimbursement of RPM physiologic monitoring services.

• The new reimbursement opportunities for RPM services, themselves, make RPM programs more attractive to long-term care; especially coupled with the recent ability to be reimbursed for providing chronic care management to patients with a single chronic disease.

To date, many hospital systems are scrapping their remote patient monitoring (RPM) programs. The reason; the RPM systems are not working to improve patient health as proactive actions are not executed as intended. However, all is not lost, as there are solutions which are working - but in an unexpected way.

THE PROBLEM The current offerings of RPM devices in the marketplace are technology-only, data-centric solutions. In other words, they are a pure tech play that only provides results back to an EMR. This data then must be acted upon by a clinician, or another healthcare worker. However, there is not always a vested interest by that hospital staff to act. Instead, they are deeming the alerts as insignificant.

An example would be sudden weight gain. If an RPM device reports back to the EMR that there is a sudden 6lbs gained by the patient, an alert is sent to the responsible staff member to act. Yet sudden weight gain is not an actionable event for most hospital staff. Rather, it is perceived as frivolous information in the scheme of all that bombards the clinician on a daily basis. Thus, nothing happens. But a 3lb weight gain can be serious in a CHF patient. If no action

takes place to validate the weight gain or the acuity level of the alert, the patient likely ends up back in the ER - exactly what the RPM was designed to prevent.

There is a clear disconnect between the RPM, the patient, and hospital staff; perceived acuity and taking action. Actionable events reported by the RPM are usually reserved for serious indicators such as a massive spike in blood pressure or heart rate. However, there are many indicators that must also be taken seriously. Weight gain, oxygenation of the blood, cardiac output, etc. can all be serious indicators of emergencies.

But the acute care hospitals just do not have the staffing model that accommodates tracking of risk and complications in the ambulatory care arena.

THE SOLUTION The disconnect between the RPM results and hospital staff is solved with an intermediary service. A warm observation of all RPM alerts must be acted upon by a dedicated clinician in order for the system to reach full potential. This is the only proven method that creates success in an RPM system is to include a clinical wrapper.

Hospitals should not consider an RPM solution which does not include dedicated clinician monitoring results. If left to al-

ready overburdened hospital staff, much of the RPM’s results will go unchecked. It is the lack of dedicated staff that is fueling the RPM failures nationwide.

Going forward, RPM will succeed, but hospital systems must acknowledge that the tech alone is not enough. A warm delivery of the information, by way of a phone call

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John (Jay) Best is a partner in Nahakama Investments, CEO of Total Medical Concepts and Chief Sales Officer of NAHA Health, a multi-platform healthcare consortium focused primarily on transitional, chronic, critical, and behavioral post-discharge patient care. He can be reached at jbest@ nahakama.com, or visit www.nahakama.com

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Mobile Clinics to Puerto Rico Prove the Value of Quality Medical Care to Rural Communities

By TONY COWAN

Up a steep hill from the city center on the Island of Vieques, Puerto Rico, past the VA hospital that has never re-opened, at the back of a cinderblock housing community, is the municipal diagnostic and treatment center or CDT. This small building and the three mobile clinics in the parking lot are the only medical care available without a plane or ferry trip off the island. The three mobile clinics include a dental office, a general exam clinic, and an OB-Gyn office with pediatric care. These clinics were purchased

by SALUD (the Puerto Rican Department of Health) using FEMA disaster response funds.

That was 18 months ago. During those eighteen months, the three mobile clinics have generated their own power in the face of multiple failures in the island’s power grid and survived three named storms, sustaining no damage. Amidst this chaos, the clinics have been providing critical medical public health services, but most importantly, they passed their accreditation survey to become fully licensed facilities. Mobile clinics that were deployed for disaster response, pivoted into licensed healthcare facilities.

Thanks to Clinics on Wheels™, the people on the island of Vieques, Puerto Rico now have a General Exam Trailer with mobile X-Ray and telemedical capability to live chat with Sentro Medico in San Juan.

They have a Dental Trailer with two, fourhanded dental surgery chairs, dental X-Ray, and sterile processing. They have an OB-Gyn Exam Trailer with pediatric care, pharmacy stores, and sterile processing. Each clinic has an ADA compliant ramp, exceeding life safety standards, and generating and storing their own solar power. All three mobile units can store water, while being connected to the Internet via a satellite dish, which is also solar powered.

How is this relevant to our local issues with providing quality care to our rural health areas? Regardless, of a patient’s insurance provider or deductible, the most expensive way to begin a medical treatment is by starting it in the emergency room. Tragically, the number of people who are using emergency rooms as their primary care provider is growing.

Nearly half of all U.S. medical care is delivered by emergency departments, according to a study by researchers at the University of Maryland School of Medicine. A critical step in decreasing the need for people to turn to emergency rooms is the 17

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use of mobile medical units. The clinics on Vieques demonstrate how hospitals and physician groups can reduce costs and increase patient volume while still providing a superior level of service to the patient.

When diseases or medical issues are diagnosed in an emergency room, they have often already progressed to the point of causing severe symptoms. The hospital has few options but to admit the patient. These are the very kinds of situations that result in the highest rate of readmittance. At this point, the patient is in a health crisis.

When you consider that Medicare fines are incurred every time the hospital fails to provide a “30-day guarantee”, the need for a better solution is obvious for both financial and public health reasons. Hospitals have the added benefit of linking mobile capability with their non-profit foundations which gives them capital acquisition support as they care for the local community and generate revenue at the same time.

Now that healthcare has centralized around large hospital networks, rural small towns have lost independent practices, and healthcare deserts are a growing threat to the most vulnerable communities throughout the U.S. According to the Sheps Center, 104 rural hospitals have closed since 2010.

Clinics like those providing services on Vieques are effective in reaching these communities as they can generate their own power, water, and revenue all while being towed to the most austere locations with a simple pick-up truck. While the specialist that a patient requires could be hundreds of miles away, with telemedicine, neighborhood consults are possible.

Today’s healthcare tends to start at the hospital, and patient care rarely leads back to the independent practitioner. Mobile clinics are a way for the independent practice to take back primary care of their patients while increasing the area they can serve.

Telemedicine by itself is not enough to deliver quality healthcare. This was illustrated in September 2019 when the American Telemedicine Association denounced the Video Doctor Network. While there are quality telehealth companies out there, it is difficult for the consumer to tell the difference between them. One way to ensure quality and avoid Medicare fraud, is to have services delivered in a quality mobile medical platform, not just via an Internet connection.

When the health professional is in a mobile medical facility that includes telehealth as part of its infrastructure, a full

spectrum of services is available. The health professional does not need to be an MD or an RN, which will dramatically reduce cost, but with tele-health, a doctor can have direct access via a Point of View (POV) experience with the patient. The health professional in the unit has all the medical tools to complete diagnostic tests. One doctor can literally see hundreds of patients throughout underserved communities while never having to leave their office.

The patient provider relationship is intact, with true continuity of care being maintained. Connected health advocates have long noted the difference between (store-and-forward) systems in which a patient and provider communicate online or by phone, text, and messages, rather than in real-time via an audio/ video portal. Clinics on Wheels™ directly connects the provider and the patient to ensure true continuity of care is maintained.

To prevent emergency room visits as a first option and promote equivalency of care,

practices and hospitals need to give consideration to mobile units that can bridge the gap in rural populations lacking hospital access and provide preventative care to people across the nation. Over the last eighteen months the Clinics on Wheels™ in Puerto Rico have passed life-safety inspections, and an accreditation survey that has pivoted them from disaster response assets to fully operational medical public health infrastructure. This accreditation makes Clinics on Wheels™ not just a humanitarian asset, but a potential revenue generator. Let’s hope that is enough to move the needle on getting the equivalency of care to the growing healthcare deserts locally and across the country.

Tony Cowan is a Healthcare Risk Manager, the Director of Emergency Response Technologies for Clinics on Wheels™ at World Housing Solution, Inc. An experienced healthcare consultant, he supported hundreds of surgery centers to attain on-budget, on-time openings, passing state licensure, Medicare certification, and accreditation. Currently he develops and delivers mobile clinics to rural or disaster impacted areas that are medically compliant, can pass accreditation, and become part of the medical public health infrastructure for communities in need. tonyc@worldhousingsolution.com

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Our Aging Population Needs Regenerative Medicine

By QUINTIN L. GUNN, SR.

There is an exciting development in China; Chinese hospitals are starting to sell experimental cell therapies... China is creating an emerging market for Regenerative Medicine, and Japan has already made significant investments to advance their global impact in this field.

Here is an update to this article and additional proof: https://celltrials.org/news/ response-new-cell-therapy-regulations-china So, will the US fall behind in regenerative medicine advancements?

It is possible that the US will lag behind in Regenerative Medicine therapies due to over-regulation, and the overly critical view of advancements in regenerative medicine. Can our aging patient population afford to wait?

Effective Oct 1, 2019, Google has globally restricted advertiser use of most regenerative medicine and stem cell treatments being promoted: • Speculative and experimental medical treatment • The promotion of speculative and/ or experimental medical treatments is prohibited.

• Examples of products and services that will be prohibited (non-exhaustive) • Stem cell therapy, cellular (non-stem) therapy, gene therapy and similar forms of regenerative medicine, platelet-rich plasma, biohacking, do-it-yourself (DIY) genetic engineering products, and gene therapy kits.

Biologics such as PRP, Exosomes, A2M, Wharton’s Jelly, Cord Blood, and Amino, to name a few, are cell assisted products that have the greatest opportunity to move the future of medicine forward. By being so restrictive or narrow in its thinking, could they be hurting medical innovations? Is it slowing down cures?

Could it be destroying the financial aspects of what patients can afford and what doctors can recommend in treatment protocols?

Yes, the efficacy of these treatments needs to be documented and measured, but beyond that, who are the right types of doctors to administer these advancing technologies, and where are the best places for them to be educated or trained for the benefit of their patients?

There are several well-known organizations like IFATS, Boston BioLife, A4M, EmCyte, TOBI, World Stem Cell Summit, Perinatal Stem Cell Society, and the Interventional Orthopedic Foundation where doctors can get an introduction to stem cells or receive advanced training.

We also have many wonderful resources for doctors to gain access and information related to the latest in regenerative medicine innovations like BioInformant, Regenerative

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Medicine Foundation, and Regen Med No doubt, we need advancements in healthcare. But what we really need is to have highly trained and skilled doctors who can administer new medical innovations and treatments. It is very likely the U.S. could actually stagnate and, unfortunately, fall behind the rest of the world as a result of over-regulation. This can only happen if we don›t have enough doctors and speed up our acceptance of regenerative medicine alternatives. We get a glimpse of the future as we start to see U.S. citizens heading overseas to look for these emerging medical alternatives.

The urgency of this issue becomes even more concerning, as the global population has shifted to a more elderly population. Unfortunately, the data also shows that 71% of youth do not even have enough good health to qualify for military service due to obesity, drug use, and criminal records. How can they help manage the upcoming tsunami of aging patients?

Does this article become especially critical because data within actuarial studies show where the human population is headed? Global Aging In A Warming World Who will take care of us if the youth are not even able to take care of themselves?

Science and doctors have to work together to develop protocols that help to improve the health and well-being of our aging population in new and innovative ways.

What we know so far is the only prevailing methods for certain orthopedic procedures are surgery or non-surgical treatments using BMAC and PRP injections. PRP being the dominant and most approved way of treating patients for joint pain, back pain, hip pain, etc. What about other conditions or injuries such as MS, Spinal Cord Injuries, Autism, COPD, Strokes, just to name a

few. We need more research to develop new therapies for these and other treatments.

It’s the view of many physicians who are now actively pursuing an education in the field of Regenerative Medicine, Functional Medicine, and Integrative Medicine, as well as Age Management/Anti-Aging that they are constrained due to the limitations of accepting insurance. These doctors are awakening to the low cost and high benefits of regenerative medicine advancements.

Using the Fee-For-Service model allows patients to choose for themselves and doctors to go with the best treatment plan that they see fit for their patients. When doctors attack the problems at the root cause via cell assisted therapies, nutrition optimization, and lifestyle changes, they give patients a fighting chance to see improvement.

Consider this, our current insurancebased model is causing burn out and job dissatisfaction due to too low reimbursements, too much regulation, overwork, and little pay. So, the once desired medical field is now becoming a second option for new college students.

We acknowledge that there has been a sharp uptick in the number of bad actors or profiteers who prey on the weak and elderly — however sharing within local medical boards, FDA regulations, and standardized protocols that meet regulatory guidelines for the safe use of cellular and regenerative medicine treatments. It’s the belief of many that the country should be a leading regenerative medicine industry for others to emulate.

Regulatory guidance has to be based upon scientifically documented findings and knowledge from physicians who are currently on the front line of treating real patients.

Scientists and doctors alike should provide a defense for an aging population.

Without them both, our future progress in medicine gets impeded, and our healthcare system collapses under the weight of just too many patients and no new ways to treat them. Which could lead to a trail of untreated or untreatable patients?

Today the RMAT process via the FDA›s TRG Rapid Inquiry Program (TRIP) allows studies for catastrophic injuries or illness and is certainly becoming an orderly way beyond the older IRB process. It provides doctors with the necessary framework to organize new treatment protocols and to move the needle of science and medicine further. This approach allows doctors to place their focus on where it belongs, and that›s on the patient. Plus, it gives them a chance to ward off catastrophic medical problems by detecting and treating the onset of certain health issues earlier.

Regenerative Outcomes LLC has created a program to help doctors prepare for submission of their regenerative medical protocols so that doctors are not left in a lurch without guidance or Regenerative Outcomes Foundation resources.

Often online, we find disagreements between doctors within certain medical communities versus some PhD physicians related to 351 or 361 regulatory issues. In reality, it›s in everyone›s best interest to collaborate and work toward a common goal through data sharing that will provide clinical transparency and self-regulation using patient data management for the advancement of regenerative medicine as a whole.

Taking a personalized precision approach to medicine has mainly come from patients who are willing to pay out of pocket when traditional medicine has failed to give them results. Personalized Precision Medi(CONTINUED ON PAGE 19)

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American Lung Association ‘State of Tobacco Control’ to Be Released End of January Report finds Florida must do more to prevent, reduce tobacco use Tobacco use remains the nation’s leading cause of preventable death and disease, taking an estimated 480,000 lives every year.

This year’s State of Tobacco Control report from the American Lung Association finds Florida earned failing grades on its efforts to reduce and prevent tobacco use. The American Lung Association calls on Florida officials to enact provisions of Constitutional Amendment 9 approved by the voters that would save lives by expanding current smoke-free protections to include the use of e-cigarettes.

The need for Florida to take action to protect youth from tobacco is more urgent than ever, with youth e-cigarette use reaching epidemic levels due to a 78 percent increase in high school e-cigarette use from 2017 to 2018, according to results from the Centers for Disease Control and Prevention (CDC)’s 2018 National Youth Tobacco Survey. This equals one million additional kids beginning to use e-cigarettes, placing their developing bodies and lungs at risk from the chemicals in e-cigarettes as well as a lifetime of addiction to a deadly product. This has caused the U.S. Surgeon General to declare e-cigarette use among young people an epidemic in an Advisory issued in December 2018.

“In Florida, our smoking rates remain at 16.1 percent. Tobacco use is a serious addiction and we need to invest in the proven measures to prevent and reduce tobacco use outlined in State of Tobacco Control,” said American Lung Association Director of Advocacy, Ashley Lyerly. “The report provides a roadmap on how to save lives, but much work remains to be done in communities across Florida to prevent and reduce tobacco use.”

The 17th annual State of Tobacco Control report, set to be released on Wednesday January 29, grades states and the federal government on policies proven to prevent and reduce tobacco use. While Florida has taken significant steps to reduce tobacco use, including voters approving a constitutional amendment prohibiting e-cigarette use in public places and workplaces where smoking is prohibited, elected officials must do more to save lives and ensure all Florida residents benefit from reductions in tobacco use and exposure to secondhand smoke. The report looks at five categories when gradings states: 1. Funding for State Tobacco Prevention Programs 2. Strength of Smoke-free Workplace Laws 3. Level of State Tobacco Taxes 4. Coverage and Access to Services to Quit Tobacco 5. Minimum Age of Sale for Tobacco Products to 21

The American Lung Association en-

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courages Florida to fully fund tobacco control efforts at levels recommended by the CDC. Both the U.S. Surgeon General and the National Academies of Science, Engineering and Medicine have warned about the risks of inhaling secondhand e-cigarette emissions, which are created when an ecigarette user exhales the chemical cocktail created by e-cigarettes.

The American Lung Association applauds Floridians for standing up for public health by overwhelmingly approving Amendment 9 and extending protections from secondhand smoke and secondhand e-cigarette emissions to workers in Florida.

The Florida Legislature should move swiftly to pass authorizing legislation to add e-cigarettes to Florida’s Clean Indoor Air Act. This health protection would benefit everyone and is especially critical for those who work in the service and manufacturing sectors who are often exposed to secondhand smoke and secondhand e-cigarette emissions daily. “Opportunities for better health begin where people work, live and play, and a person should not have to be exposed to the dangers of secondhand smoke and secondhand e-cigarette emissions to put food on the table,” said Lyerly.

State of Tobacco Control 2019 provides a blueprint that states and the federal government can follow to put in place proven policies that will have the greatest impact on reducing tobacco use and exposure to secondhand smoke in the U.S. The real question is: Will lawmakers in Florida end their failure to act and take this opportunity to achieve lasting reductions in tobacco-related death and disease?

The next “State of Tobacco Control” report will be released on January 29, 2020.

For more information, visit www.stateoftobaccocontrol.org. A report release will be held on January 29 from 8:15-9:30am at the American Lung Association office located at 851 Outer Road Orlando, FL 32814. Local Executive Director Janelle Hom will present on the report’s findings and incorporate a panel discussion; panelists will include Advent Health and the Florida Department of Health. Please RSVP to the State of Tobacco Control release event by emailing Janelle.Hom@lung.org The American Lung Association is the leading organization working to save lives by improving lung health and preventing lung disease, through research, education and advocacy.

The work of the American Lung Association is focused on four strategic imperatives: to defeat lung cancer; to improve the air we breathe; to reduce the burden of lung disease on individuals and their families; and to eliminate tobacco use and tobacco-related diseases. For more information about the American Lung Association, a holder of the coveted 4-star rating from Charity Navigator and a Gold-Level GuideStar Member, or to support the work it does, call 1-800-LUNGUSA (1-800-586-4872) or visit: Lung.org.

Our Aging Population Needs Regenerative Medicine, continued from page 18 cine or WellCare seems to give the best options versus trying to keep up with insurance forms, billing codes, and the ongoing lowering of reimbursements and restrictions.

When you consider the rising cost of our current healthcare model, are we more focused on insurance approved treatments and payments than WellCare or preventative maintenance? The cost to care for certain age-related illnesses is outstripping our ability to meet the needs of this growing elderly demographic.

When science and doctors work together, both patients and doctors are hap-

pier and, subsequently, there’s less doctor burnout from volume patient care requirements related to the current insurance model. We have the technology, and we have a large pool of doctors who want to be trained, let’s get with it!

So: Will the US Fall Behind in Regenerative Medicine Advancements?

Only time will tell but can the aging patient population afford to wait for the answer?

Quintin L. Gunn Sr. is a Practice Development Consultant with Social Media Solutions for Doctors. Visit SocialMediaSolutionsforDoctors.com

MY CHAMBER IS INNOVATION.

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Your Waiting Room – An Often-Missed Asset and Marketing Tool

By DOUG MINTZ

Waiting rooms are consistently the most overlooked asset in a clinic. When you consider that 97 percent of patients get frustrated by long wait times at the doctor’s office, you must wonder why waiting rooms don’t receive more attention by clinic owners and their executive directors or office managers.

The reason is rather simple. Both the PROS of having a nice waiting room and the CONS of not having a nice waiting room are somewhat intangible and difficult to measure. Well, let me share some interesting statistics that will get you thinking more about this.

Okay, so 97 percent of patients are frustrated by their waiting room experience.

Does this mean that a clinic loses 97 percent of its patients every year? Of course not.

But here are more stats that will start to raise some eyebrows and get you thinking.

According to the 2018 Vitals study, there’s a strong correlation between how long a patient had to wait and the star rating of the healthcare facility. Physicians with the highest rating had an average wait of just over 13 minutes while those with the lowest ratings had average wait times of more than 34 minutes. Here’s the nitty gritty from Vitals when it comes to wait times;

cent of respondents said they consulted review websites with some frequency to view or post comments and ratings for health care providers. This year, that number jumped to 94 percent. Over 500 U.S. patients were surveyed about their use of online reviews sites.

It was also found that the trend of patients using online reviews sites to research medical providers continues to grow.

One more very relevant statistic: Almost three quarters (72 percent) of patients use online reviews as the very first step to finding a new doctor, so your online reputation is often the first impression you make on many potential new patients.

At the end of the day, if reducing patient waiting times seems a bit daunting, let’s take a small bite out of the elephant. Let’s look at this from another angle. If you can’t reduce your waiting room time per patient, why not enhance their waiting room experience so the wait time doesn’t seem so long? There are many ways to do this. Considering that a patient’s perception of time can be influenced by their immediate surroundings, fixing your waiting

room could be the key to better patient experience, better ratings, and more new patients.

They may wait longer at your clinic compared to national statistics, but they won’t walk out or cop an attitude if they are preoccupied with a pleasant waiting room environment. And if they don’t walk out, they hang out and make the best of it.

Then as long as the doctor does his/her job and has a wonderful bedside manner, the patient’s perception of their overall experience is much more positive, and this will directly translate to higher online ratings.

We all know that the costs of patient satisfaction and patient retention are considerably lower than the cost of new patient acquisition.

This, and the fact that 72 percent of new patients initially review their new doctor and clinic options from online ratings, further supports my prior statements that a positive waiting room experience can drive an increase in new patients.

So, how do we create this wonderful waiting room environment? There are several components to this. Here’s a quick list.

• Waiting room furniture that looks good, feels good, and is sturdy enough to handle larger patients that need good arm rests and support to get up from their chair after being seated for a while. This also includes some bariatric seating as well (If you’re not familiar with this term, then you definitely need a little help).

• A functional layout that looks inviting – NOT institutional and in rows.

For example, clusters of seating with nearby coffee tables or end tables and magazine tables.

• While we’re on the subject of magazines, provide current and interesting publications that suit most of your demographics.

• Offer a variety of beverages and even snacks. Coffee, tea, water, cocoa, small cookies, etc. Ever been to a big fancy new car dealership lately? This (CONTINUED ON PAGE 21)

Five-star rating: 13 min, 17 sec Four-star rating: 21 min, 32 sec Three-star rating: 22 min, 11 sec Two-star rating: 29 min, 34 sec One-star rating: 34 min, 11 sec

How does your clinic wait time compare to the above? Do you even have systems in place to measure this? Regardless, let me get to my point. Would you agree that you would prefer 4-star and 5-star ratings overall, and that anything less may be detrimental to your business?

Now let’s look at a couple of more statistics. Up to 30 percent of patients have left a physician’s office before being seen because of the wait time. 20 percent would even consider changing providers over long waits. And another study states that 1 in 5 patients say they have in fact switched doctors because of long wait times!

And . . . There’s also a direct correlation between the amount of time a patient waits and a doctor’s rating on the Vitals’ web site.

The report, along with a related patient survey of 675 online respondents, showed that 84 percent of people believe wait time is either “somewhat important” or “very important” to the overall patient experience at a doctor’s office.

Per Software Advice, last year 82 per20

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Periodontitis and its Effect on Systemic Diseases

By DR. KENYA HOOVER

The mouth is the window into the health and wellbeing of the body. Systemic diseases may often begin showing signs in the mouth, Coelianc and Crohns disease often manifest as aphthous ulcers. Most notably periodontal disease with its prevalence in the American population has a direct correlation to diabetes and cardiovascular disease. The effects of periodontitis on the risks for systemic diseases makes it essential that all clinicians encourage patients to seek periodic exams and maintenance of their oral health.

Periodontitis also known as gum disease, is a chronic inflammatory disease of the mouth that involves the gingiva, teeth, and supporting bone. Clinically defined as the loss of connective tissue attachment to the teeth and alveolar bone loss. A recent CDC report1 estimates that 42 percent of U.S. adults age 30 years or over with one or more teeth have periodontitis, the condition is more common in men than women and increases with age, 70.1 percent of adults 65 years and older have periodontal disease1.

At first, it’s silent, practically invisible and sometimes even a painless disease, but once periodontal disease strikes it’s only a matter of time until it makes its presence known with uncomfortable, unsightly and quite possibly irreparable side effects.

Periodontal disease is the major cause of tooth loss in adults and caused by bacterial biofilm that forms constantly on teeth.

The bio film turns into plaque if not removed this plaque hardens into calculus along and under your gums. The clinical signs of periodontitis2 include swelling, redness and bleeding from the gums, sensitive gums, spacing between teeth, loose teeth, changes in occlusion, halitosis, and exposure of root surfaces through loss of bone around the teeth. The disease can present locally, involving a few teeth, or be more generalized.

Patients with diabetes (both type 1 and type 2) are at an increased risk of developing periodontitis3. Periodontitis has been referred to as the sixth complication of diabetes2 and is often more generalized in patients with diabetes. Several studies found a higher prevalence of periodontal disease among diabetic patients than among healthy controls2. The risk increases as glycemic control worsens and evidence of loss of tooth support, often seen as spreading of teeth resulting in diastemas. Despite similar plaque scores, patients with poorly controlled type 2 diabetes display more severe gingival bleeding compared to those with diabetes in good or moderate control3.

In broad terms, the risk of periodontitis is increased approximately three-fold in people with diabetes and the risk is greater with poor glycemic control. Unfortunately, many people with diabetes remain unaware of their increased risk of developing periodontal disease. A two-way relationship between periodontitis and diabetes has

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been described, with each condition having adverse impacts on the other. Periodontitis has been associated with worse long-term glycemic control4 in people with type 2 diabetes, as well as increased risk of diabetic nephropathy (macroalbuminuria and endstage renal disease) and cardiorenal mortality, Ischaemic heart disease and diabetic nephropathy combined.

Furthermore, individuals with periodontitis have two to three times the risk5 of having a heart attack, stroke, or other serious cardiovascular event. Shared risk factors, such as smoking, unhealthy diet and socioeconomic status, may explain the association. There’s an increasing suspicion that periodontal disease may be an independent risk factor for heart disease. The association between coronary heart disease and periodontal disease may be due to an underlying response trait, which places an individual at high risk for developing both periodontal disease and atherosclerosis. It was suggested that periodontal disease, once established provides a biological burden of endotoxin and inflammatory cytokines, especially thromboxaneA2, prostaglandin E2, interleukin (IL) 1L=1, and tumor necrosis factor-β, which serve to initiate and exacerbate atherogenesis and thromboembolic events6.

It is imperative that patients with diabetes and heart disease are made aware of the potential effects it may have on their oral and periodontal health7. It is highly recommended that patients with periodontal disease be assessed by dental professionals, it

should be routine in people with diabetes to assess for both periodontitis and the other potential oral complications of the disease, such as dry mouth, candidal infections, burning mouth, and dental caries.

Dr. Kenya Hoover, Clinical Director/Owner of NuLife Dental and Med Center, is a graduate of Universidade Vale do Rio Doce School of Dental Science and holds a post-graduate degree in Operative Dentistry as well as a Masters in Science from Nova South Eastern University. After her post graduate degree Dr. Hoover became an Assistant Professor for the Department of Restorative Dentistry at Nova South Eastern University, before opening her own practice in 2019. She can be reached at Drhoover@mynulifedental. com. Visit www.mynulifedentalandmedcenter.com

Your Waiting Room, continued from page 20 industry is all about the customer experience. They want you to feel like a million dollars when you are about to spend an average of $36,718 on your new 4-wheeled family member.

• Do you have a large flat screen TV on the wall? What channel is it on? Fox News? CNN? Regardless of your politics, don’t rile up your patients with these channels! Find a channel that’s fun and entertaining. Better yet, launch an entertaining video loop about your office and your services. How about personalized doctor profiles to better connect with your patients? After all, people choose to be around people they know, like, and trust. What is more personal to entrust someone else with than your own health?

• Waiting room colors are also very effective and a very inexpensive way to change the “feel” of your waiting room. Calming colors are best, including blues, greens, grays, tans, and

even paler yellows. Pastels are always better and again, the object is to bring calmness to your patients.

• Waiting room artwork can also contribute to mood. And there are other diversions as well that can contribute to your desired end-result. An aquarium can be very enticing, and simple water features are popular these days.

At the end of the day, step back and look at your present waiting room. Put yourself in your patient’s shoes. Is this a room you’d like to spend time in, like your favorite den or family room at home? If not, then you probably have some things to consider that will enhance your patients’ experience and earn you more “gold stars” on the internet.

Doug Mintz, founder of CPOF Inc – Cubicles Plus Office Furnishings, has been in the office furniture industry for over 20 years. His focus is primarily on the patient’s waiting room experience, as well as the ergonomic health and well-being of clinic employees. Visit www.CubiclesPlusOF.com or email Doug@CubiclesPlusOF.com

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Real Estate: The Second-Highest Expense in Your Practice

By DOUG PRICE

When it comes to managing expenses in your practice, there are dozens of categories to evaluate: equipment, technology, loan costs and interest rates, sundries, marketing and on and on they go.

Many practice owners are quick to shop-out what they believe are the most obvious expenses, but few understand the impact of one of the largest expenses and how it can be dramatically reduced to increase profitability. The highest expense for most practices is payroll, followed by real estate.

Real estate encompasses your monthly rent or mortgage payments, along with the property’s operating expenses, maintenance fees, utilities, and janitorial costs.

If you consider these top two expenses, payroll and real estate, only one of them is really negotiable. With payroll, you can either pay people their value or they usually find another job that will. You may decide that you can cut staff, but if you need people you need to pay them what they deserve, or they will eventually leave.

Real estate, however, is 100 percent negotiable. You have the choice of leasing or owning, as well as being in an office building, retail center, a stand-alone building, or large medical complex with many other providers.

You can choose the size of your space, the design, and the landlord you want to work with – or to be your own landlord. And if you do own, you get to decide whether to buy an existing building, an office condo, or to develop your own building from the ground-up.

When negotiating the economic terms of a lease, you get to have a say in the length of lease, the desired concessions including build out period, tenant improvement allowance, free rent, lease rates, annual rate increases and many other provisions.

With this many choices to evaluate and understanding that each one affects the final economic outcome, why is it that so many practices fail to capitalize on their real estate opportunities? The short answer is that most practice owners and administrators simply don’t have the knowledge and expertise in commercial real estate to understand how to make the most of these opportunities. They view real estate as a necessary evil instead of an incredible opportunity to improve profitability, reduce expenses and improve the quality of their patients’ experience. When the correct approach is taken, you may actually look forward to it instead of dreading your real estate negotiation.

Let’s take a look at three key ideas that will help you make the most of your next real estate transaction.

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TIMING Every type of transaction has an ideal timeframe to start the process. When starting too early or too late, you communicate to the landlord or seller that you don’t really know what you’re doing. When that message is communicated, it hurts your ability to receive the best possible terms. For example, don’t wait for your landlord to approach you on a lease renewal negotiation. Start by consulting with a professional so you can understand the ideal timeframe to start your transaction, come up with a specific game plan for what you want to achieve, and then you be the one to approach your landlord with renewal terms.

vantage of a small tenant who is not an expert, doesn’t have a full complement of real estate knowledge and skills, and who doesn’t have adequate representation.

When you understand that commissions are paid in commercial real estate just like they are in residential real estate— they are set aside in advance for two parties, not just one—then you understand there aren’t any savings by not having a broker. And if there aren’t any savings by not having a broker, then showing up without one only further detracts from your credibility.

REPRESENTATION Landlords and sellers prey on unrepresented tenants who don’t really know the market or what their options are. If the tenant was a Fortune 500 company, the landlord would approach them with a high level of respect, expecting that they either have a real estate broker hired to represent them or have a team of professionals internally that are well equipped to handle the transaction.

In contrast, when a landlord or seller starts speaking with a tenant who isn’t represented, and who they don’t believe knows the market as well as they do, that tenant is not going to get the same level of respect through the process. This is because the landlord senses an opportunity to take ad-

LEVERAGE AND POSTURE It is nearly impossible to emerge victorious from a negotiation without leverage and posture which are created by having multiple options in the market. If you limit yourself to one property, you are at the mercy of that owner. Since most landlords and sellers negotiate professionally, it is easy for them to know when you don’t have other viable options.

Simply telling a landlord that you have a proposal from another landlord won’t give you a strong enough posture. Most landlords look at unrepresented tenants and assume they do not know the market, do not understand all their options, and are not really serious about making the landlord compete for their business. Leverage and posture are

created when you have the right timing, professional representation, an understanding of all your available options, and a detailed game plan of what you want to accomplish in order to capitalize on the market.

These three key ideas are the first of many factors that allow healthcare tenants and buyers to reduce their second highest expense which dramatically impacts profitability and cash flow.

Doug Price is an agent with CARR Healthcare, the nation’s leading provider of commercial real estate services for healthcare tenants and buyers. Every year, thousands of healthcare practices trust CARR to achieve the most favorable terms on their lease and purchase negotiations.

CARR’s team of experts assist with start-ups, lease renewals, expansions, relocations, additional offices, purchases, and practice transitions. Healthcare practices choose CARR to save them a substantial amount of time and money; while ensuring their interests are always first. Contact Doug at Doug.Price@carr.us

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Save Money in Multiple Ways with Solar Panels

By JENNIFER FLOREZ

A New Year’s resolution is a tradition, in which a person resolves to continue good practices, change an undesired trait or behavior, to accomplish a personal goal, or otherwise improve their life. Most of the people review the way they spend money and decide to make clever decisions regarding their budget.

If saving money is part of your new year’s resolution, solar energy is a great option because it will help you on a monthly basis, and it will bring even more savings with time.

1

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You are going to save money

Energy prices are only going up. Invest in your home instead of your utility company.

Have a Fixed Payment and put a stop to an uncertain energy future.

PV Systems has a guaranteed return on investment. Your current electric bill does not.

2ND You are adding value to your property

Today’s realtors are finding that homes and businesses that have Solar PV Systems installed are selling faster and for more money than other similar properties. Professional appraisers have estimated that for every $1 in savings generated by a Solar PV System, you can see up to $20 in increased property value! That means that a system that produces/saves $100 per month in electricity translates to a property value increase of $20,000!

3TH You are performing concrete actions for a positive impact on the environment

It’s no great secret embracing clean, reliable energy is critical if we are to tackle climate change. Having Solar Panels could be the equivalent of planting hundreds of trees per year, reducing millions of carbon footprint emissions and driving billions of miles.

4 You can apply for Government Incentives TH

When you purchase a residential solar

system, the federal government will give you a 26 percent tax credit, lowering the amount of taxes you owe by 26 percent of the cost of the solar system.

If you purchase a home solar system that costs $25,000, you can apply for a Federal Tax Credit to receive a credit of $6,500 when you file your personal federal income taxes the following year. This solar incentive is different from a cash rebate, which gives you money back after filing for the rebate.

2020 is the last year that is going to be 26 percent. The federal solar investment tax credit for residential rooftop solar is set to expire in 2021. There has never been a better time to go solar - click here to find out if solar by Clever Energy is right for you!

5TH You are developing a Green Industry

From electric vehicles to green construction to habitat conservation plans, many companies across the world are making tremendous efforts to build stronger,

more conscious and healthier generations.

At Clever Energy, we will always celebrate smart and noble goals like these because we believe empowering people also means empowering a greener, safer, and more resilient future for all.

Whatever solar needs you have, at Clever Energy we customize your solar system to meet your energy needs, match your budget, help you save money, and reduce your carbon footprint. We provide industry leading-service packages and warranties that make going solar simple and easy. Get your Free Solar Quote Jennifer Florez is the business developer for Clever Energy, in Orlando, a family-owned solar company specializing solely in solar panels and offering free personalized consultation in both Spanish and English with licensed installers.

Customized solar proposals are based on the specifics of the house – roof space, shade analysis and energy consumption. Clever Energy is part of Pro Who Knows presented on Channel 6 every Saturday at 6:55 am. Call 407.274.1531 or book your consultation online at https://gocleverenergy. com/calendary/

Deteriorating Medical Malpractice Trends

By ROBERT HALL

Earlier this year, I wrote an article for The Orlando Medical News entitled Pain & Suffering. Within the piece, I alluded to my own experiences working as a managing agent for a national medical malpractice carrier. The story was about me being part of a claim management team that lost a medical malpractice case and we had to pay $5.3 million, plus legal expenses. Back in the late 1990s, the pain and suffering component was unlimited. The good news, in 2003 the Florida state legislature passed a law capping pain and suffering. From that time period forward, medical malpractice insurance premiums fell, the insurance market stabilized, and the related premiums were low by historical standards. However, in June 2017, the Florida Supreme Court overturned the pain and suffering caps. The impact on the medical malpractice insurance market has taken better than two years to develop, and now most malpractice carriers are experiencing deteriorating loss experience. Outside Florida, a perfect example comes from a July 2, 2019 article from the Baltimore Sun detailing a $229 million medical malpractice loss. (https://www.baltimoresun.com/maryland/ baltimore-city/bs-md-ci-hopkins-medical-malpractice-record-20190702-story.html) Or, here in Florida, an April 17th, 2019 article from

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the Miami Herald detailing a $24.5 million medical malpractice loss. (https://www.miamiherald.com/news/local/community/broward/ article229386529.html) If you have lived in Florida over the past fifteen years, you will remember we have had a lucky streak with what, in the commercial insurance business, we define as catastrophic losses. Overall, the favorable CAT years resulted in a stable insurance market across all coverages. We all know that the weather patterns have shifted. Couple the two shock loss examples with several others and add the unfavorable CAT years and the logic dictates that the money or premium has to come from somewhere to absorb the losses and fund surplus for future expected losses.

The insurance business has always been and will always be about actuarial science; the mathematical and statistical modeling for risk and uncertainty.

And to express my singular thought and point, we are heading into an uncertain period. In 2020, I expect all insurance coverage premiums to begin a steady increase, except for worker’s compensation insurance.

Another component adding to this fire is the already hardened reinsurance market. I’ll not discuss that part for this article, but an easy way to think about reinsurance is that insurance carriers manage their insured book risk by purchasing contracts with reinsurers to

minimize their exposures. For our purposes, let me state the medical malpractice insurance market is hardening. We are seeing carriers implement less favorable underwriting coverage and renewal pricing. We have large national markets taking steps to retrench and re-underwrite their books of business to improve long-term performance and assure credit rating services (like AM Best) they have taken steps to improve future results.

I think it important to note that hospitals are under the same financial and risk management pressures. If they purchase commercial insurance or manage an alternative risk model – captives, risk purchasing groups or risk retention groups – they have to budget for the needed funds to pay for insurance or fund the captive.

Over my 25-year career in medical malpractice placing coverage for physicians, hospitals and a wide range of medical facilities, I’ve seen and worked within a hard market. I know what it feels like, and I can assure anyone that reads this article, a broker or consultant does not want to present rate increases during a difficult healthcare delivery environment.

WHAT TO DO? Simple question, ask your broker why?

In this coming market, I think practice administrators should expect multiple carrier quotes and the broker should provide a side-

by-side comparison of each carrier’s financial situation, show their track record, and long-term business strategy. It’s a temptation, but do not go bare. The reason being for every dollar in premium a carrier takes in, about 50 percent goes back out as allocated legal fees. Can you fund a medical malpractice case for three years? And that assumes you get out of the case with a zero.

Also, if your practice or facility has a temporary downturn, or unexpected expenses, communicate with your broker and insurance carriers. I know they want to work with you, remember it’s a financial issue that can be worked-out.

We work with multi-billion-dollar medical malpractice insurance markets that are experiencing financial turbulence. The numbers are larger, but they have all done one verb with our brokerage. They don’t hide; they communicate their situation. If some are downgraded, I’m not concerned because they have resources. I have a four-word recommendation, communicate, communicate, communicate and communicate.

Robert Hall, a broker in healthcare products for ARCW Insurance in Pinellas Park, has over twenty-four years of experience in the healthcare, life sciences, and long-term care liability insurance and risk management business. He holds the ARM designation and has developed an expertise in healthcare, having placed complete insurance programs for hospital systems and large physician groups. He has also created captive feasibility studies and other alternative risk models. He has a strong understanding of HMO Reinsurance and Provider Stop-loss. Contact him at robert@ arcwinsurance.com orlandomedicalnews

.com

GrandRounds Central Florida MGMA Elects New President The Central Florida Medical Group Management Association has elected Pam Scott to serve as their President for 2020.

Scott, a native Floridian and charter member of CFMGMA, has been employed in healthcare for over 35 years in the Orlando area, and currently serves as the Administrator for Oral & Facial Surgeons of Mid Florida.

“I’m excited about the upcoming year and happy to serve as President of CFMGMA,” said Scott.

Also elected to the board were: Ashley Androski, Pres Elect; Anne Sady, Treasurer; Dorothea Wynne, Secretary and the immediate past president is Maryann Simmons.

Celia Myres, Maryann Simmons, Gina Todd and Debbie Howard were chosen as members-at-large.

Healthcare and the practice of medicine are experiencing the most dynamic and challenging time in the history of medicine. Both the patient and provider are being impacted by staggering medical advancement, technology, government and major corporations.

Medical Group Management Association (MGMA) is the premier association for professionals who lead medical practice. Since 1926, through data, people, insights, and advocacy, MGMA empowers medical group practices to innovate and create meaningful change in healthcare. With a membership of more than 45,000 medical practice administrators, executives, and leaders, MGMA represents more than 12,500 organizations of all sizes, types, structures and specialties that deliver almost half of the healthcare in the United States. Visit the Central Florida chapter at www.cfmgma.com

CMS Office of the Actuary Releases 2018 National Health Expenditures Total national healthcare spending in 2018 grew 4.6 percent, which was slower than the 5.4 percent overall economic growth as measured by Gross Domestic Product (GDP), according to a study conducted by the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS) and published today ahead of print

by Health Affairs.

As a result, the share of the economy devoted to health spending decreased from 17.9 percent in 2017 to 17.7 percent in 2018.

Growth in overall healthcare spending has averaged 4.5 percent for 2016-2018, slower than the 5.5 percent average growth for 2014-2015, that was affected by expanded Medicaid and private insurance coverage and increased spending for prescription drugs, particularly for drugs used to treat hepatitis C. The growth in total national healthcare expenditures was approximately 0.4 percentage point higher than the rate in 2017 and reached $3.6 trillion in 2018, or $11,172 per person.

According to the report, private health

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Orlando Medical News Intern Graduates!

insurance, Medicare, and Medicaid experienced faster growth in 2018. The faster growth for these payers was influenced by the reinstatement of the health insurance tax which was applied to private health insurance, Medicare Advantage, and Medicaid Managed care plans. The health insurance tax was a fee imposed on all health insurance providers beginning in 2014 as a part of the funding for the Affordable Care Act (ACA) and was subsequently amended to institute a one-year moratorium on the fee for 2017.

Private health insurance spending (34 percent of total health care spending) increased 5.8 percent to $1.2 trillion in 2018, which was faster than the 4.9 percent growth in 2017. The acceleration was driven in part by an increase in the net cost of private health insurance, which was a result of the reinstatement of the health insurance tax in 2018 following a one-year moratorium in 2017.

Medicare spending (21 percent of total health care spending) grew 6.4 percent to $750.2 billion in 2018, which was faster than the 4.2 percent growth in 2017. The faster growth in Medicare spending in 2018 was influenced by faster growth in the net cost of insurance of Medicare private health plans (mostly Medicare Advantage plans) due to the reinstatement of the health insurance tax in 2018, faster growth in Medicare spending for medical goods and services, and an increase in government administration spending after a reduction in 2017.

Medicaid spending (16 percent of total health care spending) increased 3.0 percent to $597.4 billion in 2018. This was faster than the rate of growth in 2017 of 2.6 percent. The faster rate of growth in 2018 was driven by faster growth in the net cost of insurance for Medicaid managed care plans, also due in part to the reinstatement of the health insurance tax.

Out-of-pocket spending (10 percent of total health care spending) includes direct consumer payments such as copayments, deductibles, and spending not covered by insurance. Out-of-pocket spending grew 2.8 percent to $375.6 billion in 2018, which was faster than the 2.2 percent growth in 2017.

Faster out-of-pocket spending growth for retail prescription drugs, durable medical equipment, and dental services more than offset a slowdown in out-of-pocket spending for hospital care.

Health care spending growth was mixed in 2018 for the three largest goods and service categories – hospital care, physician and clinical services, and retail prescription drugs.

Hospital spending (33 percent of total healthcare spending) increased at about the same rate in 2018 as in 2017, growing 4.5 percent and 4.7 percent, respectively, to reach $1.2 trillion in 2018. The steady growth in 2018 was driven by an acceleration in hospital price growth that was offset by slower growth in the use and intensity of hospital services.

Physician and clinical services spending (CONTINUED ON PAGE 25)

Jennifer Cerna is a recent graduate of the University of Central Florida with a bachelor’s degree in Marketing and Professional Selling. She has experience in a variety of industries and companies in sales, digital marketing and project management. Jennifer will continue working with Orlando Medical News by helping local companies create and improve their marketing initiatives to improve their reach and exposure to their target audiences. She is excited about the new year and what’s to come!

(20 percent of total healthcare spending) inbusinesses (20 percent), state and local govcreased 4.1 percent to reach $725.6 billion ernments (17 percent), and other private revin 2018. This was slower than the rate of enues (7 percent). growth in 2017 of 4.7 percent. The decelerThe National Health Expenditure estiation in 2018 was driven by slower growth in mates have been revised to reflect the most the use and intensity of physician and clinirecent and up-to-date source data that is cal services, as physician and clinical price available (and may not have been available growth accelerated in 2018. for last year’s vintage of the National Health Retail prescription drug spending (9 Expenditure Accounts). percent of total healthcare spending) grew The 2018 National Health Expenditures 2.5 percent in 2018 to $335.0 billion followdata and supporting information will appear ing slower growth of 1.4 percent in 2017. on the CMS website at: https://www.

This faster rate of growth was driven by cms.gov/Research-Statistics-Datanon-price factors, such as the use and mix Nemours Children’s Hospitaland-Systems/Statistics-Trends-andExpanding of drugs consumed, which more than offset Reports/NationalHealthExpendData/ by 30of New Beds a decline 1.0 percent in prices for retail NationalHealthAccountsHistorical. prescription drugs. html.

In order to continuefrom to offer laboration as part of our commitment to Additional highlights thechildren report in need the most advanced care possible excellence patient and family-centered include: 6. Noinphoto and to keep up with growing demand, care,” said Hartley.

As the project was Sponsors of Healthcare. In 2018, the Nemours Children’s Hospital will phase being planned, participation was sought federal government’s spending on health in 30 new beds by early 2020.

This $29 by not only doctors and hospital staff, but care increased 5.6 percent, accelerating AMA Announces New million expansion of the inpatient hospital also of families, via the Family Advisory from growth of 2.8 percent in 2017, and Effort whose to Train More willfaster servegrowth both cardiac and non- Council, children had hospital wascapacity driven by in the federallycardiac patients, and will include an adstays.

“Nemours Children’s Future PhysiciansHospital on was funded portions of Medicare and Medicaid ditional operating room and catherization from its inception designed with the input expenditures. Private businesses’ health care Health Systems Science lab, scheduled to open in January. of our families, who understand their spending increased 6.2 percent in 2018 due Furthering its member work to isensure future Building out the shell space on the needs when a family treated in primarily to faster growth in employer-sponphysicians are well-equipped to deliver care top floor of the 630,000 square-foot, 100the hospital.

This expansion project presored private health insurance premiums. to patients within modern health systems, bed hospital, which just marked its seventh sented another opportunity for them to The federal government and households the American Medical Association (AMA) year, wasfor always part of shares the plan, share their insights.” accounted the largest of explains spendtoday announced aarenew effort Nemours Children’s Hospital Chief Op“When families on the sixthaimed floor, at ing (28 percent each), followed by private erating Officer Randy Hartley. they will find a space that was designed “The additional 40,000 square feet with input of families who are sensitive of working space allows Nemours to add to their needs from experience having critical-care capable beds and enable the loved ones in the hospital,” said Tanielle hospital to handle more cardiac and other Randall, co-chair of the Family Advisory critical-care patients,” Hartley said. “A car- Committee. diac care delivery system can now be ofOne was Samuelle Henry, whose son fered in one location that is comprehensive Nasir spent his first four months of life in from admission to discharge, and includes the hospital. “We’ve spent a lot of time the newest technology to improve the care there, and the simple fact that management we deliver.” wanted to accommodate the patient’s fam“This consolidation and coalescence ily in their designs means so much to me,” of cardiac services offers a more seamless said Henry. and enhanced experience for our cardiac Staff and families met over the course patients,” said Dr. Peter D. Wearden, MD, of several months using IFD to design opPhD, cardiothoracic surgeon and Director portunities that would lead to improved of the Nemours Cardiac Center, Florida. quality, delivery, and patient satisfaction.

To bring the project to fruition, They tested detailed scenarios repeatedly medical staff, patients and families were to improve processes engaged over several months in an inThe new space on the sixth floor of tegrated facility design (IFD) process to Nemours Children’s Hospital saw its first create the most ergonomic and patient- patients in early December. The cardiac friendly space, with most up to date tech- operating room and catherization laboranology and state-of-the-art equipment. tory are scheduled to open in January, and “This integration and expansion another section is scheduled to be availproject was a great opportunity for col- able in late January.

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GrandRounds training more future physicians in Health Systems Science. The AMA’s new Health Systems Science Scholars Program will provide select medical school and residency program faculty with the resources and coaching they need to design, implement and evaluate Health Systems Science curricula at their institutions.

“The AMA is committed to ensuring all future physicians are ready to enter practice with a better understanding of how health care is delivered, how health care professionals work together to deliver care, and how they can improve patient care and health care delivery in modern health systems. This is the latest step toward achieving that goal,” said AMA President Patrice A. Harris, M.D., M.A. “We will continue to work with our community of innovation to develop and share additional resources and best practices to help prepare our future physicians to deliver care that meets the needs of modern patients on their first day in practice. This work will move the U.S. health system to improve patient experiences, improve population health, and reduce health care costs.”

During the 12-month program, faculty members—selected through a competitive application process—representing 38 medical schools and residency programs across the country will receive resources and individual coaching and mentorship from nationally known experts in Health Systems Science. Over the course of the year, each scholar will complete a curriculum project that their institution can use to integrate Health Systems Science into physician training, attend a two-day faculty-development workshop, participate in webinars, and meet with a designated mentor.

The Scholars Program is part of the newly formed AMA Health Systems Science Academy. In addition to providing faculty development and curricular resources to teach Health Systems Science, the academy serves as a community for national medical educators and health care leaders to work together on an ongoing basis to advance the field.

Scholars who complete the program will join the Academy. The Scholars program will be held annually and those interested in next year’s program will be able to submit applications beginning in summer 2020.

Health Systems Science emerged in 2016 as one of the major innovations developed through the AMA’s Accelerating Change in Medical Education Consortium, and is now considered the third pillar of medical education that should be integrated with the two historic pillars—basic and clinical sciences. The AMA has developed numerous resources to teach Health Systems Science, including the AMA’s Health Systems Science textbook. To date, the textbook has sold more than 5,000 copies worldwide and is being used in more than 30 medical and health professions schools and residency programs. The second edition of the textbook is currently in development and is expected to be published in 2020.

Most recently, the AMA published its new Health Systems Science Review book—the first study tool of its kind—to

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NeuLife Rehab Names Eric Patten VP of Marketing

help physicians-in-training and other health professionals, as well as their instructors, evaluate competencies in Health Systems Science and learners’ readiness for navigating modern health systems. This includes competencies in the value of health care, medical economics, and health care policy.

The AMA also offers a series of free, online education modules—called the Health Systems Science Learning Series—for students to help them develop competencies in Health Systems Science. The series is available on the AMA Ed HubTM. Additionally, the AMA recently collaborated with the National Board of Medical Examiners (NBME) to develop a standardized exam aimed at assessing medical student readiness for residency in Health Systems Science. The exam is free for all medical schools through June 30, 2020.

More information about the exam, including availability, content, purpose, length, cost, score reporting and research components, is available in the following documents: “HSS At-A-Glance” and FAQ. The AMA will continue its efforts to drive the future of medicine by reimagining medical education, training and lifelong learning—ensuring physicians are better equipped to provide care in the rapidlyevolving health care environment.

Central Florida Regional Hospital Receives the Florida Award for Safely Reducing Primary C-Sections

Eric Patten, RN, BSN, has been named the New Executive Vice-President of Business Development and Marketing for NeuLife Rehab. Patten is an experienced national clinical leader and with proven results. He has over 26 years of clinical experience and expertise. He is focused on program and business development. With 20 years in workers compensation- catastrophic case management, business development and clinical education, he is an asset to NeuLife Rehabilitation. Patten’s specialties include program and business development, clinical sales, team building, strong leadership experience, national speaker, panelist and several authored/published articles.

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The Agency for Health Care Administration (AHCA) and the Florida Department of Health (DOH) announced Central Florida Regional Hospital as one of 19 Florida hospitals in 2018 that achieved the Healthy People 2020 (HP2020) Maternal and Child Health goal focused on reducing cesarean section deliveries for first-time mothers with low-risk pregnancies.

Once a woman has a cesarean, she has a greater chance of having a C-section for subsequent births, increasing her risk of major birth complications. For the baby, some of the consequences can include a longer hospital stay in the neonatal intensive care unit, as well as higher rates of respiratory infection.

The goal of the Florida Award Program for Safely Reducing C-sections is to highlight the importance of this health care quality issue statewide and to recognize those hospitals that are contributing to providing quality health care for mothers and infants. Both AHCA and DOH have recognized that the high rate of low-risk cesarean births is a major maternal and child health issue in Florida, as the state has one of the highest rates in the nation.1 C-section rates for first-time, low-risk pregnancies in Florida range from 13 percent to 60 percent. In response to the rise of unnecessary C-sections across the United (CONTINUED ON PAGE 26)

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GrandRounds States, the U.S. Department of Health and Human Services adopted the HP2020 target of reducing nationwide C-section rates for low-risk births to 23.9 percent.

Florida’s 2018 C-section rate is 36.8 percent2, one of the highest state rates in the nation.3 Central Florida Regional Hospital’s C-section rate in 2018 was 12 percent, well below the 23.9 percent national goal.

“Central Florida Regional Hospital’s high-quality patient care is evident throughout the hospital – including in our Baby Suites,” said CEO Trey Abshier. “Not only do we want our new moms and their babies to be comfortable during their stay, we also want them to be happy and healthy throughout the rest of their lives. Achieving the HP 2020 Maternal and Child Health Goal highlights our ongoing commitment to protecting the health and best interests of these growing families.”

Orlando Health Expands Virtual Visit The month of December signals the beginning of the peak period for catching the cold and flu. As the cold and flu season gets underway, adult patients seeking convenient and quality care now have access to board certified physicians around the clock with the expansion of the Orlando Health Virtual Visit system.

Powered by telemedicine provider Teladoc Health, the Orlando Health Virtual Visit app now provides care anytime and anywhere to adults suffering with a non-emergency symptom such as a rash, conjunctivitis “pink eye”, urinary tract infection, as well as a sore throat and cough. Patients can connect with a doctor in real time by using a smartphone, tablet or computer to receive a diagnosis and a treatment plan for their condition.

“Orlando Health is committed to doing all we can to provide the best care to our patients. This commitment requires us to have as many touchpoints available as possible, so that patients can access quality health care when needed,” said Greg Ohe, senior vice president of ambulatory services for Orlando Health.

“The expansion of Orlando Health Virtual Visit represents another expansion of our efforts to create a robust telemedicine infrastructure and it demonstrates our desire to serve our patients well, anytime and anywhere.”

Previously, the system was accessible to Orlando Health employees and parents of pediatric patients seeking treatment. With the release of Virtual Visit to the general public, now everyone has access to Orlando Health’s most convenient service offering coupled with a cost that is often cheaper than a trip to an urgent care or emergency room. Within less than 30 minutes, patients will have a diagnosis and treatment plan with any required prescription sent to their local pharmacy for pick up.

“We are very proud of this achievement. The care our adult patients will now receive via this platform is efficient and very effective as a diagnosis can be provided within minutes—which optimizes outcomes for the patient,” Ohe added.

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Virtual Visit is available to all patients throughout Central Florida. Persons seeking more information about the system can visit OrlandoHealth.com/virtualvisit or can download the app to their mobile device.

Three Orlando Health Hospitals Earn Top Hospital Designations Orlando Health Arnold Palmer Hospital for Children, Orlando Health – Health Central Hospital and Orlando Health South Lake Hospital have been designated as 2019 Top Hospitals in the nation by the Leapfrog Group, an independent hospital watchdog organization. The annual Top Hospitals list has included at least two Orlando Health hospitals every year since 2015 with Orlando Health Arnold Palmer earning the recognition each year. Performance across many areas of hospital care is considered in establishing the qualifications for the Top Hospital award, including infection rates, practices for safer surgery, maternity care, and hospitals’ capacity to prevent medication errors.

“All of our hospitals, having received this prestigious award at least once over the last five years, demonstrates our commitment to serve our customers well,” said David Strong, president and CEO, Orlando Health, “while affirming the efforts our teams put forth every day to provide patients with safe, high-quality care.”

“To be recognized nationally for the care we provide patients speaks to each caregiver’s dedication to embrace quality and safety,” said Thomas Kelley, MD, vice president, quality and clinical transformation, Orlando Health. “It is an honor that all of our clinical and non-clinical team members are happy to share.”

The Top Hospital designation recognizes the highest performing hospitals in the Leapfrog Hospital Survey and is widely cited as one of the nation’s most competitive quality awards. Orlando Health – Health Central and Orlando Health South Lake are two of only 37 hospitals in the country to be designated 2019 Top General Hospitals. In November, the hospitals were also recognized by the Leapfrog Group for patient safety and awarded “A” grades. Orlando Health Arnold Palmer is one of only 19 in the nation to earn the 2019 Top Children’s Hospital designation. (Pediatric hospitals, including Orlando Health Arnold Palmer Hospital, are not included in Leapfrog’s safety grading program.)

Albertsons Companies Specialty Care Joins AssistRx Specialty Pharmacy Network Albertsons Companies Specialty Care is now using the AssistRx technology platform to give patients and providers quicker access to their specialty prescription medications and support services.

Through AssistRx’s integrated access solution, iAssist, patient prescription infor-

Axiom Bank Hires Amy Carlson, VP Commercial Team Lead Axiom Bank N.A., a Maitlandbased, leading community bank, recently hired Amy Carlson as VP, Commercial Team Lead. In this role, Carlson will work with Axiom’s commercial clients throughout Central Florida to help them achieve their business goals.

Carlson has over two decades of experience in financial management, customer relationship development, commercial lending and sales.

“For our clients, Amy’s financial expertise and skill at developing adaptive business solutions will be a tremendous asset,” said Ted Sheppe, Executive Vice President of Commercial Banking at Axiom Bank. “Her stellar track record

in leadership and strategy makes her a valuable addition to our team.”

Carlson graduated from Ferris State University with a bachelor’s degree in financial management.

Emergency Services at AdventHealth Winter Park to Expand AdventHealth Winter Park today announced the upcoming construction of a new 32-bed emergency department that will upgrade current emergency services in the area. Crews will begin tearing down an older portion of the hospital in late January for construction of the new ER, which is scheduled to begin in spring 2020.

The n e w, a p p rox i m a t e l y 27,000-square-foot ER will have all private rooms, two trauma/bariatric rooms and a separate ambulance entrance from the public walk-in entrance. It will also include pediatric friendly rooms and a separate pediatric waiting area to make visits more inviting for young patients.

Generous community support through AdventHealth Foundation will help fund the renovations.

“This new ER will modernize and expand the whole-person care we provide to Winter Park and surrounding communities,” said Jennifer Wandersleben, CEO of AdventHealth Winter Park. “AdventHealth Winter Park has a more than 60-year history of providing world-class hospital care to our community and the

new ER will continue that tradition.”

Medical units on the first and second floor of the old building — including the nuclear medicine and cardio suite, dialysis, respiratory and acute therapy, BioMed and general offices — will be moved to new areas on property in preparation for demolition.

Throughout construction, all emergency services will continue to be available in the existing ER’s current location.

Once complete, the entrance to the new ER will face Mizell Avenue and include a second sculpture by renowned artist JEFRË. It will serve as a statement of hope and healing and act as a visual cue to the hospital’s emergency department.

JEFRË previously installed a halo sculpture near the corner of Lakemont and Aloma avenues.

The ER is the latest area of AdventHealth Winter Park to undergo renovations. Earlier this year the hospital opened the Nicholson Pavilion, featuring a firstof-its-kind inpatient rehabilitation unit in Central Florida.

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GrandRounds mation is captured electronically by Albertsons Specialty Care—reducing missing, incomplete or inaccurate information—to streamline the process and delivery of prescriptions to the pharmacy. It also gives the patient’s health support team, including the prescriber, Albertsons Companies Specialty Care in-house support team, and the Albertsons Companies pharmacy, a full view of the prescription status in real time. Status updates include when the medication is ready to be picked up at the pharmacy, if it is picked up, or if there are any changes to the patient’s status. The patient also has greater flexibility in prescription pick-up locations due to the proactive, easy-to-use pharmacy selection tool in the iAssist workflow. iAssist is the only multi-therapy, multicategory platform to support prescribing and program enrollment through one easyto-use workflow. This free, integrated access solution features comprehensive acceleration e-support services—including e-prescribe, e-eligibility, e-enrollment, e-consent, e-prior authorization, financial support and more—that simplify the steps to getting patients started on and finishing their prescribed medication therapy.

“As the patient’s advocate, we are continually looking for ways to encourage patients to initiate and adhere to their medication therapies,” said Brian Hille, vice president, specialty and wellness services, Albertsons Companies. “By integrating AssistRx’s technology into our pharmacies, we can better serve our patients and with increased speed to therapy, quick access to support programs, easy visibility into patient status, and better coordination of care.”

The AssistRx application will help support the thousands of specialty prescriptions Albertsons Companies Specialty Care manages each week. Providers who use iAssist may submit enrollments to Albertsons Companies Specialty Care, complete prior authorization requests, and enroll patients in access support programs all in one workflow.

“We are committed to building upon our industry-leading offerings and providing our clients and partners with innovative solutions that help drive better patient care,” said Jeff Spafford, president and chief executive officer of AssistRx. “As one of the largest specialty pharmacies in the nation that strives to improve patients’ lives and drive positive outcomes, we are proud to have Albertsons Companies Specialty Care as a member of our network to help us transform lives through access to therapy.”

To learn more about iAssist, visit www. assistrx.com.

Nemours Children’s Hospital Honored as Top Children’s Hospital by the Leapfrog Group For the third time in its seven years of operation, Nemours Children’s Hospital was named a national Top Children’s Hospital by the Leapfrog Group. Nemours is one of only 10 children’s hospitals to make the prestigious list of 120 hospitals in 28 states.

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widely acknowledged as one of the most respected honors that hospitals can receive in the country.

Performance across many areas of hospital care is considered in establishing the qualifications for the award, including infection rates, practices for safer surgery, maternity care, and the hospital’s capacity to prevent medication errors. The rigorous standards are defined in each year’s Top Hospital Methodology.

“Nemours is particularly proud of this prestigious acknowledgment,” said R. Lawrence Moss, MD, President and CEO of Nemours Children’s Health System. “It exemplifies our unwavering commitment to high-quality, safe care for children. This achievement recognizes the passion and dedication of our committed team of doctors, nurses, health professionals, administrators, and support staff.”

“This recognition reflects our commitment to patient safety and excellence of care,” said Randy Hartley, Chief Operating Officer at Nemours Children’s Hospital.

Awards will be presented at the Leapfrog Group’s annual meeting in Washington, D.C. To qualify for the Top Hospitals distinction, hospitals must rank top among peers in the 2019 Leapfrog Hospital Survey, which assesses hospital performance on the highest known standards for quality and patient safety, and achieve top performance in its category.

“We are pleased to recognize Nemours Children’s Hospital as a 2019 Leapfrog Top Hospital,” said Leah Binder, president and CEO of The Leapfrog Group. “This demonstrates extraordinary dedication to patients and to the Orlando community. We congratulate the board, staff and clinicians whose efforts made this honor possible and know they share pride in this achievement.”

e5 Pharma Launches Generic Form of Diazoxide; Approved by FDA e5 Pharma, LLC., today announced the U.S. launch of Diazoxide, USP Oral Suspension, the first generic version of the reference listed drug, Proglycem®. e5 Pharma received final approval from the U.S. Food and Drug Administration (FDA) for its Abbreviated New Drug Application (ANDA) using the Competitive Generic Therapy (CGT) Pathway.

Created under the FDA Reauthorization Act of 2017 (FDARA), the CGT pathway established a process through which FDA may, at the request of an applicant, designate a drug with “inadequate drug competition” as a CGT and may also expedite the development and review of the abbreviated new drug application (ANDA) for that drug. The pathway also includes a new type of 180-day exclusivity for the first approved applicant of a drug with a CGT designation for which there were no unexpired patents or exclusivities listed in the Orange Book at the time of the original submission of the ANDA. Chief Executive Officer of e5 Pharma, Bob Edwards, commented, “We are excited to launch our first generic drug designated

Clean Beauty Influencer Emerges in Central Florida Central Florida Pharmacist, mother and clean beauty advocate - Dr. Sejal Patel, has launched a new beauty platform – DR. SEJAL BEAUTY. The launch coincides with 2020 New Year’s Resolutions - one of the most popular is “going clean” with your beauty products.

This scientific data-driven platform is available at www.drsejalbeauty. com. It is a free resource providing a steady flow of critically evaluated and evidence-based information on clean beauty products - and an easy to follow program for those looking to upgrade their beauty regimen.

To further promote adoption of clean, simple, and sustainable beauty, “for you, your family and the environment,” Dr. Patel volunteers her time to offer a variety of community outreach programs and initiatives. “The clean beauty concept embraces human-made and natural ingredients, putting the focus on safety while preserving efficacy.

The Dr. Sejal Beauty platform is designed to promote all aspects of clean beauty and offer consumers an easy to

follow program to upgrade their beauty routine.” Dr. Sejal Patel, creator of DR. SEJAL BEAUTY Dr. Sejal Beauty is driven by the passion of Dr. Sejal Patel who was inspired by her two-year-old daughter’s skin condition to dive deep into the world of clean, simple, and sustainable beauty. Leveraging her training as a pharmacist on the Dr. Sejal Beauty website www.drsejalbeauty.com, Dr. Patel offers viewers a collection of essential and free resources to help them make the best possible decisions when it comes to beauty products.

Oviedo-Winter Springs Regional Chamber of Commerce Kicks Off New Decade with a Refreshed Brand Strategy Bridget Lake, President of the Oviedo-Winter Springs Regional Chamber of Commerce (OWSRCC) is excited to announce that the chamber will be unveiling a refreshed brand strategy to connect its community and commerce in an even more innovative way throughout the next decade. This brand refresh allows the chamber to continue to be relevant and to best serve its members, constituents, and Oviedo-Winter Springs/East Orlando region at large. The new logo and strategy will be presented to the OWSRCC membership at its Chamber 2020 Party on January 9th at 5:30PM at the chamber offices, located at 376 N. Central Avenue, Oviedo, FL. This energized approach nurtures and enhances the values that the chamber was founded upon in 1983 when 10 local business people came together to give their community a united voice and to create a vision to connect commerce and community. Over the last 36 years, the chamber’s name has changed, membership has grown, and the area has become more diverse.

However, the chamber’s mission has remained constant: To serve as a plat-

form for enhancing business and community interests in our region.

Lake explains: “OWSRCC leads by example. Our members and chamber team embody Integrity, Community, Growth, and Connection in all that they do. Just as our founding members believed in 1983, we still strive to be a valuable resource that connects our region’s business interests with our area’s strong sense of community. This brand refresh reflects the core values of the communities we serve and enhances our strategic plan to make our region’s economic impact even stronger.”

Throughout 2020, the chamber team will present an elevated brand identity through the new logo (shown above), an enhanced website, and refreshed marketing collateral materials.

In addition, the brand experience will include a fresh perspective for member programming which increases the visibility and positive impact of the chamber through collaboration, education, and political advocacy.

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GrandRounds as a competitive generic therapy. Our mission is to provide patient access to affordable medicine. We are not looking for the next big thing; we are looking for the next great thing. Products that make all the difference in the world to people who need them, regardless of market size.”

About e5 Pharma, LLC: e5 Pharma is a specialty pharmaceutical committed to the development and distribution of generic drugs. The company was founded on a single principle that, most times, the simplest solution is also the best solution. Our focus is not necessarily on the development of new molecules, but instead on cost-reducing generic therapies and solutions.

The Columbus Organization Acquires Progressive Journey Group in Central Florida The Columbus Organization, a leading provider of case management services for individuals with Intellectual and Developmental Disabilities, today announced the acquisition of Progressive Journey Group (PJG), a leading provider of support coordination for the Spanish speaking I/DD community in central Florida.

“The acquisition of PJG gives The Columbus Organization a leading presence in the Central Florida region. Their stellar reputation for providing Spanish-speaking ser-

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vices, in many cases non-English speaking, gives Columbus a leading edge in the state providing for this population with intellectual and developmental disabilities,” stated Jeff Klimaski, President and CEO. “Our entry into this market, combined with our current presence in Tampa and Tallahassee, gives us one of the top, if not top market shares in Florida. We will continue to look at other acquisitions to enhance our ability to drive our brand of support coordination throughout the Florida market.”

Gina Ingrassia, a support coordinator in Orlando, will be appointed Regional Director and charged with overseeing operations and growth in the Central Florida region. “Gina has gained a loyal following over her years in support coordination. Her passion for our consumers, and overall business acumen and presence will be a perfect fit for this market,” according to Jeff.

The Columbus Organization empowers individuals to realize their meaningful– life goals through nationally recognized care coordination, professional clinical staffing, and quality improvement services for the intellectual/developmental disability (I/DD) or behavioral needs community. Leveraging an unmatched depth of expertise, breadth of resources, diversity of thinking, and dedication to finding the most appropriate, personalized solutions for clients, The Columbus Organization provides a wide array of services specifically for families, individuals and the organizations that support them. For more

‌ ushman & Wakefield Negotiates Sale of Two C Grover Corlew Office Buildings in Metrocentre Corporate Park for $7.45M

Cushman & Wakefield has negotiated the sale of two medical and professional office buildings at Metrocentre Corporate Park.

The Cushman & Wakefield Capital Markets team of Greg Miller, Scott O’Donnell, Miguel Alcivar and Michael Ciadella represented Grover Corlew in the dispositions of 2440-2478 and 2500 Metrocentre Boulevard in Palm Beach County.

NRK Property, Inc. acquired 24402478 Metrocentre Boulevard. Metro Partners 2500, LLC purchased 2500 Metrocentre Boulevard. The buildings were sold for a combined total of $7.45 million. Kris Hustad at Touchstone Webb Realty Company represented Metro Partners 2500, LLC. 2440-2478 and 2500 Metrocentre Boulevard are single-story office buildings developed in 1991. The assets are located within Metrocentre Corporate Park, an attractive business campus that also houses a number of other medical offices, hotels and restaurants — all in close proximity to West Palm Beach’s major hospitals.

2440-2478 Metrocentre Boulevard is a ±30,482-square-foot building located on a ±4.39-acre site. The building was 100% leased at the time of sale. Notable tenants include Florida Department of Revenue, The Imaging Center of West Palm Beach and VITAS Healthcare.

2500 Metrocentre Boulevard is a ±18,020-square-foot asset situated on a ±1.4-acre site. The asset was 75% leased at the time of sale with availabilities of 1,589 and 3,055 square feet. Major tenants in the building include VIP Kids and Tradesman International.

“When we initially purchased the Metrocenter office buildings in 2014, they were under-preforming at 55%

occupancy, but offered unrealized potential in terms of location and quality,” said Grover Corlew Partner Mark Corlew. “With key upgrades and strong management direction we transformed these buildings into an attractive asset for the right investor. Cushman & Wakefield’s market knowledge and highly professional marketing efforts ultimately connected us with that investor, allowing us to meet our goals.”

“Fully leased, 2440–2478 Metrocentre Boulevard provides a contractually stable and secure investment via long-term leases with limited rollover exposure, which was especially attractive to a number of 1031 and offshore investors,” said Miller. “2500 Metrocentre offers tremendous upside via the lease-up of existing vacancies.”

Metrocentre Corporate Park is ideally located in close proximity to the Interstate 95 interchange at 45th St. in central Palm Beach County. The park is one of the few premier, master-planned business campuses in West Palm Beach, offering excellent access to all of Palm Beach County and a full range of nearby amenities.

Metrocentre Corporate Park boasts a roster of long-standing medical and professional tenants with an average duration of occupancy of eight years. The hospital systems and the extensive roster of existing medical tenants in this corridor serve as a great source of potential tenancy, providing the opportunity to target and attract more medical tenants.

“True value-add office opportunities are rare, and with limited capital infusion required, Metrocentre Corporate Park is well positioned for medical and professional tenants preferring the immediate access to I-95 or the nearby JFK Medical Center,” said O’Donnell.

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Getting Through the Holidays

By CONNIE ORTIZ

This is the time of year when everyone is in hustle mode. Houses to clean and decorate cookies to be baked. Running to the stores to shop for just the perfect gift alone could bring on so much stress. We have parties to attend and or parties that we host.

And all the while if you’re a parent whether its to kids or to pets they, amid all, the rest still need, want and demand. It’s all so glorious and stressful at the same time. All of this puts your body’s sympathetic nervous system into high gear.

For some this season is the hardest to get through. This season just makes them feel overwhelmed, sad or even depressed.

For some this is not the “Happiest time of the year”. CBD just might be a natural alternative that will not give you that euphoria

feeling but could help change your cognition, CBD affects your mood, with consistent use you could notice a difference with anxiety, and you could feel more alert.

For all these reasons and more a lot of people are turning to the natural way of helping them get through all the craziness of the season. Although stress and anxiety can be higher at this time of year for some, it effects a lot of us all the time. Stress and anxiety sometimes are too much for our bodies to handle and we end up getting sick. Is stress and anxiety causing you to have digestive problems, sleep issues? It can even affect our skin and more.

Start the New Year using Nona Oils CBD, and you’ll find, like so many others have that CBD can work for you because our bodies were made to work with CBD. With our endocannabinoid system and our

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CB1 and CB2 receptors that help keep us in homeostasis especially during times of stress.

The benefits of using CBD besides those mentioned above is, there’s not a long list of side effects and it is non addicting the best part is, you can still function in your everyday life because there is no euphoria feeling, you are not going to get high like you would with cannabis which has a high amount of THC. CBD comes with .3% THC and some with zero THC. Don’t go at it alone, do like so many others and start your journey with CBD you just might be happier for it.

Connie Ortiz, who has been serving customers for over 25 years, is CEO of Nona Oils, LLC, and is a Certified Health and Wellness Coach. She discovered the benefits of CBD and after 6 years in the industry, now has her own products as well as certification as a CBD Coach through the CBD Training Academy. Contact her at NonaOils@outlook.com or visit www.nonaoils.com

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January 2019

American College of Surgeons Honors AdventHealth Waterman Excellent outcomes for surgical patient care have earned AdventHealth Waterman recognition by the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®). The hospital is one of only 88 nationwide named for such distinction.

ACS NSQIP is a major program of the American College of Surgeons and is currently used in nearly 850 adult and pediatric hospitals.

As a participant in ACS NSQIP, AdventHealth Waterman is required to track the outcomes of inpatient and outpatient surgical procedures and collect data that assesses patient safety to help direct improvement in the quality of surgical care.

The ACS NSQIP recognition program distinguishes a select group of hospitals for achieving a meritorious composite score in either an “All Cases” category or a category which includes only “High Risk” cases. AdventHealth Waterman was recognized on both the “All Cases” and “High Risk” Meritorious lists.

Risk-adjusted data from the July 2019 ACS NSQIP Semiannual Report, which presents data from the 2018 calendar year, were used to determine which hospitals demonstrated meritorious outcomes.

Each composite score was determined through a different weighted formula combining eight outcomes. The outcome performances related to patient management were in the following eight clinical areas:

• mortality, • unplanned intubation, • ventilator greater than 48 hours, • renal failure, • cardiac incidents (cardiac arrest and myocardial infarction);

The surgical team at AdventHealth Waterman celebrates earning recognition by the American College of Surgeons National Surgical Quality Improvement Program for their excellent outcomes for surgical patient care.

• respiratory (pneumonia); • SSI (surgical site infections-superficial and deep incisional and organ-space SSIs); and • urinary tract infection.

Based on outstanding quality scores across the eight areas listed above, 88 hospitals achieved this distinction. There were 72 hospitals recognized on the “All Cases” list and 72 hospitals were recognized on the “High Risk” list. The 72 hospitals represent 10% of the 722 calendar-year 2018 ACS NSQIP hospitals. Only 56 hospitals – including AdventHealth Waterman – were recognized on both the “All Cases” and “High Risk” lists.

ACS NSQIP is the only nationally validated quality improvement program that measures and enhances the care of surgical patients. This program measures the actual surgical results 30 days postoperatively, as well as risk adjusts patient characteristics to compensate for differences among patient populations and acuity levels.

The goal of ACS NSQIP is to reduce surgical morbidity (infection or illness related to a surgical procedure) and surgical mortality (death related to a surgical procedure) and to provide a firm foundation for surgeons to apply what is known as the “best scientific evidence” to the practice of surgery. Furthermore, when adverse effects from surgical

procedures are reduced and/or eliminated, a reduction in health care costs follows.

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and to improve the care of the surgical patient. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 82,000 members and it is the largest organization of surgeons in the world.

procedure and consult rooms, an interior reception area and a large, glass-enclosed lobby.

AdventHealth Medical Group’s primary care model represents a growing trend for the health system, creating more commu-

nity-based facilities with convenient access to multiple services for patients.

The architect was Gresham Smith and the main contractor was Robins & Morton.

GrandRounds AdventHealth Waterman Celebrates Opening for Medical Plaza in Mount Dora AdventHealth Waterman will celebrate the opening of the Adventhealth Medical Plaza in Mount Dora on January 22. This two-story, 22,260-square-foot facility is the first of its kind in northern Lake County.

The first floor is home to AdventHealth Medical Group family medicine physicians Dr. Veronica Chastain, Dr. Devlin O’Connor, Dr. Anielka Rodriguez and Dr. Kurt Wagner, as well as Estrellita Lu, an advanced practice registered nurse (APRN).

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The practice will provide primary care services and offer extended office hours and care coordination resources.

The second floor will open by the end of 2020 and will be home to AdventHealth Medical Group specialists and pediatric care.

The new AdventHealth Medical Plaza in Mount Dora has a sleek, bright, modern design to go with the modern-day approach to patient care. The spacious facility includes 21 examination rooms, two physician workrooms,

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NorthCentralFlorida GrandRounds AdventHealth Waterman Names New Director of Finance AdventHealth Waterman has selected Mario Duncombe to serve as the director of finance.

In his new role, Duncombe is responsible for providing financial services and management to help achieve strategic and operational initiatives at AdventHealth Waterman.

Duncombe has 16 years of experience in finance and accounting and most recently served as the senior accounting manager for AdventHealth Hospice Care in the Central Florida Division which serves Orange, Osceola and Seminole counties. In his previous

role, he was responsible for managing day-to-day functions related to patient financial services, revenue cycle and general accounting. He also handled the financial reporting and analysis for several AdventHealth joint ventures which constitutes AdventHealth post-acute care.

A Tavares resident, Duncombe earned a Bachelor of Business Administration in accounting from the University of Central Florida and a Master of Business Administration from Webster University.

The AdventHealth Waterman Foundation raised nearly $3.9 million in 2018. Pictured here, BraVo, an annual charitable fundraising event of Artisans on fifth, presents a check to the AdventHealth Waterman Foundation. These funds helped AdventHealth Waterman provided 133 mammograms in 2018 to patients who could not afford one.

Gainesville Company etectRx® Announces U.S. FDA Clearance of Novel Ingestible Event Marker etectRx®, Inc. (etectRx), a privately-held digital health company, today announced U.S. Food and Drug Administration (FDA) clearance of its breakthrough patented ingestible event marker, the ID-Cap® System.

The ID-Cap System is the first and only ingestible event marker to transmit digital messages from within the body to an external receiver without the need for direct skin contact for the purpose of recording ingestion events.

Comprised of the ID-Capsule, ID-Tag, ID-Cap Reader, and related software, the IDCap System provides real-time, dose-level ingestion event verification. The ID-Capsule is a standard pharmaceutical capsule containing the ID-Tag, an ingestible sensor that emits a very low-power digital message from within the patient after it is ingested and activated by the patient’s stomach fluid. The ID-Cap Reader (worn on a lanyard) verifies the message as a valid ingestion event and forwards the data to a secure smartphone-based mobile application and to the healthcare provider in a secure webbased portal. etectRx’s advanced communication technology will allow for incorporation of the receiver into a variety of wearable and offbody devices in the future.

“This is a historic event for etectRx and the larger digital health market,” said Harry J. Travis, president and CEO of etectRx. “It is the first product enabled by our proprietary in-vivo communication technology platform to gain clearance. We are very excited about the many opportunities that the ID-Cap System will provide patients and clinicians to improve therapeutic outcomes and deliver better care.”

AdventHealth Waterman Foundation Recognized by the Association for Healthcare Philanthropy

The company is building collaborations with key stakeholders, including healthcare providers, health systems, pharmacies, pharmaceutical manufacturers, and clinical research organizations, to bring this innovative technology to digital medications of the future and other valuable applications in the medical, pharmaceutical, and consumer markets.

Researchers at Brigham and Women’s Hospital and Fenway Health are evaluating the ID-Cap System in ongoing and planned clinical studies focusing on HIV medication when used for treatment and prevention.

“We look forward to continuing our work with etectRx to assess the potential impact of the ID-Cap System on the health of patients, clinical decisions of healthcare providers, and goals of health systems,” said Kenneth H. Mayer M.D., medical research director and co-chair of the Fenway Institute at Fenway Health. “We need innovative solutions, including cleared medical devices such as the IDCap System, to better evaluate the challenges of medication non-adherence, which have the potential to be part of tailored interventions.”

The ID-Cap System is classified by the FDA as an ingestible event marker (CFR 21 §880.6305) and Class II medical device. It will be available by prescription. The FDA clearance is based on data from pivotal clinical trials of device effectiveness and safety, biocompatibility assessments, human factors and usability validation studies, bench performance tests, electrical safety evaluations, and wireless performance tests.

The AdventHealth Waterman Foundation was recently recognized by the Association for Healthcare Philanthropy and was one of 83 organizations included on the 2019 High Performer’s list.

Association for Healthcare Philanthropy recognized 74 U.S. and 10 Canadian philanthropic organizations as high-performing fundraisers in the healthcare industry for fiscal year 2018.

In 2018, the AdventHealth Waterman Foundation raised nearly $3.9 million, including over $480,000 to support the emergency department construction. Additionally, the AdventHealth Waterman Foundation awarded 17 local students with scholarships to pursue careers within the healthcare industry and provided 133 mammograms to local women in need.

“We are honored to be recognized as one of the Association for Healthcare Philanthropy’s high-performing philanthropic organizations,” said April Kauffman, AdventHealth Waterman Foundation president and chief philanthropy officer. “We are so thankful for our donors. This award is a testament to the power of generosity and stewardship. The impact is a blessing to the patients AdventHealth Waterman is called to serve.”

A total of 212 U.S. and 35 Canadian institutions submitted data on their fiscal year 2018 philanthropic activities, with response rates of 24.5 and 26.5%, respectively.

Ocala Regional Medical Center Receives Comprehensive Stroke Center Certification

Ocala Regional Medical Center has received certification from DNV GL Healthcare as a Comprehensive Stroke Center, a prestigious designation that reflects the highest level of competence for treatment of patients who have experienced a stroke.

Scientific evidence shows that when a stroke, or also called brain attack occurs, immediate assessment and treatment will reduce the effects of stroke and lessen the chances of a permanent disability. Ocala Regional Medical Center is the only Comprehensive Stroke Center in Marion County and is also the closest Comprehensive Stroke Center to patients in Sumter, Citrus, and parts of Lake 31

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County. Patients no longer have to travel out of the area to receive the high-quality treatment that can result in more favorable outcomes for patients who have had a stroke.

“With stroke care, you must have the best clinicians and resources, but also the ability to act organizationally with extreme efficiency because of the time-critical nature of these events,” says Chad Christianson, CEO, Ocala Health. “Earning national accreditation through a program such as DNV shows ORMC’s commitment to quality, process improvement and providing excellent healthcare.”

The DNV GL - Healthcare Comprehensive Stroke Center Certification is based

on standards set forth by the Brain Attack Coalition and the American Stroke Association, and affirms that the medical center addresses the full spectrum of stroke care – diagnosis, treatment, rehabilitation and education – and establishes clear metrics to evaluate outcomes.

“Achieving certification shows commitment to excellence,” says Patrick Horine, CEO of DNV GL - Healthcare. “And it helps demonstrate to your community that you are performing at the highest level.” Dr. Iraj Nikfarjam, a Neurointerventionalist at Ocala Health says “By achieving this certification, Ocala Regional Medical Center is being recognized for the care they provide

The 84 organizations recognized – including the AdventHealth Waterman Foundation – represent the top 25% in net fundraising returns per each entity type reported. They are primarily foundations affiliated with nonprofit hospitals or health systems that were surveyed for the Association for Healthcare Philanthropy’s 2019 Report on Giving, which provides key industry benchmarks for healthcare fundraisers.

“We are thrilled to recognize a record number of high performers this year,” said Alice Ayres, Association for Healthcare Philanthropy president and CEO. “The change in criteria allowed us to continue to award those outstanding achievements of our members supporting larger scale communities, but also to call out those working within smaller facilities that are producing the same level of exceptional work. We’re eager to see where their performance carries them in 2020.”

The Association for Healthcare Philanthropy was established in 1967 and represents nearly 4,500 development professionals at 1,900 nonprofit hospitals, medical centers, health systems, and related facilities internationally. Association for Healthcare Philanthropy has sponsored the annual Report on Giving for 35 years and has released the 2019 Report on Giving last week. To learn more about the Report on Giving and view the full list of 2019 high performers, visit www.ahp.org/reportongiving.

to patients in Marion County as well as patients in Sumter, Citrus, and parts of Lake County. With this designation, patients suffering from all types of strokes such as large brain clots and hemorrhages, can now receive immediate care closer to home.”

Comprehensive stroke centers are typically the largest and best-equipped hospitals in a given geographical area that can treat any kind of stroke or stroke complication.

In a growing number of states, stroke center certification determines to which facility a patient should be taken for the most appropriate care when a stroke occurs.

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January 2019

IBM Watson Health™ Names Halifax Health Medical Center a Top Cardiovascular Hospital Halifax Health Medical Center of Daytona Beach has been named one of the 50 Top Cardiovascular Hospitals in the United States by IBM Watson Health™.

The 50 Top Cardiovascular Hospitals list is an annual study published by IBM Watson Health that identifies the best U.S. hospitals for inpatient cardiovascular services based on a balanced national scorecard of hospital performance metrics. Formerly known as the Truven Health Analytics® 50 Top Cardiovascular Hospitals study, this study has been conducted since 1998.

Halifax Health is just one of three hospitals in Florida recognized by the study and is grouped in the category, “teaching hospitals without cardiovascular residency programs.”

“This is a tremendous honor for Halifax Health. Our collaboration with University of Florida Health for heart and vascular surgery services has helped to transform and advance heart and vascular care in East Central Florida. Our partnership has been a win for both institutions as well as our

community” says Matt Petkus, vice president of operations for Halifax Health.

This year’s study included 989 U.S. hospitals with cardiovascular service lines. Based on comparisons between the study winners and a peer group of similar hospitals in the study, the winners delivered better outcomes while operating more efficiently and at a lower cost. Extrapolating the results of this year’s study, if all Medicare inpatients received the same level of care as those treated in the award-winning facilities: More than 11,000 additional lives could be saved; • More than 2,800 additional heart patients could be complication-free; and • Over $1.5 billon could be saved.

• Key performance benchmarks set by this year’s Watson Health 50 Top Cardiovascular Hospitals include: • Significantly Higher Inpatient Survival: Winning hospitals had significantly higher inpatient survival rates (28.7% to 47.4% higher).

• Fewer Complications: The 50 Top Cardiovascular Hospitals achieved 6.3 to 27.7 percent fewer patients with complications.

• Lower Cost: $1,485 to $6,704 less in total costs per patient case (the smallest difference was for heart failure and the largest was for coronary artery bypass graft surgery).

• Lower Average 30-day Episode of Care Payments for Acute Myocardial Infarction and Heart Failure ($1,323 and $706 less per episode, respectively).

“Heart disease is the leading cause of death for men and women and numerous health disparities exist in heart health.

When patients and families confront this disease, it is essential to find the right system and provider for you or your loved ones to ensure the best cardiovascular care. Our data-driven study highlights top hospitals that have achieved an outstanding balance of clinical and operational excellence in a complex healthcare landscape. In ad-

Pictured commemorating this recent honor are Halifax Health officials and physicians and staff of University of Florida Health Heart and Vascular Surgery at Halifax Health.

dition to showcasing the best in heart health, we believe that our study provides attainable and actionable benchmarks for hospital leaders across the country, as they work to raise their own organizations’ standards of performance,” explains Kyu Rhee, M.D., M.P.P., vice president and chief health officer at IBM Watson Health.

Since the 2015 launch of UF Health Heart and Vascular Surgery at Halifax Health, the program has been named among the top 10 percent of heart programs in the nation, having been awarded the highest three-star rating by the Society of Thoracic Surgeons. The program has also achieved accreditation by the Intersocietal Accreditation Commission in Vascular Testing in the area of Peripheral Arterial Testing.

GrandRounds AdventHealth Names Chief Financial Officer for Medical Group AdventHealth has selected Sam Fulton as chief financial officer for AdventHealth Medical Group in the Central Florida Division – North Region.

Effective Jan. 6, Fulton took over strategic financial and capital planning, investment and debt management, rate setting, and reimbursement and financial reporting for AdventHealth’s employed group of more than 300 providers, including 160 primary

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care doctors and specialists in Volusia and Flagler counties.

Fulton has 22 years of leadership experience and previously served as the vice president and chief financial officer for the medical group at CHI St. Luke’s HealthBaylor St. Luke’s Medical Center in Houston, Texas. In this role, Fulton oversaw financial functions for CHI Texas – Physician Enterprise, a multi-specialty medical

group encompassing more than 400 providers across southeast Texas.

At Sam Houston State University in Huntsville, Texas, Fulton earned a Bachelor of Business Administration and a Master of Business Administration.

A Houston native, he was the board president for the Prenatal Clinic of the Brazos Valley in Bryan, Texas, and is a member of the American Medical Group Association and the Healthcare Financial Management Association.

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Volusia/Brevard GrandRounds AdventHealth Names New Supply Chain Director AdventHealth has selected John DeMarinis to serve as the director of supply chain for hospital operations in Flagler and Volusia counties.

In his new role, DeMarinis is responsible for providing leadership and strategic direction for all supply chain functions and will focus on implementing efficient supply chain strategy that aligns with Adven-

County, City of Titusville Reappoint Three Parrish Medical Center Board Members Brevard County Commission and Titusville City Council have reappointed three members of the Parrish Medical Center Board of Directors to new fouryear terms.

Herman Cole Jr. was reappointed to the Board of Directors for a full term at the December 10, 2019 Titusville City Council meeting.

Retired USAF Colonel and Vietnam veteran, Cole has served on the Board for the past 19 years. His military leadership experience is matched by an extensive career background in directing, managing, and administering large, worldwide construction projects.

Jerry Noffel of Titusville was also reappointed by County Commission on November 19, 2019 and confirmed by the Titusville City Council on December 10, 2019 for a term of 4 years. He was first appointed to the hospital’s Board of Directors in 1999. He is a retired partner of a free-standing group of ambulatory care centers and holds a Master of Business Administration with an emphasis in hospital administration.

Noffel has helped guide Parrish Medical Center’s strategy for more than two decades of its vision of Healing Families— Healing Communities®.

Dr. Elizabeth Galfo of Titusville was reappointed by the Brevard County Commission on November 19, 2019 to serve another 4 years on Parrish’s Board.

Galfo has been a Board Member since 2015. She currently serves as the Chief Medical Officer of Hospital of St. Francis. Dr. Galfo also practiced medicine as a Major in the 4th Medical Support Group at Seymour Air Force Base during Desert Storm/Shield.

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tHealth’s initiatives.

DeMarinis has 15 years of experience and has held many supply chain roles during his career, including informatics analyst, contract manager, materials manager and supply chain director. He most recently served as the regional supply chain director for TrinityHealth, a not-for-profit Catholic health system headquartered in Livonia,

Michigan. In this role, DeMarinis led all supply chain processes for the organization’s Mid-Atlantic region.

A Port Orange resident, DeMarinis earned a Bachelor of Science in accounting from Thomas Edison State University and a Master of Business Administration from Holy Family University.

Jess Parrish Medical Foundation Raises More Than $129,000 at Treasure Island Gala Benefiting the Children’s Center

Jess Parrish Medical Foundation’s annual benefit gala Treasure Island was a tremendous success, raising more than $129,000 in net proceeds to benefit The Children’s Center. Presented by the law firm of GrayRobinson, P.A., and Laura and William Boyles, the event was held Oct. 12 at Cruise Terminal One in Port Canaveral.

More than 350 enthusiastic guests donned mermaid and pirate inspired attire and enjoyed an evening of swashbuckling elegance, signature cocktails, a tropical island inspired dinner and treasure hunting at the silent auction. Sherriff Wayne Ivey emceed the live action and paddle raise in support of The Children’s Center to fund current and future needs and help bring the center into its 20th year of providing access to services, guidance and support for children and their families.

“It is gratifying to know that our investment is providing access to high-quality care that develops Strong Families for Life and will continue to provide future generations of our children with a safe place to learn, grow and reach their full potential. It is a privilege to be a part of such a worthwhile event for the community of North Brevard,”

said William Boyles, shareholder at GrayRobinson. P.A. and gala presenting sponsor.”

Abigail Thompson, the event’s keynote speaker, shared the story of her daughter Mylah’s autism diagnosis and the families experience working with The Children’s Center. “My husband and I often wonder where we would be today without The Children’s Center. There was never a moment we questioned whether Mylah was receiving the care she needed. They exceeded our expectations in providing Mylah the absolute best care, stated Abigail.”

Mylah shared center stage with Sheriff Ivey and bloodhound Junny, spokesdog for the Brevard County Sheriff’s office during a one-on-one interview. Mylah, who loves to dance, captivated the audience with her favorite dance steps.

Holly Carver and Laura Anne Pray were co-chairs for the event. Gala committee members included, Judy Allender, Winnie Brewer, Kelley Broome, Mary Coleman, Lauren Coyne, Carlos Diaz, Lori Duester, Voncile Franklin, Betty Greene, Samantha Guyre, Nadine Itani, Jessie Kirk, Elizabeth Kump, Melissa Lugo, Christina Morrison,

Susan Morse and Dr. Tanya Taival.

One thousand pieces of gold were at stake in the Hooks ‘n Tails costume contest, a highlight of the evening. Taking home the honor of best mermaid and pirate were Becky Walters and Rick Wrubel.

We are overjoyed by the tremendous support we have received for Treasure Island, and are thrilled to have so many organizations and community partners joining us to make a difference in the health of our community,” said Judy Allender, event underwriting chair.

“On behalf of the Jess Parrish Medical Foundation board of directors and staff, we extend our heartfelt thanks to all those who supported our 2019 gala and contributed to its success. We have been overwhelmed by the outpouring of support which will impact children and their families in our community for generations,” said Jessie Kirk, chair, JPMF board of directors.

For more information about Jess Parrish Medical Foundation or how to get involved or support the foundation, visit www.parrishmedfoundation.com.

Volusia County Medical Society Invites Physicians to be Doctor of the Day in Tallahassee The Doctor of the Day Program began in the 1960s, initiated by a former Representative, Dr. Walter Sackett, MD, when he urged the Florida Medical Association to bring a physician to Tallahassee each day of session. This program is a vital service to the legislators, as they are in Tallahassee without a physician home base. The program, which is administered by the Legislative Clinic, provides essential medical professional services to Florida Legislators, their families, and all legislative employees. To serve as Doctor of the Day, the physician must be sponsored by his or her legislator, arrange his or her own travel, and be available for medical problems throughout the day. Scheduling for Doctor of the Day starts a few months prior to ses-

sion, in December and January. To be sponsored, a physician must contact his or her Legislator requesting sponsorship, get approval for the sponsorship by the Legislator’s office, and then complete an application.

Serving as Doctor of the Day to the State Legislature is quite an honor, as the physician is the only non-elected individual allowed to enter the floor of the House or Representatives or the floor of the Senate. I served this past year as Doctor of the Day. All of the representatives were so welcoming and friendly, ensuring I was comfortable, enjoying my day, and understanding of what was happening around me. Although I was not needed for many medical interventions, I was available if needed and in case of

emergencies, and the Legislators were very appreciative of my service.

Please consider serving as a Doctor of the Day - it’s a wonderful education and a thoroughly enjoyable experience! An application is provided for your review and use.

Volusia County Medical Society Providing Access to Confidential Counseling for Physicians Your VCMS is providing you access to completely confidential and autonomous counseling sessions to help you release the stress that comes with the territory.

No identifying information is shared with or reported to the VCMS. The counselors confirm that the physician holds a valid Florida Medical License and practices in Volusia County. Your VCMS will pay for up to three counseling sessions with any of the certified counselors enrolled in our program.

The certified counselors are experienced in coaching healthcare professionals and offer flexible hours and availability. If you or a colleague could benefit from this service, please pick up the phone and call one of program counselors.

No appointment needed. Just pick up the phone and call. Or visit her personal website for additional support: www.drdeliciamd.com

LOCAL RESOURCES: Delicia Haynes, MD - 386-492-1064

Dawn Parr Chappell- 386-299-3606

Dr. Haynes has offered her time for physician members who need to talk things through or who could simply use a friendly confidential ear.

Karen Ste. Claire Spicer, PhD

386-322-4676 - www.drkarenspicer.com Amanda Nixon - 386-255-0044

https://www.laureloakscounseling.com/amanda-nixon https://www.dawnparrchappel.com/ This program is generously supported by AdventHealth Daytona Beach and Halifax Health.

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Volusia/Brevard GrandRounds AdventHealth Daytona Beach Auxiliary Installs 2020 Executive Board, Donates $100,000 The AdventHealth Daytona Beach auxiliary installed their executive board for 2020 during an annual holiday luncheon on Dec. 6 at Halifax Plantation in Ormond Beach.

The AdventHealth Daytona Beach auxiliary’s executive board for 2020 includes: Bob Hornak, president; Linda Carter, vice president; Judy Eaton, recording secretary; Jim Bishop, personnel secretary; Florence “Mima” Eaton, corresponding secretary; Lucia Begin, general treasurer; John McCarthy, Pinkadilly Thrift Shop treasurer; and Pat Jones, Bird Cage gift shop treasurer.

During the luncheon, the auxiliary do-

nated $100,000 to AdventHealth Daytona Beach. The majority of the funds will be used to purchase various hospital equipment, such as sleep recliners, stretchers, beds, defibrillators, and more. A portion of the donation will support AdventHealth Daytona Beach’s 2020 mission trip to Africa and will help fund a new well for clean water in the remote villages of Kenya.

For 53 years, the AdventHealth Daytona Beach volunteer auxiliary has provided approximately 2.86 million hours of volunteer support and raised $5.1 million to benefit the hospital and community.

Halifax Health-Foundation Provides Hospital Funds for Newest Technology in Total Knee Replacement

Pictured with the Stryker’s Mako Robotic-Arm Assisted Total Knee application are: (L-R) Andrew Leech, chairman, Halifax Health-Foundation Board of Directors; Mary Bennett, board member, Halifax Heath-Foundation; Harold L. Goodemote II, chairman, Halifax Health Board of Commissioners; Jeff Feasel, president and chief executive officer, Halifax Health; and orthopedic surgeon Charles B. Williamson, M.D.

Halifax Health-Foundation recently provided $790,000 to Halifax Health Medical Center of Daytona Beach for the purchase of the newest technology in total knee replacement – Stryker’s Mako Robotic-Arm Assisted Total Knee application.

The Mako Total Knee application is innovative robotic technology that allows surgeons to personalize procedures to each patient. The knee replacement treatment option is designed to relieve the pain caused by joint degeneration due to osteoarthritis. Through CT-based 3D modeling of bone anatomy, surgeons can use the Mako System to create a personalized surgical plan and identify the implant size, orientation and alignment based on each patient’s unique anatomy. The Mako System also enables surgeons to virtually modify the surgical plan intra-operatively and assists the surgeon in executing bone resections.

“Mako is changing the way joint replacement

surgeries are performed by providing each patient with a personalized surgical experience based on their specific diagnosis and anatomy,” says Eric Little, director of surgical services for Halifax Health. “Using a virtual 3D model, the Mako System allows surgeons to personalize each patient’s surgical plan preoperatively before entering the operating room.

During surgery, the surgeon can validate that plan and make any necessary adjustments, while guiding the robotic-arm to execute that plan,” Little explains.

To learn more about the procedures and programs offered by the nationally recognized orthopedics team at Halifax Health - Center for Orthopedics, visit halifaxhealth. org/orthopedics.

For more information on Halifax Health-Foundation, the official charitable gift receiving agency for Halifax Health, visit halifaxhealth.org/foundation

Neurosurgeon Joins AdventHealth’s Employed Physician Group Board-certified neurosurgeon Dr. Federico Vinas has joined AdventHealth Medical Group.

As an AdventHealth Medical Group physician, Vinas joins AdventHealth’s employed group of physicians with more than 300 providers, including 160 primary care doctors and specialists in Volusia, Flagler and Lake counties.

Vinas has cared for the Daytona Beach community for nearly two decades.

He specializes in the diagnosis and surgical treatment of patients with injuries or disorders of the brain, spinal cord, spinal

column and peripheral nervous system. He also performs minimally invasive surgery and cervical arthroplasty, a type of joint replacement procedure to replace a cervical disc in the spine.

In Detroit, Michigan, Vinas earned his medical degree from Wayne State University and completed his residency at Henry Ford Hospital. His practice accepts new patients and most insurance plans. His office is located at 305 Memorial Medical Pkwy., suite 505, Daytona Beach and can be reached at 386-231-3540.

Orthopedic Physicians Sands, Lombardo Join Steward Health Care The Steward Health Care family is welcoming two longtime orthopedic surgeons: Kenneth Sands, MD, and Anthony Lombardo, MD. Dr. Sands specializes in minimally invasive robotic-assisted surgery to relieve joint pain. He graduated from Tulane University School of Medicine in New Orleans and completed his residency at State University of New York in Brooklyn. His fellowship in orthopedic joint replacement surgery was at the Florida Orthopaedic Institute in Tampa.

“As I went through medical school, I realized that orthopedics is a great specialty as far as helping people,” said Dr. Sands.

“People usually come in with some kind of acute or semi-acute pain and we’re able to make them better rather quickly.”

Board-certified by the American Board of Orthopaedic Surgery, Dr. Sands belongs to the American Academy of Orthopaedic Surgeons and the American Association of Hip and Knee Surgeons. Before coming to Florida, he practiced in Rome, Ga., serving as medical director of a total joint center he helped set up.

Dr. Sands is a U.S. Army veteran who was director of William Beaumont Army Medical Center’s program for adult joint reconstruction. He was also a faculty member at Texas Tech University Health Sciences Center School of Medicine in El Paso, Texas.

Dr. Lombardo’s specialties include sports medicine, and his orthopedic practice on knees and shoulders in Brevard stretches back to 1989. He said that his work is a good fit with his mechanical aptitude and his in-

terest in people.

“In orthopedics, you’re always figuring things out, having to adapt – ‘MacGyvering’ things,” he said. “You go from plan A to plan B to plan C, which is a challenge I like. It also gives me a chance to be compassionate, to work with people, find out what they need, help them get better.”

Dr. Lombardo earned his medical degree from the University of Miami Miller School of Medicine, Jackson Memorial Hospital, where he also interned. He completed a four-year orthopedic surgical internship at the University of California, San Francisco.

Among Dr. Lombardo’s specialties are total joint replacement, arthroscopic knee and rotator cuff surgery, and reconstructive orthopedics – both for adults and children 10 and older.

He is a member of the American Academy of Orthopaedic Surgeons, the American Medical Association, the Florida Medical Association, the Brevard County Medical Society and the Florida Orthopaedic Society.

Both surgeons are accepting new patients. Contact them at 321-541-1777.

AdventHealth New Smyrna Beach Foundation’s Holiday Charity Ball Raises Nearly $70,000 More than 300 community members helped raise $68,000 for AdventHealth New Smyrna Beach during the Foundation’s 23rd annual Holiday Charity Ball at the Brannon Community Center on Nov. 23.

Hosted by the AdventHealth New Smyrna Beach Foundation, the black-tie event featured an evening of dinner and dancing, as well as a silent auction.

This years’ proceeds will support the purchase of new 3D mammography equipment for the AdventHealth New Smyrna Beach.

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Ball, we have the opportunity to celebrate the season with friends and colleagues while giving back to our local community,” said Bob Demers, co-chair for the AdventHealth New Smyrna Beach Foundation Holiday Charity Ball. “That’s what I believe the holiday spirit is all about.”

“At AdventHealth New Smyrna Beach, we know that we are truly greater as a whole,” said Pat Driver, AdventHealth New Smyrna Beach Foundation chair and cochair of the Holiday Charity Ball.

The Holiday Charity Ball is a New

Smyrna Beach tradition that began in 1996.

New Smyrna Beach philanthropist and business owner Kaye Walker planned the first event with the goal to support various local charities.

AHNSB Holiday Charity Ball: More than 300 community members helped raise $68,000 for AdventHealth New Smyrna Beach during the Foundation’s 23rd annual Holiday Charity Ball. orlandomedicalnews

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