Orlando Medical News July 2018

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Physician Recruiters Shifting Focus Trend in Florida is toward hiring more advanced practice providers, fewer primary care physicians; specialty shortage prominent

By P.L. JETER

The healthcare industry may have found a way to minimize the demand for primary care physicians by hiring more physician assistants, nurse practitioners and now assistant physicians.

According to Merritt Hawkins’ Annual Review of Physician and Advanced Practitioner Recruiting Incentives, the number of searches for primary care physicians dropped 19 percent last year, down 32 percent over the last three years.

“Average compensation for family medicine is $240,000, compared to $129,000 for nurse practitioners,” said Mark Conley, vice president of Merritt Hawkins’ eastern regional office, noting

ON ROUNDS

PHYSICIAN SPOTLIGHT Prakash Maniam, MD ... 3 HEALTH INNOVATORS

A Recipe for Building an Innovation Movement, From Scratch ... 5 Consumerism in Healthcare ... 5

THE LOWEDOWN ON HEALTH LAW

How Does the GDPR Affect My U.S.-Based Medical Practice? ... 7

RADIOLOGY INSIGHTS

Emergency Room vs. Urgent Care: What’s the Difference? ... 15

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PHYSICIAN VIDEOS

that busy advanced practice providers earn more via enticing production plans.

“Because healthcare organizations are having such a difficult time finding family medicine physicians, they’re replacing them with advanced practice providers.”

CONTROVERSIAL MEASURES After a few stumbles, Missouri lawmakers found a unique way to fill its severe statewide primary care physician shortage via assistant physicians, not to be confused with physician assistants.

State representative Keith Frederick, DO, an orthopedic surgeon who has championed difficult healthcare issues such as ways to address the alarmingly

rising rate of medical student suicides, worked with colleagues on legislation to ease qualifications standards for medical school graduates unable to practice medicine until completing their residency.

“We’ve been trying for years to ad-

dress our maldistribution of physicians in the country,” Frederick told the St. Louis Post-Dispatch. “We have all sorts of incentive programs and all sorts of ways to try to get them to go out to Podunk, but a lot (CONTINUED ON PAGE 2)

HEALTHCARELEADER

Josie Weiss, PhD UCF Nursing Professor and Shepherd’s Hope Volunteer has Spent Her Career Serving Vulnerable Populations Josie Weiss, PhD, FNP-BC, FAANP has a CV that is both expansive and impressive. It chronicles more than 25 years of funded research and published papers focusing on vulnerable populations, with a particular interest in teen pregnancy prevention.

With a background in community and public health before embarking on a career in academia, Weiss currently serves as director of the University of Central Florida’s Family Nurse Practitioner, Adult-Gerontology Primary Care Nurse

Practitioner, and Advanced Practice DNP programs in UCF’s College of Nursing, along with teaching as a tenured associate professor.

Weiss graduated from Florida State University with a BSN degree, and earned her MSN and PhD degrees from the University of Florida. She is a licensed ARNP and a Fellow of the American Association of Nurse Practitioners, as well as a member of the American Association of Nurse Practitioners, Florida Nurse Practitioner Network, National Organization of Nurse

Practitioner Faculty and Sigma Theta Tau International.

In 2014, Weiss became involved in Shepherd’s Hope as a clinical volunteer.

Later this year, she will also take on the role of a liaison between UCF and the West Orange Healthcare District, which recently funded a community-focused service learning program for undergraduate and graduate nursing students at the Shepherd’s Hope clinic in Ocoee and its new center in Winter Garden, which is scheduled to open in early 2019.

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HEALTH PODCASTS UP-TO-DATE CONTENT

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Physician Recruiters Shifting Focus, continued from page 1 of them just don’t want to go to Podunk.”

Under the new law, all legal U.S. residents who have graduated from medical school within three years and have passed their medical licensing exams within two years may apply for an assistant physician license in Missouri. The catch: assistant physicians practice alongside a licensed physician -- 10 percent of the time -- in a healthcare shortage area. In Missouri, that accounts for 98 of 101 rural counties with significant physician shortages, according to data from the U.S. Department of Health and Human Services.

Even though medical school enrollment nationwide has increased 25 percent since 2002, per the Association of American Medical Colleges (AAMC), the National Resident Matching Program reported that 11,122 of 41,334 applicants in 2015 were denied residency slots.

“They’re sitting there idle,” St. Louis plastic surgeon Edmond Cabbabe shared with a Nebraska media group, after Nebraska lawmakers began mulling the option. “They cannot earn a living. They cannot gain any experience, and there was no solution available to them.”

NATIONAL RECEPTION The controversial new medical classification of assistant physicians, which won the approval of the Missouri State Medical Association but not the American Medical Association, has caught the eye of

healthcare organizations seeking ways to minimize overhead costs while also seeing more patients. Some healthcare executives view the approach with cautious optimism. Others question the new solution. “(We’re) concerned by efforts that would bypass the experiences necessary for physicians to provide safe and effective patient care independently,” said Matthew Shick, AAMC director of government relations and regulatory affairs. “They’re going to have to be trained a little bit before they can get into the system.”

The new trend of more advanced practice providers and fewer primary care physicians may be short-lived if demand outpaces salary boosts.

“We’re seeing advanced practice providers’ salaries increasing quite a bit because the need is driven by a demand for experienced providers,” explained Conley. “Oftentimes, they’re looking for someone who can really step into the breach and see patients at a fairly high level from day one.”

Because “Florida tends to be a trailblazing state … trying different models in healthcare delivery,” noted Conley, sunshine state lawmakers may consider a similar measure.

years and is one of the nation’s largest recruiting firms, highlighted other surprising trends. Last year, three of four recruiting requests involved specialists. By 2030, the specialist shortage could top 70,000 nationwide, according to the report.

“The notion that we should be training more primary care physicians while maintaining or reducing the supply of specialists is a grave miscalculation,” said Merritt Hawkins president Mark Smith.

“We should be training more of both types of physicians.”

According to the survey, 80 percent of specialists are overextended or at capacity, leaving only 20 percent to see more patients or take on additional duties.

With invasive cardiologists garnering the highest starting salaries at nearly $600,000 annually, followed by orthopedic surgeons at $533,000, gastroenterologists at $487,000, dermatologists at $425,000, and pulmonologists at $418,000, “hospitals will have to take a hard look at their budgets and margins to see where room can be made for more labor spending if they’re to keep care delivery quality and access high, allowing them to remain competitive with other systems,” wrote Healthcare Finance.

OTHER WHITE PAPER FINDINGS

SUNNY BABY BOOMERS

Merritt Hawkins (NYSE: AMN), that has produced the annual survey for 25

With Florida’s aging population, demand remains strong for psychiatrists, cardiologists, rheumatologists, gastroenter-

ologists, radiologists and dermatologists.

“Florida represents a number of unique markets,” said Conley. “Orlando is different from Miami and the panhandle. Because there’s an older population throughout the state, demand in Florida will always be robust.”

Radiology and dermatology specialties have noteworthy characteristics that might skew the numbers at first glance, Conley pointed out.

“Because radiology is a fairly stable practice, often, radiologists stay a while,” he said. “We’re seeing a core of radiologists starting to get into that 55 and older (category) and starting to slow down, maybe working just three or four days, maybe not taking calls. Because of that scenario, we’re seeing demand increase dramatically for nighthawk radiologists.”

Dermatologists in Florida are trending to a “three- or four-day pace,” Conley said. “They still earn a very robust income, and it allows them to not necessarily be a full-time employee. Therefore, we’re finding people to fill that gap.”

Psychiatry remains a specialty in crisis as healthcare organizations continue to prioritize physical health above mental health, in part because cash-strapped community-based organizations postpone hiring psychiatrists while hospitals weigh cost benefits.

Compared to hefty specialist salaries, primary care physicians making $240,000 a year may seem like a bargain.

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PHYSICIANSPOTLIGHT

Prakash Maniam, MD

Urologist chose a career in medicine while suffering kidney stones

Prakash Maniam’s journey to becoming a urologist began with a painful, yet fateful moment as an undergraduate at The Ohio State University. An aspiring engineer at the time, he was on his way home from class when he suddenly felt a severe pain in his side.

“My brother drove me to the emergency room, where I learned that I had a kidney stone, which was something I’d never heard of before,” he recalled. “I passed the stone, but it opened my eyes to medicine, and specifically urology. I shifted gears from engineering to pre-med and went from there.”

After earning his medical degree at Ohio State University College of Medicine, Maniam completed general surgery and urology residencies at Case Western Reserve University in Cleveland, Ohio.

He then worked in private practice in Augusta, Georgia, and recently relocated to Central Florida with his family.

Today, kidney stones are one of the most prevalent conditions he treats as a board-certified urologist at Medical Specialty Group at Poinciana and Osceola Urology Associates, where he serves patients at Poinciana Medical Center and their sister facility, Osceola Regional Medical Center. He specializes in general urologic care, including treatment for cancers of the urinary tract, prostate diseases, sexual dysfunction and urinary incontinence. He is also a member of the American Urological Association.

cancer and kidney cancer and for urinary reconstruction. Both Poinciana Medical Center and Osceola Regional Medical Center house a surgical robot, which Maniam is trained to use for these procedures.

Another promising technique is using laser, or green light, therapy to treat moderate to severe urinary symptoms caused by an enlarged prostate, or benign prostatic hyperplasia (BPH).

Maniam specializes in photoselective vaporization of the prostate (PVP), using a laser to melt away excess prostate tissue and enlarge the urinary channel. Depending on the size of the prostate, the procedure can take anywhere from one to one-and-a-half hours.

According to the Mayo Clinic, laser surgery offers several advantages over other methods of treating BPH, such as transurethral resection of the prostate and open prostatectomy.

“It lowers the risk of bleeding, shortens or eliminates the hospital stay, speeds up recovery and reduces the need for a catheter,” Maniam said. “Patients like it because they can go home the same day.

Most importantly, the outcomes have been very good, and improvement is noticeable right away. The goal is to get the patient to where they don’t have to worry about basic things like passing urine, and laser

therapy allows us to do this easily and more rapidly.”

UNMET NEEDS IN POINCIANA These outcomes are rewarding for Maniam, who came to Poinciana after recognizing the opportunity to fill unmet healthcare needs in Osceola and Polk counties. He first heard of Poinciana Medical Center while visiting sister facility Osceola Regional Medical Center, during a trip to the Orlando area to scout out schools for his son, who has special needs.

Since Poinciana Medical Center opened its doors in 2013, the hospital has steadily added new service lines and deepened its bench of specialists.

“I saw a chance to help people who otherwise had to leave the area to get the help they need,” Maniam said. “We have an older population in Florida, which is associated with more prostate disease, enlargement and cancer. Being in the Southeast, we see a lot of kidney stones, related to diet and lifestyle, as well as our climate.”

Patient education and prevention is a key element of Maniam’s practice, particularly because urological issues can sometimes cause patients to feel embarrassed or intimidated. “We emphasize that men should have routine prostate screen-

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FULL CIRCLE In reflecting on his path from a patient to a physician, Maniam says that empathy helps him deliver better care.

“I remember how it felt to be their shoes, and that’s what inspires me every day,” he said. “I can take someone who’s in severe pain and bring them to a point where they’re completely relieved and can go back to their lives again. On the other hand, I treat chronic diseases where I can follow patients for a long time. My goal is to see them as whole individuals rather than only seeing their disease state.”

“Using all of the latest tools and technology to treat sometimes complex diseases is rewarding. It’s a challenge that really drives me. If it were easy, I’d probably get bored.”

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ADVANCEMENTS IN CARE Maniam enjoys keeping up with advancements in the fast-changing field of urology. One of his favorite aspects of the job is problem-solving, considering both traditional and new techniques to determine what is best for the patient.

“Kidney stone disease is still evolving, and treatments that were the best solution five years ago, aren’t anymore,” he said.

“It’s similar with prostate disease, incontinence, and so forth.”

In Augusta, Maniam gained experience in robotic surgery to treat prostate

ings, and patients who have kidney stones should follow up for regular screenings, so we can treat them before it escalates into an emergency.”

Involving family members is also critical, Maniam said. “After the patient leaves, these loved ones oversee their care, so they need to be educated about what’s going on and the treatment plan we’ve established.

We talk with them about the disease process, what they can look for, and things they can do to prevent a recurrence.”

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HEALTHCARELEADER Josie Weiss, PhD, continued from page 1

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Tell us about your interest in serving vulnerable populations.

I started working in indigent care 25 years ago when I was in graduate school.

I developed such an appreciation for this population who, for the most part, are so very, very grateful for anything we can do for them. Once I was in that environment, I never left.

In 2000, our family moved to Okeechobee, Fla. I worked in a community health center as a family nurse practitioner while teaching at Florida Atlantic University in their College of Nursing. I also worked with incarcerated adolescents during that time.

The teen pregnancy rate in Okeechobee is very high. In 2012, the birth rate to mothers age 15-19 was double the rate in Florida as a whole. These rates are highest in under-served adolescents who often do not appreciate the importance of finishing high school and obtaining some type of post-secondary education or training before starting a family. Most of the incarcerated young people did not have strong parent figures in their lives. They needed someone to care about them, and explain that if they could postpone having children until their 20s, what a better decision it would be for both the parents and the baby.

In 2014, I returned to Orlando to work at UCF. With the shift in population from rural to more urban, my research gravitated toward how to promote meaningful interactions between parents and their adolescents; what I like to call “healthy sex chats.” It is so important for parents to have open conversations with their children about healthy sexual decision-making.

Talk about the volunteer work you do with Shepherd’s Hope, and the involvement of UCF’s nursing students.

I volunteer one night a week at the Ocoee clinic in West Orange County, seeing both children and adults.

Our undergraduate nursing students also volunteer regularly as a component of the West Orange grant. They teach patients how to develop healthy habits such as the importance of maintaining normal blood pressure, eating a healthy diet and getting regular exercise. We’ve also had three graduate students do their doctoral projects through Shepherd’s Hope and we are looking forward to more beginning soon.

It is important to help our students understand the needs of the underserved and want to work with that population.

We really need good, strong nurse practitioners in those environments. Shepherd’s Hope is helping us achieve that.

“The impact of our four year collab4

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orative relationship between Shepherd’s Hope and the UCF College of Nursing has been significant for our organization and the uninsured patients that we serve,” said Marni Stahlman, president and CEO of Shepherd’s Hope, Inc. “This latest collaboration will have students, faculty and our clinical provider team working side by side to directly improve the health of our patients in West Orange County.”

Is there a memorable patient encounter that is especially meaningful to you?

Yes. It was my first night at Shepherd’s Hope, and I was on the fence about whether this was something I wanted to do. That night, a patient took my hands in hers, held them and said to me, “You are in the right place, and you are doing God’s work. Thank you so much.” I never saw the woman again, but from that moment on, I was committed.

The encounter still makes me tearyeyed. Her words resonated with me about how grateful these patients are and how important the work is that we do. These people simply don’t have any place else to go for their healthcare.

It’s interesting, too, that sometimes our patients are not who you would expect. For instance, I’ve treated physicians from other countries whose circumstances brought them to Shepherd’s Hope. I remember one was an anesthesiologist from South America and another was a physician who knew she had an ear problem and needed help.

Through Shepherd’s Hope, we were able to get the scans she needed to diagnosis a growth in her ear and connect her to a specialist for treatment.

What would you tell other medical professionals who may be interested in volunteering at Shepherd’s Hope?

While Shepherd’s Hope is always looking for more volunteer physicians, nurse practitioners and physician assistants, there is also a very real need for RNs and LPNs to work up the patients and support the practitioners.

It doesn’t matter how much time you have to give – one day a week or every other month – Shepherd’s Hope will work with you. I can tell you that almost everyone who volunteers feels blessed to be there and realizes they get so much more than they give.

TO LEARN MORE

about how to become a Shepherd’s Hope volunteer, contact Volunteer Program Manager Abby Seelinger at (407) 876-6699, ext. 233, or abby.seelinger@shepherdshope. org, or visit www.shepherdshope. org/volunteers.

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HEALTH INNOVATORS

INNOVATION INNOVATOR'SHEADLINES HEADLINES

A Recipe for Building an Innovation Movement, From Scratch

By KELLI MURRAY, MedSpeaks

Pulling together a hyperlocal group of healthcare stakeholders from across competing corporations, non-profits, investors, independent groups, and entrepreneurs is no simple effort. But, in June, that’s exactly what the Florida-based community-building team known as Health Innovators did.

Having a track record for building communities around the State of Florida, our small team set out to find other Orlandolike cities and unearth the unique talent that is often the overlooked gem of driving health and medical innovation. The goal was to unite key stakeholders in Charlotte, North Carolina in order to manufacture a collective movement toward putting the Queen’s City on the map for new and broadening solutions being developed in their region.

In less than 60 days, we worked

with local partner, Scott Pope, to feverishly gather and personally invite select senior executives from Atrium Health and Novant, the state’s largest hospital systems, Premier, Inc., the second largest group purchasing organization (GPO) in the country, Bank of America, Deloitte, partners at venture capital and angel groups, non-profit leaders, members of the media, strategy consultants, and many more who collectively made the “Inaugural Top 40” to join together in a unique meeting of the minds.

The real story however, is about the entrepreneurs that were hand-selected to facilitate introductions and dialogue among all participants. Each was chosen for their mission, ability to significantly impact care, wow-factor, and their practical yet forward-thinking application for patients and healthcare systems. The 4 companies selected were:

• Mako Medical - a cutting edge, high-service reference lab focused on independent physicians • Tavia - a feminine hygiene product subscription service on a mission to keep girls in school • Digitize.ai - an artificial intelligence “teammate” that for smarter, faster prior authorizations • RediPay - a patient-to-provider direct payment system that links the delivery of vision and dental benefits What was so great about this gathering is that there was no sales or marketing pitch. No investor pitch. No gimmicks. Just “neighbors” gathering around the table together to get to know each other and learn about what new solutions were happening in and around their city. Even further, the entrepreneurs were able to take time to share their (CONTINUED ON PAGE 8)

Consumerism in Healthcare: The Relentless Chase Of An Elusive Goal

By JOHN NOSTA

I guess it all converges on one point: the customer. From the dry cleaners to the operating room, the goal now seems to be customer-centricity. Yes, thumbs up, four stars, and likes are today's currency of success. In a recent survey by Kaufman Hall, that examined 200 hospitals and healthcare systems, the headline was loud and clear.

SURVEY OF MAJOR HEALTH SYSTEMS REVEALS A GREAT EMPHASIS ON CONSUMER-FOCUSED STRATEGIES, BUT PROGRESS REMAINS SLOW Let's take a closer look.

It's interesting that 90 percent of re-

spondents stated that improving the customer experience is a high priority – a number that's jumped up from 30 percent in 2017. Further, the role of digital tools to engage customers has also climbed significantly from 14 percent to 64 percent over the same short time span. Hospitals seem to be catching the same consumer bug that pharma has been infected with for several years. But I don't know if the cure is worse than the disease.

I remain worried. And there are two central concerns: • Will patient-centricity truly trump superior care and drive a market where style over substance can adversely impact the quality of care?

• Are hospitals wasting valuable dollars by following the herd with poorly planned and tracked consumer marketing programs?

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[APOPKA, FL] Paramedics, ER doctors work together through new app.

Florida Hospital is the first health care system in the state and the Apopka Fire Department is the first agency in Florida to use the app.

[PLANTATION, FL] CarePredict Unveils AI-Powered Elder Care Technology Platform which continuously observes, learns, and triggers just-in-time care for seniors.

[CLEARWATER, FL] Startup Synzi brings virtual care to home health entities, hospitals and health plans through the use of video, email and secure messaging.

[PALM BEACH GARDENS] Healthcare startup, Bridge Connector, raises $4.5 million from VCs, including former Publix CEO. Disclosure: Readers, please take note that the companies featured in the Health Innovators section have not paid for or bartered for these acknowledgements. All companies are selected based on merit, intrigue, and their potential to move healthcare forward towards the Quadruple Aim. In a noisy and biased market, we believe this to be a valuable distinction.

UPCOMING EVENTS Wellness Dinner by Welli The Cancer Conversation JULY 11 | 6:30PM - 9:30PM

https://www.facebook.com/events/189879944999042/

CEO Talk with President of Florida Hospital System

JULY 18 | 3-5:30PM | ORLANDO CAMPUS’ WERNER AUDITORIUM

OK, nice waiting rooms and on-line scheduling is fine. Let's even throw in some billboards and TV spots too. But just as pharma seems to be defined by their ubiquitous "I've got my life back" taglines, I sense that hospitals are looking to become the next Apple story or Amazon experience. (I wonder what Atul Gawande would think?) But does this obsession with the patient – I mean the consumer – reflect the best strategy for superior medical care? The blurred distinctions of consumer brands rely on perception as the path to creating a key reality. But perceptions of efficacy and safety are vastly different and the imposition of "joy" and "satisfaction" as the new statistical p value. Well, perhaps p now stands for patient!

Here's a quote from the study that confounds this even more.

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[ORLANDO, FL] HealthGrid CEO awarded Ernst & Young’s Entrepreneur of the Year for Florida Region in the Health Care Technology category

https://www.eventbrite.com/e/personalizing-healthcarein-the-age-of-disruption-tickets-46633260337

TedX Orlando | JULY 18 7PM | ORLANDO SCIENCE CENTER https://www.eventbrite.com/e/tedxorlando-salonusing-business-as-a-force-for-good-tickets46693013059?aff=efbeventtix

Florida Blue Statewide Heath Care Innovation Pitch Competition for Anxiety & Depression | OCT 10 http://www.usf.edu/entrepreneurship/initiatives/ healthcare-innovation/

Opioids & Florida: The Collaboration Imperative | OCT 22

GUIDEWELL INNOVATION CENTER http://dev.guidewellinnovation.com/opioid-crisis

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

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Silicon Makes its Way to Healthcare Design

PICTURES ARE WORTH A 1,000 WORDS BUT…

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PROMOTIONAL INTERVIEW STYLE VIDEO • Basic Package: $1,095 • 1-Hour Video recorded interview session (typically collecting enough content for 10 short videos).

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• Video will appear on Orlando Medical News’ website and Social Media Pages • Full Package: $1,795 • 1-Hour Video recorded interview session (typically collecting enough content for 10 short videos).

• Up to 5 Branded Short Videos that included intro, outro, music, title screen, and animated logo for Additional videos $250.

• All videos will appear on Orlando Medical News’ website and Social Media Pages

By AMBER CLORE

When it comes to healthcare design, technology in all aspects of the industry tend to be top of conversation. The interior design, decoration and overall appearance plays an important role in the branding of a healthcare facility. Close second are the materials that licensed interior designers specify for use in these spaces. As research and development in the textile world shows, coverings and fabrics are becoming more resilient and inherently sound. Companies that service the commercial and healthcare industries are thinking and creating of innovative ideas and applications at a very quick rate.

Let’s take the performance fabrics being produced by companies like ArCom, Siltech and Sileather, for example. Their fabrics have scratch and tear resistance along with incredible stain resistance and ease of cleaning. Sileather has 100 percent silicone textiles that are eco-friendly, sustainable, easy to clean, weatherproof, and highly durable performance fabrics.

There are endless applications for these fabrics such as interior and exterior design, public transportation, outdoor furniture, healthcare and hospitality. As a designer concerned with wellness, it is perfect these fabrics also meet all the safety standards that focus on health.

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LET’S TALK ABOUT SILICON… Did you know that silicon is the most abundant element on Earth after oxygen?

It’s true! In fact, when you realize that we encounter silicon products in our everyday lives a whole new world of discovery is revealed. One should be familiar with such uses of silicon like computer chips and some forms of breast implants, but there is vast research and development on the use of silicon in everyday products like the textiles we touch and wear.

GETTING TECHNICAL… SO, WHAT DO WE KNOW ABOUT SILICONE? We know they are a diverse family of specialty, high-performance materials.

We know they are widely used in a variety of consumer and industrial products.

And we know these materials provide essential benefits in key segments of our economy; including health care, aerospace, personal care, electronics, transportation and construction. But how do we use silicon in design?

We consider silicon to be part of the rubber family. But, if you define plastics widely, silicone is something of a hybrid between a synthetic rubber and a synthetic plastic polymer. Due to these characteristics, it can be used to make malleable rubber-like items, hard resins, and spreadable fluids. Given it’s many plasticlike properties (flexibility, malleability, clarity, temperature resistance, water resistance) we still treat silicone as a plastic. Like plastic, it can be shaped or formed and softened or hardened into practically anything.

However, silicon is much more temperature resistant and durable than most plastics and has a low reactivity with chemicals. It is water resistant and highly gas permeable, making it useful for medical or industrial applications. As advancements in technology increase, so do the uses of silicone.

By now, you may have detected that silicone is a human-made material. It is created by combining the same proportion of elements of different molecular weights, better known as a synthetic polymer. The prefix comes from the base element of the polymer: sand (silica). Sand is mixed with oxygen, carbon, and hydrogen to create a pliable, rubber-like material which is able to withstand extreme temperatures and heavy use.

In Interior Design, silicone is being used to create high-performance textiles, particularly useful in healthcare environments. Some advantages are: 1. It’s pure “green”, meaning it’s made from natural elements (CONTINUED ON PAGE 8)

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THE LOWEDOWN ON HEALTH LAW

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How Does the GDPR Affect My U.S.-Based Medical Practice?

By ERIC BOUGHMAN

The European Union’s General Data Protection Regulation (GDPR) recently took effect and this has businesses asking whether their own website and data procedures must comply with the comprehensive new data law. Several commentators have suggested that everyone who does business on the internet – including information gathering – is subject to the GDPR’s broad reach and stiff fines. In one podcast, a European commentator suggested that GDPR regulators may show up on the doorsteps of American companies to perform data privacy audits; and he claimed several companies could be bankrupted by fines for non-compliance.

Medical providers are keenly aware of HIPAA’s stringent protection of patient health data, but the GDPR is different.

Of particular concern, is the treatment of non-patient information and other data

that might be captured by a website or through internet marketing activities. This may include general personal information, such as names and email addresses, and metadata, such as the location of a website visitor’s computer, the frequency of website visits, and the amount of time a website user spends on webpage.

The GDPR purports to apply to any company, anywhere in the world, that possesses, controls, or processes data of any EU citizen. If an EU citizen visits your website, whether you realize it or not, your website likely captures data about that person’s visit. Non-compliance can result in stiff fines: up to the greater of 20 Million Euros or 4 per cent of a company’s annual revenue. But a careful reading of the law, coupled with some practical knowledge, suggests that most U.S. medical providers, particularly those servicing mainly U.S. resident patients, have no need to worry.

A closer look at the GDPR’s 99 Articles and 173 interpretive Recitals helps explain.

TERRITORIAL SCOPE Article 3 describes three categories of companies covered by the GDPR: (1) those located in the EU; (2) those outside the EU that offer goods or services to anyone in the EU; (3) those outside the EU that monitor individuals in the EU. The internet’s broad reach makes

it possible for virtually any business here in the U.S. to “offer” goods or services to EU residents, even if that offer is merely incidental and not specifically intended.

Consequently, some interpret this section to mean that virtually every company with a website must comply with the GDPR. A closer look at the regulation doesn’t support this interpretation.

Recital 23 speaks further to the GDPR’s territorial reach and says that a company is deemed to “offer goods or services” to EU residents only when it intends to do so. The mere fact a website is accessible by EU residents is “insufficient to ascertain such intention.” Intent can be a murky question, but Recital 23 helpfully offers some factors for consideration. These include whether a company’s website: • uses the language of an EU Country; • allows purchases in the local currency of an EU Country; • mentions other customers or users who are in the EU. Other factors may include whether a company has a website with a domain suffix of an EU Country, or whether a company routinely provides services for EU residents.

As I read Recital 23 and Article 23 together, a U.S.-based business only becomes subject to the GDPR if it targets EU residents. Having a web presence – or even broad internet marketing – doesn’t

suffice. Consider, for example, a medical provider here in the U.S. that operates a website through which prospective patients can review the biographies of physicians providing highly specialized cosmetic surgery. The webpages are written in English, marketing and search optimization campaigns are directed to U.S. residents, and the practice only accepts payment in U.S. Dollars. That practice would not fall under the GDPR, even if the occasional EU resident finds the practice through a Google search and completes a contact inquiry form to sign up for the practice’s monthly newsletter. Of course, the analysis entirely changes if the practice operates a French language website, has a “.fr” domain suffix, and offers to reimburse travel expenses to Parisians who travel to the U.S. for cosmetic procedures.

PRACTICAL CONSIDERATIONS What if I’m wrong and EU regulators find our fictional medical practice subject to the GDPR? Might EU regulators show up here in the U.S. and start issuing multimillion dollar fines? First, there are serious questions as to whether the EU has any jurisdiction over any U.S. business that does not purposely avail itself of EU law by specifically targeting EU residents. There are certainly questions as to whether the EU has any authority to fine U.S.-based companies over which it has no jurisdiction.

(CONTINUED ON PAGE 8)

A human-centric approach to enhancing the user experience by elevating the environments we live, work, play and heal.

We design different.

Forster Boughman Lefkowitz & Lowe is a boutique law firm catering to the professional, entrepreneur and investor seeking customized domestic and international asset protection strategies.

Our firm also analyzes potential exposure to individuals and businesses and provides strategies to insulate vulnerable assets.

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2200 Lucien Way, Suite 405, Orlando (Maitland), Florida 32751 Local: (407) 255-2055 Toll-free: (855) WP-GROUP Info@ForsterBoughman.com Office hours: Open weekdays from 8:30 AM to 5:30 PM

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HEALTH INNOVATORS A Recipe for Building Innovation, mission, values, and traction, and to simply let their community know what they specifically need in order to grow locally, create jobs, and take better care of healthcare systems and patients.

Unfortunately, one key ingredient was missing. Can you guess what it was?

Physicians.

At the center of health innovation ecosystems are physicians. We need you.

Your knowledge and experience offers an invaluable lens that each community needs for growth. You will be inspired, motivated, and encouraged about how a new wave of fresh thinkers are pushing the envelope to make an impact. Perhaps

continued from page 5

it could be your recipe for a renewed sense of passion, purpose, and influence that you once thought was burnt out like a charcoal brick on the 4th of July.

Knowing the challenges and burdens placed upon you, how can we better collectively engage forward-thinking physicians and local entrepreneurs? The answer may possibly be the secret sauce of creating a value web that secondary cities, like Orlando and Charlotte need to catapult a reputation for transformational innovation.

If you’d like to get involved in Orlando’s health and medical innovation ecosystem, drop me a line at kelli@medspeaks.com.

Consumerism in Healthcare: The Relentless Chase Of An Elusive Goal, continued from page 5 "We are assuming we know what they (consumers) want, but I'm not sure we do….un-named executive."

And as we dig a little deeper, we find that many hospitals are ill prepared to do the "history and physical exam" of marketing to be successful. Only 15 percent of respondents indicated that they have personnel trained and experienced in consumer research. And only 25 percent had a fully operational team in this area.

And this is where we end up: at a point where "progress remains slow."

Healthcare is broken. Just ask anyone.

And the path to repair may be less about the "consumerization" of care but the implementation of quality, data-driven guidelines

for both care receiver and care provider. And advances in technology can certainly help drive change. But that "search for joy" may be taking our eyes off the ball and making us seek more of an elusive than practical goal.

Of course, the patient experience is essential. But the prioritization of strategy is as important as the strategy itself. Pushing customer-centricity to the front of the pack and implementing it with an ill-informed staff is no path at all. It's simply not affordable and might just be a dangerous waste of time.

Follow me @JohnNosta for a more informed and healthy future.

Republished with Permission from the author as previously published on Forbes.com.

JOINY!

TODA

IPNetworkFlorida.com

Silicon Makes its Way to Healthcare Design, continued from page 6 2. Does not degrade over time or from hydrolysis (when a compound is broken down via reaction with water into smaller compounds) 3. No stains or ink marks can stick to the surface 4. Inherently flame retardant 5. Does not support microbiological growth In particular, silicone provides advantages for the healthcare sector since it doesn’t need additives to deter microbiological growth, can withstand heavy wear-and-tear, and hold up against cleaning products. As finishes, they help fabrics retain shape, texture and resistance to abrasion and they are used to help achieve uniformity and brilliance of color.

Its treatment makes the materials more durable and repels dirt and moisture. In addition to the properties it provides to textiles, paints made with silicones offer exceptional adhesion, pigment dispersion and chemical, weather and stain resistance.

It is wonderful to see companies creating products for their versatility and convenience and I believe we have already revolutionized fabrics and coverings of all kinds. It’s for sure, silicone products can be used to create an interior that inspire, support well-being, and exceed expectations.

All great things!

Amber Clore, ASID, is a Florida Registered Interior Designer (#ID6200) and owner of A.Clore Interiors located in downtown Sanford. The firm specializes in designing healthy spaces in Commercial and Residential environments. She is currently the President for the Florida North Chapter of The American Society of Interior Designers.

Amber can be reached at amber@acloreinteriors.com or www.acloreinteiors.com

Independent Physicians

The Unequivocal Solution to the Healthcare Crisis!

Managing patients in an independent environment saves significant healthcare dollars for payers, employers, and consumer-patients.

CENTRAL FLORIDA’S INTEGRATED INDEPENDENT PHYSICIANS NETWORK • 1,000+ Physicians • Preserving and protecting the independent practice of medicine, and providing independent physicians the tools to succeed in this era of healthcare reform.

• Value-based shared savings agreements with the payers • Lower out of pocket costs for patients at physician and ancillary visits

FOUNDING PRINCIPALS • Manage Patients • Improve Patient Outcomes • Improve Patient Satisfaction • Improved Reimbursement • Cost Effective Delivery of Healthcare

THE LOWEDOWN ON HEALTH LAW How Does the GDPR Affect My U.S.-Based Medical Practice? continued from page 7

In fact, EU member countries struggled with these same issues in assembling the GDPR. Recital 151 notes that “the legal systems of Denmark and Estonia do not allow for administrative fines as set out in this Regulation.” Competent national courts in those countries are admonished to “take into account the (GDPR’s supervisory authority’s) recommendation” to issue fines. But, will a court in Denmark or Estonia blindly follow the recommendation of an overly zealous EU regulator from Italy, Lithuania, or some other EU Country to fine a local merchant into bankruptcy (as suggested by the podcaster to whom I referred above)?

Regardless of the EU’s view, I’m certain U.S. companies can find competent counsel to challenge the reach of the GDPR here in U.S. Courts. And, I doubt U.S. Courts will blindly enforce foreign judgments from the EU which are excessive or which are entered without proper regard for due process concerns.

CONCLUSION There are many issues regarding the GDPR’s territorial reach and enforcement that still need to be sorted out. U.S. based medical practices serving U.S. residents need not panic. We already have plenty to worry about with U.S. regulations, particularly those already imposed

by HIPAA, and the ever-changing threats presented by U.S. based litigation – such as the recent spate of ADA Website Compliance lawsuits. Instead, take this opportunity to view the GDPR as an example of “best practices” for handling non-patient data and privacy issues (that may not be subject to HIPAA).

If you envision doing business with the EU market in the future, compliance will ultimately be required. Here in the U.S., we may very well see a local regulation modeled on the GDPR. Achieving GDPR compliance is therefore a worthy goal, regardless of whether it is required.

But don’t expect any EU regulators to show up on your doorstep next month.

And, if they do, please contact me.

Eric Boughman is a founding partner of Forster Boughman Lefkowitz & Lowe.

Michael R. Lowe, Esquire is a boardcertified health law attorney at Forster, Boughman, Lefkowitz & Lowe.

Mr. Lowe, Mr. Boughman and our law firm regularly represent providers, physicians and other licensed health care professionals, and facilities in a wide variety of health care law matters.

For more information please visit our website www.FBL-Law.com or call our office at (407) 255-2055.

1101 N. LAKE DESTINY ROAD, SUITE 300, MAITLAND FLORIDA 32751 || 407-475-9213 8

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THE HR LADY

sponsored by

y d a L R H THE

By WENDY SELLERS

Q: Should I do background checks for independent contractors and vendors?

It depends! What access do they have to not only your physical office and information, but physically to your employees and patients? The more access someone has to “anything” that can affect your legal liability and reputation, the more concern you should have regarding “anyone” who works for or with you. Contractors and vendors who have access to sensitive information or who work on site are used to submitting background check information. In fact, they often have more respect for their clients who ask for it. They just need to sign a document granted you the right to conduct the background check doing so otherwise is illegal. Be prepared for action and to treat all results equally, no matter what your relationship is with them. Better safe than sorry!

Q: How do I tell if my staff hates me?

Hate is a strong word, perhaps they fear you or are simply annoyed by you? If you are asking this question, that may be the first sign! Obvious signs are that your employee turnover is high, people avoid you most days, they happily refer patients to another provider, and/or your lunch vanishes from the refrigerator. Seriously though, if someone gives you the “deer in the headlights” look, it may be a personality conflict and not hate. You may be direct and demanding while they need more time to process information and gather facts before saying “yes or no.” Or you may be the leader who overwhelms others with too many details when they just need bullet items and a deadline. Perhaps you forget to say hello and ask about their weekend –

or perhaps you cut them off mid-sentence when they are asking about yours? Consider looking into a personality styles assessment for the team or simply asking your staff: what can I do differently? The key is to actually shut up and listen – then act.

Q: I struggle with working with

younger people. Common sense is not common. How is everyone else dealing with this?

“She has no common sense!” We have all used this phrase, admit it. But let’s get to the heart of the matter. The problem is that what is “common sense” for one generation doesn’t always get passed along to the next generation. Why? Because osmosis doesn’t work with humans. We often assume someone else is teaching our colleagues, employees or even our children only to find out that they are not being taught a common set of skills, ranging from cooking and sewing, to typing and using shorthand, to writing thank you notes. Coaching and mentoring is needed, as well as good oldfashioned communication! Often the skill isn’t passed down or taught because it is a skill that is becoming obsolete or is now done in a different manner. For example, technology has taken over a great part of written communication, therefore not as many younger people have great handwriting skills. In fact, most schools are not even teaching kids how to write in cursive. Does that mean they have no common sense?

Well, it depends who is saying that. They do not have a common set of skills as their grandmother, but they do indeed have a common set of skills as their siblings.

Here’s the point: common sense isn’t a sense at all. It’s a set of skills. Skills are activities that we learn so well that they become automatic. Walking, writing cursive and driving a car are skills that must be

learned. Once we have learned and practiced those skills, they become second nature or just common sense. Passing along common sets of skills and expected behaviors requires dedication by groups of skilled people to take the time to train and coach less skilled people. Take time from your day to teach someone “common sense” (Excerpt from my leadership book, Suck It Up, Buttercup.)

Q: I put all new hires on a

probation period for 90 days.

Everyone does that, right?

A. Yes, many companies do this. But why be like everybody else? Why not call it an orientation period instead of a negative, demeaning probationary period? “Hello, new employee. We value you so much and are excited to have you on board – welcome, you are on probation!” The only reason leaders use those 90 days is to avoid a claim on unemployment claims. Why don’t you turn your culture toward a posi-

tive and effective culture by focusing on onboarding, training and feedback during those first 90 days. This doesn’t happen magically. This takes time, effort and dedication. You need to assign mentors to teach the new kid the ropes. The assignments must be clearly defined using metrics and allowing the mentor proper amount of time, which means you need to extend some of their other deadlines. Rushing this process will destroy the morale of everyone involved and will be ineffective.

“The HR Lady,” Wendy Sellers, is a leadership coach, author, speaker and COO of BlackRain Partners, a business consulting company focused on coaching, training, development and HR. She has a master’s in healthcare administration, a master’s in human resources, SHRM-SCP and SPHR certifications.

Wendy’s leadership book, “Suck It Up, Buttercup” is available on Amazon. com. Download the eBook today and learn how not to be a jerk leader. Why? You might be part of the problem. Visit www.blackrainpartners.com

People. Performance. Profit.

Do you want to reach your Revenue Goal in 6 months vs 6 years?

Do you want to be a Best Employer and Retain Top Talent?

Do you want consistent Best Practices & Procedures?

Do you want your managers to hold staff Accountable?

Do you want to Improve Customer Service?

WWW.BLACKRAINPARTNERS.COM

SUCK IT UP, BUTTERCUP

Get Wendy Sellers’ leadership book now!

Suck it up, Buttercup. You might be part of the problem.

Dominant, direct leaders who don’t get emotional get the job done, right? Take charge and cut to the chase, right?

Other people who allow their emotions to get in the way of business need to just “suck it up.” Right? Wrong!

Wendy Sellers, Chief Operating Officer and Leadership Coach with BlackRain Partners, is The HR Lady who is often heard saying Suck It Up, Buttercup. The phrase has taken a whole new meaning. In the past, it was directed at what she believed were inept employees.

Now it is directed at the true root cause: leaders who are unwilling to consider others’ ideas or perceptions.

In her short book, Suck It Up, Buttercup, she will show you how to be a strong yet positive, effective leader using skills that motivate people to want to work hard for you and, eventually, increase the bottom line. All leadership books should be direct, short and realistic. Who has time to read these days?

Get the e-book today, or pre-order the print copy on Amazon.

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Change Starts Today Call us 407.367.0883 #Leadership #Engagement

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GrandRounds MDsave and St. Cloud Regional Medical Center Help Patients Save Money, Access Needed Care

MDsave and St. Cloud Regional Medical Center are working together to help local residents without insurance or with high-deductible health plans save money and get more of the medical care they need. Through the MDsave marketplace, patients at St. Cloud Regional will have access to a wide variety of medical procedures* at up-front prices as well as simplified billing and educational resources.

MDsave was previously featured in a Fortune magazine article citing an estimated 17.4 million Americans are on high-deductible health plans, where the average deductible is $6,000 a year or more. Another 38 million Americans had no insurance coverage at all as of January 2015. In both cases, out-of-pocket expenses can prevent many individuals and families from getting medical care they need, especially preventive procedures that could help stave off future health issues. MDsave and St. Cloud Regional Medical Center are working to create better options for these patients.

“In today’s marketplace, healthcare can be confusing, especially for consumers who are uninsured or carry highdeductible insurance plans,” said Brent Burish, CEO, St. Cloud Regional Medical Center. “This service can help patients access quality healthcare they have come

Orlando Health CFOs Recognized by Becker’s to expect at our hospital at a lower cost.”

MDsave empowers patients to take more control over their healthcare decisions by offering transparent pricing and educational resources on diseases and treatments. MDsave's website allows patients to geographically search by procedure, provider, specialty, or ailment, and compare pricing. The process is upfront and easy. Just choose the best option, add to your cart, and check out online - the price posted is what you pay. The price includes all costs associated with the procedure including physician billing. Patients will not receive another bill.

“Through this program, people are getting the lower-level care they need to address health concerns rather than ending up with a medical emergency that requires costly ER care,” says MDsave co-founder and CEO Paul Ketchel. Similar savings are available on many of the procedures offered, from mammograms to cardiac catheterization to hip arthroscopy and more.

“Working with St. Cloud Regional Medical Center, we are taking an important step toward making healthcare more accessible and affordable,” says Ketchel. “We know that the cost of preventive treatments is often a factor in consumers neglecting to have them.

We hope that our strategic alliance will increase access to quality medical care and, as a result, help save lives.”

INTERNAL & FAMILY PHYSICIANS Shepherd’s Hope, the largest free and charitable clinic in Florida, is seeking Internal and Family Physicians 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 Seelinger, Manager of Volunteer Programs (407) 876-6699, ext. 233 | abby.seelinger@shepherdshope.org or visit www.shepherdshope.org/volunteers.

Two Orlando Health Chief Financial Officers were recognized as one of 150 health system CFOs to know in 2018 by prominent industry publication, Becker’s Hospital Review.

The list includes health care executives across the country that lead financial departments and play a vital role in their organization’s strategic growth. Bernadette Spong, Chief Financial Officer of Orlando Health and Lance Sewell, Chief Financial Officer of Orlando Health South Lake Hospital were included in this year’s list.

Since joining Orlando Health in 2015, Spong has brought financial transparency and growth to the organization. During Spong’s leadership, the Orlando Health posted its highest operating margins. She has received numerous honors and has been recognized by Becker’s Hospital Review as one of 150 health system CFO’s to know since 2015.

Sewell serves as CFO of South Lake Hospital and Dr. P. Phillips Hospital. He is an active member of the community and sits as a board member on the Community Foundation of South Lake. Sewell’s financial involvement within the community is respected by the 700 business members of the South Lake Chamber, one of the largest in Central Florida.

AMA Adopts Ethical Guidance on Medical Tourism

New ethical guidance on medical tourism was adopted at the American Medical Association’s (AMA) Annual Meeting to help physicians understand their fundamental responsibilities when interacting with patients who seek or have received medical care outside the U.S. Every year, American patients cross borders to receive treatments and procedures outside the United States. Despite this growing trend, many aspects of medical tourism confound core ethical expectations regarding patients’ rights, including informed consent, continuity of care, and

access to medical records. Issues of safety and quality can loom large, especially when traveling for care that is unapproved or legally or ethically prohibited in their home system.

Many returning medical tourists do not have records of the procedures or medications they obtained while abroad, or contact information for the foreign health care professionals who provided services. Medical tourists often need to secure follow-up when they return, even if only to monitor the course of an uneventful recovery. Patients who develop complications may need extensive follow-up care when they return home.

“When asked to make right what (CONTINUED ON PAGE 11)

IS YOUR MEDICAL BILLING SERVICE… ANSWER

NO

• Locally Owned and Operated?

• Fully Licensed and Compliant with all HIPAA Regulations?

• Employing ONLY AAPC-Certified Medical Billing and Coding Professionals?

• Proficient in Current ICD-10, CPT, and HCPCS Codes?

DEBBIE HOWARD & THE STAT HEALTHCARE REVENUE TEAM Offering specialized services for the Healthcare Industry:

SHARE YOUR PASSION: Help those in need of hope and healing in our community by joining the over 2800 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.

•

Charge entry, payment posting, & patient balance collecting

•

MACRA/MIPS implementation plan

•

Medical coding & audits

•

Medical claims processing

•

Internal controls, processes, & policies

•

Medical practice consulting

•

Corporate Compliance creation & implementation plan

•

Denials management & A/R follow-up

•

Revenue cycle analysis

407.451.8593 D H O W A R D @ S TAT H E A LT H C A R E R E V E N U E . C O M | S TAT H E A LT H C A R E R E V E N U E . C O M

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GrandRounds went wrong as a result of medical travel, physicians can be confronted with a problematic position when they lack vital information to guide follow-up care,” said AMA Immediate Past Chair Patrice A. Harris, M.D. “The AMA’s new ethical policy will help guide physicians on the implications of medical tourism and their responsibilities with patients.”

Among the key points of the new guidance, individual physicians should: • Familiarize themselves with issues in medical tourism to help support informed consent; • Help patients understand the nature of risks and likelihood of benefits, especially when patients desire an unapproved therapy; • Advise patients who consult them in advance whether the physician is willing to provide follow up care; • Offer their best professional guidance, as they would for any care decision; and • Respond compassionately to requests for follow-up care from returning patients who had not consulted the physician before seeking care abroad, and carefully consider the implications before declining to provide nonemergent follow-up care.

The new ethical policy provides companion guidance to AMA principles adopted in 2008 on medical tourism, which call for all medical care outside of the U.S. to be voluntary. The AMA principles address financial incentives, insurance coverage for care abroad, and the use of internationally accredited institutions. The principles also urge coordinated follow-up care, a transfer of medical records that adhere to HIPAA requirements, and the tracking of safety and quality data for procedures performed outside the U.S.

Nemours and the GiveWell Community Foundation Team Up

Children and families of Polk County, Fla. will soon benefit from a $20,000 Impact Polk grant from the George W. Jenkins Fund within the GiveWell Community Foundation and a project designed by Nemours Florida Prevention Initiative (FPI) to establish healthy habits in the first five years of life.

Through this project, Nemours FPI will work with collaborative partners, Early Learning Coalition (ELC) of Polk County and Lakeland Regional Health (LRH) to extend Healthy Habits First Five Years in Polk County. The project uses a train-thetrainer model and helps childcare providers develop wellness policies. The sites also receive technical assistance that will help them sustain healthy eating and physical activity best practices that will help create a healthier early learning environment.

“We’re excited to extend the success of our work from a prior grant in Orange County to promote healthy habits and reduce the risk for early childhood obesity with a cohort of early learning programs in Polk,” says Kelly Rogers, program manager, Nemours FPI. “This is the first time we will be able to engage child care providers in Polk County in adopting best practices and addressing the potentially avoidable risk behaviors associated with childhood obesity. We want to help children develop positive associations with eating fruits and

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vegetables, being physically active and drinking water when they are thirsty.”

Over the 12-month pilot-test project, a team of early learning and health care professionals will be trained from a wellness policy workbook originally developed by Nemours that reaches 600 children, age 0 to 5, among a group of participating early learning centers. Long-term impact includes increased awareness of positive health habits, reduced morbidity and mortality rates, and overall lower healthcare costs.

“By encouraging healthful eating and activity in early life, children will have the foundation for healthy habits in life,” says Lloyd Werk, MD, MPH, division chief of general academic pediatrics and director of Nemours Healthy Choices Clinic.

“Child care providers will receive tools, resources and support to meet best practices related to healthy eating and physical activity in an early learning setting while families receive information to continue these healthy habits at home,” says Rogers. “Helping children grow up healthy and ready to learn is what we want to achieve and we cannot do this without engaging those involved in a child’s life where they live, learn and play.”

Orlando Health Acquires Medical Office Building in Oviedo

Orlando Health successfully completed the purchase of a medical office building in Oviedo at 1000 West Broadway Street. The purchase closed on May 25th.

Purchased from Oviedo Medical Properties, LLC, the two story building is more than 72,000 square feet and situated on approximately 7.7 acres. The purchase price was not disclosed. The facility will continue to be used as medical office space, and will expand Orlando Health's services to the community.

Doctors Seeking Freedom from Hospital Employment Now Have Role Model and Tool Kit

The recent release of 90 doctors in Charlotte, North Carolina, from their untenable hospital-employment contract has caused many doctors nationwide to wonder if they, too, might be able to break free of their burdensome employment contracts. To help them in that quest, the Association of Independent Doctors released today an independent doctors tool kit.

The free guide is designed to help doctors become independent.

“Mecklenburg Medical Group’s departure from Atrium Health is welcome news,” said Marni Jameson Carey, executive director of AID, a national nonprofit trade association that supports independent doctors, and educates consumers, businesses and lawmakers about why their survival is critical to the nation’s health-care.

“We hope their exodus is the beginning of a trend, and that it lights the way for other physicians who want to practice medicine the way they believe is best, without the intrusion of hospital administrators who often put profits before patients,” she said.

Nationwide, large hospital systems have been aggressively buying up independent doctors and turning them into employed physicians. “When hospital sys-

Pictured left to right, Paul Ledford, President and CEO of FHPCA, Nadia Soulouque, Cornerstone Hospice Director of Training and Professional Development, and Alicia Brady, Vice President of Business Development at HospiceRx which sponsored the award.

Cornerstone Hospice Honored with Award of Excellence for Program to Acclimate New Nurses to Organization Cornerstone Hospice and Palliative Care has received an Excellence in Program Innovation Award – Clinical Practice from the Florida Hospice and Palliative Care Association (FHPCA) for its Nurse Onboarding Program. It is one of six hospice agencies across Florida to receive Awards of Excellence at the recent FHPCA 2016 Forum.

The program was developed in April 2017 to help educate and acclimate new nurses to the hospice environment while familiarizing the new employees to Cornerstone Hospice’s internal processes and culture. The new nurses shadow an experienced Cornerstone Hospice nurse as he or she interacts with patients, family and other members of the Cornerstone interdisciplinary team, which may include home health aides, social workers, chaplains, bereavement counselors and physicians.

“We had key objectives in developing the Cornerstone Hospice nurse onboarding program,” said Nadia Soulouque, MBA/HRM, PHR, SHRM-CP, Director of Training and Professional Development. “We want to ensure new hires are comfortable working in a hospice setting and that

tems buy private medical practices, costs sky rocket, monopolies form, and quality suffers,” said Carey. “AID is working to reverse that trend, which is not healthy for patients, doctors or communities.”

Studies show that most doctors would rather be independent than employed, but many don't know where to start, Carey said.

“The free tool kit is for any doctor looking to break away from hospital employment as well as for medical residents who don't want to work for someone else.”

Hospital systems who want to keep doctors under their control often draft restrictive contracts that include non-

they become proficient with the necessary documentation required by Cornerstone Hospice and the Centers for Medicare & Medicaid Services. We also wanted to facilitate an early sense of camaraderie for the new hires and enhance job satisfaction.”

“We are in a highly competitive environment where there is a nursing shortage across the board. Combined with Cornerstone Hospice’s significant and steady increase in our daily patient census, it is critical that we recruit skilled and compassionate nurses to care for our patients,” said Chuck Lee, President and CEO of Cornerstone Hospice. “Since implementation of the Cornerstone Hospice Nurse Onboarding Program, turnover of nurses has declined 18 percent. Ultimately, these positive results mean our patients and family receive a higher level of care in all of our coverage areas.”

The FHPCA Excellence in Program Innovation Award recognizes services and programs provided by a hospice organization that demonstrate the power of creativity and ingenuity to impact the practice and the community.

compete clauses that forbid doctors who leave from practicing in the area, which makes doctors feel stuck. They also require employed doctors to hit quotas for referrals, admissions, procedures, and tests, which causes doctors to over treat and drives up costs.

These were among the complaints in the suit Mecklenburg Medical Group filed against Atrium.

AID’s tool kit offers a step-by-step guide, complete with checklists for every aspect of forming a practice, from setting up a legal entity, equipping an office, (CONTINUED ON PAGE 12)

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GrandRounds building a brand, hiring staff, and managing cash flow. Whether a doctor wants to start a solo, small group, large group, or direct patient care practice, the tool kit is designed to demystify the process.

“This terrific tool kit provides a practical overview of the process of transforming to an independent practice and will inspire people who don’t know where to start,” said Guy Kezirian, a Scottsdale-based ophthalmologist and founder of Physician CEO, a university-based certificate program that helps doctors develop better business skills.

For more information about AID and a free tool kit, go to www.aid-us.org, or call (407) 571-9316.

Physician Burnout: AMA Adopts Policy to Improve Physician Access to Care

With growing concern among the medical community and the public regarding physician and medical student depression, burnout, and suicide, the American Medical Association (AMA) adopted policy during its Annual Meeting continuing its efforts aimed at improving physician access to mental health care. The new policy will help reduce stigma associated with mental health illness to ensure physicians are able to seek the care they need for burnout, anxiety, depression, and substance-related disorders without fear of punitive treatment or licensure and career restrictions.

“We are deeply concerned that physicians and physicians-in-training are oftentimes discouraged from seeking mental health services because they are afraid that publicly disclosing a mental health issue would unfairly stigmatize them and impede their ability to obtain a medical license,” said AMA President David O. Barbe, M.D. “Too many of our physician colleagues are dealing with burnout, depression and even suicidal thoughts—with physicians facing a higher rate of suicide than the general population. We must do everything we can to improve physician wellness and eliminate any barriers that stand in the way of physicians accessing needed mental health care services so they can have more meaningful and rewarding professional experiences and provide the best possible care to their patients.”

The new policy aims to help alleviate concerns about the presence and phrasing of questions on medical licensing applications related to a physician’s past health impairment. Specifically, the policy encourages state licensing boards to require physicians to disclose physical or mental health conditions that currently impair their judgment or would otherwise adversely affect their ability to practice medicine in a competent, ethical, and professional manner, or when the physician presents a public health danger.

Additionally, the policy urges any state medical boards that wish to retain questions about the health of applicants on medical licensing applications to use the language recommended by the Federation of State Medical Boards. This language reads, “Are you currently suffering from any condition for which you are not appropriately being treated that impairs your judgment or that would otherwise adversely affect your ability to practice medicine in a competent, ethical and professional manner? (Yes/No).”

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Free back-to-school physicals for uninsured children Florida ranks 47th in the nation for the percentage of uninsured children, with an estimated 27,000 uninsured children living in Central Florida. For their families, back to school physicals are a luxury most simply cannot afford.

Shepherd’s Hope, the largest free and charitable clinic in Florida, is stepping up to meet this incredible need by partnering for the fifth consecutive year with Nemours Children’s Health System to offer free back-to-school physicals and other medical services for local uninsured and underinsured families at three locations between July 24 and August 1. Funding to support this initiative is being provided by a grant from the Harper Family Charitable Foundation which provides for the health, education, maintenance and well-being of disabled children and adults of all ages in the Central Florida area.

The free back-to-school physicals will include general health assessments and sports physicals (minus immunizations) with a Nemours specialist, as well as vision and hearing screenings at select locations.

In addition, mammogram screenings will be available for women accompanying their children at the Longwood Shepherd’s Hope Health Center location on July 30 in conjunction with the Florida Hospital for Women Mobile Wellness Coach.

To qualify, children must be under

The policy adopted builds on the AMA’s continued efforts to prevent physician burnout and improve wellness, and support physicians throughout their career journey. Through the AMA’s Professional Satisfaction and Practice Sustainability initiative launched in 2013, the AMA is partnering with physicians, leaders, and policymakers to reduce the complexity and costs of practicing medicine so physicians can

age 18 and uninsured. Following the completion of their physical exam, they will receive the required Florida Department of Health form (DOH 3040) which meets the state requirement for enrollment in public or private school.

Physicals will be conducted at the following Shepherd’s Hope health clinic locations. Appointments must be scheduled in advance and can be made by calling (407) 876-6699, ext. 243: Dr. Diebel, Jr. Memorial Shepherd’s Hope Health Center Samaritan Resource Center, 9833 E. Colonial Drive, Orlando, FL 32817 · Tuesday, July 24 | 6-9 PM

Ocoee Shepherd’s Hope Health Center Located at Vista Clinical Diagnostics, 10101 West Colonial Drive, Ocoee, FL 34761 · Wednesday, July 25 | 1-4 PM

Longwood Shepherd’s Hope Health Center The Sharing Center Plaza, 600 N. US Hwy 1792, Suite #124, Longwood, FL 32750 · Thursday, July 26 | 9 AM – noon · Monday, July 30 | 6-9 PM · Wednesday, August 1 | 9 AM – noon

Downtown Shepherd’s Hope Health Center Orange County Medical Clinic, 101 S. Westmoreland Drive, Orlando, FL 32805 · Tuesday, July 31 | 6-9 PM

“It continues to be an undeniable fact that the failure of the State of Florida to expand Medicaid in 2015 has resulted in a healthcare crisis for the most vulner-

Shepherd’s Hope/Nemours Children’s Health System. able among us – our children,” said Marni Stahlman, president and CEO of Shepherd’s Hope. “Now in our fifth year, we once again step in to fill an incredible coverage gap. Our continued partnership with Nemours Children’s Hospital and new this year, funding from the Harper Family Charitable Foundation to help offset medical equipment and supply needs, will unquestionably make a difference in the lives of thousands of children simply trying to enroll in school.”

“This is our fifth year working sideby-side with Shepherd’s Hope on their free back-to-school physicals. We believe it’s important for children to be prepared as they start the school year so they can be successful the rest of the year,” said Al Torres, MD, chief of critical care and transport at Nemours Children’s Hospital.

“Everyone from Nemours who volunteers at Shepherd’s Hope wants to return, including me.”

continue to put patients first. As part of this work, the AMA’s Steps Forward program offers a series of practice transformation modules designed to improve the health and well-being of patients by improving the health and well-being of physicians and their practices. These online modules focus on improving physician wellness, preventing burnout, and increasing resilience.

The AMA has also adopted numer-

ous policies over the past several years to reduce physician burnout and create the medical school of the future to ensure a healthier practice environment for physicians and close the gaps that exist in medical education to improve the health of the nation.

(CONTINUED ON PAGE 13)

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GrandRounds AMA Adopts New Policies at 2018 Annual Meeting

The American Medical Association (AMA) voted to adopt new policies related to immigration, gender equity in medicine, and increased access to naloxone on commercial airlines, among other items, during its Annual Meeting.

The AMA's House of Delegates is the policy-making body at the center of American medicine, bringing together an inclusive group of physicians, medical students and residents representing every state and medical field. Delegates work in a democratic process to create a national physician consensus on emerging issues in public health, science, ethics, business and government to continually provide safer, higher quality and more efficient care for patients and communities.

The policies adopted by the House of Delegates include:

Advancing Gender Equity in Medicine Documented gaps exist in compensation and career advancement between male physicians and their female counterparts, even after accounting for other factors and characteristics. New policy adopted by the AMA seeks a wide array of solutions to the persistent problem of gender equity in medicine.

The sweeping new policy includes specific directives to reduce gender bias, promote objective criteria for equal base pay, create guidance for instructional transparency of compensations, and establish educational initiatives on institutional and structural bias within medicine.

“As the nation’s largest physician organization, the AMA not only wants to advance gender equity in medicine, but also set an example by committing to pay equity for its own employees,” said AMA President Barbara L. McAneny, M.D. “I am proud that many women have joined me in leading the AMA at the highest level, and have contributed a strong voice to our comprehensive efforts.”

Currently, 30 percent of the AMA Board of Trustees are women, including AMA President Barbara L. McAneny, M.D. and AMA President-elect Patrice A. Harris, M.D. The AMA will continue its commitment to provide leadership opportunities for women physicians to shape the national discussion on health care issues.

Promoting Diversity in the U.S. Medical Workforce With large areas of the country facing a physician shortage, the AMA called on the government to clear the backlog for conversion from H1-B visas for physicians to permanent resident status. There is a backlog of international medical graduates who are actively practicing in the United Sates and waiting to receive a green card. The policy builds on AMA policy aimed at ensuring an adequate physician workforce and promoting diversity in the U.S. medical workforce.

“Opening the door to more qualified physicians would benefit patients, many of whom have difficulty accessing care because of a physician shortage where they live,” said AMA Board Member Bobby Mukkamala, M.D. “One in four physicians in the U.S. is an immigrant physician. Immigrant physicians do not replace American workers; instead, they fill gaps in U.S. health care, create more jobs, and serve

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rural and underserved areas.”

Reporting Child Abuse and Neglect in Military Families Rates of maltreatment of military children continue to climb. In the past five years alone, military child abuse and neglect rose from 4.8 incidents per 1,000 children to 7.2 incidents. The high rate of relocation among military families exacerbates the issue further, making it difficult to track these cases. To address the issue, the AMA adopted policy supporting state and federal-run child protective services in reporting child abuse and neglect to the Family Advocacy Program (FAP) within the U.S. Department of Defense.

“It is no wonder that abuse and neglect goes unreported – only 15 states currently have laws or policies intact that require state child protective services to report cases to the FAP. We hope our new policy helps close that loophole and ensure cases do not fall through the cracks,” said AMA Board Chair Gerald E. Harmon, M.D.

Increasing Access to Naloxone on Commercial Airlines The Federal Aviation Administration requires commercial air carriers to carry onboard emergency medical kits, but the opioid overdose antidote - naloxone - is not a required item in these kits. As a potential life-saving measure, the AMA adopted policy supporting the addition of naloxone to airline medical kits.

“The AMA has been a longtime supporter of increasing the availability of naloxone for patients, first responders and bystanders who can help save lives and seeks to bolster efforts to increase access to this medication,” said AMA Board Member Albert J. Osbahr III, M.D. “The AMA will encourage all U.S. airlines to include naloxone in their airline medical kits.”

The AMA’s dedication to reducing deaths from overdose is a part of the organization’s broader efforts to combat the opioid epidemic, while at the same time preserving access to medically necessary treatments for pain.

‘Last chance at life’ Advanced Cardiac Unit Expands at Florida Hospital Chris Rodriguez was working as a deejay when his lungs failed. Doctors initially gave the 28-year-old no hope at recovery.

But that changed when he came to a specialized unit at Florida Hospital that offers life-support via the ECMO machine, which does what the lungs and heart cannot by pumping a patient’s blood outside their body, oxygenating it, and then filtering it back into the body.

Florida Hospital is the only provider in Central Florida to treat adults with ECMO, and today, the organization is expanding its specialized cardiac unit so up to 1,000 more people with advanced heart and lung problems can be treated each year.

Many of those patients will turn to ECMO. “When someone’s heart or lungs fail, ECMO becomes their last chance at life,” said Dr. Scott Silvestry, surgical director of thoracic transplant a Florida Hospital. “There’s a growing need for this life-saving treatment, and that’s why this expansion is so important. We are privileged to provide this specialized care to our community and state.”

The ECMO machines — and the team of nurses and physicians specially

trained to operate the devices — are housed within the cardiovascular intensive care unit at Florida Hospital Orlando.

Because of the generous support of donors, Florida Hospital expanded this unit and created a new Advanced Cardiac Surgical Unit, which features eight new spacious rooms.

The new unit — with rooms that are 40 percent larger than the previous — makes it easier for the clinical team to accommodate the large ECMO equipment, and to provide a better experience for patients and their families during their long hospital stay. The expansion also created a private family waiting room and additional work spaces for staff and physicians.

Patients are slated to move into the new unit this week.

Last year, the Advanced Cardiac Surgical Unit team cared for cared for hundreds of critically ill patients, including 95 on ECMO (which stands for extracorporeal membrane oxygenation), and dozens who received heart or lung transplants.

One of those patients was Rodriguez, who is recovering from a lung transplant and is doing well.

Opposing Lock-Out Provisions in Medicaid Waivers As states pursue waivers to modify and tailor their Medicaid programs, the AMA announced its opposition to “lockout” provisions that terminate Medicaid patients’ coverage – for up to six months in some states – for failure to comply with administrative requirements. In states pursuing lock-outs, patients can be barred from Medicaid and lose important access to health care services for failing to meet deadlines, satisfy burdensome work requirements, or make premium payments on time – even if they subsequently comply with the requirements within the lock-out period. In many cases, lock-outs will punish patients who fail to keep up with paperwork but otherwise continue to meet the underlying eligibility criteria for coverage.

The AMA believes that Medicaid policies should support continuity of care, and Medicaid patients should be permitted to reapply immediately for redetermination if coverage is terminated.

“Discontinuing health care for thousands of our most vulnerable citizens for failure to meet administrative burdens is a (CONTINUED ON PAGE 14)

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GrandRounds cruel, bureaucratic response to our neediest patients. As physicians, we recognize that many of our Medicaid patients lead complicated, difficult lives, and we should value empathy over rigid adherence to red tape,” said AMA Board Member William A. McDade, M.D., PhD.

Arnold Palmer Hospital Named a “Best Children’s Hospital” in 5 Specialties

U.S. News & World Report, the global authority in hospital rankings and consumer advice, has ranked Arnold Palmer Hospital for Children in its 2018-2019 Best Children’s Hospitals rankings published online today. It is the most recognized hospital in Orlando, with designations in five pediatric specialties.

• #36 Pediatric Cardiology & Heart Surgery • #34 Pediatric Diabetes & Endocrinology • #34 Pediatric Orthopedics • #38 Pediatric Pulmonology • #44 Pediatric Urology U.S. News introduced the Best Children’s Hospitals rankings in 2007 to help families of children with rare or life-threatening illnesses find the best medical care available. They are the only comprehensive source of quality-related information on U.S. pediatric hospitals.

“We are excited to learn that we have been ranked as a Best Children’s Hospital for the ninth year in a row,” said Cary D’Ortona, president of Arnold Palmer Hospital. “Our priority has always been to provide the highest level of care for our patients and we’re honored that U.S. News & World Report continues to recognize our team’s hard work and dedication to our community.”

The 12th annual Best Children’s Hospitals rankings recognize the top 50 pediatric facilities across the U.S. in 10 pediatric specialties: cancer, cardiology and heart surgery, diabetes and endocrinology, gastroenterology and gastrointestinal surgery, neonatology, nephrology, neurology and neurosurgery, orthopedics, pulmonology and urology.

Dr. Rajan Wadhawan (chief medical officer at Florida Hospital for Children), Julie Bennett (NICU mom), Brea Weiss (board chair of the Walt Disney Pavilion), Deborah Spielman (vice president of operations at Florida Hospital for Children), Jocelyn Shaw (chaplain at Florida Hospital for Children.)

Florida Hospital for Children staff and medical team learn about the ranking.

Florida Hospital for Children Nationally Ranked in Neonatology U.S. News & World Report, the global authority in hospital rankings and consumer advice, ranked Florida Hospital for Children’s neonatology program No. 42 in the nation in the new 2018-19 Best Children’s Hospitals rankings released today.

The 12th annual Best Children’s Hospitals rankings recognize the top 50 pediatric facilities across the U.S. in 10 pediatric specialties: cancer, cardiology and heart surgery, diabetes and endocrinology, gastroenterology and gastrointestinal surgery, neonatology, nephrology, neurology and neurosurgery, orthopedics, pulmonology and urology.

“Florida Hospital for Children provides the highest quality, most advanced and compassionate care to the children and families we serve, and this first-ever ranking is a recognition of that

steadfast commitment,” said Daryl Tol, president and CEO of Florida Hospital and the Central Florida Division of Adventist Health System. "Delivering a baby prematurely or having a critically ill child is a very stressful time for parents.

Our stellar team of talented nurses, physicians and volunteers — who care for more than 2,000 babies in our neonatal intensive care unit each year — demonstrate their compassion and unmatched skill every day.”

“The U.S. News Best Children’s Hospitals highlight pediatric centers that deliver state-of-the-art medical care to children with complex conditions,” said Ben Harder, Chief of Health Analysis at U.S. News. “Children with lifethreatening or rare conditions need the level of quality care that these hospitals deliver day after day.”

U.S. News introduced the Best Children’s Hospitals rankings in 2007 to help families of children with rare or lifethreatening illnesses find the best medical care available. They are the only comprehensive source of quality-related information on U.S. pediatric hospitals.

The U.S. News Best Children’s Hospitals rankings rely on clinical data and on an annual survey of pediatric specialists. The rankings methodology factors in patient outcomes, such as mortality and infection rates, as well as available clinical resources and compliance with best practices.

This year’s rankings will be published in the U.S. News & World Report’s “Best Hospitals 2019” guidebook (ISBN 9781931469906), available in stores late September.

Puerto Rican Hurricane Survivor Benefits From This Life-Saving Heart Procedure

Osceola Regional Medical Center recently performed its 100th TAVR cardiac life-saving procedure on an 84-year old hurricane survivor from Puerto Rico. The procedure, transcatheter aortic valve replacement (TAVR), is a minimally invasive alternative to open-heart surgery for high-risk patients who suffer from a narrowed aortic valve. This is a sophisticated and advanced procedure not offered at many hospitals.

Ramona Centeno Santos was initially told by doctors in Puerto Rico that she had no chance of survival, as they did not have any treatment options for her aortic stenosis – a condition where the aortic valve is too narrow to fully open and the heart becomes overworked. After Hurricane Maria damaged her home in September 2017, Santos relocated to Central Florida where she learned of the TAVR procedure at Osceola Regional Medical Center and

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RADIOLOGY INSIGHTS

sponsored by

Emergency Room vs. Urgent Care: What’s the Difference?

By LEENA KAMAT, MD

The difference between an urgent care clinic versus an emergency room (ER) is the level of care and treatment each facility is capable of providing. For life-threatening injuries or severe illness, an emergency room is the best option for immediate care.

If a patient’s symptoms need to be treated quickly but are not life-threatening, then an urgent care clinic is the most efficient and least expensive option.

Most urgent care clinics are open seven days of the week with extended hours. Urgent care medical professionals are equipped to respond quickly to a variety of non-life-threatening illnesses and injuries, such as: allergies, asthma, back pain, headaches, infections, sprains, minor burns, etc.

Emergency rooms are the best option for life-threatening events that may require advanced treatment such as surgery. These facilities are open 7 days a week and 24 hours a day with access to a range of medical professionals/specialists.

The high level of care typically increases the cost of an emergency room visit. A few medical problems that may require ER attention include: chest pain, ingestion of poisons, traumas, severe burns, shock, un-

controlled bleeding, difficulty breathing, etc.

Emergency rooms function by treating patients with the most serious and demanding conditions first and leaving those with less severe problems to wait.

Approximately, 12.5 percent of ER patients are served within 1 hour or less while urgent care clinics usually treat 88.6 percent of their patients within 1 hour.

Lastly, urgent care centers are typically cheaper than a visit to the ER, approximately seven times cheaper!

Urgent care clinics and ERs do share the potential need for imaging for their patients; urgent cares may offer X-rays while hospital ERs offer all modalities include X-ray, CT, MRI and ultrasound.

Radiology Specialists of Florida is a specialized group of radiologists comprised of over 100 physicians and nearly ten different subspecialties within the practice of radiology who are committed to provide not only the most advanced

imaging services, but also the highest quality customer service to both patients and their caregivers, as well as referring physicians.

All physicians at Radiology Specialists of Florida are boardcertified in diagnostic radiology and dedicated to providing high-quality and compassionate emergency imaging services to all referring physicians and patients at Florida Hospital and Florida Radiology Imaging (FRi) locations.

Because of their extensive experience and training in emergency imaging, they provide outstanding interpretation to our patients, supporting their diagnosis, treatment and recovery.

Leena Kamat, MD, is a board certified diagnostic radiologist, sub-specialized in breast imaging for Radiology Specialists of Florida at Florida Hospital. She earned her medical degree at the University of Florida, College of Medicine and following graduation completed her residency at the University of South Florida and a fellowship in breast imaging at the Moffitt Cancer Center.

GrandRounds its potential to save her life. After a successful surgery earlier this week, she’ll be able to go home with her family soon.

The Osceola Regional TAVR team includes Dr. Sayed Hussain, Interventional Cardiology and Medical Director, Valve Program, Dr. Jooby John, Interventional Cardiology, and Dr. Wade Fischer, Thoracic and Cardiac Surgery. Together, the team treats patients who are candidates for this advanced procedure. Osceola Regional is one of few hospitals in the Central Florida area to offer the TAVR procedure and the only one in Osceola County.

Since the inception of its TAVR program, the cardiac physicians at Osceola Regional have performed twice the national average of TAVR cases annually with no interoperative mortalities, and a lower pacemaker and stroke rate than national averages. “As we mark the milestone of our 100th TAVR case, Ramona’s story is a poignant reminder that this procedure has a tremendous impact on the lives of our patients and their loved ones,” said Dr. Sayed Hussain. “These successes are a testament to our dedicated team, and we are proud to offer this life-saving procedure to our community.”

Orlando Foot & Ankle Clinic Opens In Volusia County

Orlando Foot & Ankle Clinic is happy to announce the joining of Dr. Joseph F. Thomas and Dr. Zachary A. Cavins to our practice. Dr. Thomas has a well established reputation of bringing quality foot care to the Deltona area for over 30 years.

In order to better serve the growing needs of the West Volusia County community, Orlando Foot & Ankle Clinic acquired Dr. Thomas’ practice and has brought in Dr. Zachary Cavins to the Deltona location.

About Joseph Thomas, DPM

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Dr. Thomas was a Lieutenant Commander United State Naval Reserve. He graduated Cum Laude in 1977 from Temple University School of Podiatric Medicine in Philadelphia, PA and carried out his residency in podiatric surgery at Philadelphia Osteopathic Medical Center in 1982. Dr. Thomas is a Diplomate of the American Board of Podiatric Surgery, certified in Foot and Ankle Surgery and a Fellow American College of Foot and Ankle Surgeons.

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Zachary Cavins, DPM Dr. Cavins was born at Florida Hospital South, and grew up in Deltona. He graduated Suma Cum Laude with his International Baccalaureate Diploma from Deland High in 2005, and graduated Magna Cum Laude from Florida State University in 2008 with a Bachelors in Biology and Minor in Chemistry and Religion. He then attended Temple University School of Podiatric Medicine and graduated in 2015 and then went on to train at Florida Hospital East Orlando for residency.

A 3 year surgical residency for Foot and Ankle trauma and reconstruction as well conservative and surgical treatment for lower extremity pathology where he served as chief resident.

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1+1=7: Leveraging Value-Based Healthcare for Positive ROI

By GREGORY T. REINECKE

Change is about change! In the healthcare industry, the Patient Protection and Affordable Care Act of 2010 included another definition for clinical success. The government determined success to mean a patient does not return to the clinic within 30 days of original discharge. This is now old news. Yet a survey in 2017 showed that 59 percent of healthcare organizations (up from 33 percent in 2016) still had concerns about the Affordable Care Act. The consensus was that dealing with this move from a volume-based care requirement to a value-based one is still of concern.

The shift from fee-for-service to a value-based model is driving change and a rethinking of doctor/clinic and patient relationships. With change you are forced to review allocation of resources, investment strategies, and even to do more with less.

In this changed landscape—in a valuebased environment—how do you define ROI? Where do you invest?

With a greater awareness and focus that past practices in treating and releasing patients will need to be revamped, new consideration on non-clinical patient information has become important. In the current approach, the doctor is concerned with the patient in a one-on-one relationship. In the new environment, the interaction with the patient goes beyond the clinic and into non-clinical areas. What is in the patient’s home environment that supports or does not support healing and wholeness? What external factors are detrimental to a patient’s ideal recovery?

These factors have been noted to include social and physical determinants. How does one sort these new factors and determine where to invest?

Value-based healthcare clearly shifts the practice to include more people-side intangible factors—into areas not as comfortable for the medical practitioner. The practice of medicine deals mostly with specifics, not with non-specifics such as feelings and emotions. The new practice of medicine is moving into a full partnership with intangible factors, especially social determinants that affect success of healing and wholeness for a patient.

A 2018 report of data collected from 300,000 Americans identified factors that create healthy living environments. They reported that only 12 factors contributed to 90 percent of the variations in the wellbeing of people across the country. These factors were related to demographics, clinical care, social and economic factors, and the physical environment. It is clear the welfare of patients is no longer focused in the clinic, but has broadened into a holistic, community enterprise. You have heard it said that it takes a village to raise a child; now it takes a community to help people heal! No doubt this recognition of the broadening healthcare enterprise may be part of the reason 59 percent of health 16

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providers find the new healthcare expectations challenging.

As a means to begin to understand how to peel back this onion, we have looked at what options healthcare organizations have in making change.

A good place to start is to follow where we currently spend money and use resources and then decide where we need to reallocate funding for the new healthcare needs. So which investments might lead to a more applicable and responsive patient care program? In every organization, there are seven types of investments available. In the outline below, we view each of the seven investments from the perspective of the current Fee-for-service focus to the Value-based focus. For each investment, we have imagined what change result might be desired. The first five capitals followed with asterisks are people or people-derived investments.

HUMAN CAPITAL*

Fee-for service: Patient is a number Value-based: Patient is a person Change desired: Consider a clinical team focused on what an ideal (people focused) value-based healthcare system could be

RELATIONSHIP CAPITAL*

Fee-for service: Transactional: buyer (patient) and Seller (doctor) Value-based: Familial: cooperative solutions, especially post-clinic Change desired: Need to better engage patient in their community; build relationships, understand subgroups

SPIRITUAL CAPITAL*

Fee-for service: Formal (culture, satisfaction, norms) Value-based: Informal (family-like: culture, satisfaction, personal, relationships) Change desired: Need a support network for patient: partner and co-fund with community groups for health and wellness; environmental integration

PHYSICAL CAPITAL

Fee-for service: Focus on clinical needs and technology Value-based: Invest in post-clinical and discharge needs Change desired: Need to fund ongoing support, such as with out- patient wellness support to include wellness integration aides

FINANCIAL CAPITAL

Fee-for service: Revenue generation first Value-based: Patient satisfaction followed

by Revenue generations Change desired: Need to fund ongoing support, such as with an out- patient ‘wellness’ aide We have previously shown that an investment on either the task or people sides requires an investment on the opposite side to reap optimal ROI. For example, an investment of new technology requires an investment in people to maximally exploit the technology. Or if one invests in people to do work, look for ways to invest in materials or technology to help people optimally perform. Since 71 percent (5 of 7) of the investment opportunities are on people or people-derived assets, investment opportunities are mostly on the intangible, soft side.

Value-based healthcare investments are thus people-side ones.

Understanding the patients’ demographics as well as well as geography will be important in characterizing diverse subgroups in communities under consideration. In order to plan for investments, a strategic approach is needed to tactically allocate resources. We believe that what underpins an effective tactical response is knowledge and understanding of situations and challenges on the ground. They directly affect why people get sick but also can expose the environmental factors that will slow their recovery and adversely affect ROI. Proactively responding to complex challenges at the core must fundamentally go beyond traditional 1+1=2 solutions and embrace a broader range of intangibles into the equation. Depending on the desired change result, one invests accordingly. With this mindset, we are certain that the ROI will be better than 1+1=2, and more like 1+1=7!

Gregory T. Reinecke, President, GeoDimensional Decision Group LLC has over three decades of experience delivering powerful value-driven solutions focused on ROI to healthcare, public safety and government agencies. GeoDD creates solutions that help clients manage risk and solve difficult problems, utilizing big data, geography, geospatial engineering, plus social science and demography to reveal new solution possibilities. For more on Gregory T. Reinecke, please visit www. geoddgroup.com.

CUSTOMER CAPITAL*

Fee-for service: Cordial formal service Value-based: Collegial informal service; partnering together for health Change desired: Need a new mindset to think health and wellness, holistically; see patient in their environment.

ORGANIZATIONAL CAPITAL*

Fee-for service: Clinic and equipment support Value-based: Invest to support patient beyond the clinic Change desired: Need to imagine ways to connect/build wellness infrastructure to include community partners and ancillary health groups

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The Realities of the Real-Time Enterprise

By JENNIFER SCHWARTZ and MARIE MURPHY

As if healthcare leaders, especially those in health IT, didn’t already have enough on their plates, something new is on the horizon that could have a profound effect on every area, from clinical to financial to operations and beyond: the impending real-time enterprise.

The proliferation of transformative computing trends such as the internet of things, machine learning, artificial intelligence, and virtualization is changing the way we view data – and the way we consume it. As a result, both our traditional hub-and-spoke networks and the devices that increasingly tie into them, such as sensors and mobile devices, are now able to share a virtually unlimited barrage of streaming data.

This capability opens up all sorts of new possibilities. Because streaming data is continual and immediate (as opposed to batch data, which comes in at set intervals), it gives enterprise-level healthcare organizations the ability to make decisions and take actions as the data is delivered. In fact, with the right infrastructure in place, all of this streaming data can be routed to a data lake, making a much broader range of data from disparate sources available to business intelligence solutions, enabling healthcare organizations and their many business functions to create actionable insights.

Of course, all this massive, real-time computing and decision-making power comes at a cost that is both technical and financial. That’s why, before jumping in to become a real-time enterprise, healthcare organizations must first ask themselves whether these real-time capabilities are necessary. They may find that near real-time data is perfectly suited to many needs, and even that batch operations are still useful in many settings.

The key is to understand what the organization needs to best manage its flow of data regardless of where or when it is created. It can then use these five steps to develop the appropriate enterprise information management strategy.

Start with the business objectives to determine if real-time data is even needed

The time for adopting technologies simply for their own sake is long past. Key executives within the organization must collaborate to determine whether there is an actual business need that calls for immediate access to, or use of, information as it is created. This need must also be balanced by practical considerations.

Real-time data requires a much higher level of network resources than data that is sent every hour, or once a day, as batch processes often are. Does the organization already have those resources at its disposal, or will it need to make a significant investment? More important is the 17

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nature of the data itself.

Take telemonitoring for example. For some patients, receiving a daily or even hourly update of vital signs is sufficient to monitor trends and alert clinicians to potential issues before they occur.

For other high-risk patients it may be necessary to monitor them continuously, as sudden changes can quickly trigger an adverse event that results in an emergency department visit or an inpatient admission. Once organizations understand their information needs they can set the proper data flow strategy.

Have a plan for mobile and outside devices

Healthcare was traditionally slow to adopt the use of outside devices as a result of concerns about security and maintaining the privacy of patient protected health information (PHI). That is rapidly changing, however, with tablets and mobile phones rapidly replacing computers on wheels (COWs) and pagers. Not to mention the widespread use of Wi-Fi-enabled medical devices. Essentially, the once-hardened edge of a hospital’s or health systems’ network has become far softer, particularly in the era of value-based care where patient information must be shared quickly with partners across the care continuum.

To be effective in this new reality, healthcare organizations must have a data and device strategy that ensures they can access the data they want, when and how they want. They must also develop asset management strategies for those devices to ensure the information on them, especially PHI, is properly controlled, secured, and maintained. Not just while on-premise, but also off-premise, including what to do if a device is lost or stolen. It’s a complex issue that requires tremendous thought and expertise.

Make data available to the enterprise at large

Healthcare organizations gather a massive amount of disparate data due to the digitization of administrative, clinical and financial information in electronic health records, bill and other IT systems – clinical, claims, financial, supply chain/inventory, personnel, operational, individual departmental, the list goes on. Traditionally analytics to make use of that data has focused in one specific area.

Today, those siloes are breaking down, with new business objectives creating a need for users to access data from multiple sources in order to drive real business improvement. This change often requires the creation of a data lake to consolidate all of the data in one place and normalize it for use by business users. Whether planning for real-time, near real-time, or batch use, a strategy must be in place to store, govern access, protect, and back it up as-needed.

Think of how users

will consume the data

While it’s important to make information available in the digital age, thought must be given to how users will consume it. Otherwise it just becomes more noise – which no one needs.

Consider data dedicated to monitoring the status of systems in a hospital.

A sensor that monitors the condition of emergency lighting fixtures may only need to report once a day via an email or other non-urgent format. One that monitors the temperature of a refrigerator where temperature-sensitive medications are stored will need to trigger an immediate alarm, text, etc. if the reading goes above a pre-determined level in order to avoid spoilage. The goal should be to provide the information when it’s most needed, whether that’s immediately, in a colorcoded dashboard, or in some other form, to minimize alarm fatigue and ensure the most important needs are acted on first.

Ensure the data can be used for multiple analytics

Different users will need to apply the data to their analytics in different ways.

Any enterprise information management strategies should be able to accommodate all of them.

Some will want to use it to understand and diagnose what has already happened (descriptive). Others will seek to understand the variables that could occur, such as using predictive analytics to forecast staffing needs at certain times of the week, month, or year. Then there are prescriptive analytics that help organizations look at alternative possibilities to help inform decisions about what they should do.

Data that can’t be incorporated into analytics is of little use. A proper data strategy that facilitates analytics is the

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key to driving value.

Planning for the long-term

What makes all of this challenging, especially in healthcare, is the never-ending battle between solving what’s urgent today and what’s going to take the organization where it needs to go in the long-term.

That’s why having a strategy is so critical. By following the five steps above, organizations can ensure they are managing today’s challenges while preparing themselves to become the real-time enterprise the will one day need to be.

I think long term enterprise analytics capabilities are so crucial – by funneling information into BI solutions that analyze and report on the date, healthcare providers can make better administrative, client and financial decisions that improve patient care and create a positive impact on reimbursement.

Jennifer Schwartz is an accomplished professional with special expertise in enterprise information programs, consulting, strategic planning, and mobile solution architecture. As the Enterprise Information Management solution lead for CTG, Ms. Schwartz focuses on business process management and automation, providing best practice guidance, and executing special projects that help transform data into action. Jennifer works across industries, advising clients on the execution of projects to realize efficiencies.

Marie Murphy is the Managing Director, Delivery and Operations, for CTG’s Health Solutions practice. She is a Registered Nurse and a professional healthcare executive with more than 30 years of healthcare consulting, informatics, and professional services leadership. Her experience spans provider, ambulatory, inpatient, vendor, and regulatory. She has helped multiple healthcare organizations ensure that their EHR becomes a vehicle for improved clinical and financial outcomes.

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Top Tips to Keep Your Patients Coming Back to Your Practice

BY MARA SHORR and JAY A. SHORR

We’ve seen this issue time after time: doctors come to us telling us they need assistance with their marketing. Their reasoning: they’re not seeing enough patients during the course of the day and believe that marketing will solve this issue.

We’re not discounting the value of a great marketing campaign. In fact, we see incredible value in a strong campaign that’s bringing your practice the patients you so obviously need. However, this article focuses on what you need to do to KEEP your patients coming back to you long after that campaign works its magic… and after your hard-earned marketing dollars are spent.

1. Make sure your staff is properly answering your phones. We’ve all

had those days in our practices: the phone’s ringing off the hook and you have a line of patients at your check-in and check-out desk. You’ve spilled coffee on your lap on your way into the office, and life just isn’t at its finest.

We’re going to be honest here: none of that matters to the patient on the phone. Each and every patient in front of you and on the phone deserves to have your team’s full attention and not given the abbreviated, shortcut treatment. Make sure that your team properly greets each and every patient, gets their first and last name, as well as a phone number to call them back in case the call gets disconnected and doesn’t cut them off or put them on hold without asking. This last one should go without saying, so make sure each and every patient gets the smile they deserve from your team… even over the phone. You must be able to HEAR a smile.

2. Remind patients of their upcoming appointments. It used to be that

this was something that needed to be done through a manual phone call.

However, most practice management software systems now offer this service through their technology. Look into your software to see how to implement appointment reminders, either through voicemails, text message reminders or email reminders… or all of the above. This both frees up time for your staff to work on other things AND reduces missed appointments in your office. Finally, while we still have practices ask us whether this is a better alternative than a personal call from a member of the team, our answer is simple. We encourage you to look at how many patients are actually

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answering the phone when your team calls.

In today’s digital age, more people than ever before are sending their calls to voicemail. Finally, if your current practice management software doesn’t already have this capability, we encourage you to look into a third-party system, such as the Solutionreach, that speaks directly to your practice management system.

3. Wish patients a happy birthday.

Most of the software systems we discussed above also the ability to send out an automated message to your patients on their birthday.

Consider a text or email that’s customized with your practice’s branding, even including a photo of your team. Everyone likes to be remembered on their birthday, and your patients are no different. All of these tiny touches add up.

4. Put their next appointment on the calendar before they leave the office, even if it’s an annual exam.

While this may seem like a given for most of you, you’d be surprised how many practices that we come in contact with aren’t doing this, especially if you have a more elective specialty where a patient doesn’t NEED to return on a certain date. Putting your patient’s next appointment on the calendar keeps them coming back to YOU, ensuring them a spot when they need it next.

5. Sell private label products to serve as marketing for your practice. This works better for varied

specialties. However, if you’re in a specialty that would benefit from private label skincare products, such as dermatology or plastic surgery (or another specialty that does focus on the cosmetic side of the practice), or a specialty that would benefit from a private label supplement line, we encourage you to consider this as a marketing AND revenue tool. Even private label garments would fit in well with your practice! Consider both from a branding perspective, as well as looking at these opportunities as permanent business cards for your practice.

6. Strengthen your online review process. When your patients are

grateful and appreciative of your services, stretch that appreciation by asking them to leave a review online.

Whether it’s about your practice’s medical assistant with excellent bedside manner or the doctor’s incredible knowledge, potential new patients see the practice as a whole team.

We encourage practices to have a separate review card to distribute to patients, letting them know how they can review your office on Google Plus, Healthgrades, RealSelf, Facebook, Yelp and more. Have that card ready to hand out to each patient on a moment’s notice by any member of your team, and make sure that cards include specific URLs to your review sites.

7. Keep in touch on social media. Just

like we mentioned having a postcard to distribute to patients to give your review sites, have signage in your office encouraging each patient to follow your practice on your social media sites. A member of your team should continue to post relevant content to your practice’s social media accounts in an ongoing fashion, not just a “Happy Friday!” message once a month. Post about industry related news that’s relevant to patients, celebrate staff milestones and birthdays together and invite patients to come in for a specific check-up or treatment. Always keep in mind that all responses should remain HIPAA compliant!

8. Send out email marketing on a monthly basis (if not twice a month). We encourage practices to

keep patients abreast of the practice’s news via social media, and also sending directly to their inboxes.

While the content differs depending on your specialty, we know certain seasons are ripe with ideas. August

means “Back to School,” October brings the “Fall Season,” November brings a list of “What We’re Thankful For” and December/January bring the “Holidays and New Year,” in addition to the end of the insurance year for those of you taking insurance.

Craft your calendar towards what you’ll plan to cover months ahead of time to be sure that your content is in place. Be sure you confirm each patient’s email address and insurance information (if applicable) with every patient phone call and visit, in case anything has changed.

9. Keep customer service in mind!

Yes, you’re a medical practice. But you’re also a business. Each business comes with customer service, and your office shouldn’t be any different.

We find that the number one reason a patient is likely to leave a medical practice, other than insurance changes, is that the details of customer service is ignored. Is your practice constantly running an hour behind? Is your front desk staff rude to your patients? Are they calling prescriptions into the wrong pharmacy when a patient has multiple pharmacies on file? Are your providers making the patients feel rushed during their appointments, with one foot literally out the door before questions are done being asked?

All of these things are important when it comes to a patient feeling “the love” for your practice.

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

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

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

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Providing Answers for Your Sinusitis Patient, One Sinus CT at a Time Nice weather draws people outside for all kinds of activities. However, for those with chronic sinus problems or sinusitis, that can trigger allergies. When allergies flare up, you may see an influx of patients with sinus problems scheduling appointments to see you, with questions as to how to get rid of these sinus problems, once and for all.

For patients who display symptoms of sinusitis, such as nasal congestion, nasal obstruction, thick nasal drainage and loss of sense of smell, a CT of their sinuses can provide the answers you need in order to determine the course of your patient’s care.

“Sinusitis is one of the most common diseases treated by primary care providers today,” says Peter Bove, MD, neuroradiologist with Center for Diagnostic Imaging (CDI). “Good candidates for a CT sinus exam include patients who have had multiple sinus infections and are not responding to traditional antibiotic treatment.”

With a sinus CT, you’ll be able to evaluate sinus obstruction, and you’ll get a better visualization of pathology, specifically within the sphenoid and ethmoid sinuses. You’ll also be able to visualize the underlying anatomical abnormalities that may predispose a patient to sinusitis, identify the anatomical relationships of key structures of the diseased area, as well as the extent of the disease. You’ll also have a preoperative evaluation of your patient’s nose and paranasal sinuses.

Two of the most common sinus CT exams are CT sinus, limited, which is an exam used for patients with suspected sinus disease, and a CT sinus, complete,

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which is an exam for patients with recurrent acute or chronic sinusitis. Both of these exams are typically completed in about five minutes. This quick exam time means that you and your patient can get the answers you need right away.

When your patient is facing potential sinus surgery, it’s crucial to have clear images and an accurate read of your patient’s images. This means choosing an imaging provider you can trust. At CDI, our on-site subspecialized radiologists ensure your patients receive a higher level of care and diagnosis by providing you with high-quality images and an accurate, thorough read of those images. We can work

with you to determine which CT sinus exam is the best to order for your patient, and our technologists can implement any specific protocols you have in order to provide the images you need.

A CT of your patient’s sinuses brings you one step closer to a diagnosis and treatment plan for your patient. CDI is your partner in providing that diagnosis.

Together, we can get your patient out of pain and discomfort, and back outside to the activities that they love.

To learn more about scheduling patients for a sinus CT exam, please call Deanna Vigliotta, at 407.256.8162.

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