Orlando Medical News June 2019

June 2019 > $5

Competition and Transparency

A rundown of newly passed healthcare legislation begins taking effect July 1

After this spring’s legislative session, there were conflicting messages from lawmakers on streamlining competition in healthcare.

“Like any Legislative session, we will likely look back at a number of positive steps forward but also some missed opportunities and challenges that lie ahead. From a physician perspective this session is likely to be remembered for the injection of competition that the Legislature is attempting to deliver through the repeal of Certificate of Need and the expansion of Ambulatory Surgery Centers,” said Fraser Cobbe, executive director of Orange County Medical Society and Seminole County Medical Society.

In disappointing fashion, telehealth was

hardly addressed, except to gain more accountability over out of state physicians.

“Telehealth legislation has caused some concern, and we missed a real chance to join the vast majority of states that make sure payment mechanisms are tied to the provision of telehealth services. That failure will likely limit expansion of these services to patients in Florida,” Cobbe said.

“Finally, while at the same time expressing concern over consolidation in healthcare, the Legislature has passed a number of additional mandates on physician practices which will apply more pressure on expanding overhead and operational costs.

While those bills individually are all well intentioned, such as the ePrescribing mandate,

office surgery rules, non-opioid alternatives, human trafficking, etc., when taken together they pile on additional compliance costs that continue to build and threaten the viability of small practices. The Legislature will need to address the burgeoning overhead for small independent practices if they want to continue to drive competition in the marketplace,” he pointed out.

A look at this year’s package

The certificate-of-need process is over.

Almost. And sort of.

After years of lobbying for a repeal of the often community-dividing, red-tape clogging CON laws, hospitals reached victory this year with the passage of House

Bill 221, landmark legislation for Florida.

On July 1, CON applications will no longer be required for new or expanding general hospitals across the state.

Specialty hospitals have two years before the CON repeal law goes into effect.

Exempt from the CON overhaul: single-specialty hospitals.

“The language has confused some people because the definition of specialty and single-specialty hospitals is very similar,” said Cobbe. “Concerning single-specialty hospitals, Florida law prohibits any hospital from being relicensed if more than 65 percent of DRGs are related to (certain) services.”

“There was an effort to get rid of that single specialty hospital ban, but ultimately (CONTINUED ON PAGE 2)

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Brain Patients Have Options

Mariel Szapiel, MD, Orlando Health Physicians Neurosurgery Group Mariel Szapiel, MD, FAANS, is a neurosurgeon on a mission to spread the word to people who suffer from movement disorders like Parkinson’s Disease and Essential Tremor – and also for those suffering from epilepsy: You have options.

“There are more options than they’ve ever thought about” said Dr. Szapiel. “It’s very personal for me. Even today, I find patients that have been told, ‘You are not a candidate,’ or ‘There is nothing else we can do for you’ when they could have had surgery many years ago. This is particularly true among people with Essential Tremor. They

just don’t know. They live with the tremor and don’t do anything about it because they don’t know this is an option.

“More than once I have had a patient crying on the operating table or the day after surgery. And they’re crying because they are so happy because the surgery worked.”

•• •• • •

A board-certified neurosurgeon and the director of functional neurosurgery with Orlando Health Physicians Neurosurgery Group, Dr. Szapiel craves interaction with her patients and finding ways to help brain cells communicate better. “I specialize in functional neurosurgery,” she ex(CONTINUED ON PAGE 5)

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Competition and Transparency, continued from page 1 that wasn’t successful.”

HB843

Healthcare TRAIN

House Bill 843 was loaded with healthcare regulatory issues covering dental services, Hospital Quality Report Cards, and Florida TRAIN. The key components for hospital administration changes are buried somewhat in the middle.

“The first important note is HB 843 is the change of the 24-hour length of stay in an ambulatory surgery center,” explained Cobbe. “As of July 1, you’ll no longer have that midnight restriction, where previously in our state, you had to discharge a patient from a surgery center once the clock struck midnight. This language makes it clear that it’s 24 hours length of stay from the start of a procedure before having to discharge them.”

Specific language deals with pediatric patients that authorize the Agency for Healthcare Administration to establish rules for the length of time in a surgery center.

“The pediatric rules will have to be developed, so there’ll be a delay in implementation of length of stay for pediatric patients,” said Cobbe. “But for all your adult patients, that 24-hour length of stay will come into effect July 1.”

Cobbe anticipates HB 843 will have a major impact on physician members that have interest in ambulatory surgery centers.

“Included in TRAIN legislation, hospitals are required to disclose performance measures for patients admitted to their facility within a certain time frame,” said Cobbe.

Information will be required to provide data about performance measures related to infection, readmission and other issues.

“There are also requirements on hospitals to provide notification of patient status change, so if you’re going to change a patient’s status from inpatient observation or vice versa, they’re required to notify the patient and their treating physician,” explained Cobbe. “Other language requires hospitals to let patients know when they’re admitted they have a right to ask the hospital or hospitalist staff to consult with the patient’s primary care physician or specialist that admitted them to the hospital.”

Care coordination requirements were placed in the statute for communities in which local hospitals have instituted preferred contracts for hospitalists and others.

“This one’s a big deal for those physicians who want to make sure that, if you have a patient admitted, you’re able to follow care being provided and have some input into care that’s rendered,” said Cobbe.

“That’s probably a really good thing for our physicians and their patients. And then as far as discharge notification, there are time frames for the hospital to notify a patient’s primary care physician upon discharge.

Cobbe pointed out language in the bill invalidates restrictive covenants.

(CONTINUED ON PAGE 3)

OTHER BILLS THAT PASSED HB451 Education and Alternatives to Opioids • Effective July 1, 2019 • Requires Department of Health to publish pamphlet online containing information on non-opioid alternatives for pain relief. *Will take time to develop.

• Before prescribing a Schedule II opioid for treatment of pain or anesthesia, physician must inform the patient of non-opioid alternatives, discuss the advantages and disadvantages, and provide the patient the DOH pamphlet.

HB1113 Shared Savings Programs • Effective July 1, 2019 • Creates voluntary shared savings programs that must be offered by carriers.

• Carriers report benchmark contracted rate for shoppable services • Patients can share in at least 25% of savings if they find treatment below the benchmark.

• Shoppable Services include but are not limited to: 1. Clinical laboratory services.

2. Infusion therapy.

3. Inpatient and outpatient surgical procedures.

4. Obstetrical and gynecological services.

5. Inpatient and outpatient nonsurgical diagnostic tests and procedures.

6. Physical and occupational therapy services.

7. Radiology and imaging services.

8. Prescription drugs.

9. Services provided through telehealth.

HB851 Human Trafficking • Effective July 1, 2019 • Mandatory 1-hour CME Course for all MDs and DOs by 1/1/2021(and other medical professionals) • Must post a sign in your office with a hotline to call if they are a victim • Must be in English and Spanish • Must be a specific size - 11in by 15in • Compliance date is 1/1/2021

SB182 Smokable Medical Marijuana • https://knowthefactsmmj.com/smoking

HB375 PDMP Hospice Exemption HB411 Non-Emergency Medical Transportation Services – Uber for Medicaid SB322 Health Plans • Association Health Plans • Essential Health Benefits – limited coverage plans

HB19 Prescription Drug Importation Program

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Competition and Transparency, continued from page 2 “The ban on restrictive covenants in employment agreements is very limited,” he said. “It’s only if the single entity practice or hospital employs all the specialists within a county. If every urologist in the community is in one practice, then if you have a restrictive covenant in your employment agreement, then that covenant wouldn’t be enforceable.

“A physician could leave the practice and start up another one within that community and not have to adhere to the noncompete clause.”

Last year, the legislature passed primary care and direct primary care agreements, and language in the new law extends it to get rid of the term “primary care” and replaces it with healthcare.

“It’s an attempt to broaden the use of these direct contracting agreements between patients and physicians,” Cobbe detailed. “It lets specialists enter into those agreements as well. And just a reminder, those direct primary care agreements are basically like a gym membership, where a patient would pay a physician a certain amount of money per month in return for a menu of services in a monthly rate.”

Step therapy protection was also included in the bill.

“It’s somewhat limited, but it says if the patient was previously approved by another insurance carrier for a specific drug, another insurance carrier couldn’t come along and discontinue therapy under that prescription,” he said. “It certainly doesn’t go all the way we wanted on step therapy protections for patients. It does provide at least one measure of protection for patients who are on a drug that’s been approved, not getting switched off that drug.”

HB843 Health Care TRAIN • Effective July 1, 2019 • 24-Hour Stay in Ambulatory Surgery Centers • Pediatric rules will be established by AHCA • Hospital disclosure of performance measures • Hospital Notification of patient status change, ability to have their physician consult with hospital staff and discharge notification within timeframes • Invalidates restrictive covenants if one entity employs all specialists in a county.

• Enables Direct Health Care Agreements • Step Therapy Protection – Patients can bypass if drug previously approved by another insurance carrier

HB23

Not much for Telehealth

For yet another year, Florida legislators did little to improve the state’s telehealth services.

“At least there’s a bill now on the books for telehealth in the statutes,” said Cobbe.

In HB 23, language addressing payment parity for insurers to reimburse physicians the same amount for a telehealth visit versus an in-clinic visit.

“The only thing it really is set up a process where out-of-state physicians will be able to register in Florida to provide telehealth services to Floridians,” said Cobbe. “There’s clear language that says if they do want to open up a brick-and-mortar practice, they’d of course require a full license to practice in 3

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the state of Florida.”

The new law establishes a process where insurers and physicians may establish mutually acceptable payment rates for telehealth services.

“That’s kind of going on already, so I don’t know that’ll change the landscape much,” he said. “It clearly falls short of a mandate for insurers to reimburse physicians for telehealth services at the same rate as for other services,” said Cobbe. “But I guess it does set up a process to start to engage with insurers, negotiate reimbursement rates for telehealth services.”

HB23 Telehealth • Effective July 1, 2019 • Requires out of state physicians to register in Florida • Prohibits them from opening traditional practice without securing the required license • Allows insurers and physicians to establish mutually acceptable payment rates for telehealth services

SB366

Fighting Infectious Disease

The Infectious Disease Elimination Act (SB 366) removes the pilot program tag from the University of Miami needle exchange program, making it permanent. The bill also paves the way for the creation of similar programs.

“It continues the ban on the use of public funds to operate these programs,” said Cobbe. “There was an effort during session to let cities and counties provide at least some public money to run these programs. The House really wasn’t in favor of doing that.”

Hillsborough County commissioners have discussed opening a similar program in Tampa.

“This is good news,” said Cobbe. “It’s definitely a bill the FMA and organized medicine supported. It’s fantastic to see the University of Miami’s program being recognized for great work.”

SB366 Infectious Disease Elimination Act Needle Exchange Program • Effective July 1, 2019 • Removes “Pilot” tag from Miami program • Provides County Commissions the authority to approve new programs • Mandates specific resources, reporting and security measures that must be provided • Maintains ban on the use of any public funds for the programs

SB732

Office Surgery

SB 732 addresses the troubling rise in patient deaths at plastic surgery offices, primarily in South Florida, with new rules and regulations impacting levels two and three surgery centers.

“The final version focuses on liposuction procedures performed on level two or three surgeries done in a physician’s office,” said Cobbe. “It requires those surgeons to register with the Department of Health. Also, each facility that performs office surgery must des-

ignate a responsible physician who will be held accountable for the office surgery suite living up to responsibilities to the state of Florida especially concerning patient safety.”

The new law, effective Jan. 1, 2020, requires the Department of Health to conduct annual inspections of all registered officebased surgery.

“It’s my understanding as a physician, you can currently name the practice as an additional insured on your med mal policy, which is something you’ll need to do to ensure you’re adhering to the same financial responsibility requirements as you are for the individual physicians practicing there,” said Cobbe.

SB732 Office Surgery • Effective Date January 1, 2020 • Any office that does liposuction or Level II or Level III surgeries must register with the Department • Bill does not change the current definitions of Level II or III. • Must designate a responsible physician and notify within 10 days if there is a change/ appointment of a new physician.

• Must establish financial responsibility to the same degree as currently required for physicians.

• Name the practice as an additional insured.

• Each physician must notify the Department within 10 days of practicing at the location.

• Annual inspections from the Department – Unless you are accredited by a national organization recognized by the Board of Medicine

If a physician determines that it is in the best interest of the patient to give them the paper script, they can that, provided they make sure to document it in the medical record why you’re not doing it electronically and why they determine it’s in the best interest of the patient.

There is also a clause that says if the patient determines it is in their own best interest to get a paper script so they can shop around, or for whatever other reason, they can demand a paper script if the physician documents it in the record. There is also an exemption if the physician is actually the dispensing entity, and one for hospice and nursing home patients.

HB831 Electronic Prescribing • Effective Dates – Jan. 1, 2020 & July 1, 2021 or upon license renewal – whichever is earlier* • Physicians that have EMR must e-prescribe all medications unless: • Physician determines it is the best interest of the patient • Patient determines it is in their best interest to shop around • Must be documented in the medical record • Physician determines it would be impractical for patient to get electronic script filled in timely manner • Physician receives an economic hardship from the Dept of Health • Physician is the dispensing entity.

• Hospice or nursing home patient • FDA requires a written prescription • Prescription cannot be transmitted electronically under the National Council for Prescription Drug Programs SCRIPT Standard.

HB831

YourPrescribing Host and Presenter: Electronic

“This is another bill that’s going to have a wide impact on a lot of physicians in the state, said Cobbe.

This was modeled after federal legislation that passed last year, which was simply a mandate on e-prescribing controlled substances.

“The state of Florida, with this bill, is DeArcy Vaughan going far beyond what Dr. Congressional legislaPharmD, MBA, BCACP, CDE, CTTS tion mandates because this is going to impact every prescription. So, it’s not just limited to controlled substances,” Cobbe pointed out.

The effective date of this bill is Jan. 1, 2020, but it’s somewhat nuanced because the language that requires physicians to e-prescribe says that effective July 1, 2021, or upon license renewal, whichever is earlier, prescribers would have to come into compliance. The state will provide clarity, but it looks like those whose license renews January 31, 2020, would have to come into compliance and then for everybody else it would be the next renewal cycle, which would be January 31, 2021.

“We were able to get in a number of exemptions to this. The language is very specific.

It says that physicians that have electronic medical records must be prescribed. It doesn’t force you to get EMR if you don’t have EMR currently. I know there was some concern for some physicians that just do temporary voluntary work, or physicians that are nearing retirement age and have not invested in electronic medical records. This does not force them to do that. But to the point that you have implemented EMR, then you must be prescribed by these effective dates,” said Cobbe.

There are a number of, exclusions to this.

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Dr. DeArcy Vaughan, PharmD is the owner of the Jacksonv growing medical service franchise in the country. She earne of Business Administration degrees from the University of Flo 23 years in pharmacy in the pharmaceutical industry, comm settings. Her last assignment in managed care was working quality measures and HEDIS scores. She has a passion for specialty credentials through the years including a Board (BCACP), Certification in Diabetes Education (CDE), and Ce (CTTS). She also served as President of the Duval County and is still active on their board. Throughout her years in h failures in the system for both the patient and provider. DeA consultant and is excited to share with you how partnering patient outcomes while, at the same time, greatly increas work, DeArcy and her husband, Alyn, like doing home imp their kids, Genevieve and Campbell, playing on the beach in

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PHYSICIANSPOTLIGHT

Mariel Szapiel, MD, continued from page 1 plained. “We concentrate on modulating the nervous system. We don’t always go into the brain and take out stuff. We fine-tune the patients, so they can function a little better.”

This fine-tuning can mean different kinds of medication, and it can also mean physical intervention, such as placing a device like a neuro-pacemaker inside a patient to help the patient’s brain function better, giving the patient a more normal life.

For the areas that Dr. Szapiel focuses on – movement disorders and epilepsy – the causes and treatments differ, of course, but there are some similarities.

In Parkinson’s Disease, for example, she said, the brain cells that produce dopamine in the area of the brain that helps to initiate movement – the substantia nigra – actually begin to die. Dopamine is one of the brain’s neurotransmitters, helping to carry signals between brain cells. Without enough dopamine, the patient experiences a variety of problems; the most obvious involves certain uncontrollable muscle movements.

“If medication isn’t working, one of the most effective treatments is to place a neuro-pacemaker in the brain to stimulate the brain’s own production of dopamine,” said Dr. Szapiel. “The problem is the dopamine isn’t being produced, so the communication isn’t happening appropriately. So, we are going to tweak the brain cells with electricity. Once in place, we can fine-tune this activity so it flows a little closer to what Mother Nature intended.”

Similarly, a neuro-pacemaker can provide deep brain stimulation to help patients who suffer from Essential Tremor, a condi-

tion that produces uncontrollable shaking of the hands or arms. “Some people think that tremors are not a big deal or that some seizures aren’t that important. But for the person suffering, these can be major quality of life issues,” Dr. Szapiel said, describing situations in which patients stop going out in public because they can’t feed themselves, executives who cannot give effective presentations, because their tremors are confused with nervousness, and some people who self-medicate with alcohol, because that seems to bring short-term relief, but which carries all sorts of other health risks, including alcoholism.

In the case of patients with epilepsy, the problem isn’t a lack of dopamine, it’s abnormal electrical activity in the brain, said Dr. Szapiel. “For patients who are not responding to medication, we can offer them surgery. It can range from pacemakers to stimulators,” she said. “Since 2013 we have had a new option for a pacemaker in the brain. This one is called responsive neurostimulation. It is a very interesting device.

We put a small wire in the area of the brain that is having the seizures. That electrode is listening all the time to the brain’s signals.

And when it detects an abnormal brain signal that looks like a seizure is happening, the device sends back a pulse of energy to abort the seizure. It’s like having your own epilepsy monitoring unit inside your head.

But instead of having to be in a doctor’s office, connected to a monitor, the device is there with you. Long term studies are showing that some of those patients are having reductions in seizures of up to 70 percent.”

Dr. Szapiel had not always thought of

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being a doctor. “I came to medicine through the brain,” she laughs, describing how a professor in college led her biology class on a tour of the human body. “We went from organ system to organ system, and when we got to the brain and I discovered how cells talk to each other, I was just floored. I was like ‘Boom, that’s it, I’ve got to do something with neuroscience.’”

After medical school and a surgical internship at the University of Puerto Rico, Dr. Szapiel was accepted for a fellowship in stereotactic and functional neurosurgery at The Ohio State University Medical School.

About a year ago, she was practicing at a hospital in Colorado when Dr. Robert Hirschl, Chairman and Medical Director of Neurosurgery at Orlando Health, approached her with the idea of building program devoted to functional neurosurgery. “I realized that Orlando has an extreme need for a city this size. I believe right now I may be the only one, or one of only two doctors in the community who have the fellowship training to take care of these patients.

“Both of these specialties (movement disorders and epilepsy) are multidisciplinary practices,” she said. “This is not work I do on my own. I work hand-in-hand with my neurology colleagues. It requires a lot of coordination with them, radiology, neuropsychology and many other disciplines. We have all the pieces in place now to get the functional neurology program up and running.

“It’s very Your exciting.”

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Dr. DeArcy Vaughan, PharmD is the owner of the Jacksonv growing medical service franchise in the country. She earne of Business Administration degrees from the University of Flo 23 years in pharmacy in the pharmaceutical industry, comm settings. Her last assignment in managed care was working quality measures and HEDIS scores. She has a passion for specialty credentials through the years including a Board C (BCACP), Certification in Diabetes Education (CDE), and Ce (CTTS). She also served as President of the Duval County and is still active on their board. Throughout her years in h failures in the system for both the patient and provider. DeA consultant and is excited to share with you how partnering patient outcomes while, at the same time, greatly increas work, DeArcy and her husband, Alyn, like doing home imp their kids, Genevieve and Campbell, playing on the beach in

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Can You Hear Me Now? Celebrate Dad with the Gift of Health & Hearing

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June is upon us bringing the start of the hurricane season, longer days, International Men’s Health Month and of course, Father’s Day, celebrating fatherhood, paternal bonds and the influence of fathers in society. Father’s Day started with no profit motive in 1909 when Sonora Louise Smart Dodd decided her father, a widower who raised six children single-handedly deserved to be honored the same way Mothers were recognized in May. The commercialization of Father’s Day came shortly thereafter, promoted as “second Christmas” by the National Retail Dry Good Association. Despite spotted celebrations over the years it would take nearly 60 years after Mother’s Day was established, for Father’s Day to become a national holiday, signed into law

by President Richard Nixon in 1972.

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suggest cards and gifts focused on tools, grills, sports, cars and relaxing with a beer or mixed drink. But since it is National Men’s Health Month I propose improving the quality of life for that special guy by ensuring they are focused on their well-being “Getting it Checked” following the Men’s Health Network maintenance schedule to improve health and reduce premature death and disability. Yearly physicals monitoring blood pressure, cholesterol and evaluating risk for disease is essential. But recent studies have also indicated that hearing is not just about our ears but can also impact our health and life making hearing checks a critical part of our screening regimen.

Hearing loss has a profound impact on everything we do daily and yet most people wait seven to ten years before acknowledging having a problem and seeking a solution. In fact, more Americans report getting a colonoscopy than a hearing test. So why the hesitation? Is it denial, fear of looking old or is the loss of hearing so gradual we don’t

realize it until it is significant?

Dr. Charlotte Yeh (Harvard Health Publishing) suggests that failing to get tested and treated early could contribute to aging more quickly. “Hearing loss is associated with early onset dementia, earlier mortality and six times the rate of falls compared to those with normal hearing.” Adding to this is the feeling of isolation and loss of interaction due to inability to hear clearly resulting in loneliness, impacting health equivalent to smoking 15 cigarettes a day. Diminished input causes the brain to lose the ability to distinguish sounds making it more difficult when hearing aids are finally introduced.

Given the research, I visited Dr. Kyle Clifton (Ascent Audiology & Hearing) to find out more about the current hearing tests, recommendations on “baselines” and to learn more about hearing aids available in 2019. I referred an older individual wearing hearing aids that screeched loudly for Dr. Clifton’s evaluation. She turned them up, turned them down and out of frustration,

simply took them out. Dr. Clifton did a thorough exam explaining that while the product was good, the amplifier was not fitting properly causing feedback. He took a mold of the ear canal and adjusted the amplifier so that sound bounced off the eardrum offering optimum results. On the follow up exam, he made additional adjustments to the sound level allowing the aids to pick up more conversation and less outside noise.

The possibility of hearing aids is a big step and he wants to make sure each patient makes the best possible decision for themselves. Therefore, offering a complimentary consultation and trial period is an important part of his practice. His state-of-the-art facility offers an opportunity to view the ear canal during examination and a thorough explanation of the results.

I took the opportunity to ask about the various hearing aids and the benefits of each. The innovation in this technology is fantastic and quite unexpected. Models in(CONTINUED ON PAGE 7)

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Can You Hear Me Now?, continued from page 6 clude a simple aid using batteries to the latest innovation with Smartphone Compatibility connecting directly to an Android or Apple smartphone and rechargeable models. The Livio Al hearing aids even offer artificial intelligence and integrated sensors detecting when a wearer falls, sending alert messages to selected friends and family members.

Given the ease in the exam, the technology available and results of the latest research, why do men, resist? A compilation of several surveys explained that reasons varied from:

• Too busy • Men should be strong and self-

reliant resulting in resisting routine exams • Fear of Diagnosis • Uncomfortable with exams • “Frugality” So, as you decide on the perfect gift for Father’s Day, consider giving that special guy a nudge to the doctor for his annual exams AND hearing test. Good health is the best gift you can give yourself, your loved ones AND your business.

Did you know a national survey found consumer perceptions of chamber members to be very positive? Consumers are 49 percent more likely to think favorably of a busi-

ness belonging to a chamber member and 80 percent more likely to purchase goods or services from the company in the future.

There is a 73 percent increase in consumer awareness and 68 percent increase in a company’s local reputation making Chamber Membership a true value. At the East Orlando Chamber of Commerce, we take it one step further offering health benefits, industry focused networking, education and much more! Give us a call to examine your options in membership for the health of your business. Visit eocc.org or call 407277-5951 today.

vidual at a time.

His passion is patient centered care.

Dr. Clifton evaluates, diagnoses, treats and manages hearing loss, tinnitus and balance disorders in newborns, children and adults.

He knows that buying a hearing aid is a big step, so he wants to make sure each patient makes the best possible decision for themselves. That is why he offers complimentary hearing consultations and trial periods.

The result is positive feedback from patients like Karen who says, “Dr. Clifton is incredibly knowledgeable and helps explain every single detail of why it’s important to not allow our hearing decline…he was patient

answering all my questions and explaining my results.” For 8-year-old Mason, a comprehensive hearing evaluation, multiple test sessions and referral to an ENT specialist discovered an Arachnoid cyst on the brain stem was the culprit for hearing issues. Two years after brain surgery to remove the cyst, Mason is thriving with no recurrence and passing his latest hearing test with flying colors.

When he is not being a champion for his patients, Dr. Clifton enjoys spending time with his family, visiting local theme parks, competing in a bowling league and being a proud member of the East Orlando Chamber of Commerce.

EOCC MEMBER FEATURE

Kyle Clifton, Au. D, Doctor of Audiology, Owner, Ascent Audiology & Hearing 11602 Lake Underhill Rd., Ste 130, Orlando, FL 32825

Dr. Clifton founded Ascent Audiology & Hearing on two simple truths – that hearing is a vital sense which plays a significant role in quality of life and that hearing loss affects everyone uniquely. That is why he works to solve hearing problems one indi-

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Dr. DeArcy Vaughan, PharmD is the owner of the Jacksonv growing medical service franchise in the country. She earne of Business Administration degrees from the University of Flo 23 years in pharmacy in the pharmaceutical industry, comm settings. Her last assignment in managed care was working quality measures and HEDIS scores. She has a passion for specialty credentials through the years including a Board C (BCACP), Certification in Diabetes Education (CDE), and Ce (CTTS). She also served as President of the Duval County and is still active on their board. Throughout her years in h failures in the system for both the patient and provider. DeA consultant and is excited to share with you how partnering patient outcomes while, at the same time, greatly increas work, DeArcy and her husband, Alyn, like doing home imp their kids, Genevieve and Campbell, playing on the beach in

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Dr. DeArcy Vaughan

WHITE GLOVE CONCIERAGE ESTATE ACQUISITIONS with Betsy Newman, VP, Senior Mortgage Originator & Lisa Owens, PLLC, Realtor ® FROM

market because of the increased growth and the beautiful Florida weather.

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How is the rental market in Orlando?

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Betsy Newman What defines an established Doctor?

• An established doctor/dentist is defined as a doctor/dentist who has been employed as a Non-Resident/Intern/Fellow for at least 12 months by a hospital, physician group or facility OR has been self employed as a medical doctor/dentist for at least 2 years.

What defines a new Doctor?

• A new doctor is defined as a licensed Intern/Resident/Fellow scheduled to complete medical school and commence work within 90 days of the Note date OR has commenced work within the last 12 months with a hospital, physician group or facility.

Does this program allow me to refinance my property?

• Yes, we allow Rate/Term Refinancing for your Primary home.

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• Medical License • Non-Contingent contract from hospital, physician group or facility signed by all parties • Self Employed Physician will need two Personal and Business Returns with yearto-date Profit and Loss and Balance Sheet

What type of documentation will be needed for a New Doctor?

• Graduate of Medical School • Medical License or • Non contingent contract from hospital, physician group or facility • Pre-Graduates of Medical School: PreGraduates are considered students that will be graduating from a medical program with the months of March, April May and June Only.

• Contract or offer letter from hospital, physician group or facility (contract or offer letter cannot contain any additional contingencies • Future Income: • Income from future employment (current under contract with a hospital, physician group or facility can be used to qualify the borrower.

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CyberInsecurity: The Rise of Ransomware and What it Means for You

By M. BRETT JAFFEE

Ransomware is not just big business – it’s big and exploding business. Ransomware attacks skyrocketed in the first quarter of 2019, according to the Beazley Breach Response (BBR) Services team, which reported a 105 percent increase in the number of ransomware attack notifications against clients compared to Q1 2018.

It is such big business that recently the hackers responsible for GandCrab, a popular form of ransomware that was sold to clients on the dark web, are now retiring and going legitimate with their earnings.

The hackers claim that GandCrab netted its clients around $2 billion, all extracted from victims who opted to pay for a decryption key after falling prey to the ransomware.

The hacking group also claims it “earned more than $150 million per year” from GandCrab and is now “leaving for a welldeserved retirement.”

If you are understanding this at home, there are many companies that sell ransomware software to anyone with the desire to purchase it, AND they have all made so much money doing it, that some have decided to stop. The fact that there is one less player in this market might seem like good news, but I assure you, it is not.

According to HIPPA: Healthcare Data Breaches by Year

Between 2009 and 2018 there have been 2,546 healthcare data breaches involving more than 500 records. Those breaches have resulted in the theft/exposure of 189,945,874 healthcare records.

That equates to more than 59 percent of the population of the United States. Healthcare data breaches are now being reported at a rate of more than one per day.

(See graph) In Q1 2019, the average ransomware demand reported to the BBR Services team was $224,871, an increase of 93 percent over the 2018 average of $116,324, said the Beazley Breach Insights report.

Not only has the frequency of attacks skyrocketed, but attackers are fine tuning their focus, and demanding higher ransom payments, said the report.

A ransomware attack against any business could be potentially devastating, but there are some sectors which are more at risk from file-encrypting attacks are than others.

Cybercriminals prey on industries which can’t afford to lose access to their networks.

REPRINTS: If you would like to order a reprint of a Medical News article in a PDF format or request an additional copy of an issue, please email: jkelly@orlandomedicalnews.com for information.

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number of attacks to two main factors.

“First, anytime the average ransom demand goes up, it’s going to pull in more attack groups interested in making money.

Second, the easy availability of exploit kits (GandCrab) and ransomware means there is a lower barrier to entry for would-be hackers.” Said differently, the hackers don’t have to be smart anymore.

The report recommended the following measures if a company’s system has been infected:

Some cybercriminals will be attempting to compromise any organization possible with a generic attack. Professional threat actors will create specially tailored attacks in order to make them look as authentic as possible – even by making the message look like it comes from a colleague or friend.

Ransomware is most often delivered via a phishing email, which provides an explanation as to why NTT Security’s Global Threat Intelligence Report lists business and professional services as the sector most likely to be targeted by ransomware.

Given that opening financial spreadsheets, job applications, and other email attachments is at the very heart of this modern sector, it makes sense that over a quarter of ransomware attacks (28 percent) were directed at business and professional services firms.

What are the top 4 industries to be targeted? (according to the NTT Security report)

• 19 percent of ransomware attacks were targeted at government and government agencies.

• Healthcare is the next highestprofile target for cybercriminals,

accounting for 15 percent of attacks.

It was a ransomware attack against an LA hospital which infamously highlighted the problem, taking the network offline for days until the hospital paid a $17,000 Bitcoin ransom.

• Ransomware attacks against the retail industry account for a further 15 percent of all incidents.

• All other industries make up the remaining 23 percent, While attacks using ransomware as a service (RaaS) platforms remain commonplace, tending to hit unsuspecting small businesses, more sophisticated variants are being deployed through phishing emails and tricking users into activating banking Trojans, the report affirmed.

“We have witnessed a considerable uptick in notifications of both ransomware and banking Trojans in the first few months of this year,” emphasized Katherine Keefe, head of Beazley Breach Response Services, in a statement accompanying the report.

The report quoted Bill Siegel, CEO of Coveware, who attributed the increased

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• Disconnect infected machines from the network (wired and wireless) as soon as possible and preserve them for forensic investigation.

• Reset passwords for any users of the machine and alert employees to change passwords for any personal accounts they may have accessed through the machine.

• Notify external cyber experts who can investigate the incident and determine whether data has been exfiltrated that gives rise to a legal obligation to notify affected individuals.

Protective Measures

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A Look at Gastric Polyps

By SRINIVAS SEELA, MD

The lesser commonly talked about masses of the gastrointestinal tract include gastric polyps. A polyp is an abnormal growth of tissue found projecting from the lining of the body’s mucous membranes and similar to polyps found in one’s colon during a colonoscopy. Gastric polyps can also be found in your stomach during an upper endoscopy. About 6 percent of people in the United States have gastric polyps, and over 90 percent of those are completely asymptomatic. Symptoms of gastric polyps are very non-specific and include abdominal pain and the development of anemia from chronic bleeding, therefore most polyps end up being diagnosed incidentally during an upper endoscopy. Since there are numerous types of gastric polyps, similar to those of colonic polyps, biopsies are required to rule out pre-cancerous lesions and malignancy as they have no discernable distinguishing features from simple visualization. Biopsies of the surrounding gastric tissue are also recommended to rule out any coexisting abnormalities that may be present. Management of gastric polyps is determined based on the specific histology and cell type confirmed from biopsy, so adequate sampling of the tissue and surrounding areas is imperative. Larger polyps may cause stomach pain, vomiting, losing an unusual amount of weigh and blood in the stool.

Types of Gastric Polyps: The initial approach to gastric polyps should include an endoscopic and evaluation of polyp histology and the surrounding mucosa.

In the Western world, where the prevalence of the bacteria Helicobacter pylori is relatively lower, the most common type of gastric polyp is a fundic gland polyp.

It accounts for 47 percent of polyps in the stomach and is named after its location in the fundus, or the top-most farthest point from the distal opening of the stomach. These are mostly from either the use of protonpump inhibitors (PPI) like omeprazole, or sporadically on their own. A small subset of these polyps can arise in the context of familial adenomatous polyposis (FAP), which is a rare genetic condition predisposing one to hundreds of polyps throughout the gastrointestinal tract beginning at an early age. Fundic gland polyps occur in 20 to 100 percent of patients with FAP and 11 percent of patients with malignant adenomatous polyposis (it is important to note that they have virtually no potential, less than 1 percent, to grow into a cancerous lesion so the use of PPIs should not be discounted due to gastric polyps alone). Fundic polyps that show no signs of abnormal cells do not require any further follow up, but multiple polyps or if abnormal cells are seen, colonoscopy and further genetic testing can be done to rule out hereditary polyposis syndromes. Fundic gland polyps are typically small (0.1 to 0.8 cm), hyperemic, sessile, and have a smooth surface contour.

Fundic gland polyps, in contrast with

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adenomas in patients with FAP, rarely progress to cancer. The possibility of a familial polyposis syndrome should be considered in patients with ≥20 polyps.

The second most common type of gastric polyp is a hyperplastic polyp. Although they may arise anywhere, they are typically found in the antrum, or the more distal end where the stomach empties into the small intestine. Hyperplastic polyps can also appear in your stomach. In fact, they’re the most common type of stomach polyps. Hyperplastic Fundic gland polyp polyps are usually smooth, dome- Gastric Fundic Gland Polyp shaped, or stalked with an average size ranging from 0.5 to 1.5 cm.

Hyperplastic polyps are often multiple and them a common incidental and consequently multiple endocrine neoplasia or MEN. may develop in the antrum, body, fundus or less significant finding on upper endoscopy.

Although typically indolent, a subtype of cardia. They’re usually benign and rarely Going forward, the only preventative carcinoids can be aggressive and present develop into cancer. Hyperplastic polyps measure patients can take to prevent gastric with symptoms of episodic flushing, are strongly correlated with the presence polyps may be lifestyle and diet modification wheezing, nausea, and diarrhea after it has of the Helicobacter pylori bacteria accounting to avoid and control chronic gastritis. metastasized to the liver. Treatment of the for 80 percent of cases. Due to the strong benign lesions is simply resecting the lesion correlation, hyperplastic polyps do account but more invasive gastric resection may Srinivas Seela, MD, finished his fellowship in Gastroenterology at Yale University for the majority of gastric polyps where the be required for the metastatic subtype.

School of Medicine. He is an Assistant Professor at the University of Central prevalence of the H. pylori bacteria is much Surveillance for these tumors is that of Florida School of Medicine, and a higher. Most of these polyps will regress on any other gastric lesion, ranging between 6 teaching attending physician at both the Florida Hospital Internal Medicine their own after successful eradication of months to 1 year.

Residency and Family Practice Residence the bacteria. The remainder of the cases Gastric polyps are most commonly (MD and DO) programs. Visit www.dlcfl. com for more. Visit www.dlcfl.com arise from chronic gastritis and pernicious asymptomatic and benign in nature, making anemia. Although still very low, the dysplastic potential of hyperplastic polyps is slightly higher than fundic polyps and can vary between 1-20 percent depending on their histological subtype. The pedunculated subtype that are greater than 1 cm carry the highest risk, therefore all polyps greater than 0.5cm should be resected completely.

Shepherd’s Hope, the largest free and charitable clinic in The risk of malignancy in hyperplastic Florida, is seeking gastroenterologists to provide volunteer polyps is increased in polyps >1 cm and pedunculated in shape. Repeat surveillance care for our patients (one three hour shift per month) at one for the recurrence of these polyps is then of our five convenient locations in Central Florida. recommended at 1 year.

Gastric adenomas are the lesser For volunteer information contact Abby Seelinger, Manager of Volunteer Programs common of the three types of gastric polyps (407) 876-6699, ext. 233 | abby.seelinger@shepherdshope.org at 6-10 percent. They are true neoplasms or visit www.shepherdshope.org/volunteers. most commonly found in the antrum and are closely related to atrophic gastritis, a change in the cells lining the stomach due to chronic inflammation. Gastric adenomas occur equally in men and women and tend to present most commonly in patients in their 60s and 70s. These are also direct precursors to gastric cancer rendering them most dangerous of the three. Size and histological subtype are also very important in predicting risk for cancer, which varies between 8-59 percent, so resection and pathological analysis is crucial for management and follow up. Polyps with high grade dysplasia SHARE YOUR require close endoscopic surveillance of shorter intervals than low grade dysplasia PASSION: ranging from 6 months to 1 year.

Help those in need of More volunteer doctors and

One of the more rare types of nurses needed now more than hope and healing in our gastric polyps is a neuroendocrine ever to help fill the immense community by joining the tumor, also known as a carcinoid. These demand for healthcare over 2800 clinical and appear as firm yellowish lesions in the services to the uninsured and non-clinical volunteers at fundus and body, or middle of the stomach. under-insured men, women They can appear as solitary lesions or in Shepherd’s Hope. and children in Central Florida. the context of tumor syndromes such as

We Need Your Help!

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CBD: Quality, Profitable Income Stream

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Stacy Birnbach, prior to becoming the CEO and Founder of CBD for Total Health, suffered from clinical bipolar depression for 30 years, five of which she was suicidally depressed. After overcoming her bipolar depression, her doctor suggested that she try CBD to help with her interstitial cystitis. CBD provided significant relief from her bladder discomfort and she was able to stop taking her bladder medications, pain free. During Stacy’s struggle with bipolar depression, she underwent 40 rounds of ECT which caused significant memory loss. Since taking CBD, her memory has returned and is sharper than it has been in 20 years. Additionally, during her first 3 months of being on CBD Stacy lost 7 pounds without even trying because it regulated her blood sugar levels and reduced cravings. She also has felt a significant decrease in fatigue. After experiencing such incredible results, Stacy Birnbach, former executive recruiter, has switched career paths.

She has joined the booming CBD industry in order to spread awareness of CBD’s amazing, therapeutic effects and of the additional revenue stream from selling CBD. CBD is a safe and effective nutrient found in the hemp plant. Articles and testimonials cover the internet, attesting to the remarkable medicinal effects of CBD, help-

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The endocannabinoid system, discovered in the early 1990s by Dr. Raphael Mechoulam, the father of cannabis research, plays a substantial role in human health.

CBD’s medicinal effects are attributed to it targeting the endocannabinoid system receptors to restore homeostasis and diminish inflammation. Because of its role in maintaining homeostasis, it is quickly emerging as a potential drug target for a variety of immunemediated central nervous system diseases.

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When medicating with CBD, in order to achieve results, it is important to use high quality, pure products. Kannalife Sciences, Inc. is the only company to hold a Licence Agreement

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With the passing of the 2018 Farm Bill legalizing the regulated production of hemp, the industry is rapidly growing and now is an advantageous time to get involved. Given that the cannabis industry is expected to be worth $100 billion by 2025 and that network marketing is currently a $200 billion a year industry, whatever your goals, selling CBD can both help your patients as well as help you achieve the life you envision for yourself and your family. In fact, one of the top CBD salespeople is earning $83 thousand a month and has made $2 million this year through CBD product sales.

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Is Your Patient a Victim of Human Trafficking?

By AMY WASDIN, RN

Most healthcare providers are aware they have a responsibility to identify and report victims of child abuse, elder neglect, and domestic violence. Another type of abuse –human trafficking – is, however, on the rise in every state throughout the nation.

The National Human Trafficking Hotline statistics for 2017 include 8,524 cases reported and 26,557 calls received.

This crime occurs when a trafficker uses force, fraud, or coercion to make an individual perform labor or sexual acts against his or her will. Victims can be any age (adults or minors), any gender, and from any cultural or ethnic group. The trafficker, or abuser, might be a stranger, a family member, or a friend. This criminal industry is very profitable, generating billions of dollars worldwide. Lack of awareness and misconceptions can allow opportunities to identify victims to go unnoticed and unreported.

Although trafficking victims rarely find opportunities to interact with others without approval from the abuser, research shows that an overwhelming majority of victims see a medical or dental professional during captivity. A visit to a physician or dental practice provides a rare opportunity for an individual to receive help.

Human trafficking victims are commonly seen in medical and dental practices with the following conditions:

questions can help in identifying victims: • Has anyone threatened you or your family?

• Can you leave your job or home if you want to?

• Are there locks on your doors and windows to keep you from leaving?

• Do you have to get permission to eat, sleep, or use the restroom?

• Has someone taken your personal documents or identification?

Human trafficking is a federal crime with severe penalties. The Trafficking Victims Protection Act, enacted in 2000, provides tools to address human trafficking on a national and worldwide level. Many states also have laws and penalties for human trafficking.

If you suspect that someone is in immediate danger, call 911. If you suspect that a patient is a victim of human trafficking, contact the National Human Trafficking Hotline: • Call: 888.373.7888 • Text: 233733

abuse or neglect situations. All states require reporting of child trafficking but may not require reporting for adults. While the HIPAA Privacy Rule allows the disclosure of protected health information without authorization in some circumstances, such as imminent danger, contact your risk manager or legal counsel if you are in doubt. Unless calling the authorities is mandatory or impending danger is suspected, it is best not to do so without the patient’s permission.

Healthcare practices and facilities should have protocols in place that outline a process for recognizing the signs of human trafficking and taking action. Staff training opportunities should include role-playing scenarios for various human trafficking situations.

For more information, contact: patientsafety@thedoctors.com.

• E-mail: help@humantraffickinghotline.org

Additional Resources

• Online Report: https://humantraffickinghotline.org/reporttrafficking

• American Hospital Association, Protocols and Guidelines to Combat Human Trafficking

Follow state laws regarding mandatory reporting to provide notification of patient

• American Medical Association, How Physicians Can Identify, Assist Human Trafficking Victims

• Centers for Disease Control and Prevention, Sex Trafficking • National Human Trafficking Hotline, Service Providers • The Joint Commission, Quick Safety 42: Identifying Human Trafficking Victims • U.S. Department of Health and Human Services, Adult Human Trafficking Screening Toolkit and Guide

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

Reprinted with permission. ©2019 The Doctors Company (thedoctors.com).

Amy Wasdin, RN, MBA, is a Patient Safety Risk Manager II for The Doctors Company.

• Trauma such as broken bones, bruises, scars, burn marks, or missing teeth.

• Poor dental hygiene.

• Gynecological trauma or multiple sexually transmitted infections.

• Anxiety, depression, or insomnia.

Victims are usually afraid to seek help for reasons that stem from fear, shame, or language barriers. Medical and dental providers and their staff should be trained to recognize the signs of human trafficking and know what steps to take.

Below are examples of red flags exhibited by human trafficking victims: • Fearful.

What’s in your Lobby?

• Depression or flat affect.

• Submissive to his or her partner or relative.

• Poor physical health.

• Suspicious tattoos or branding.

• Lack of control over personal identification or finances.

• Not allowed to speak for himself or herself.

• Reluctance or inability to verify address or contact information.

• Inconsistency with any information provided (medical, social, family, etc.).

Victims may be fearful and distrustful of their environment, so it is best not to ask individuals direct questions about being a victim of human trafficking. The following 12

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Christine P., Practice Manager

Nadia V., Practice Manager

Used the software for: 1-2 YEARS PROS: The software is easy to install and simple to navigate. It has truly streamlined our office. I don’t know how we lived without it for so long! You won’t go wrong with this software.

OVERALL: It allows patients to check in without standing in line or writing their name on a log in sheet.

Medical Practice, 11-50 EMPLOYEES Used the software for: 6-12 MONTHS Value for Money Likelihood to Recommend: LIKELYEXTREMELY / LIKELY PROS: Love that sign in looks professional and is HIPAA compliant. The whole office knows status of the patient, it has alerts no one can forget to check in the patient or room the patient. We can leave notes as well for next user... patient in wheelchair, collect copay at checkout, etc.

OVERALL: Professional and the whole team knows status of the patient.

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The Endocannabinoid System 101

By MICHAEL PATTERSON

In 1902, Thomas Edison said, “There were never so many able, active minds at work on the problems of disease as now, and all their discoveries are tending toward the simple truth that you can’t improve on nature.” Eastern medicine of China, India, and Tibet have known this for thousands of years. However, western medicine has been much slower in integrating nature’s medicines into our health care system.

Now that medical marijuana (MMJ) continues to gain popularity as a legal medicine, currently legal in 33 states including Florida, there is a push in America to move towards more natural based medicines. Furthermore, with United States citizens 65 years or older now taking 13 prescription medications per day on average, they are tired of taking more and more pills with numerous side effects that do not make them feel better.

As cannabis usage increases for medicinal purposes, there are still many physicians who question if cannabis has any factual basis to help the body, other that getting “high”. With the discovery of the endocannabinoid system (ECS) by Dr. L.A. Matsuda in the 1990s, we have a basis to validate the ability of the human body to use cannabis and hemp-based CBD, which contain cannabinoids, to assist the body in maintaining

homeostatic wellness.

Wikipedia defines the endocannabinoid system (ECS) as a biological system composed of endocannabinoids, which are endogenous lipid based retrograde neurotransmitters that bind to cannabinoid receptors, and cannabinoid receptor proteins that are expressed throughout the vertebrate central nervous system (including the brain) and peripheral nervous system.

We know through research that the ECS is involved in regulating many physiological and cognitive processes such as fertility, pregnancy, appetite, pain sensation, mood, and memory. Some of the other areas of the ECS that have been discovered over the last 25 years are as follows:

• All animals have an endocannabinoid system (invertebrates and vertebrates) • The ECS has been found to play a role in many diseases. Due to having ECS receptors throughout the body, the ECS can affect many disease states, therefore validating the ability to MMJ and hemp-based CBD to benefit multiple physical ailments.

• Clinical Endocannabinoid Deficiency Syndrome may be a root cause in many diseases. More research is pinpointing the lack of cannabinoids as a precursor to many diseases that (CONTINUED ON PAGE 21)

The Future of Health Care is Innovation, Not Excel Sheets and Check Boxes

By ABHINAV SHASHANK

U.S. healthcare is nowhere near what technology made us dream of a decade back. Healthcare technology was meant to act as a means of reducing costs, eliminating burnout, and making care delivery patientcentric. Cut to today, where a broken leg can cost a patient as much as $7,500, 7 out of 10 physicians do not recommend their profession to anyone, and we rank poorly among other developed countries in terms of the number of preventable deaths.

Why did technology fail?

While disruptive technology solutions did flood healthcare in the last couple of decades, many of them required physicians to go the extra mile to comprehend those sophisticated systems.

Today, physicians are still crunching large data files day in and day out, nurses are doubling up as technical executives, and patients are perplexed by the fact that their providers hardly have time for them.

It’s time for technology to care

If a technology solution is not assisting organizations in improving care quality, reducing costs, and optimizing utilization levels, then its very relevancy is questionable.

Healthcare organizations need technologies 13

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that can help them actuate their data, realize their strategic goals, and bring patients closer to their providers.

Health IT solutions should make the lives of providers easier. Any health IT solution that puts an additional burden on providers is unjustified and unacceptable. Providers are not data analysts and expecting them to train tirelessly to understand an IT system and spend a couple of hours each day navigating through complex interfaces can drastically reduce physician-provider time and pave the way for physician burnout.

In with ultimate integration. We need to bring together EHRs, PHMs, payer claims, and HIEs and put it all in the palm of the providers’ hands. Whether it’s quality management or data management, it should be simple.

In with relevant insights right at the point of care. Providers are tired of wading through complicated EHRs and excel sheets.

What we need now is to seize the nanosecond and realize truly automated care delivery that helps boost the clinical outcomes.

In with 100% transparency and bidirectional interoperability. Healthcare providers are often forced to access bits and pieces of electronic healthcare analytics and referrals on disparate applications. Physicians need to capture real-time care gaps, coding opportunities, patient education opportunities, and more; the only problem is that they

don’t know how exactly to accomplish this.

Providers should be able to capture the gaps in patient care right when they need to and enhance the patient experience of care.

In with true patient-centric care.

Healthcare is not just providing episodic care to patients, it is about building relationships with them. In a world where the quality of care directly influences the financial success of an organization, providers should look forward to aligning the needs of their patients to their treatment procedures.

Healthcare of the 2020s needs reliable data activation platforms

“If you can’t explain it simply, you don’t understand it well enough.” –– Albert Einstein Buzzwords like innovation, intelligence, and analytics make sense in today’s time; however, unless the user experience is seamless, the charisma of backend development does little good for healthcare professionals.

We’re moving into an age of intelligence, and in this age, successful organizations do one thing right- they know the worth of their data. This is the same thing that we need to do in healthcare. Organizations have to switch from a makeshift approach to engage patients and find a concrete strategy that is suited to their advantage, but this needs to be done with the support of data.

To correct everything that is wrong with healthcare technology, we need to reevaluate how we look at it in the first place. Partial patient views on EHRs cannot advance the mission of value-based care. Unless provider teams know what factors impact their patients the most and what patients do outside the four walls of their facilities, they cannot formulate a strategy to address those factors at a population or even individual level.

Organizations need AI-enabled data activation platforms that can surface relevant insights in real time to enable evidencebased care. The ability and speed at which such platforms can ingest, cleanse, and actuate data coming in from disparate sources are pivotal in making it happen.

The road ahead

Technology isn’t healthcare - it is merely a medium to optimize its quality.

The future of healthcare technology will be defined by the amount of data systems can process to generate actionable information relevant to all the stakeholders across the healthcare spectrum. It’s time we bring data closer to reality, engineers closer to doctors, and care closer to patients.

Abhinav Shashank, Co-Founder & CEO at Innovaccer, is an expert in population health management and robust technologies. For the better part of the decade he has been working to revolutionize healthcare delivery with 25+ valuefocused organization and making over 10 million lives better.

Visit www.innovaccer.com

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Chronic Care Management

By DeARCY VAUGHAN, PHARM D

In 2010 Medicare saw that 46 percent of their total spending was going to patients with chronic conditions.

The Centers for Medicare & Medicaid Services (CMS) recognizes Chronic Care Management (CCM) as a critical component of primary care that contributes to better health and care for individuals.

In 2015, Medicare began paying separately under the Medicare Physician Fee Schedule (PFS) for CCM services furnished to Medicare patients with multiple chronic conditions.

CPT code 99490 requires at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month with the following required elements: Multiple (two or more) chronic conditions Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation or functional decline Comprehensive care plan established, implemented, revised or monitored There are multiple other CPT codes including complex CCM services that share a common set of service elements. They differ in the amount of clinical staff service time provided; the involvement and work of the billing practitioner; and the extent of care planning performed.

This means Medicare will reimburse the physician with 20 minutes of NON Face to Face time with the patient. But a complicated process discouraged the physician from providing the service leading to only 1.5 percent of 40 million eligible patients enrolled into the program.

Patient Eligibility includes the 3 items listed above. Billing practitioners may consider identifying patients who require CCM services using criteria suggested in CPT guidance (such as number of illnesses, number of medications or repeat admissions or emergency department visits) or the profile of typical patients in the CPT prefatory language. Examples of chronic conditions include, but are not limited to, the following:

• Alzheimer’s disease and related dementia • Arthritis (osteoarthritis and rheumatoid) • Asthma • Atrial Fibrillation • Autism Spectrum disorders • Cancer • Cardiovascular Disease • Chronic Obstructive Pulmonary Disease • Depression • Diabetes • Hypertension • Infectious diseases such as HIV/ AIDS For a new patient or patient not seen

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within one year prior to the commencement of CCM, Medicare requires initiation of CCM services during a face-to-face visit with the billing practitioner – an Annual Wellness Visit (AWV) or Initial Preventive Physical Exam (IPPE), or other face-to-face visit with the billing practitioner. This initiating visit is not part of the CCM service and is separately billed.

Practitioners who furnish a CCM initiating visit and personally perform extensive assessment and CCM care planning outside the usual effort described by the initiating visit code may also bill HCPCS code G0506 (Comprehensive assessment of and care planning by the physician or other qualified health care professional for patients requiring chronic care management services [billed separately from monthly care management services] [Add-on code, list separately in addition to primary service]). G0506 is reportable once per CCM billing practitioner, in conjunction with CCM initiation.

Obtaining advance consent for CCM services ensures the patient is engaged and aware of applicable cost sharing. It may also help prevent duplicative practitioner billing.

A practitioner must obtain patient consent before furnishing or billing CCM. Consent may be verbal or written but must be documented in the medical record.

The CCM service is extensive, including structured recording of patient health information, maintaining a comprehensive

electronic care plan, managing transitions of care and other case management services, and coordinating and sharing patient health information timely within and outside the practice.

• Structured Recording of Patient Health Information: Record the patient’s demographics, problems, medications and medication allergies using certified Electronic Health Record (EHR) technology.

• Comprehensive Care Plan: A person-centered, electronic care plan based on a physical, mental, cognitive, psychosocial, functional, and environmental assessment, and an inventory or resources (a comprehensive plan of care for all health issues, with particular focus on the chronic conditions being managed) A comprehensive care plan for all health issues typically includes, but is not limited to, the following elements: • Problem list • Expected outcomes and prognosis • Measurable treatment goals • Symptom management • Planned interventions and identification of the individuals responsible for each intervention

• Medication management • Community/social services ordered • A description of how services of agencies and specialists outside the practice will be directed/coordinated • Schedule for periodic review and, when applicable, revision of the care plan This is where companies can provide services to help assist the physician. CCM services that are not provided personally by the billing practitioner are provided by clinical staff under the direction of the billing practitioner on an “incident to” basis. These companies hire HIPAA certified, medical clinicians or case managers make the calls for the physician, record interactions with patients and Medicare reimburses the practice for every monitored patient. This means that a physician with 1,000 Medicare patients enrolled can generate around $20,000 of additional revenue each month.

If you would like to learn more about a company that can help implement CCM into your practice please contact: DeArcy Vaughan, PharmD, MBA, BCACP, CDE, CTTS with RX2Live at growrevenue.rx2live.co or dvaughan@rx2live.com.

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Indoor Environment Maintenance

By M. DON SNYDER

We are all victims of having an over frustrating schedule, especially if you have a family. Daily, everyone is fighting traffic to get to work on time as well as getting home at a decent hour. Throughout the day we are busy working with either our patients or customers, depending which field we are involved with.

Of course, the home life can be chaotic as well. After giving some time, a neglected indoor environment tends to begin developing issues. These issues range from elevated allergens to even the spread of the cold/flu viruses, not to mention many other issues.

There’s a misconception that housekeeping and janitorial services is the only way to help the indoor environment. These services only merits are appearance management for both the workplace as well as the home. A deep clean by a trusted organization such as one that is a certified by the Institute of Inspection Cleaning and Restoration Certification (IICRC) will help dramatically improve the indoor environment to a healthy level.

Here is a quick reference to help determine if you are overdue for a deep cleaning at your office or home: • Traffic areas on the floor: (Carpet, Tile/Grout, Vinyl) If the appearance of the main traffic area in the center

displays a major difference from the areas around the baseboards, then most likely it is overdue for a deep cleaning company visit.

• Upholstered Items: (chairs, sofas, etc.)

If you pat the upholstered items in a well-lit area and it creates a dust cloud, then these items are filled with allergens and need to be cleaned immediately.

A good service provider will help create a program that will be cost effective in both extending the life of the floors and furnishings, as well as maintaining the indoor environment to a healthy level.

Here are some industry-standard frequency of service tips for different areas of deep cleaning: • Carpets – Carpets were originally designed to help filter the indoor environment. They can filter up to 80 percent of indoor air. When neglected, they can have a huge reverse reaction.

The chart provided is the recommend cleaning schedule to help make sure they last a long time as well as performing their main job.

• Tile/Grout – The tile itself is solid and easy to maintain, but the grout is porous and very difficult to keep clean.

Within a year of cleaning or installing, the grout tends to turn black in traffic areas. That means the grout is most

likely growing mildew and needs a professional deep clean.

• Vinyl & Wood Floors – The dull look of the traffic areas is fine sand etching its way into the floor. The annual cleaning and finish will help these floors not just look good but last a long time as well.

• Upholstered items – Under the fabric of upholstery is a sponge or some sort of absorbent material. People tend to sit on upholstered items for hours at a time shedding skin cells that get absorbed into the sponge. This causes breeding of dust mites and other allergens to build up, meaning that your upholstered items can carry up to ten times the number of allergens than your floors! Annual deep cleaning will keep this issue at a healthy level.

• Exterior Cleaning – Your exterior surfaces do affect your interior environment!

Sidewalks, driveways, and parking lots help people track in outside contamination.

Toward the end of Spring, as well as the end of Fall is ideal for pressure washing.

A clean exterior will not only make a presentable appearance, but it does make people feel the interior is healthy as well.

There are over a thousand deep cleaners in central Florida. Less than 1 percent are fully trained, certified, and licensed in the industry. Many of these people give cut rate pric-

ing thinking they are providing a professional service but only end up providing unfavorable results or do a bait & switch tactic. This leads to issues and misconceptions for service work being performed. The result is that this makes the decision of re-hiring that same company, joining a cleaning plan, or even shopping for a new company even less desirable.

Protecting your indoor environment will save money in the long run by extending the life of the floors and furnishings, as well as lowering the risk of illness. When you have a clean, healthy, and beautiful environment; you can be more profitable due to an increase in productivity and morale. That is why a good deep cleaning service provider will also help provide a plan. This plan will schedule services throughout the year to keep you worry free. That way you know the service will be performed, providing one less stressor in your work and personal life.

When deciding on such plan, choose a properly licensed/insured company.

M. Don Snyder has been in the cleaning industry for over 10 yrs. His prior history was 12 years in Aviation ranging from operations to maintenance and manufacturing, including 5 years in the United States Marine Corp. He is a founding member of Evolution Deep Clean and he is a Certified Technician for the Institute of Inspection Cleaning Restoration Certification (IICRC).

He can be reached at DonS@instadry.biz.

Visit www.EvolutionDeepClean.com.

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SERVING PHYSICIANS & HEALTHCARE PROFESSIONALS IN LAKE, MARION & SUMTER COUNTIES

AdventHealth Ocala Brings Dedicated Pediatric Unit Online

Colorful farm-themed scenes line the hallway of the unit.

Within a year of AdventHealth taking control of Munroe Regional Medical Center, and its related outpatient locations, increased investment and commitment is already paying dividends for Marion County area patients.

The hospital opened their 16-bed, dedicated pediatric inpatient unit in May, to become the only hospital in Marion County to provide birthing services, a level-2 NICU, dedicated children’s emergency department,

Patient rooms are fun and functional.

and now a pediatric inpatient unit for area families. The unit will be staffed with pediatric trained nurses and AdventHealth for Children board-certified pediatric hospitalists.

The reopening represents an investment of $189,000 and required 90 days of renovation and construction upgrades.

“We want to provide the best health care possible for every patient, at every stage of life,” said Joe Johnson, President and CEO of AdventHealth Ocala. “The pedi-

A place to play!

atric unit at AdventHealth Ocala will close a gap in health care in our community and alleviate the burden on families who have to travel for that care.”

“The pediatric inpatient until was previously closed prior to our purchase in August of 2018 but we believe our children deserve their own specialized unit,” said Darlinda Copeland, Chief Operating Officer of AdventHealth Ocala.” Research has shown it’s imperative for children to be in a

healing environment that includes the element of play and we’re excited to provide that to our patients.”

The hospital has had a dedicated Children’s Emergency Department since 2012.

It consists of nine beds and its own imaging room. The Children’s Emergency Department is located on the first floor of the hospital and should a child need to be admitted for additional care, they’ll be placed on the new (CONTINUED ON PAGE 17)

DOH – Marion County Identifies Case of Hepatitis A in Ocala Food Service Worker, Encourages Vaccination OCALA —The Florida Department of Health in Marion County has identified a case of hepatitis A in a food service worker in Ocala. Per the department’s epidemiological investigation, the affected individual worked at Zaxby’s, located at 6033 SW Highway 200, while infectious from May 13 – June 2, 2019.

The hepatitis A vaccine may provide protection against the disease if given within two weeks after exposure. Therefore, the hepatitis A vaccination is recommended for anyone who has not previously been vaccinated for the virus

whom ate or drank at this restaurant between May 22 and June 2.

Those who consumed food or beverage between May 13 and May 21 should observe for signs and symptoms of hepatitis A infection. This includes sudden onset of abdominal discomfort, dark urine, fever, diarrhea, pale white stools, and yellow skin and eyes (jaundice). Anyone experiencing these symptoms should promptly seek medical attention.

The Department of Health in Marion County is offering free hepatitis A vaccina-

tions to potentially impacted individuals. To get vaccinated, visit the department’s Ocala location, 1801 SE 32nd Ave., from 8 a.m. to 4:30 p.m. Monday through Friday.

The best way to prevent hepatitis A infection is through vaccination with the hepatitis A vaccine.

It’s also important to practice good hand hygiene, including thoroughly washing hands after using the bathroom, changing diapers, and before preparing or eating food, and to avoid sharing food, drinks, drugs or cigarettes.

For more information on hepatitis A, visit FloridaHealth.gov/HepA, email HepA@flhealth.gov, or call the toll-free Department of Health information line, 1-844-CALL-DOH (844-225-5364) from 8 a.m. to 5 p.m. Monday through Friday.

(CONTINUED ON PAGE 17)

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SERVING PHYSICIANS & HEALTHCARE PROFESSIONALS IN LAKE, MARION & SUMTER COUNTIES

AdventHealth Ocala Brings Dedicated Pediatric Unit Online, continued from page 16 pediatric inpatient unit on the second floor.

There will also be extra staff development and new equipment to meet patient needs.

“The unit will be staffed with nurses who have specialized training in pediatrics.

We will also have 24/7 board certified AdventHealth for Children pediatricians on the unit. Our goal is to open with a dedicated nurse for every five patients,” said Copeland, adding, “We’ve purchased a new echo machine and our echo techs are receiving additional training for use on our NICU and pediatric patients. Because of this technology, pediatric cardiologists within our connected network of care are able to immediately review the results and make timely treatment decisions. All nurses and ancillary departments are receiving the additional training from AdventHealth for Children in Orlando.

The farm theme unit, which ties in the spirit of Ocala, will consist of all new upgrades, including new sleeper sofas for parents and families; kid-friendly specialties such as a ‘Barnyard Breakfast,’ ‘Mama Llama’s Lunch’ and a brand new play room complete with video games, and a hay bale slide.

Children and families at AdventHealth Ocala also have full access to the connected AdventHealth network of care, which means pediatric patients who require more complex, specialized care do not have to transfer to other health care systems.

“Continuity of care is of one of our top priorities so that we can make it easy for parents,” said Copeland. “When families visit us, we want them to know they’re surrounded by a care team that is dedicated to exceptional whole person care.”

From left to right, Dr. Kreangkai Tyree, AdventHealth for Children; Curt Bromund, Executive Director Marion County Hospital District; Darlinda Copeland, COO of AdventHealth Ocala; Imee Unto, CNO of AdventHealth Ocala cut the ribbon to their new dedicated pediatric unit.

NorthFlorida GrandRounds

Generous Donation Helps AdventHealth Provide Free Mammograms

Mom-to-Be Expo Leesburg Regional Medical Center (LRMC) and its Life Center for Women team invite you to the 2019 Mom-ToBe Expo on Wednesday, June 19 from 2 to 4 p.m. at the main hospital campus located at 600 E. Dixie Avenue in Leesburg. The event is free and open to all new, expectant, and potential parents and their families.

Guests at the Mom-To-Be Expo will learn about preparing for their baby, childbirth, breastfeeding, and additional resources and educational opportunities. Nurses, lactation specialists, and physicians will be available to answer questions. Tours of the labor and delivery suites will be offered.

Door prizes will be awarded throughout the event, including diapers, gift baskets, fully stocked diaper bags, nursing pillows, gift certificates, and other popular baby items. One grand prize winner will go home with a brand new Chicco Travel System stroller and infant car seat set valued at over $400!

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The Life Center for Women at LRMC features private, spacious labor and delivery suites, a 10-bed newborn nursery, and state-of-the-art operating and recovery rooms for caesarean deliveries.

A team of Pediatric Hospitalists provides around-the-clock care to every newborn baby. Each year, more than 1,300 babies are born at LRMC! For more information about the event, visit www.LeesburgRegional.org/ MomToBe or call (352) 323-7777. Light refreshments will be offered and your advance RSVP is requested.

SEBRING – AdventHealth Sebring Foundation announced it has received a donation from the South Florida State College Student Government Association to help provide free mammograms for men and women in Highlands and Hardee Counties.

These lifesaving dollars will go directly into the mammography fund supported by the AdventHealth Sebring Foundation and its partner, Samaritan Touch Care. This fund provides breast imag-

ing services to Highlands and Hardee County men and women who otherwise cannot afford imaging.

“It is a blessing to have a community partner like South Florida State College teaching our next generation of caregivers and medical professionals the kind of compassionate, whole person care AdventHealth believes in,” said Christen Johnson, AdventHealth Foundation Director. “We are so blessed to receive this

(CONTINUED ON PAGE 18)

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GrandRounds SERVING PHYSICIANS & HEALTHCARE PROFESSIONALS IN LAKE, MARION & SUMTER COUNTIES

Generous Donation Helps AdventHealth Provide Free Mammograms continued ... financial gift to help those in our comsupport our programs and our nursthem, so that’s what we did,” said Andy munity live their healthiest life possible.” ing and healthcare-focused students Polk, South Florida State College StuThe mammography donation from throughout their education, whether it dent Government Advisor. the Student Government Association at be financially through scholarships, or To qualify for the mammogram fund’s South Florida State College was made with hands-on training and clinical hours assistance you must be 40 years or possible through a fundraiser last fall. within one of their three local hospital older, a resident of Highlands or Hardee The group sold shirts to raise breast campuses. We had this chance to give county, not covered by medical insurcancer awareness. back and our student government offiance of any kind, and have a household “AdventHealth is a respected and cers and members wanted to support income at or below 200% of the federal dedicated community partner. They an institution that does so much for poverty level – for a family of four, that is

Leesburg Regional Medical Center Wound Care & Hyperbaric Center Recognized with National Award

an annual household income of $50,200 or less. To apply, please contact Samaritan’s Touch at 863-471-1870.

For more information, or to donate, contact the AdventHealth Sebring Foundation at 863-402-5525 or visit www.adventhealthsebringfoundation.com.

Florida Department of Health-Marion Recognized for Emergency Readiness

The Florida Department of Health in Marion County was recognized for receiving a designation of Public Health Ready from the National Association of City and County Health Officials and the Centers for Disease Control and Prevention at the June 4 Marion County Board of County Commissioners meeting. Pictured from L to R: Commissioner Carl Zalak, Commission Vice Chairman David Moaore, Commission Chairman Michelle Stone, Florida Department of Health in Marion County Administrator Mark Lander, Public Health Preparedness Planner Randy Ming, Emergency Management Director Preston Bowlin, Commissioner Kathy Bryant, and Commissioner Jeff Gold.

The Leesburg Regional Medical Center (LRMC) Wound Care & Hyperbaric Center has been honored with the Center of Distinction Award from HealogicsTM. The award was given in recognition of the Center’s outstanding clinical outcomes, high patient satisfaction and high healing rate.

Only 423 Centers nationwide achieved this honor. “This award is an affirmation of the great care and service provided to our patients at the LRMC Wound Care & Hyperbaric Center,” said Bill Pfingsten, vice president of ambulatory services at Central Florida Health. “Congratulations to our physicians and staff for this prestigious accomplishment.”

The LRMC Wound Care & Hyperbaric Center is a member of the HealogicsTM network of nearly 700 wound care centers and provides access to benchmarking data and proven experience treating approximately 2.5 million chronic wounds. HealogicsTM is the nation’s largest provider of advanced wound care services.

The LRMC Wound Care & Hyperbaric Center offers highly specialized care to patients suffering from diabetic ulcers, pressure ulcers, infections and other chronic wounds which have not healed in a reasonable amount of time. Treatments include negative pressure wound therapy, total contact casting, bio-engineered tissues, biosynthetic dressings and growth factor therapies. The Center also offers hyperbaric oxygen therapy, which works by surrounding the patient with 100 percent oxygen to help progress the healing of the wound.

“We are honored to be recognized for our dedication to patient care and quality outcomes,” said Navin Reddy, MD, Medical Director of the LRMC Wound Care & Hyperbaric Center. “We strive to provide each patient with the necessary advanced therapies for optimal healing.”

The sixth annual Wound Care Awareness Week will be held June 3 to June 7 and will bring attention to the chronic wound epidemic and the 6.7 million Americans who are currently living with non-healing wounds. If left untreated, chronic wounds can lead to diminished quality of life and possibly amputation of the affected limb.

People with wounds that have not improved with traditional methods of treatment may benefit from a visit to the LRMC Wound Care & Hyperbaric Center. To learn more, visit www.LeesburgRegional.org/Wound

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OCALA —Marion County residents have some positive news as hurricane season begins. The Florida Department of Health in Marion County has been recognized by the National Association of County and City Health Officials (NACCHO) for its ability to plan for, respond to, and recover from public health emergencies.

The department demonstrated these capabilities by meeting the comprehensive preparedness benchmarks required by Project Public Health Ready (PPHR), a unique partnership between NACCHO and the Centers for Disease Control and Prevention. The Department of Health in Marion County joins a cohort of more than 500 local health departments across the country that have been distinguished for excellence in preparedness through PPHR, either individually or as part of a region. The department presented its award noting its Public Health Ready recognition at the Marion County Board of County Commissioners meeting on June 4.

“We are proud to have been recognized by Project Public Health Ready for our high level of preparedness,” said Florida Department of Health in Marion County Administrator Mark Lander. “A rapid and robust response is critical when our residents face a potential public health crisis, and we look forward to continuing to improve our abilities to maximize effectiveness and service to our community.”

PPHR recognition confirms that the department has a thorough and coordinated emergency response plan in place and that staff have the training to protect the health of the community during an emergency. Local health departments recognized by PPHR undergo a rigorous evaluation by peer review to assess their ability to meet a set of national standards for public health preparedness. These standards align with federal government require-

ments and other national best practices.

PPHR recognition also requires health departments to collaborate with their state, local, and community partners to develop plans that account for all the constituents in their jurisdictions. A prime example of this collaboration is when the department recently completed a special needs shelter exercise with Marion County Emergency Management, Marion County Public Schools, community health professionals, and volunteers.

This exercise highlighted the cross-sectional partnerships that are needed to prepare Marion County to respond to and recover from a potentially catastrophic event.

“Public health preparedness planning, response, and recovery begins at the local level. Local health departments play an essential role in creating healthy, resilient communities that can respond to and recover from disaster.” said Lori Tremmel Freeman, NACCHO Chief Executive Officer. “NACCHO commends the Department of Health in Marion County for being a model of public health emergency preparedness.”

NACCHO, the voice of the nearly 3,000 local health departments across the country, provides resources to help local health department leaders develop public health policies and programs to ensure that communities have access to vital programs and services that people need to keep them protected from disease and disaster. Its mission is to be a leader, partner, catalyst, and voice for local health departments to ensure the conditions that promote health and equity, combat disease, and improve the quality and length of all lives.

For more information on Project Public Health Ready, including recognized sites, project tools, and resources, visit http://www. naccho.org/PPHR .

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GrandRounds AdventHealth Breaks Ground on Lake Nona ER Community leaders and neighbors in Lake Nona joined AdventHealth to break ground on a new emergency room to serve the region.

The new ER expands AdventHealth’s care network in southeast Orlando.

The ER will have 24 patient rooms, including two pediatric-friendly rooms to make visits more inviting for young patients); respiratory therapy; diagnostic imaging, including CT scans, X-

ray and ultrasound; and a full-service laboratory.

The one-story, 19,000-square-foot facility will be staffed by a comprehensive clinical team including boardcertified emergency physicians and emergency nurses. The ER will employ a team of approximately 100 people.

This facility will complement AdventHealth’s existing footprint in Lake Nona, which includes CentraCare and

AdventHealth Medical Group practices including cardiology, women’s imaging, diabetes and endocrinology, family medicine, general surgery and sports and concussion medicine.

The Lake Nona ER, which will be located at Lake Nona Boulevard and Narcoossee Road, is expected to open in summer 2020.

Medi-Law Firm Holds 2019 Resident of the Year Awards The MediLaw Firm held its annual Resident of the Year Awards to salute emerging leaders and established physicians in medicine. The awards acknowledge and celebrate the accomplishments and impacts made in their residency programs.

Max A. Adams, Esq., founder of the law firm spoke and presented awards.

Awards are presented for “The Resident of the Year” “The Coordinator of the Year,” and this year, “The Physician of the Year Award” was added.

WINNERS ANNOUNCED WERE: The “2019 Dentist of the Year” recipient is Dr. Russell Hamarnah. He is motivated about the profession of dentistry and bringing quality affordable dental care to Central Florida. As the owner of Paradise Dental of Orlando, he has built a successful and wellknown practice in Orlando, Florida with a focus on empowering dental patients to make informed choices about their health.

The “2019 DO Physician of the Year” recipient is Dr. Parham Eftekhari. He is a Nephrologist and practicing partner at Florida Kidney Physicians South-East Division Fort Lauderdale, FL. Dr. Eftekhari is Chairman of the Department of Medicine at Broward Health Medical Center and Director of their Nephrology Curriculum for Internal Medicine Residency Program.

He is the current Vice Chair of the Department of Medicine at Broward Health. He is an Assistant Clinical Professor of Medicine & Nephrology of Broward Health’s Internal Medicine Residency Program.

Dr. Eftekhari has written several research articles and has dedicated a 19

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big part of his life to the fight against Synthetic Drugs and keeps doing so.

He is also on a mission to educate the community about the intrinsic dangers involved with using synthetic designer drugs, such as flakka, bath salts, and synthetic fentanyl.

The “2019 MD Physician of the Year” recipient is Dr. Gerardo Ferrer, a board-certified psychiatrist, and attending, and Psychiatry Residency Program Director at Larkin Community Hospital in Miami, Florida. He is an Assistant Clinical Professor of Psychiatry at St. George’s University, Medical University of the Americas, NOVA Southeastern University, Saba University and Lake Erie College of Osteopathic Medicine. He also serves as the Chairman of Education and Training at Larkin Community Hospital as well as chair of several institutional committees.

Dr. Ferrer has numerous recognitions for both his academic contributions and service to Miami-Dade County communities, in addition to the residency program. He has multiple published works including case reports and studies on mental health, on the subject of burnout and sleep quality, the epidemic of opioid addiction, positive and negative emotions and burnout’s influence on mood and behavior.

“Resident Coordinator of the Year” is awarded to Yuli Simon, Dermatology & Dermatopathology Cutaneous Surgery, University of Miami School of Medicine.

Yuli is responsible for update of Faculty and Residents data in ACGME, ABD, ERAS, NRMP, and New Innovations. Residents/Fellows evaluations, duty hours, procedure logs, assignments, scholarly activities, etc.

Overseeing the collection, processing and compliance of necessary documentation for the programs in all systems and other National Census Survey is also part of her responsibilities.

The “MD Resident of the Year” is Andre Coombs, MD, General Surgery, Mt. Sinai Medical Center. Dr. Coombs was born and raised in the Republic of Trinidad and Tobago, until the age of 18 when he left for medical school. As a medical student he was involved in numerous projects on the global stage as the President of the Jamaica Medical Students’ Association within the International Federation of Medical Students’ Associations (IFMSA).

He completed his Preliminary Surgical Internship year at the top of his class in the highly challenging, yet richly rewarding environment of Jackson Memorial Hospital/Ryder Trauma Center. His positive attitude, hard work and dedicated service to patients, culminated into a second year categorical position at Mount Sinai Medical Center, Miami Beach, where he will complete the final few months

of his General Surgery residency.

The “MD Resident of the Year” is Suchismita Tia Paul, MD, Dermatology, University of Miami/JMH. Dr. Paul is a Chief Resident in the Department of Dermatology at the University of Miami/ Jackson Memorial Hospital. She has a Florida Department of Health, Board of Medicine Training License and is Basic Life Support (BLS) Certified.

Dr. Paul gives back to the community through the Dermatology Health Fairs in South Florida and volunteered in Grand Anse, Haiti post disaster to diagnose skin diseases to provide medical interventions for people affected by Hurricane. She has co-published several dermatology publications. Her latest one to the Journal of the European Academy of Dermatology and Venereology is titles “Dermatology: more than an outpatient specialty.”

The “DO Resident of the Year” is Michael Madden, DO, MA, Orthopedic Surgery, Broward Health Medical Cen-

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GrandRounds ter. Dr. Madden, a Chief Resident, is currently working on a project looking at trends in small joint replacements of the hand. He is also involved in a study about how ride-sharing services like Uber and Lyft have decreased the overall number of orthopedic traumas seen from motor vehicle accidents in South Florida.

After completing his residency this year, he will complete a Hand/Microsurgery fellowship at the University of Minnesota.

Heart of Florida Regional Medical Center Wound Care & Hyperbaric Medicine Earns National Awards Heart of Florida Regional Medical Center Wound Care & Hyperbaric Medicine has been awarded the President’s Circle award for outstanding performance.

The wound care center received the honor after achieving patient satisfaction rates higher than 92 percent and a healing rate of at least 91 percent in less than 30 median days to heal, for a minimum of two consecutive years. The wound care center also received Center of Distinction and Center of Excellence awards for 2018.

“These recognitions demonstrate our commitment to maintaining high quality standards year after year,” said Adelor Zamora, M.D., Medical Director of Wound Care & Hyper-

baric Medicine. “Our team strives to do what’s right for every patient that comes through our doors.” The center received these prestigious honors by Healogics, the nation’s largest provider of advanced wound care services. Out of 413 eligible Centers, 29 were honored with the President’s Circle award nationwide. The award is named for Dr. Robert A. Warriner III, a pioneer in wound care and the former Chief Medical Officer for Healogics.

The wound care center offers highly specialized wound care to patients suffering from diabetic ulcers, pressure ulcers, infections and other chronic wounds which have not healed in a reasonable amount of time. Treatments at the center include negative pressure wound therapy, total contact casting, bio-engineered tissues, biosynthetic dressings and growth factor therapies. The center also offers hyperbaric oxygen therapy, which works by surrounding the patient with 100 percent oxygen to help progress the healing of the wound.

Axiom Bank Donates $200,000 To Emory University for Brain Diseases Axiom Bank, N.A., a leading community bank headquartered in Central Florida, has donated $200,000 to the Emory Brain Health Center. This gift will help fund further research aimed at developing new treatments for brain diseases such as epilepsy, Parkinson’s and depression through the

Oviedo Medical Center Launches Comprehensive Spine Care Program Oviedo Medical Center has announced the opening of the Spine Care Center, providing a comprehensive range of solutions for patients suffering from back pain.

The Spine Care Center provides the latest surgical techniques, including minimally invasive surgery to provide patients treatment options that lead to smaller incisions, less pain and minimal downtime. In addition, the availability of robotic technology helps to ensure safety and quality.

Using the Mazor X™ Robotic Guidance Platform, the surgeon can develop a comprehensive surgical plan and visual outline of the pro-

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Emory Neuromodulation and Technology Innovation Center (ENTICe).

ENTICe is a collaborative effort between the Emory University departments of neurosurgery, neurology, and psychiatry and behavioral sciences in partnership with scientists and biomedical engineers from Georgia Tech. They work together to facilitate research and technical investigation, developing more effective medical devices and strategies to improve neuromodulation treatments for brain disorders.

RN’s Graduate from Cornerstone Hospice’s Nurse Residency Program Cornerstone Hospice is celebrating the recent graduation of two registered nurses from its Nurse Residency Program.

Patrick Carey, of Sebring, and Robert Broyles, of Lakeland, successfully completed the six-month program which is designed to cultivate nurses who have no previous nursing experience and to specifically train them in the areas of hospice and palliative care. Carey and Broyles are the third and fourth graduates of the program.

Throughout the program the nurse residents gain valuable insight to disease progression, team building, symptom management and palliation, documentation requirements and the interdisciplinary approach. They participate in patient care that takes place at home, in a facility, in one of Cornerstone’s four Hospice Houses and the Cornerstone Hospice Care Unit at Orlando Health. Additionally, the nurse residents experience the roles RN’s have in admissions and in the Cornerstone Hospice call center which take inquiries from patients and families.

“Upon graduation from the program, each resident fills an integral role in the organization as a competent hospice nurse who can support our mission in any Cornerstone Hospice setting,” said Nadia Soulouque, MBA/HRM, PHR, SHRM-CP, Director of Training & Professional Development. “Additionally, it supports our retention efforts by exposing the nurse residents to opportunities for growth within the organization.”

Acceptance in the Cornerstone Hospice Nurse Residency Program requires a minimum two-year commitment to remain at Cornerstone Hospice if offered a full-time position.

Success Story!

I am an RX2Live franchise owner.

cedure prior to and during surgery.

This ensures accuracy and limits the amount of radiation to the patient as well as the surgical team. In addition, the use of minimally invasive techniques for many spine procedures provides the patient added benefits of less blood loss and lower risk of infection.

The Spine Care Center at Oviedo Medical Center will provide solutions for a wide range of conditions, including herniated discs, spinal stenosis, myelopathy, compression fractures, facet osteoarthritis, spondylolisthesis, degenerative scoliosis, kyphotic deformities and spasticity.

We were promoting a Physician & Practice Administrator event, Thursday, May 9th, at Ruth’s Chris Steakhouse introducing RX2Live’s exciting new revenue opportunities for physician practices. Despite investing in franchise marketing campaigns, registration was low.

One week prior to the event I reached out to John Kelly & the Orlando Medical News team.

He smiled, then designed and ran Targeted Promotional Email Distributions in Central Florida & North Florida. Within 3-days we received RSVP’s maxing out the room! The revenue enhancers and steaks were HOT! Physicians requested follow-up appointments and RX2Live is becoming a component of successful Central Florida Physician practice.

Learn more about RX2Live’s proved physician practice Revenue Enhancing opportunities at www.dvaughan.rx2live.com or speak with Dr. Vaughan personally; 239.980.3303

WWW.DVAUGHAN.RX2LIVE.COM WWW.ORLANDOMEDICALNEWS.COM WWW.NORTHFLORIDAMEDICALNEWS.COM

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GrandRounds St. Cloud Regional Medical Center Announces Plans to Build Medical Office Building St. Cloud Regional Medical Center has announced a new on-campus, ambulatory Medical Office Building.

The approximately 50,000 square feet, two-story building will be constructed on the corner of U.S. Highway 192 and Budinger Ave. It is expected to take approximately 12 months to complete.

Once complete, the building will

house St. Cloud Medical Group physician practice offices. These offices will include both specialty care practices and primary care offices, including a walk-in care clinic on the first floor which will be open extended hours.

Ancillary hospital departments will also move into the new space, along with space for private retail, new outpatient

services, and private physician offices.

St. Cloud Regional Medical Center has contracted with Florida-based Catalyst Healthcare Real Estate to develop the new Medical office Building. Catalyst HRE has healthcare real estate projects in over 14 states nationally; including additional medical office building located in Osceola

County, Fla, and brings a leadership team with over 100 years total collective healthcare real estate experience.

The new Medical Office Building was also built with input from the City of St. Cloud to become part of the city’s Medical Arts District designation.

Van Firios

Hunt Dawkins

Axiom Bank, Announces Two Promotions Axiom Bank N.A., a Maitlandbased, leading community bank, recently announced two promotions to Vice-President.

Van Firios was named VP, Commercial Relationship Manager. In this role, Firios will develop commercial relationships and drive revenue growth.

“Van is results-focused and relationship-oriented, with a long track record of serving commercial customers,” said Ted Sheppe, Executive Vice President, Commercial Banking of Axiom Bank. “His expertise will be invaluable as we continue to become the bank of choice for customers seeking financial solutions to enhance their businesses.”

Firios brings more than two decades of experience in banking and sales

management. He previously served as Vice President, Small Business Banker at a national bank.

Also promoted was G. Hunt Dawkins to the position of VP, SBA Division Manager. In his new role, Dawkins will lead Axiom’s programs for extending government-guaranteed loans to small businesses.

Dawkins has more than three decades of experience in banking.

He joined Axiom Bank in 2018 as VP, Commercial Relationship Manager.

Dawkins graduated from the University of Central Florida with a bachelor’s degree in business administration and finance. Later, he went on to complete the graduate program in banking at Louisiana State University.

The Endocannabinoid System 101, continued from page 13 affect all of us.

• Endocannabinoid receptors are the most abundant neuromodulator receptors in the body.

• Exercise has also been shown to boost the body’s natural cannabinoids.

Scientists have found that prolonged aerobic exercise increases levels of anandamide, the “feel good” endocannabinoid.

With decreasing restrictions to conduct research on cannabis and hemp-based CBD, more and more high-quality research on the ECS, cannabis, and hemp will be made available to physicians all over Florida and the United States. However, due to the ide-

ology of cannabis and hemp-based CBD as being bad for people and society, the mass adoption of cannabis as a medicine will take time. Physicians who will educate themselves on the benefits of the ECS, cannabis, and hemp-based CBD, will have the ability to provide an alternative treatment to patients who have not responded to traditional prescription-based medicines.

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

He can be reached at mpatterson@uscprd.com

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CyberInsecurity: Rise of Ransomware and What it Means, continued from page 9 sources. In addition, macros should not be allowed to run, and employees should be suspicious of links leading to web pages that ask for login credentials.

Employees should also be trained not to store any personal login information on their computers, even through their browsers.

British Prime Minister Winston Churchill famously said in 1948, “Those the Twho fail to learn from history are condemned to repeat it.”

Ransomware attacks continue to succeed because targets, like city governments, healthcare practices and anyone doing business after 2015, aren’t doing security basics.

One of the best examples, in March 2018, ransomware took down at least a third of Atlanta’s 424 software programs, about 30 percent of which were considered “mission critical.” The recovery price tag is now somewhere in the range of $21 million, or

about 420 times the $51,000 ransom demand.

You might think that kind of disastrous history–recent history–would prompt municipalities from coast to coast to implement at least a few security basics like replacing outdated software and patching current software. Not so much. Recorded Future reported more than two dozen attacks so far this year. And the most recent and most egregious example is Baltimore, MD, which is struggling to climb out of a digital black hole caused by a May 7, 2019 ransomware attack that essentially locked the city government’s voicemail, email, parking fines database, and the online system for paying water bills, property taxes and vehicle citations.

The attack also froze the processing of real estate transactions, although city officials did work out a manual workaround that would let those transactions proceed.

Baltimore shouldn’t have even needed the Atlanta attack to put it on notice. It had its own history–the city’s 911 system was hacked in March 2018, just days after the Atlanta attack.

Baltimore had 14 months to prepare for what was coming and chose not to. That doesn’t make them much different than 85 percent of all the physician offices across America.

The warning shots have been fired on every business, industry and individual computer owner in the world.

M. Brett Jaffee is VP of Sales for NSG and has over 25 years of experience selling and marketing primarily to Fortune 1000 companies.

After successful stints at HearFromMe.com and WelltalityHealth.com, where Brett was responsible for HIPPA and Data Compliance systems, Brett has brought his experience and protocols to NSG. Visit www.nsgi-hq.com

John Kelly jkelly@orlandomedicalnews.com ——

AD SALES John Kelly, 407-701-7424 Di-Anne Elise, 407-579-9903 Media Resource Consultant ——

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CREATIVE DIRECTOR Katy Barrett-Alley ——

CONTRIBUTING WRITERS

Google is Where You Search, Social Media is Where You Discuss, continued from page 4

to realign their marketing plans, only to find that after six months, Google’s guidance has changed. We see this now with their upcoming algorithm update for mobile searches. At which point it becomes necessary to re-engineer the entire marketing plan mid-stream to avoid revenue losses. Additionally, by limiting potential consumers to a local search result, they reduce the visual exposure of other brands for consumers to get access too. Social Media provides a more consistent outcome and more variety outside local search, because many of the individual connections are out of state, or country.

In the big picture, these may seem like

PUBLISHER

Michael Lowe, , Quinton L. Gunn, Sr., Dorothy Hardee and M. Brett Jaffee ——

SOCIAL MEDIA DIRECTOR small losses, but the impact on Google will be a revenue drain. I expect that businesses will begin to transfer their dollars to a more consistent platform, which social media is now becoming. The costly nature of paid search and the diminishing returns are making business owners take a second look at where they spend their marketing dollars.

Be ready to take advantage of the changes Social Media continues to grow, expand, and drive consumer engagement and brand awareness. Every day more and more businesses Get Social and Stay Connected!

Social Media Solutions for Doctors encourage every business owner to take advantage of the opportunities that social media can provide for their goods or services. Recognize that this platform is more adept at meeting the needs of our mobile population and new business start-ups.

How Social Media will additionally change again in the near the future is yet to be determined, so hold on to your hats and stay tuned!

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

John Singleton 352-442-6674

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Orlando Medical News is published monthly by K&J Kelly, LLC. ©2018 Orlando Medical News.

All Rights Reserved.

Reproduction in whole, or in part without written permission is prohibited. Orlando Medical News will assume no responsibility unsolicited materials.

All letters to Orlando Medical News will be considered Orlando Medical News property and therefore unconditionally assigned to Orlando Medical News for publication and copyright purposes.

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LOWEDOWN ON HEALTH LAW

presented by

LOWE & EVANDER, P.A.

Is Your Practice Prepared for Cyberattacks?

By MICHAEL R. LOWE, Esq.

Cyberattackers understand the value of the data that is held by healthcare organizations, and as a result, healthcare organizations are quickly becoming a perfect target for cyberattackers to steal copious amounts of patient records, insurance information, billing information and account information for their monetary gain resulting in identity theft and fraud against patients and employees. Given that most transactions in the healthcare sector are conducted through vulnerable hardware and software, it’s critical for providers and payers to strengthen their cybersecurity. With the boom of the digital era and the rapid digitization of the healthcare industry, patients’ medical data has become increasingly portable.

With this portability, the process of sharing and collecting data has been simplified and as such, poses major cybersecurity risks.

According to an article in the Washington Post published on May 16, 2018, “Hospitals are vulnerable in part because they often rely on equipment that’s built to last 15 to 20 years, meaning it runs older software that’s trickier to update than, say, a typical office computer.

And with so many hospital devices interconnected, it’s hard to tell how an update to one will affect other equipment in the system.”

The use of legacy systems are easy targets for such cyberattacks as the security components in these older systems are not up to date and as such are vulnerable to todays sophisticated methods used by cybercriminals. Cyberattacks can affect not only computers, but devices that are connected to them including medical devices that can be manipulated to function differently than intended. Mobile devices including laptop computers, handhelds, smart phones, portable storage media have opened a world of opportunities to untether Electronic Health Records from the desktop. But these opportunities also present threats to information security and privacy.

Transporting data with mobile devices is inherently risky and all data stored on a mobile device should be encrypted.

In its quarterly threat report unveiled May 22, 2018, cybersecurity company Rapid7 found that the healthcare sector experienced a surge in cyberattacks during the first quarter of 2018 — so many that it ranked as the top-targeted industry in the first three months of the year.

Around 1.13 million patient records were compromised in 110 healthcare data breaches in the first quarter of 2018, according to data released May 3, in the Protenus Breach Barometer. Healthcare organizations accumulate risk that compounds over time when proper detection, reporting, and education do not occur, according to Protenus.

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The Breach Barometer found that it takes healthcare organizations an average of 244 days to detect a breach once it has occurred.

A solo practitioner is just as susceptible as a conglomerate hospital organization.

Cybercriminals will infiltrate where there are vulnerabilities that can be exploited and/or penetrated. Human error, including falling for phishing attacks, is one of the leading causes for security breaches. Ensure that your staff and all personnel are trained properly on security, encryption, and how to detect cyberattacks including phishing, virus attacks and ransomware possibilities. When everyone is well-educated and made to see warning signs of cyber-risks and what they can do to stop or thwart cyberattacks, we can limit the damaging effects of cybercrime.

Cyberliability coverage is a key component in ensuring that your practice, and license are protected. Do you have cyber insurance? If you do, do you know what your limits of coverage are, do you have coverage for legal representation if you do have a security event or breach?

Healthcare providers should always use strong encryption programs for all patient data and protected health information and limit who has permission to access medical charts. Healthcare facilities and systems should use multifactor authentication or other types of consumer security that is already utilized in the U.S. financial services arena.

Ensure that your anti-virus software is maintained and up to date with regular updates in order to protect from the newest computer viruses and malware. Without anti-virus soft-

ware to combat infections, data may be stolen, destroyed, or defaced, and attackers could take control of the machine. Even a computer that has all of the latest security updates to its operating system and applications may still be at risk because of previously undetected flaws.

While anti-virus software will help to find and destroy malicious software that has already entered, a firewall’s job is to prevent intruders from entering in the first place. Large practices that use a local area network (LAN) should consider a hardware firewall. A hardware firewall sits between the LAN and the internet, providing centralized management of firewall settings. This increases the security of the LAN, since it ensures that the firewall settings are uniform for all users.

Sooner or later, the unexpected will happen. Have your Breach Notification Policy, and Disaster Recovery and Response Plan in place before it happens. Be prepared, set-up your Policies, Procedures, forms and security checklists now. Have a very complex set of Policies and Procedures, be aware of all the rules and apply them to areas like arm Threshold Analysis, how to determine unsecured vs. secured PHI and who needs to

be notified when an event or breach occurs.

Remember Business Associates (BA) have to report Privacy Events or Breaches to Covered Entities (CE) as soon as possible and the CEs and BAs must coordinate the notification.

When preparing your Policies, Procedures and forms, enlist a qualified security firm and have qualified healthcare counsel to advise you and walk you through the process to ensure you are compliant. Have a Security Assessment done to identify any areas that need to be looked at, updated and addressed.

The Healthcare Team at Lowe & Evander, P.A. understand the hard work and sacrifices it takes to become a health professional or provider and aggressively defend health professionals regarding protecting their license, practice, career, assets and reputation.

Using our experience and expertise, we navigate the obstacles our clients face, serving not only as their attorneys, but also as their legal strategists, trusted advisors and protectors of their rights and interest against government investigations and lawsuits when necessary, and we help chart a course through the maze of state and federal health care laws, rules and regulations.

Michael R. Lowe, Esquire is a Florida board-certified health law attorney at Lowe & Evander, P.A. Brian C. Evander, Esquire and Mr. Lowe regularly represent providers, physicians and other licensed health care professionals, and facilities in a wide variety of health care law matters.

For more information regarding those health care law and such matters please visit our website https://www. lowehealthlaw.com/or call our office at (407) 332-6353.

LOWE & EVANDER, P.A. MICHAEL R. LOWE, ESQ., BOARD CERTIFIED IN HEALTH LAW BY THE FLORIDA BAR 407.332.6353 | LOWEHEALTHLAW.COM 707 MONROE ROAD, SANFORD, FL 32771

Nothing is ever as it seems. Hide in plain sight. Perception becomes reality. If you’ve had one or more of these thoughts today, you may want to give us a call.

Florida-based Law Practice Representing Physicians & Physician Group Practices

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