Orland Medical News March 2019

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A Game Changer in Canine Scent-Based Cancer Detection: BioScentDX

Screenings offer affordable, non-invasive means of early cancer detection

By MELANIE KILGORE-HILL

A Central Florida startup is changing the future of cancer detection. Located in Myakka City, BioScentDX is harnessing the long-recognized scent skills of canines to offer earlier diagnosis of the most common cancers in the U.S.

HEATHER JUNQUEIRA

ON ROUNDS

PHYSICIAN SPOTLIGHT Omar Beidas, MD ... 3 Administrative Defense Coverage and/or Administrative Proceedings Defense Coverage: Welcome Addition or Necessary “Evil”? ... 4

MEDICAL CITY

Spring has Sprung.

Eat Responsibly, my Friend ... 8 How Much Should You Really Spend On Medical Marketing? ... 10 Different Routes of Administration of Medical Marijuana ... 11

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A NOSE FOR DETECTION “Humans have long relied on dogs’ extraordinary scent detection capabilities for a variety of tasks, from hunting to explosive and narcotic detection,” said BioScentDX co-founder and lead researcher Heather Junqueira.

“Through years of training and working extensively with these dogs and the medical commu-

nity, we’ve learned to harness their ability to catch cancer in its earliest, most treatable stage.” Junqueira spent nearly two decades in veterinary medicine and medical research while training medical alert dogs, primarily for diabetics. Following her father’s death from a late-stage cancer diagnosis, she set out to learn about the possibility of using dogs for cancer detection. Turns out, she wasn’t the first. Previous studies leveraging canines in the cancer detection space have

yielded accuracy rates of up to 99 percent.

Internationally, investigators have long been working to train dogs to detect tumor-based cancers. While researchers were eager to share their data, most efforts had fizzled out for lack of funding and an inability to carry out studies long term. Junqueira soon shared her findings with Florida entrepreneurs Mike Moore and Kyle Lawton, co-founders of Sarasota-based peerVue Inc. In 2012 (CONTINUED ON PAGE 5)

HEALTHCARELEADER

Adel Eldin, MD

Beating back the frustrations of modern independent practice After practicing medicine in Florida for nearly 20 years, Adel Eldin, MD, FACC, FACP, fought for and celebrated the signing by then-Governor Rick Scott of the Direct Primary Care (DPC) Bill last March to address the frustration that he and other physicians face in today’s healthcare climate.

Eldin is known across the country for his patient advocacy efforts for senior rights, education and community outreach. He has been published in several journals and has been a part of multiple clinical and research trials involving treatment of acute myocardial infarction and coronary stent research.

He is the recipient of many prestigious awards involving the best small business of the year, First Humanitarian Award and

special recognition from President Obama for serving the community.

But in addition to his status as a board-certified cardiologist, he is a vibrant physician entrepreneur tackling the issues surrounding the realities patients and the provider community face from insurance companies and regulations.

He speaks locally and internationally with passionate fervor to “bringing the heart back to medicine.”

With that sentiment in mind, in 2010 he created ProntoCare, a full direct-patient-contracting healthcare ecosystem as an answer to the transition pains facing

healthcare.

“At the time, as you know, there was a c qu i s it ion mania. A lot of doctors just sold their practices to hospital systems, mostly for pennies, and then became employed physicians.

Unfortunately, afterwards you had a huge problem across the country in the form of physician burnout because they lost their autonomy,” said Eldin.

He pointed out that shortly thereafter, he was seeing a massive exodus as the corporate world began to shed physicians.

“Everything’s automated right now.

(CONTINUED ON PAGE 7)

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P C A N O R A N G E C O U N T Y. C O M

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4 0 7 - 8 3 6 - P C A N

In Honor of

National Doctors’ Day We extend our deep appreciation to our

VOLUNTEER PHYSICIANS for the thousands of hours of service donated to the men, women and children of Central Florida.

“Making Healthcare Available For Everyone In Our Community” Community Medicine Clinicat atAdvent Florida Hospital, Dental Care Foundation, Community Medicine Clinic Health, Dental CareAccess Access Foundation, Department of Health-Orange, GraceMedical Medical Home, Home, Healing thethe Children, Shepherd’s Hope, Hope, FloridaFlorida Department of Health-Orange, Grace Healing Children, Shepherd’s and SpecialCare membersofofthe thePrimary Primary Care Care Access (PCAN). and SpecialCare areare allall members AccessNetwork Network (PCAN).

FOR VOLUNTEER OPPORTUNITIES, CONTACT: Community Medicine Clinic FloridaHealth Hospital 407-303-7298 | Dental CareAccess AccessFoundation Foundation 407-898-1525 407-898-1525 || Florida Florida Department in in Orange County 407-858-1400 Community Medicine Clinic at at Advent 407-303-7298 | Dental Care DepartmentofofHealth Health Orange County 407-858-1400 Grace Medical Home 407-936-2785 | Healing the Children - 407-877-9311 | Shepherd’s Hope, Inc 407-876-6699 | SpecialCare, Inc. 407-836-2519 Grace Medical Home 407-936-2785 | Healing the Children 407-877-9311 | Shepherd’s Hope, Inc 407-876-6699 | SpecialCare, Inc. 407-836-2519

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PHYSICIANSPOTLIGHT

Omar Beidas, MD

Body contouring can be a vital component after weight loss It is no secret that most Americans need to lose some weight. In fact, more than two-thirds of Americans over age 20, are considered overweight, and nearly 40 percent of the population now meets the definition of obese, according to the Centers for Disease Control. It is an epidemic that afflicts 93 million people in the U.S., and it is getting worse. (https://www.cdc.gov/ obesity/data/adult.html) The health risks associated with obesity are well-known, and the benefits of maintaining a healthy weight can be dramatic.

For example, many people who through surgery or lifestyle changes have achieved a healthy weight are able to eliminate or avoid having to take medications for blood pressure, cholesterol and diabetes. But, as anyone who has tried to lose weight can attest, losing substantial weight and keeping it off is very difficult. In fact, scientists often consider obesity a progressive disease because a number of factors, including hormonal, metabolic and molecular changes in the body increase the risk for even greater fat accumulation.

So, it is probably not a surprise that weight loss surgery has emerged as one of the most effective means of treating obesity. Since 2011, bariatric surgery of all types has grown from about 158,000 procedures annually to nearly 230,000, according to the American Society for Bariatric and Metabolic Surgery. (https://asmbs.org/resources/estimateof-bariatric-surgery-numbers) However, what is probably surprising to a lot of people, especially those who have taken decisive steps to get their body weight under control, is that the health benefits of losing a substantial amount of weight can be tempered by having a large amount of loose skin afterwards. Excess skin doesn’t melt away like fat. In some cases, patients are left with large folds of hanging skin that

can become a health challenge in their own right, or which can leave them feeling as bad about their appearance as their obese bodies made them feel.

“The psychological and social aspects of visibly sagging skin can be just as devastating as being obese,” said Omar Beidas, MD. Beidas, one of the leading surgeons in the country for body contouring after weight loss, is with the Orlando Health Aesthetic and Reconstructive Surgery Institute.

While he is also a reconstructive plastic surgeon, about half the patients he sees are for body contouring surgery following substantial weight loss.

According to Beidas, problems with sagging skin for the patients often arise when they lose substantial weight quickly – usually more than 50 pounds. This can happen when a very obese person has bariatric surgery. It can also happen to patients recovering from other health problems.

Although bariatric surgery is being used more frequently, Beidas said that sometimes patients either are unaware that plastic surgery is available, or they think that it won’t be covered by their health insurance.

“Most people probably think of plastic surgery as being something for celebrities,” he said. “Eighty to 90 percent of the surgeries I perform are (medically necessary) reconstructive surgery,” he said. About 90 percent of the surgeries to remove excess abdominal skin are covered by the patient’s health insurance. Other surgeries to address excess skin on the arms, thighs and chest are often considered cosmetic by insurance companies and therefore not always covered.

Becoming an expert in this field was not an obvious choice for Beidas. As the son of an engineer, he considered pursuing that field while going to Drexel University in Philadelphia. “But I didn’t find it chal-

lenging enough,” he said. So, after earning his Bachelor of Science degree in bioscience and biotechnology, he earned acceptance to Temple University’s medical school. There, he discovered a fascination with surgery and reconstructive plastic surgery.

It was during his third year in medical school that a plastic surgeon mistook him for a resident, a new medical doctor who is in a structured training program at a hospital. “The surgeon needed some help in the operating room with a patient; he told me to scrub in and gown up, and then he said, ‘Do what I am doing.’”

After the procedure, the surgeon was surprised to discover that it was a student, not a resident doctor, that had been assisting him. It was a remarkable experience for Beidas and one that solidified his interest in reconstructive surgery.

“This is when I discovered that I liked reconstructive surgery,” he said.

After medical school, Beidas completed his residency in plastic and reconstructive surgery at the University of Oklahoma and

then a unique fellowship in body contouring and life after weight loss at the University of Pittsburgh. While completing that fellowship, he also served as a clinical instructor in the department of plastic surgery at the university’s medical center. He has since published numerous peer-reviewed articles in medical journals and textbooks on the subject.

Here in Orlando, Beidas is working to enhance Orlando Health’s team approach to weight loss health and to build a program similar to what he experienced at Pitt. “We are hoping to start the same thing here. There is no other fellowship like it. It will be part of our comprehensive team approach,” he said.

“Everyone at Orlando Health has been very supportive and excited about this program.”

“Losing substantial weight is a life-long decision,” Beidas said. “And surgery is not the easy way out. I love working with these patients. They are working very hard to achieve a healthier life, and it is very rewarding to help them complete this journey.”

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ADMINISTRATIVE DEFENSE COVERAGE AND/OR ADMINISTRATIVE PROCEEDINGS DEFENSE COVERAGE

Welcome Addition or Necessary “Evil”?

By MICHAEL R. LOWE, Esq.

While most healthcare facilities, group practices, physicians and medical providers have medical malpractice or professional liability insurance, many healthcare providers and professionals are unaware that those policies may include an Administrative Defense Coverage (“ADC”) and/ or Administrative Proceedings Defense Coverage (“APDC”) provision, add-on or endorsement.

ADC/APDC is coverage that typically covers the legal costs for defending administrative and disciplinary actions by state licensing boards (like the Florida Board of Medicine), peer review proceedings and credentialing actions by a hospital or healthcare facility, and other health care regulatory and administrative matters.

Examples of matters often covered under ADC/APDC include HIPAA violations and HHS/OCR investigations, patient complaints to state licensing boards, licensing board investigations due to professional liability indemnity payment, investigations or other actions alleging violations of fraud and abuse including compliance with the Stark or anti-kickback rules, Meaningful Use audits, DME audits, Medicare audits and subsequent appeals to Medicare audits, pre-payment and post-payment audits for both public and private insurance carriers, actions by insurance payment programs impacting licensure, participation or contract termination, including Medicare/Medicaid, and/or billing and coding errors.

In some instances, ADC/APDC will also cover civil court actions resulting from conduct as an employer or supervisor in the healthcare practice. Healthcare providers may also have to participate in investigations by federal and state government

agencies and can use their administrative defense coverage to pay for these actions which can be very expensive. The coverage can also help pay for out-of-pocket expenses for such matters, including legal expenses, attorney fees and costs, expert witness costs, consultants, court reporter and transcription fees, shadow audit expenses, fines, and penalties, practice interruption expenses, travel to defend, copy costs, and other approved costs relating to the defense of a matter.

Providers and professionals should consult with their insurer or insurance agent to determine what level of coverage you have to ensure you have sufficient coverage to properly protect your professional license. Most ADC/APDC policies have a defense costs limits of anywhere between $5,000 and $100,000 and are included with the medical malpractice insurance and/or professional liability insurance. Some carriers/policies offer the ability to purchase a secondary coverage with increased limits for ADC/APDC coverage through an outside market such as Lloyd’s of London, ProLiability, or NAS where gap coverage can be purchased as a wraparound to an existing policy.

Administrative proceedings and litigation such as peer review fair hearings, administrative law judge hearings on the state and federal level, and Medicare appeals can be extremely expensive and stressful. Health care professionals and providers should familiarize themselves with their insurance policies to determine if they have ADC/ APDC coverage, the amounts of such coverage, and the types of administrative matters that are covered under their policies. Providers and professionals should also consider buying additional wraparound or similar

types of coverage in order to increase defense limits so that they do not have to pay legal fees and defense costs out-of-pocket, which could also serve as a disincentive to continue defending against health care regulatory and administrative claims and investigations.

Simply stated, even if it costs additional dollars to purchase such coverage, health care provider sand professionals are well served to consider purchasing such coverage which is generally much less expensive than paying for the defense of administrative and health care regulatory law investigations and proceedings out-of-pocket.

Lowe & Evander, P.A. work to defend healthcare providers and professional on all of the potential areas covered by an ADC/ APDC policy, as well as with clients, the insurance companies, and agents and brokers to review and advise clients on their policies to ensure they have sufficient coverage to properly protect their professional license. Many ADC/APDC policies have a “choice of counsel” provision that allows

the insured to choose what attorney and firm they would like to have represent the insured in a ADC/APDC covered event.

Other policies assign attorneys who are on their insurance carrier panel.

Florida Board-Certified Health Care Attorney Michael Lowe and Lowe & Evander, P.A. are recognized on several insurance carrier’s panels for defense of ADC/APDC matters.

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.

As with any overview, this insurance information is general and intended to help you make informed decisions. The actual policies available in your state may contain features not discussed above. There are many variations. Some companies offer hybrid versions of claims made and occurrence policies. Exclusions vary from company to company. It is important to read your policy and understand its terms.

If you are switching insurers make sure the new policy correctly picks up retroactive coverage from the previous insurer. The importance of understanding your coverage cannot be understated. An insurance policy is a contract between you and an insurance company. You should read and understand any policy that you purchase.

If you have any questions, have the company or insurance broker or agent take as much time as you need to explain policy terms to your satisfaction.

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

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

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Physician Employment Agreements VIDEO orlandomedicalnews

.com

A Game Changer in Canine Scent-Based Cancer Detection, continued from page 1 the medical imaging workflow company was sold to industry leader McKesson, and the two quickly recognized potential in Junqueira’s work. “This was such a unique undertaking, and ordinarily there would be multiple barriers to entry,” said Lawton. “There are a lot of folks working in the vet space experienced on the dog training side, but coupling that with the unique demands of healthcare is completely different. We’ve managed to build a scalable business by navigating a very different avenue within the payer, provider and healthcare spaces.”

MIKE MOORE

partnership with the California Professional Firefighters Association to offer screenings to the group’s 17,000 members. Cancer is the leading cause of death among firefighters due to release of toxins and increased exposure time.

In fact, data shows nearly 68 percent of firefighters will develop cancer in their lifetime.

The good news? With survival rates above 90 percent for most cancers identified in stages 0 and 1, early detection is key to combating the disease.

PEACE OF MIND FOR BREAST CANCER PATIENTS THE PROCESS The company also is Junqueiera now works bringing earlier detection to alongside 26 beagles and basbreast cancer patients. In Januset hounds in BioScentDX’s ary, researchers were granted a KYLE LAWTON spacious training facility. The one-year renewal from the Inscreening process is simple. structional Review Board for a Individuals order the $50 test from the first-of-its-kind human study to determine company’s website, and wear the mask the efficacy of using canines’ scent ability to while filling out paperwork. Minutes later, detect breast cancer in women. In 2018, the the breath test is complete and ready to be IRB sanctioned the study to create a nonshipped back. Researchers insert the mask invasive test for breast cancer screening, setinto a metal canister and present it to four ting a goal of 1,000 samples from women general cancer-sniffing canines. If cancer is with a history of breast cancer, or at high detected, the dogs sit. Junqueira repeats the risk of the disease. To date, BioScentDX test for confirmation, if needed, and presents has screened nearly half that number, with positive samples to another group of dogs plans to double their goal in the coming trained in specific tumor types: currently year. That’s an impressive feat, given the breast and lung, and soon to be expanded to company’s unique niche in the healthcare include prostate, colorectal and melanoma. marketplace. “Trials involving canines fall Results are mailed back to participants (and into a gray area, because dogs are considphysicians, if requested) within 30 days. ered a diagnostic tool,” Junqueira explained.

“The process of doing medical research is PARTNERSHIPS extremely complicated, and the fact that While the process is far from tradiwe’ve been renewed shows that we’ve estabtional, results are grabbing the attention of lished enough credibility with our previous providers and researchers alike. In 2017, research that the IRB felt comfortable with the company partnered with the Lake Eerie us giving results back to patients. We help College of Osteopathic Medicine in Bradenprovide women with peace of mind when ton to better understand the science behind they can’t afford a mammogram, or when scent-based cancer detection. “We wanted to they want additional screenings between work with BioScentDX to prove scientifically yearly mammograms.” how the dogs are so effective, so we can start moving into the realm of evidence-based LOOKING FORWARD medicine,” said LECOM professor Thomas So what’s next for the promising Quinn, DO. “With the samples collected startup? Moore said the company is now over the last year and the accuracy of the partnering with imaging groups as they work dogs we are seeing, we have moved considerto better understand the science behind caably closer to that becoming a reality.” nine scent detection. “We’re in discussions with radiologists who were understandably a SAVING MONEY – AND LIVES bit cynical of our outcomes at first glance,” The company is also partnering with he said. “Now they’re on board, and we’re self-pay employers to screen high-risk emlooking at ways to help them capture new ployees – typically smokers and those with a markets (i.e. the uninsured) they may not be family or personal history of cancer. Moore able to reach otherwise. They’re also using said catching cancer in its earliest, most treatour dogs to examine subjective images for able stage saves payers upwards of $250,000 false positives and negatives. This could per patient. That’s because those who aren’t offer another data point to assist in the decidiagnosed till after symptoms develop are sion to order an invasive biopsy.” often late stage, requiring multiple hospitalizations, aggressive medical treatment and sometimes end of life care.

Early detection is particularly appealing in industries where cancer is prevalent: In November, the company announced a 5

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HEALTHCARELEADER | Adel Eldin, MD, continued from page 1 They can bring the cheap labor, like a nurse practitioner because it’s all about bottom line,” he said.

He pointed out that reimbursements were becoming a problem for physicians and patients weren’t faring much better.

“On the other side, the patient is getting literally robbed. They were promised things that never happened. If they needed medicine, it’s denied and delayed. Initially, you had to fight it through a doctor then it went down to a nurse. Then it went to a technician. Now you don’t even talk to human beings…it’s all automated,” he said.

“I built a system where’s there’s no middle-man. A patient direct program contracting for healthcare with no insurance.

Insurance is nothing but a sham, for the most part. You don’t get the benefits that you were promised. The providers don’t get paid. People butt heads. Too many people were going out of business. The patient’s paying everything out of pocket.

delay for providers to the point that have forced so many small medical practices to shut down. All this has stressed out consumers making unpaid medical bills the number one cause of bankruptcy.

Similarly staggering statistics for consumers are well documented as follows: • Over 35 million American adults will be contacted by collection agencys for unpaid • medical bills (American College of Cardiology, 2019) • 15 million adults will use up all savings to pay medical bills (American College of • Cardiology, 2019) • 10 million insured American will be unable to pay bills (Masterson, 2019) • 25 million Americans will not be able to pay for their medications (American College of Cardiology, 2019) • Half of Americans with insurance are unable to pay medical bills (Masterson, 2019) Patients are hurting and doctors are hurting because they are not getting paid, thus ending up with an alarming 70 percent physician burnout rate in America!

So, we wanted to bring back a direct relationship, thus direct contracting with ProntoCare as an alternative free healthcare market, pro-consumer, and pro-doctor choice method to end the middle man and improve healthcare delivery, cut cost, hassle, and help the entire community.

Orlando Medical News talked with Dr. Eldin to check on how the program was growing.

What were the motivating issues to create ProntoCare.

There are over 60 million Americans who have no health coverage or insufficient coverage, and this number is on the rise due to the fact that individuals, and small and medium-size businesses are unable to afford health coverage for their employees and thus are losing their good workers. They become unable to attract new employees because of health coverage issues. Ever-rising premiums, deductibles and copayments are being dumped on consumers. Then there’s the denial of benefits to patients and denial/

How does it work?

ProntoCare is a unique healthcare ecosystem, that serves patients, saves them money and helps physicians thrive economically at a time where there is so much denial of payments or at best delayed or reduced

payments.

Once enrolled in ProntoCare, acccording to your age group, you read the contract and if you like it, then you go to Paypal and make your payment for a small fraction of commercial insurance.

Once enrolled, then appropriate referrals are made to subspecialists who are members of the network and can serve patients for a discounted cash price. Average savings range between $7k-10k per person per year. We also give 5 percent back to the community for food banks to fight hunger as a part of social responsibility because we have 55 million hungry Americans mostly women, children, elderly and veterans.

So, ProntoCare promotes wellness, fights disease, hunger and brings the heart back in medicine.

What are the benefits to physicians/groups under the program?

As affiliates, their cash flow will improve so that they can continue to have thriving practices. They will eliminate the ridiculous paperwork, dealing with denial of payments, overhead costs and will be able to focus more on patient care. This will improve their professional and patient satisfaction helping to get rid of physician burnout that is becoming a public health hazard.

What kind of savings can patients see under ProntoCare?

Patients are seeing the following: • Annual savings averaging $7000-$10,000 per person per year. (As an example of a couple enrolled over three years

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have saved $45,000.00 compared with traditional insurance they had before.

• Thousands of dollars additional savings by avoiding costly emergency room visits and hospitalization.

• Discounted medications, labs, and savings on annual supply of natural supplement to stabilize the immune system for ages 40-65 years and 65-100 years of age as a part of the covered benefits.

It is an incredible deal, unmatched anywhere, not just in Florida.

What other patient services do you offer as a physician entrepreneur?

I have built a global Hub for Medical Tourism Services, (www.floridamedicaltourism.com) for patients if they need: • Any surgery or procedure or a specific therapy globally, • Patients looking for honest second opinions, • Wellness Tourism both inbound and outbound, • Rehabilitative Tourism, a unique program for those looking for non-pharmacologic treatment of pain combining centuries-old effective safe natural therapies, avoiding the opioid crisis that claimed 72,000 American lives in 2017. (https://www.linkedin.com/pulse/ non-pharmacologic-treatment-painadel-eldin-md-facc-facp/)

I believe we have a complete ecosystem for all healthcare and wellness needs for the consumer and offer a dignified model for the practice of medicine for providers.

I always believe in the power of reaching out to the community and educating people about new choices in healthcare that are truly affordable, high quality and delivered through direct contracting by ethical, caring providers giving excellent customer service and transparent pricing.

For more information, visit http://www.prontocare.co/our-story/

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Spring has Sprung.

Eat Responsibly, my Friend Spring is around the corner with its vibrant seasonal colors. Inquiring minds want to know if spring has sprung in your diet?

March is National Nutrition Month and the perfect time for the East Orlando Chamber’s Feast in the East catering showcase featuring the delicious, healthy options available through local restaurant members. So how can we use this year’s Nutrition Month theme “Go Further with Food” to enjoy the savory delights available while making choices that not only conserve money and save time, but also reduce food waste and satisfy our taste buds?

Not to be a “Debbie Downer,” but while we know good nutrition combined with physical activity is key in maintaining a healthy weight and reducing risk for chronic illness, more than half of Americans are chronically overweight and obese according to the Academy of Nutrition and Dietetics.

Poor diets are associated with major health risk factors. Smart food choices taking small steps each week to improve nutrition, makes a significant difference in health. If we know all of this, what is the barrier?

Some might say, “Eating healthy is expensive.” The Harvard School of Public Health did a study crunching the numbers,

finding that the healthiest diets cost just $1.50 more than unhealthy diets. Now, this might not be a problem for some, those with lower incomes may not be able to afford the added cost. However, the small difference may help people realize that eating healthy is within reach. Over the course of a year though, the cost equates to nearly $550 annually per person putting a real burden on some families. Dariush Mazaffarian, associate professor at HSPH and Harvard Medical suggests policies are needed to offset these costs, reducing death and disability resulting from poor habits.

On the brighter side, Rachel Grumman Bender examined ways in which you could eat healthy without breaking the bank in her article for LearnVest. She offered several creative money-saving ways to keep the budget intact.

Step one is to cook way too much food. Yes, you heard me right. Carve out time to prep meals. Vegetarian chili, pot roast, meal loaf, an entire chicken – each are easy to make.

Combine your ingredients, season and let your oven do the rest providing several days of lunches and dinners for you and your family. Don’t forget to pack your lunch in advance, too. This could save you up to $10 a day, offer healthier food choices, reduce waste and

Coffee Club Semoran at Bonefish Grill Orlando Gateway Thursday, March 21, 2019

(3RD THURSDAY OF EVERY MONTH) 8:30 – 9:30 AM BONEFISH GRILL ORLANDO GATEWAY

5463 Orlando Gateway Village Cle, Orlando, FL 32812

Coffee with the Commissioner – Orange County District 3 Mayra Uribe Friday, March 22, 2019 8:00 – 10:00 AM

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(4TH THURSDAY OF EVERY MONTH) 8:30 – 9:30 AM SAM’S CLUB LAKE NONA

11920 Narcoossee Rd., Orlando, FL 32832

Feast in the East Business Restaurant & Catering Showcase Thursday, March 28, 2019 4:00 – 9:00 PM

AVALON PARK COMMUNITY CENTER 13401 Tanja King Blvd., Orlando, FL 32828

Please visit www.EOCC.org for a complete listing of January’s 18+ Events 8

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Business Clarity Empowered by Technology Contact

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maybe even trim the waistline.

Since you are prepping, save some extra cash by chopping, cutting and portioning out everything from produce to nuts, to cheese to meat. Check out the “Ugly” produce. These could be dented potatoes, curvy carrots and blemished apples. Not only are ugly fruits and vegetables as nutritious, but more affordable; Often marked as much as 50 percent off. Stocking up on sale items is an added savings keeping your budget under control. Buy bulk, prepare and freeze individual servings saving time and money. Are you constantly throwing away fresh fruits and vegetables that go bad too quickly?

Consider frozen options.

Consumer Reports adds that you should shop strategically sticking to in-season items when buying fresh, make better use of your freezer, freezing overripe fruit and vegetables for smoothies, breads, jams or sauces, scan the labels to make sure the product is truly healthy and opt for fewer ingredients leaning towards whole foods, fresh fruits and vegetables, whole grains and lean proteins rather than processed.

Do you need a bit more structure and help? Consider speaking with a nutritionist from one of our Lake Nona healthcare facilities. Orlando Health provides nutritional counseling for anyone interested in learning how to live a healthier life and prevent or manage diabetes, high blood pressure and other weight related disorders. Nutrition is the pillar of the CREATION health philosophy offered by AdventHealth. Their expert dieticians provide comprehensive nutrition counseling helping clients gain tools and knowledge making positive, beneficial and lasting lifestyle changes. The VA Medical Center and Nemours Children’s Health System also provide comprehensive education and guidance for patients throughout their system.

So, you’ve read labels, prepped, shopped with a cause and sought out the professionals, but a person can only be so good, right? What if you need a break and want to eat out? I’m so glad you asked. Lake Nona has a variety of restaurants that offer delicious options on the healthier side. Some of our East Orlando Chamber Restaurant members with menus that will tantalize your taste buds include Boxi Park, Chroma Modern Bar + Kitchen, Canvas Restaurant & Market, Dickey’s Barbecue Pit Lake Nona, Park Pizza & Brewing Co., PDQ and Sus Hi Eatstation. The exciting news is that each will participate in our Feast in the East catering showcase March 28th at Avalon Park Community Center. Join us to sample a tasting from more than 30 restaurants throughout the 440 square miles of East Orlando. It is a great place for businesses who cater in, to try before they buy and “Go Further with Food” during National Nutrition Month. Happy eating. orlandomedicalnews

.com

MEDICAL CITY MEMBER HIGHLIGHT

Chef Jason Bergeron Lake Nona is a “leading-edge living and community development” now offering true experiences in culinary excellence. One of the Tavistock Restaurant Collection restaurants and member of the East Orlando Chamber of Commerce is Chroma Modern Bar + Kitchen, an innovative restaurant offering a colorful menu of small plates, craft beers, fine wines, specialty drinks and quality dining.

Chef Jason Bergeron pushes the limits of creativity pulling inspiration from the local culture and ingredients. Where did his inspiration come from? Chef Jason has wanted to be a Chef for as long as he could remember. He says his mom wasn’t the best cook in the world, opening an opportunity for him to show his natural culinary talent and desire creating family meals at

nine years of a g e.

Rather than j u m p i n g straight into college, he took the advice of mentors, working in the field making sure he remained passionate about his craft.

Doing so cemented the deal, graduating from the Culinary Institute of America in New York and kicking off his career.

Since it is National Nutrition Month, we asked what he would recommend for someone looking for a lighter, nutritious meal. The Tuscan Kale and Quinoa salad is an adventurous locally inspired meal packed with nutrients, proteins and super foods. Just what the doctor ordered. Bon Appetit!

“Creating Quality & Affordable Options”

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Avalon Insurance Services is extremely proud to have created the EOCC group benefits plans available to all EOCC members. In a current environment where major medical insurance is becoming hard to attain and even more difficult to afford, what we have created provides options to the employers and employees of the EOCC by offering true group insurance supplemental plans to all its members.

The policies created by Avalon Insurance Services for the EOCC are true group products. The policy is in the name of the EOCC, like an employer plan. There is no minimal size needed for a group to enroll. This means smaller groups that are not large enough to offer true group insurance can now do so through their membership with the EOCC. Second, the employer has no obligation or liability with the benefits offered. The policies are true group policies in the name of the EOCC so the company has no payroll deduction needs, no administration of the products and no liability for the coverages offered. Finally, the group products offer a competitive rate. Most products offered are less than $20 in monthly premium versus hundreds of dollars for major medical coverage.

Creating true group insurance supplemental employee benefit plans for the EOCC has ultimately brought affordable options to employers and employees who before did not have any.

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OptimaCRE.com (CONTINUED ON PAGE 11)

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GrandRounds Community Health Centers Receives National Recognition Central Florida based Community Health Centers was, recently, announced as a Best and the Brightest Company to Work For by National Association for Business Resources (NABR). This program awards companies that excel at employee relations, use innovation to motivate employees, implement creative compensation programs and more will be recognized by NABR at the National Best and Brightest Summit – Illuminate 2019 symposium and awards gala on September 15-17, in Chicago, Illinois.

The 2018 national winning companies were assessed by an independent research firm which reviewed a number of key measures relative to other nationally recognized winners. The Best and Brightest Companies to Work for Winners are not ranked. The Best and Brightest Program honored 512 national winning organizations from across the country out of 2,400 nominations. With over 20 years of experience conducting the Best and Brightest competitions, NABR has identified numerous best Human Resource practices and provided benchmarking for companies that continue to be leaders in employment standards.

“Profitability and stability is essential for businesses in today’s economic climate. Companies that recognize that their employees are the key to their success achieve staying power. Our 2018 winners create their human resource standards to ensure employee satisfaction and they set standards for every business to aspire toward,” said Jennifer Kluge, President and CEO, NABR. “Each year, Community Health Centers looks for ways to improve the workplace environment for team members and employee benefits to create a successful and prosperous place where people love to come to work. Meeting the needs of our employees and engaging them is critical to ensuring that we provide the best care possible to the patients we serve. We feel that our great benefits package including zero or low medical co-payments along with our prescriptions, vision, subsidized dental coverage, short and long-term disability, bi-weekly retirement contributions and a generous PTO & holiday program contributed towards us being selected.,” states Margaret Brennan, President/CEO of Community Health Centers.

UCF Health Welcomes Dr. Sharon Wasserstrom: Internal & Lifestyle Medicine Specialist Dr. Sharon Wasserstrom is board certified in Internal Medicine and Lifestyle Medicine. She is uniquely skilled in providing tailored lifestyle management that helps prevent, improve and reverse already established disease.

Dr. Wasserstrom received a B.A. in psychology from Brandeis University in Waltham, Massachusetts. She then went on to earn a master’s degree in interdisciplinary studies in biological and physical sciences at Touro College in Dix Hill, New York. She received her M.D. at the Technion Israel Institute of Technology in Haifa, Israel and the completed her residency in internal medicine at North Shore University Hospital of Manhasset.

Dr. Wasserstrom worked as an internist for Montefiore Medical Group in

Bronx, New York for 15 years before joining UCF Health. She has achieved a certification of professional achievement in medical nutrition and has completed nine courses in nutrition biochemistry, growth development and aging, medical nutrition therapy, clinical nutrition and counseling techniques. She was also in the first class to ever receive board certification in the field of lifestyle medicine from The American Board of Lifestyle Medicine (ABLM).

She is a highly talented and experienced physician with a passion for improving patients’ lives in a way that works for them. With 15 years of experience working in outpatient care, she is highly familiar with diagnosis and treatment of multiple disease states and health concerns.

AdventHealth for Children, LIFT Orlando Break Ground on Early-learning Center AdventHealth for Children, in collaboration with LIFT Orlando and Primrose Schools, broke ground on an innovative early-learning center for the children of the Communities of West Lakes.

The center is part of a multipronged effort led by the nonprofit LIFT Orlando — bringing together government, the private sector and nonprofits — to drive investments that strengthen the historic community around Camping World Stadium.

AdventHealth was among the founders of LIFT in 2012 and has been a proud supporter of its efforts ever since.

“AdventHealth is investing in the early-learning space because we know the first five years of a child’s life are the most important to their long-term health and success,” said Debbie Spielman, vice president and chief operating officer of AdventHealth for Children. “Our whole organization has embraced the effort to go deep into this community and help deliver highquality cradle-to-career education, which is part of our longtime support of LIFT’s holistic mission of neighborhood revitalization.”

Data published in the most recent Community Health Needs Assessment shows that while there are health centers near the community, West Lakes and surrounding areas have high uninsured rates.

The Maryland-based Bainum Family Foundation — which invests in high-

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quality early learning in Washington, D.C., and other locations across the U.S. — is providing funding of $12.75 million to the AdventHealth Foundation Central Florida toward the construction and the first 10 years of operations of the school. The Bainum Family Foundation also will provide technical assistance for the design, operations, governance and ongoing monitoring and evaluation of the early learning center.

“Reaching children during these early years with high-quality early learning and a continuum of vital wrap-around supports gives them the best chance of success in both school and life,” said David Daniels, chief operating officer for the Bainum Family Foundation. “We look forward to partnering with the West Lakes community to provide that approach, and we hope this early learning center will serve as a model to bring increased opportunities to other communities around the country.”

Additional funds for the school’s ongoing operation in coming years will be raised by philanthropic efforts by the AdventHealth Foundation Central Florida and

by LIFT Orlando.

The center will open in August for the 2019-2020 school year. It will ultimately serve approximately 220 children from 6 weeks to age 5, and will offer comprehensive services, including social support, health-and-wellness programs, and early-

literacy outreach in the community.

The West Lakes Early Learning Center’s curriculum will leverage Primrose Schools’ proprietary Balanced Learning curriculum and AdventHealth’s “CREATION Kids Curriculum” to educate and support each child in all aspects of their development, including their character development, spirituality and healthy lifestyle.

Primrose Schools, a national leader in early-childhood education and care, is in its 36th year and has close to 400 accredited preschools in 29 states. It is well re-

spected for its high-quality, innovative and collaborative approach to early-childhood education.

“Research shows the benefits of highquality early learning experiences to young children and their families, especially those children who are the most vulnerable,” said Primrose Chief School Excellence Officer Annette Heng. “We look forward to working with AdventHealth for Children, and we believe this center will serve as a pilot for similar mixed-income scholarship centers in communities around the country.”

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GrandRounds Florida Corporate Whistleblower Center Now Goes After Florida Nursing Homes The Florida Corporate Whistleblower Center has begun an aggressive initiative to build out whistleblower Medicare or Medicaid overbilling cases involving nursing homes, skilled nursing facilities, rehab centers and or acute care facilities in Floridaand they are inviting a physician or investor in Florida to financially participate in this venture for the potential of a million dollars as their share of whistleblower rewards. This offer to participate is exclusive to a medical doctor or a group of investors with the goal being potentially significant whistleblower rewards for their participation in this endeavor as the group would like to discuss anytime at 866-714 6466. http://Florida.

CorporateWhistleblower.Com According to the Florida Corporate Whistleblower Center, "We want to work exclusively with a medical doctor investor or a group of investors in Florida to go after nursing homes, skilled nursing facilities, rehab centers or acute care facilities in Florida that are overbilling Medicare or Medicare for unnecessary medical procedures, billing for medical procedures that never happened, and for billing Medicare or Medicaid as if the facility is fully staffed with healthcare workers to meet patient minimum needs when in reality the facility is so understaffed patients are dying prematurely."

"We are not kidding-patients are prematurely dying in many of these types facilities because there are not enough caregivers to take care of the minimum needs of their patients. However, the facility is billing the government as if they are fully staffed."

"Institutional Medicate/Medicaid fraud is a multi-billion dollar a year problem in Florida and we want to go after it. The medical doctor or managing investor could

probably launch a successful political career created by our results. The reason Medicare and or Medicaid are always short of money in part is because Medicare/Medicaid fraud is so widespread-especially in states like Florida. If you are a successful medical doctor or an investor group and you would like rock star status when it comes to exposing overbilling the taxpayer for Medicare or Medicaid healthcare costs in Florida please give us a call at 866-714-6466." http://Florida.CorporateWhistleblower.Com The Corporate Whistleblower Center has developed a unique approach to gain the cooperation of employees of healthcare operators nationwide that are grossly overbilling Medicare or Medicaid. The whistleblower rewards for this type of information can start in the hundreds of thousands of dollars and can go up from there as the group would like to explain to a medical doctor or investor anytime at 866-714-6466. http:// Florida.CorporateWhistleblower.Com The target nursing home, skilled nursing facility, rehab center or acute care facility could be doing business in Miami, Jacksonville, Tampa, Orlando, Hialeah, Tallahassee, Port Saint Lucie, Fort Lauderdale, Hollywood, Saint Petersburg, Cape Coral, Fort Myers, Sarasota, Saint Augustine, or anywhere else in Florida.

The Florida Corporate Whistleblower Center says, "We are convinced our results we be breathtaking and like we said-our partner can take the credit. If you want to be a rock star and do something amazing for the taxpayers and hopefully get rewarded for your participation give us a call at 866-714-6466." http://Florida.CorporateWhistleblower.Com

Dalia Cantor Earns Certified Valuation Analyst Credential Dalia Cantor, CPA, with the firm of CPA Solutions, has successfully completed the certification process with the National Association of Certified Valuators Analysts® (NACVA®) to earn the Certified Valuation Analyst® (CVA®) designation. The CVA designation is granted only to individuals who have met a high bar or both prerequisite qualifications and passed a substantive examination testing both understanding of theory and the application of skills in the field of private company business valuation.

“The CVA designation is an indication to the business, professional, and legal communities that the designee has met NACVA’s rigorous standards of professionalism, expertise, objectivity, and integrity I the field of performing business valuations, and the attendant financial consulting related to the discipline,” state Parnell Black, MBA, CPA, CVA, Chief Executive Officer of NACVA. “NACVA’S CVA designation is the only valuation credential accredited by the National Commission for Certifying Agencies® (NCCA®), the accrediting body of the Institute for Credentialing Excellence™ (ICE™),” Black added.

To become accredited by NACVA, candidates typically have completed intensive training. An initial requirement to becoming a CVA is that the applicant either be: 1) a licensed Certified Public Accountant (CPA)

holding an active, valid, and unrevoked CPA license in his or her state; 2) or hold a business degree and/ or master of business administration (MBA), or higher degree from an accredited college or university, and have two years or more of full0time (or the equivalent of) experience in business valuation and/or related disciplines. Those who have earned the CVA credential must recertify every three years in order to maintain their credential.

For more information about CPA Solutions’ business valuation, accounting, financial consulting, and related consulting services, contact Dalia Cantor, at 407-650-9088 or via e-mail at Info@MyCPASolutions.

Orlando Health South Lake Hospital Receives International Baby-Friendly Designation to successfully initiate and continue Orlando Health South Lake Hospital has received prestigious international recognition as a Designated Baby-Friendly birth facility, making it the only hospital in Lake County to be awarded this designation.

The Baby-Friendly Hospital Initiative (“BFHI”) is a global program sponsored by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF). The initiative encourages and recognizes hospitals and birthing centers that offer an optimal level of care for mothers to successfully breastfeed their babies. Based on the Ten Steps to Successful Breastfeeding, this prestigious award recognizes birth facilities that offer mothers the information, confidence, and skills needed 11

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breastfeeding their babies.

Such practices include training for all health care staff in the skills necessary to implement the Baby-Friendly policy, practicing “rooming in” which allows mothers and infants to remain together 24 hours a day, and establishing breastfeeding support groups to refer mothers upon discharge from the hospital.

“We are very proud of the hard work and dedication of our team members to provide quality care to all mothers and babies born at Orlando Health South Lake Hospital,” said Bonnie Onofre, Orlando Health South Lake Hospital Chief Nursing Officer. “This designation recognizes the level of care and commitment South Lake Hospital has to the community in providing support and education for

new mothers to begin and continue breastfeeding their babies.”

At Orlando Health South Lake Hospital, team members help new parents plan, establish and continue meeting their breastfeeding goals through education and support op-

portunities. The hospital offers prenatal breastfeeding classes, prenatal breastfeeding consultations, postnatal breastfeeding consultations, a mom’s morning out support group and a breastfeeding support phone line.

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GrandRounds Malissa M. Barbosa, DO, Leads as Area Medical Director at CleanSlate Outpatient Addiction Medicine As the number of deaths from synthetic opioids continue to climb across Florida, CleanSlate Outpatient Addiction Medicine helps those struggling with the disease of addiction in Orlando. CleanSlate is a national medical group which provides treatment for the chronic disease of addiction, primarily opioid and alcohol use disorders, through physician-led outpatient addiction treatment centers where patients receive medication-assisted treatment using the highest quality, evidence-based practices.

Patients bear too much of the burden of finding treatment. We help solve this challenge by expanding access and outreach - co-locating with other providers, partnering with community organizations and payers, introducing new services, such as telehealth, to our centers and constantly enhancing our model to meet the evolving needs of patients.

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

fellow for the Family Medicine and the Addiction Medicine programs, respectively.

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

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

Barbosa is active in the Orlando community at-large through her participation on the Orange County Treatment Committee and Seminole County Drug Free Taskforce.

She is also a public speaker and advocate providing education and information for professionals, patients, and families.

AFLAC's Jillian Doefler Competing for the Leukemia and Lymphoma Society of Orlando "Woman of the Year" Jillian Doerfler wasn’t raised with the word “impossible” in her vocabulary. A native of Winter Park, she graduated from Winter Park High School as an honors student. While in high school, she also trained and competed on her high school tennis team as well as in USTA junior tennis tournaments. She earned an athletic and academic scholarship to play tennis at Florida Southern College.

Always passionate about making an impact in her community, she participated in community service in high school and in college. She bought blankets and distributed them to the homeless. She was a regular at the animal shelter giving love and attention to each animal in need, even adopting a few. Graduating early, she started her career in the sales industry knocking down company quotas and earning awards.

Recently, she sponsored an event for the 2018 Baby DJ promotion that brings unwrapped toys to economically disadvantaged families during Christmas. It was during this event that she was approached, and accepted, a nomination to run for Woman of the Year for the Leukemia and Lymphoma Society of Orlando.

This 25-year-old Benefit Advisor with Aflac is taking on the task with full determination. The campaign is

a 10-week philanthropic competition to see who can raise the most money for those who have been diagnosed with blood cancer. From February 20th through May 4th she is asking for tax deductible donations, silent auction items, company sponsors and support to help make a difference in the cure for blood cancers. She accepted this nomination as she believes everyone gets a chance in their life to make a difference in the world and this is her opportunity. She is ready to show those diagnosed with blood cancer the support the Orlando community can provide. Please donate; https:// pages.mwoy.org/ncfl/orlando19/ jdoerfler

etectRx's Innovative ID-Cap System Selected to Track Medication Ingestion in HIV Prevention Study etectRx, a privately held digital health company, is pleased to announce that its ID-Cap System, featuring state-of-the-art ingestion event monitoring technology, has been selected for a new study to observe adherence for the HIV prevention drug TRUVADA (tenofovir/emtricitabine) for PrEP® (Pre-Exposure Prophylaxis).

The study will be conducted at Brigham and Women's Hospital in Boston and in partnership with The Fenway Institute at Fenway Health, one of the preeminent LGBT health and HIV research organizations in the world. The manufacturer of TRUVADA for PrEP, Gilead Sciences, is funding the study, led by principal investigator, Dr. Peter Chai, M.D., M.M.S., toxicologist in the Department of Emergency Medicine at Brigham and Women’s Hospital; and Assistant Professor, Harvard Medical School. The purpose of the study is to examine medication adherence patterns and understand how adherence can be increased among populations at risk for HIV infection.

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“Improved medication adherence is an essential strategy for ending the spread of HIV,” said Kenneth H. Mayer, M.D., medical director and cochair of The Fenway Institute at Fenway Health. “We are enthusiastically supporting Dr. Chai’s research in this area and looking forward to seeing the results.” etectRx’s ID-Cap System is an ingestible event marker that utilizes proprietary, in vivo communications technology between an ingestible sensor and an external, wearable reader. The system is comprised of the ID-Capsule, ID-Tag, ID-Cap Reader and related software which allows data to be displayed for the patient and clinician.

The ID-Capsule is a standard pharmaceutical capsule shell containing the ID-Tag, an ingestible sensor that emits a very low power radio frequency (RF) digital message from within the patient to the ID-Cap Reader, a wearable device which verifies the message as a valid ingestion event and forwards the data using Bluetooth technology to secure data display systems utilized

by clinicians and patients.

TRUVADA for PrEP is a prescription medicine that can help reduce the risk of contracting HIV-1 through sex, when taken every day for people who are currently HIV-negative and at risk of contracting HIV-1. In clinical studies, TRUVADA for PrEP has been shown to decrease the chance of HIV infection by close to 100 percent when users are adherent and is recommended by the Centers for Disease Control and Prevention when taken every day as one part of a complete HIV prevention plan.

The effectiveness of TRUVADA for PrEP in reducing the risk of acquiring HIV-1 is strongly correlated with adherence*.

The participants in the study currently receive care at Fenway Health and will use the ID-Cap System for 90 days.

“We are honored that these worldclass institutions have selected etec-

tRx’s ID-Cap technology to aid in the study of this life-changing prevention therapy,” said Harry J. Travis, president and CEO of etectRx. “We look forward to assessing the impact that the IDCap System can have on the lives of people at risk of contracting HIV.” etectRx submitted a premarket notification (510(k)) application with the U.S. Food and Drug Administration (FDA) for its ID-Cap System as an ingestible event marker in late 2018 and anticipates FDA clearance for marketing this year. The ID-Cap System is currently only available for investigational use in IRB-approved clinical studies.

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GrandRounds Orlando Health, Magic Gaming Form eSports Partnership

Volusia County Loses Two Well Known Physicians

Top: Pictured KingCamRoyalty in Magic Gaming/Orlando Health jersey Bottom: Pictured UCManny in Magic Gaming/Orlando Health jersey

Dr. Robert Alston as a compassionate, Merrell, Jr. died brilliant surgeon, and February 15, 2019 served as President of at the age of 84. He the medical staff at Hallived his life with unifax Hospital. He cared bridled curiosity, a for more than fifty thoutaste for adventure, sand patients, many of abiding love for his them for charity. family - and always Often, he checked on a deep commitment the progressive wellto helping those in being of his patients for need. years after their formal ROMEO M. DE GRACIA Bob was the first treatment ended. of five children born Bob was well travto Robert Alston eled, having visited Merrell and KatherAfrica, Asia, Latin ine McDonald MerAmerica, Alaska and Hawaii many times. Of rell, and grew up in course meeting and beDaytona Beach. friending many people As a boy he typically had a snake around the world and or two under study. creating lasting friendHe once harbored ships was the main a family of baby focus of his travels. diamondbacks in Dr. Romeo M. de ROBERT A. MERRELL, JR his mother's launGracia passed away dry basket! Gators, baby raccoons, Wednesday, February 13, 2019. a seagull in a wing splint, and asBorn in Fort Stotsenburg, Pamsorted other wounded wildlife panga, Philippines (later named populated his outdoor laboratory.

Clark Air Force Base) on June 7, His monkey, Chico, a noted escape 1937 to U.S. Army Major Fortunato artist, was well known in the neighde Gracia and his wife Concepcion.

He was the fifth of ten children. borhood. Bob originally planned to After attending the University of pursue a veterinary career, until his San Carlos on the island of Cebu, Philfather reasoned he might consider human medicine with animal care as ippines, he attended medical school a sideline. at Santo Thomas University in Manilla, After graduating from Seabreeze and completed his specialty in OB/ High School, studying premed at GYN at the Woman's Hospital of St. The Citadel, and obtaining a mediLuke's and Fellowship at Columbia cal degree from Duke University, University in New York City. He was Bob trained in Otolaryngology professor of OB/GYN at Southwest(ENT) at Yale Medical School where ern University Medical School in the he rose to Chief Resident. island of Cebu, Philippines.

While doing his residency in New He settled in Daytona Beach in Haven, CT, Bob married Rosalind 1971 and practiced as a board-cer(Linda) Ferrucci in 1961 and together tified OB/GYN for 41 years serving they raised five children who, with the local community. He was an actheir families, survive him – Robert tive member of St. Paul's Catholic A. Merrell, III (Rob) and his two chilChurch since 1971, a member of the dren Marina Somma and Robert A. UST Medical School Choir and an Merrell, IV (Robbie); Diane Merrell avid tennis player.

White (husband Mark) and their two Siblings who predeceased him are sons Alston and Alec; Christine MerEstrella, Rodulfo, Rebecca, Forturell and her daughter Caroline; Larry nato Jr., Teresita and Carmelita, and Merrell; and Matthew Merrell (wife his daughter Maria Amelia.

Cari) and their four children Sean, He is survived by his loving wife Haley, Mac and Kira. of 56 years, Amelia, his sons DenBob practiced medicine in Daynis and Jeffrey, his grandson Xavier, tona Beach for 48 years. He paid no siblings Lydia of New Jersey, Jose attention to self-promotion, keeping of New Orleans, and Chona of Orhis focus on continual growth of his mond Beach. practice area and the quality of the care he provided. He was known

Orlando Health is the official medical team and jersey sponsor for Magic Gaming. The announcement came during Magic Gaming’s Second Annual eSports Summit, where eSports and gaming industry leaders gathered to discuss the upcoming NBA 2K League season and the business of eSports.

Magic Gaming is owned by the Orlando Magic and is one of 21 teams across the country competing in the NBA 2K League, a professional eSports league that began play in May 2018.

The league features the best NBA 2K players in the world. Magic Gaming’s six-man roster competes as unique characters in 5-on-5 play against the other teams in a mix of regular-season games, tournaments and playoffs.

“We’re very excited about this partnership and what it means for us as an organization and the diverse and rapidly growing community of gamers all over the world who are fans and participants in eSports,” says Andy Gardiner, senior vice president of external affairs and community relations at Orlando Health “This is a global stage for the Orlando Health brand and an opportunity to showcase our medical team’s ability to provide the

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unique care these athletes require to ensure Magic Gaming can compete and win at the highest level.”

Under the agreement, Orlando Health will be the exclusive provider of medical care to Magic Gaming players, including player examinations evaluating overall physical and mental health, as well as services throughout the season and playoffs. Additionally, Orlando Health will serve as jersey sponsor for Magic Gaming, becoming the first health system to have its brand adorn game attire for an NBA 2K League team.

“We are excited to partner with Orlando Health in their shared commitment to ensuring the health and wellbeing of our athletes," says Director of Magic Gaming Ryan DeVos. “We are looking forward to a long, fruitful relationship with Orlando Health as we prepare to embark on our second season in the NBA 2K League.”

Magic Gaming will soon draft their roster of players for the upcoming season. Orlando Health physicians will meet with the players in the weeks following the draft to conduct medical evaluations and prepare for the season, which begins in early April.

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GrandRounds Central Florida Regional Hospital Debuts International Parkway Emergency Room Central Florida Regional Hospital ER at International Parkway has opened its doors to the public. The $11.6 million, 11,000-sq.-ft., freestanding emergency department is expected to serve more than 7,500 residents from northwest Seminole County and surrounding areas each year.

Employing 55 staff members and five emergency medical physicians, the ER operates as a full-service emergency room providing 24/7 emergency care 365 days a year for both pediatric and adult patients.

All nurses at the facility are certified in advanced cardiac life support and pediatric advanced life support certifications, including ACLS, PALS, TNCC, ENPC and NRP. The new facility, complete with an ambulance entrance, offers comprehensive emergency services, includ-

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ing a dedicated Trauma and Resuscitation Room, full hospital lab and 12 private patient care rooms. Diagnostic imaging services include X-ray, CT scan and ultrasound.

“Central Florida Regional Hospital is proud to expand its footprint of high-quality care in our community,” said Trey Abshier, CEO of Central Florida Regional Hospital. “Minutes matter in an emergency, and this facility will help provide faster, expert care to thousands of residents in northwest Seminole County, as well as west Volusia and Lake counties.” The International Parkway ER is located on 28 acres at 4525 International Parkway in Sanford between SR 46 and SR 417.

This location allows for easy freeway access. For more information, visit CentralFloridaRegional.com/ER.

Booming Urgent Care Industry Filling the Gaps in Patient Care

The urgent care industry continues to experience year-over-year growth as more patients seek on-demand care for non-emergency conditions, according to the annual Benchmarking Report from the Urgent Care Association (UCA). Much of this growth is fueled by a diversifying patient population calling for immediate access to specialized and on-demand medical care.

“Urgent care centers play an increasingly vital role in the continuum of care, providing services for a wide array of patients who may be unable to see a primary care physician for various reasons, including simply not yet affiliating with one,” said Laurel Stoimenoff, PT, CHC, CEO of UCA. “As a result, the patient populations utilizing urgent care centers are evolving, with Millennials leading the way in driving demand and increased utilization. And as Baby Boomers are aging into Medicare, we are also seeing year over year growth in that sector as well.”

As of November 2018, the total number of urgent care centers in the U.S. reached 8,774, up eight percent from 8,125 in 2017.

Convenience of UCCs Resonates with All Demographics Urgent care centers provide easy access to on-demand, affordable care – meeting the healthcare needs of a variety of patient populations.

The 2018 Benchmarking Report found more than 70 percent of patients wait less than 20 minutes to see a provider at an urgent care center, and nearly 94 percent are seen in less than 30 minutes. In terms of total visit time, nearly 85 percent of patients are taken care of in less than 60 minutes.

Furthermore, 98 percent of patients seeking treatment in urgent care centers are in the right place, with just 2 percent being diverted to

emergency departments for higher acuity care or diagnostics.

According to the report, a median of 35 percent of patients seeking care at urgent care centers are unaffiliated with a primary care provider or a medical home. Urgent care centers serve as the ‘front door’, often connecting these patients with a medical home or specialists.

In addition, the number of Medicare and Medicaid patients seeking services at urgent care centers continues to grow, accounting for nearly 27 percent of all visits in 2018. This can be attributed, in part, to Baby Boomers who were already using urgent centers and are now starting to tap into Medicare benefits.

“Urgent care centers continue to expand their scope of services, catering to the needs of local patient populations,” said Stoimenoff. “Specialty services such as occupational medicine, pediatric care and telemedicine are becoming more prevalent, increasing access for patients across the country, particularly in underserved communities. These services help alleviate crowded emergency departments while reducing the impact of physician shortages in communities nationwide.”

Once again, UCA and Merchant Medicine collaborated on the annual report, bringing deep, industry insight to the data. This year’s report cites the largest urgent care organizations by ownership type, provides a comprehensive analysis of urgent care operators and includes data on urgent care saturation by core-based statistical area.

The full 2018 Benchmarking Report on urgent care and on-demand industry growth and trends is available for purchase on the UCA website here. More information about the UCA can be found at http:// www.gateway2better.org.

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Local Surgeon Elected President of National Surgical Society

GrandRounds AdventHealth´s Annual Grant Application Opens to Local Nonprofits AdventHealth’s Community Health Impact Council, also known as CHIC, is accepting grant applications from nonprofits that are launching innovative new programs that will improve the health of Central Florida.

This year, the board will provide $1.2 million in grants for programs that address issues such as food insecurity, improving access to health care or helping people manage chronic diseases.

“Our goal is to help our neighbors feel whole, and so we are excited to see the innovative ways the talented members of our community can help us further our mission,” said Samantha Kearns O´Lenick, executive director of AdventHealth Community Impact. “We hope nonprofits in our community will take advantage of this opportunity and allow us to form new partnerships and create a stronger impact for those we serve.”

Prior grant recipients include Second Harvest Food Bank of Central Florida, the Osceola Council on Aging, Grace Medical Home and As-

pire Health Partners.

Grants are awarded based on intervention and prevention in the areas of health, health care, education and community.

Funding is available for one to three years with a strong emphasis on metrics to ensure programs are truly impacting the community.

The primary goals of CHIC are to help equip and partner with other nonprofits that care for Central Florida’s underserved and marginalized, and to reducing preventable medical costs.

Since 2005, the Council has invested more than $13 million in 45 programs across the tri-county area and impacted more than 140,000 people.

The deadline to apply for a grant is 5 p.m. April 1, and program funding will begin Jan. 1, 2020.

For more information visit https:// www.mychiconline.org/about.

Orlando-based surgeon, Christopher L. Reeves, DPM, MS, FACFAS, took office as the 68th president of the American College of Foot and Ankle Surgeons (ACFAS), a national association of more than 7,600 foot and ankle surgeons, during the ACFAS Annual Scientific Conference in New Orleans.

The ACFAS Annual Scientific Conference, the largest educational meeting for foot and ankle surgeons in the US, draws attendees from around the world to discuss the most current techniques and technology for treatment of deformities, diseases and injuries of the foot and ankle.

“I am honored and inspired to help lead ACFAS alongside my fellow board members to further advance the profession and provide invaluable services to the members,” said Dr. Reeves. “I am often reminded we all have the same goal in our profession—to provide the highest quality patient care possible— and I look to the next year and beyond to focus on ways we all can help achieve that goal together,” he added.

Dr. Reeves is a foot and ankle surgeon at Orlando Foot and Ankle Clinic. He is board-certified in both

foot surgery and reconstructive rearfoot and ankle surgery by the American Board of Foot and Ankle Surgery.

Dr. Reeves holds a podiatric medical degree from Barry University School of Podiatric Medicine in Miami Shores, Florida, and completed his residency at The Western Pennsylvania Hospital/Temple University of Medicine Clinical Campus in Pittsburgh. He is a faculty member and director of Research at Florida Hospital East Orlando Podiatric Surgical Residency Program. Dr. Reeves frequently lectures on foot and ankle surgery, and his research has been published in numerous journals and textbooks.

HHS Launches Innovative Payment Model with New Treatment and Transport Options The U.S. Department of Health and Human Services (HHS), Center for Medicare and Medicaid Innovation (Innovation Center), which tests innovative payment and service delivery models to lower costs and improve the quality of care, announced a new payment model for emergency ambulance services that aims to allow Medicare Fee-For-Service (FFS) beneficiaries to receive the most appropriate level of care at the right time and place with the potential for lower out-of-pocket costs.

“This model will create a new set of incentives for emergency transport and care, ensuring patients get convenient, appropriate treatment in whatever setting makes sense for them,” said HHS Secretary Alex Azar.

“Today’s announcement shows that we can radically rethink the incentives around care delivery even in one of the trickiest parts of our system. A value-based healthcare system will help deliver each patient the right care, at the right price, in the right setting, from the right provider.”

The new model, the Emergency Triage, Treat and Transport (ET3) model, will make it possible for participating ambulance suppliers and providers to partner with qualified health care practitioners to deliver treatment in 15

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place (either on-the-scene or through telehealth) and with alternative destination sites (such as primary care doctors’ offices or urgent-care clinics) to provide care for Medicare beneficiaries following a medical emergency for which they have accessed 911 services. In doing so, the model seeks to engage health care providers across the care continuum to more appropriately and effectively meet beneficiaries’ needs. Additionally, the model will encourage development of medical triage lines for low-acuity 911 calls in regions where participating ambulance suppliers and providers operate. The ET3 model will have a five-year performance period, with an anticipated start date in early 2020.

“The ET3 model is yet another way CMS is transforming America’s healthcare system to deliver better value and results for patients through innovation,” said CMS Administrator Seema Verma. “This model will help make how we pay for care more patient-centric by supporting care in more appropriate settings while saving emergency medical services providers precious time and resources to respond to more serious cases.”

Currently, Medicare primarily pays for unscheduled, emergency ground ambulance services when benefi-

ciaries are transported to a hospital emergency department (ED), creating an incentive to transport all beneficiaries to the hospital even when an alternative treatment option may be more appropriate. To counter this incentive, the ET3 model will test two new ambulance payments, while continuing to pay for emergency transport for a Medicare beneficiary to a hospital ED or other destination covered under current regulations: • payment for treatment in place with a qualified health care practitioner, either on-the-scene or connected using telehealth; and • payment for unscheduled, emergency transport of Medicare beneficiaries to alternative destinations (such as 24-hour care clinics) other than destinations covered under current regulations (such as hospital EDs).

The ET3 model encourages highquality provision of care by enabling participating ambulance suppliers and providers to earn up to a 5% payment adjustment in later years of the model based on their achievement of key quality measures. The quality measurement strategy will aim to avoid adding more burden to participants, including minimizing any new reporting requirements. Qualified

health care practitioners or alternative destination sites that partner with participating ambulance suppliers and providers would receive payment as usual under Medicare for any services rendered.

The model will use a phased approach through multiple application rounds to maximize participation in regions across the country. In an effort to ensure access to model interventions across all individuals in a region, CMS will encourage ET3 model participants to partner with other payers, including state Medicaid agencies.

CMS anticipates releasing a Request for Applications in Summer 2019 to solicit Medicare-enrolled ambulance suppliers and providers.

In Fall 2019, to implement the triage lines for low-acuity 911 calls, CMS anticipates issuing a Notice of Funding Opportunity for a limited number of two-year cooperative agreements, available to local governments, their designees, or other entities that operate or have authority over one or more 911 dispatches in geographic locations where ambulance suppliers and providers have been selected to participate.

For more information, please visit: https://innovation.cms.gov/initiatives/et3/.

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GrandRounds AID Survey: Competing against hospitals for patients, pay gap top member concerns

Competing for patients against hospitals and health systems, which have substantial marketing budgets, topped the list of pressing problems independent doctors face, according to a new survey out from the Association of Independent Doctors, a national nonprofit trade association. The pay disparity between employed and independent doctors ranked a close second.

“Independent doctors regularly report that staying independent is difficult due to a variety of market forces,” said AID executive director Marni Jameson Carey. To uncover which pressures were of greatest concern, AID surveyed its members. Among those who responded, 26 percent said competing against the hospital for market share was their top concern; 24 percent cited the pay dis-

parity, and 16 percent said receiving inferior treatment due to not being hospital employed was a problem.

Because of hospitals’ bargaining power with payers and the fact that hospitals can charge facility fees that independent doctors can’t, hospitals can afford to pay salaries to employed doctors that are often greater than independent doctors can earn on their own, said Carey. “We all pay for that in higher premiums and taxes.”

Respondents also indicated that the pressure to join a clinically integrated network (12 percent), or to sell their practice to a hospital or private equity group (9 percent) were concerns.

However, many of those surveyed are looking to shift toward new practice models that will give them more control of their financial destiny. One third

of respondents said they currently have a concierge practice, a direct-pay practice, or a hybrid practice, where they accept both insured and direct-pay patients. Confirming a tidal shift among U.S. doctors, another 33 percent said that while they don’t currently have a direct-pay or concierge practice, they would like to move in that direction.

In a separate survey of AID’s dentist members, four out of five said they would like to move to a straight feefor-service only practice and opt out of all insurance plans, including Medicare and Medicaid.

With members in 35 states, AID works to support independent doctors, while educating consumers, businesses and lawmakers about why the survival of independent doctors is crucial to keeping health-care costs

down and to eliminating doctor burnout. Researchers at the NYU School of Medicine found that among doctors in small independent practices, only 13.5 percent suffered burnout compared to a national average of 54.4 percent.

Of the 1,022 members AID surveyed, 62 responded (6 percent). Of the 21 dental members surveyed, 10 responded (50 percent).

When asked how AID could best help independent doctors, half of respondents said by informing consumers about the importance of choosing an independent doctor, while 40 percent said by working with lawmakers to create policies that support independent doctors.

Mon Health Selects PatientMatters to Create Pre-Access Service Center to Ensure Consistent Patient Experience and Improve Revenue Performance PatientMatters, a patient access and advocacy solutions provider helping hospitals and health systems offer patients highly-personalized financial solutions, today announced that Mon Health, a leading health system serving communities in West Virginia and Pennsylvania, has chosen PatientMatters’ IntelliPass Advisory Phase I Program.

The initiative will support the organization’s work to extend its leadership in providing a positive patient financial experience, improve collections and enhance registration quality and speed, Mon Health has engaged PatientMatters as the industry’s premier experts in developing a robust Pre-Access Service Center capability.

The Pre-Access Services Center model breaks down existing silos across registration, scheduling and financial services to give patients a fast, efficient and consistent registration experience with reliable, personalized services.

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expertise that closely aligns with our vision for breaking down silos and making our process 100 percent patient focused,” said Candi Powers, Chief Revenue Cycle Officer at Mon Health. “The PatientMatters Pre-Access Service Center model will put us ahead of the curve on patient experience and revenue performance.

Most importantly, we see this work as a critical step in our ongoing effort to ensure that the highest quality care is affordable and accessible for the communities we serve.”

The IntelliPass Advisory Phase I Program includes: - Assessment – Focusing on scheduling, reminders, E&B checks, estimation and workforce allocation - Workflow Redesign – Including centralization of team structure, process workflow and related functions - Implementation and Go-Live – With full documentation, training, testing and on-going process optimization The program implementation will leverage and complement Mon Health’s

existing Cerner EHR and Experian RCM solutions as part of the project.

The agreement includes an option to engage PatientMatters’ IntelliGuide® Advocacy services as part of the final implementation.

“Mon Health shares our vision for creating a deeply-integrated, consistent pre-access capability that is at the heart of a positive patient experience,” said David Shelton, Chief Executive Officer at PatientMatters.

“Advisory Phase I is the way we start every engagement with our clients no matter which mix of our products and advocacy services we provide.

Together, we will build out their capability to deliver a level of personalization, satisfaction and efficiency that all health systems should aspire to.”

The PatientMatters IntelliPass System enables hospitals to guide patients through the maze of healthcare finance with accurate bill estimates and personalized financial plans. The IntelliPass System consists of four core modules: IntelliReg™, IntelliPass™,

IntelliPass+™ and IntelliGuide™; offered both as standalone products and services or as part of an integrated suite of solutions.

PatientMatters brings compassion and consumerism to the financial experience of care, helping hospitals and health systems offer highly-personalized financial solutions that improve satisfaction, cash flow, profitability and outcomes. Based on decades of experience, the PatientMatters IntelliPass™ System brings together a comprehensive set of patient payment and advocacy solutions, along with intelligent workflow automation tools to ensure every patient is satisfied and providers are appropriately compensated. PatientMatters serves over 130 hospital and health systems in over 350 locations across the country, providing cutting-edge technology, financial tools, process transformation services with staff training and support to help deliver a new level of consumer-friendly healthcare. To learn more, visit patientmatters.com orlandomedicalnews

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Measuring the Cost of Bureaucracy in U.S. Healthcare Closing the gaps in care and spend

By ROBERT E. GRANT

In 2014, Health Affairs published a comprehensive study conducted by a team of international health policy experts who analyzed and compared hospital administrative costs across eight wealthy nations: Canada, England, Scotland, Wales, France, Germany, the Netherlands and the United States. It’s no surprise the U.S. ranked above all others—with administrative costs accounting for 25.3 percent of total hospital expenditures—when considering that, as far back as 2010, the U.S. spent 17.6 percent of its gross domestic product (GDP) on healthcare. In fact, since the 1980s, the spending gap between the U.S. and other wealthy countries has risen exponentially, with the U.S. Centers for Medicare and Medicaid Services (CMS) now projecting an annual average increase of 5.5 percent between 2018 and 2026. Cutting to the chase, healthcare spending will hit $5.7 trillion and represent nearly 20 percent of the nation’s total GDP in less than a decade—and there’s not much anyone can do to stop it, though many have tried. To add insult to injury, there is no definitive evidence that the high administrative costs in America translate into better care.

Despite medical breakthroughs and leading-edge technology, U.S. News reports that life expectancy in the U.S. is the lowest among industrialized nations.

Thanks in large part to officious laws that prioritize insurance companies, the quality of care is slowly eroding—along with the relationship between patient and doctor. At the root, there is growing consensus among groups like Practicing Physicians of America (PPA) that third-party payers, government bureaucrats and hospital administrators are to be held accountable for “robbing patients of time” with their doctors. Even the CMS recently declared the need to reform its own burdensome regulations that are part of this growing problem after a 2018 report from the American Hospitals Association revealed that activities related to regulatory compliance cost hospitals, health systems and postacute care providers roughly $39 billion a year (or the equivalent of $1,200 per patient admitted to a hospital) and divert precious time away from direct care.

How did this happen to one of the planet’s most progressive societies?

In 2015, A. Barton Hinkle—a senior editorial writer and columnist at the Richmond Times-Dispatch—irreverently described How Bureaucracy and Big

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Government Ruined American Health Care. It’s humorous—until it becomes clear he is not kidding: “Much of the market is managed by huge, bureaucratic organizations that employ thousands of people to do nothing all day but grind through minutiae. This leads to things like the ICD-10, a diagnostic coding system that governs the classification and reporting of diseases and injuries.

With 16,000 different codes, the ICD-10 gets rather specific. Was the patient struck by a turtle? Enter code W5922XA. Was she struck by a sea lion? That’s a separate code—W5612XA. Code S30867A covers nonvenemous insect bites to the anus.

There’s one code for assault with a hockey stick, another for assault with a baseball bat.

And then there is V91.07XA, for patients who have been burned by flaming water skis.

(Burned by flaming water skis a second time?

That’s V91.06XD.)” But that’s just the tip of the iceberg.

The results of a recent study published in the Annals of Internal Medicine reveal that doctors spend approximately twothirds of their professional time on arduous amounts of non-clinical activities, from fulfilling EMR (Electronic Medical Records) and EHR (Electronic Health Records) requirements to negotiating with insurers for specific test and diagnostic approvals. The PPA reports that each year, millions of doctor hours are spent on Maintenance of Certification (MOC) tests alone, which provide no educational value yet keep doctors from spending more time with their patients, particularly those practicing in rural areas where the nearest testing center may be hundreds of miles away. It’s no wonder some 50 percent of doctors are burned out. But burnout in the medical field has far reaching consequences beyond the individual— and for obvious reasons: When the healers are sick, it threatens the healthcare industry as a whole. In a survey from MDVIP, an overwhelming 83 percent of doctors who responded admit they feel they are spread too thin. In addition to a lack of quality time spent with their patients, 75 percent report they are sleep deprived due to stress. This not only affects their ability to provide highquality care but also leads to deadly medical errors, which have become the third leading cause of death in the U.S. Measuring the true cost of a bureaucratic healthcare system may require a new set of data points since it may be decades before the tallies come in unveiling the ultimate cost to human health and wellbeing.

Until then, Americans are held hostage by a system that not only permits monopolistic mergers & acquisitions but also enables

insurers to increase healthcare premiums at will. A 2017 analysis conducted by the Department of Health and Human Services (HHS) shows that premiums have doubled for individual health insurance plans since 2013, with the average American now paying nearly $3,000 more for health insurance per year. In the states of Alaska, Alabama and Oklahoma, premiums have tripled.

Meanwhile, wait times to see doctors and specialists have soared. Even with the U.S. spending more on healthcare than any other country in the world at $10,348 per person, it still takes on average 50 percent longer to see a family medicine doctor and 30 percent longer (24 days or more) for a patient to get an appointment with a new doctor in comparison to just three years ago, according to a 2017 Merritt Hawkins survey.

Grim as the situation may be, change will come to the U.S.—one way or another.

With a greater awareness of the facts and the problems plaguing healthcare, consumers are empowered and well-prepared to not only

participate in this growing national debate but also propose solutions to solve unparalleled challenges that have reached a critical mass. As important as it is to understand how the U.S. got to this point, it’s time to move forward and find a way to close the gaps.

Robert E. Grant is founder and chief executive officer of CONCIERGE KEY Health, a premier healthcare service that provides ondemand access to top-tier doctor specialists, an assigned healthcare team, dramatic reductions in wait times and the ability to schedule an appointment with the click of a button. Most recently, Grant was CEO and president of Bausch+Lomb Surgical, leading the significant growth of its product portfolio. From 2006 to 2010, he served as president of Allergan Medical, leading the $3.2 billion Inamed acquisition and the commercial success of the Botox Cosmetic, Juvederm, Natrelle breast implants and Lap-Band brands. Grant also served as director, board chairman, CEO, president, COO and CFO of Biolase Technology from 2003 to 2006 after holding various senior management positions at Lumenis for six years.

Grant received his bachelor’s degree from Brigham Young University and graduated with honors from Thunderbird School of Global Management, where he earned his MBA. He has also attended the President’s Seminar at Harvard Business School.

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Distracting Devices in Healthcare: Malpractice Implications

By SHELLEY RIZZO, MSN, CPHRM

Digital distraction in healthcare is emerging as a great threat to patient safety and physician well-being.1 This phenomenon involves the habitual use of personal electronic devices by healthcare providers for nonclinical purposes during appointments and procedures.2 Some call it “distracted doctoring.” Matt Richtel, a journalist for the New York Times who won a Pulitzer Prize for his work on distracted driving, coined the term “distracted doctoring” in 2011.3 Like driving, attending to a patient’s complex care needs is a high-risk activity that requires undivided attention and presence in the moment to ensure the safety and protection of others.

But the threat might more aptly be called “distracted practice,” as it impacts all healthcare workers and staff. While distraction is particularly concerning in the operating room, emergency room, and critical care areas, it can impact all healthcare settings—including the office practice. Personal electronic devices can create a digital distraction so engaging that it consumes awareness, potentially preventing healthcare providers from focusing on the primary task at hand—caring for and interacting with patients. And the consequences can be devastating.

Our Devices Are Addictive In today’s electronic culture, it has become unthinkable to be without personal electronic devices. Growing evidence shows that our personal electronic devices and social media are addictive.4 The reason is dopamine. Our dopamine systems are stimulated by the unpredictable, small, incomplete bursts of information with visual or auditory cues. For example, we are never quite sure when we will receive a text message and from whom. We may keep checking to see who liked our recent Facebook post.

And when our devices ding or vibrate, we know our reward is coming. Yet as when gambling or playing the lottery, the anticipation of the reward is (usually) better than the reward itself. This results in more and more of what some call

“seeking” and “wanting” behaviors. Then instant gratification encourages dopamine looping, and it becomes harder and harder to stop the cycle.

Distraction can also be both a symptom of and a contributor to healthcare provider stress and burnout. As a symptom of burnout, digital distraction is a way to escape a stressful environment. As a contributor to burnout, digital distraction impedes human interaction because of the sheer volume of data demanding our attention.

Medical Malpractice Implications For most healthcare providers, distractions and interruptions are considered part of the job; it is the nature of their work. If we consider healthcare distraction on a continuum, on one end are distractions related to clinical care (e.g., answering team member questions or responding to surgical equipment alarms).

On the other end of the continuum are distractions unrelated to clinical care (e.g., making personal phone calls, sending personal text messages, checking social media sites, playing games, or searching airline flights).

From a litigation perspective, the distinction between distractions related to clinical care and those unrelated to clinical care is important. In a medical malpractice claim where there is an allegation that an adverse event was caused by distracted practice, a distraction caused by a clinicalcare-related activity may be found to be within the standard of care and is, therefore, often defensible. But where it can be shown that the distraction was caused by non-patient matters, the plaintiff’s attorney will certainly use that against the defendant. In these situations, the defendant’s medical care may not even enter the equation, because during eDiscovery the metadata (i.e., cell phone records, scouring findings from hard drives) serves as the “expert witness.” Even if the defendant’s clinical care was within the standard, the fact that there are cell phone records indicating that the healthcare provider was surfing the Internet or checking personal e-mail may imply distraction and could potentially supersede all other evidence.

Preventing Distractions Complex problems require a multifaceted approach. Organizations, teams, and individuals all should take responsibility and ownership for reducing the risks associated with digital distraction. The following are risk management strategies to prevent distractions and enhance patient safety.

ORGANIZATIONS • Create awareness o Recognize the extent of the problem and risks. o Model appropriate personal electronic device use behaviors. o Tier communication to batch nonemergent messages. o Refrain from sending texts on nonurgent matters. o Do not expect immediate responses for non-urgent matters.

• Educate system-wide o Train all healthcare providers and staff at orientation and conduct annual refreshers on safety concerns, legal risks of using personal electronic devices when providing care, device-user etiquette, and the addictive potential of technology. o Use simulation-based learning where distractions and interruptions are introduced during high-risk procedures. o Use case studies of real-life examples where distraction was alleged to play a role in an adverse event.

• Deploy technology solutions o Manage facility-issued devices. o Create technology-free zones. o Limit Internet access to work-related sites only—EMR, labs, images, pharmacy formulary, state Rx databases, and decision support/cognitive aids.

• Enforce o Monitor compliance with systemwide protocols and guidelines. o Clearly define how personal electronic devices are used in patient care areas.

TEAMS • Reinforce situational awareness and mindful practices with your team or department through: o Unit-specific protocols: “Sterile Cockpit” and “Below 10,000 Feet” protocols limiting or eliminating nonessen-

tial activities during critical phases of procedures and high-risk activities. o Empowering every team member to speak up when they have a safety concern. For example, encourage team members to speak up when they notice another member is so focused on a personal electronic device that he or she has lost situational awareness about the patient’s clinical condition.

Applying TeamSTEPPS® principles:

leadership, situational awareness, mutual support, and communication.

• Create a process where employees can be reached via a call to a central location, with messages relayed to the employee by a staff member. This alleviates employees’ desire to have their personal electronic devices nearby in case of a family emergency.

• Monitor compliance as part of the team’s quality measures.

INDIVIDUALS • Take personal responsibility—ignore distractions, especially during high-risk procedures, and make sure to speak up, set an example, and remain vigilant.

• Practice situational awareness: o Pay attention to what is happening in the present moment. o Increase attention, focus, and concentration. o Leave your device behind.

New CME Courses Address Distracted Practice Concerns Two new CME courses from The Doctors Company, How Healthcare Leaders Can Reduce Risks of Distracted Practice in Their Organization and The Risks of Distracted Practice in the Perioperative Area, address addiction to personal electronic devices and provide strategies that individuals and organizations can use to minimize the patient safety risks associated with distractions from these devices.

Shelley Rizzo, MSN, CPHRM, is a Patient Safety Risk Manager II with The Doctors Company The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

Find these courses and explore our extensive catalog of complimentary CME and CE activities at http://www.thedoctors.com/patient-safety/education-and-cme/ondemand/.

WORKS CITED 1. Distracted Doctoring: Returning to Patient-Centered Care in the Digital Age https://www.amazon.com/Distracted-Doctoring-ReturningPatient-Centered-Digital/dp/331948706X

2. Treat, Don’t Tweet: The Dangerous Rise of Social Media in the Operating Room

https://psmag.com/social-justice/treat-dont-tweet-dangerousrise-social-media-operating-room-79061

3. As Doctors Use More Devices, Potential for Distraction Grows

http://www.nytimes.com/2011/12/15/health/as-doctors-usemore-devices-potential-for-distraction-grows.html

4. Why We’re All Addicted to Texts, Twitter & Google

https://www.psychologytoday.com/blog/brain-wise/201209/whywere-all-addicted-texts-twitter-and-google

ADDITIONAL RESOURCES 5. Daily Time Spent on Social Networking by Internet Users Worldwide from 2012 to 2017 (in minutes) https://

www.statista.com/statistics/433871/daily-social-media-usageworldwide/

6. Anesthesia and the Law, Preferred Physicians Medical Risk Management Newsletter (August 2014, Issue 39)

https://www.ppmrrg.com/risk-management/anesthesia-law/archive

7. Interruptions and Distractions in Health Care: Improved Safety with Mindfulness https://psnet.ahrq.gov/perspectives/perspective/152/ interruptions-and-distractions-in-health-care-improved-safetywith-mindfulness

8. Distracted Doctoring: The Role of Personal Electronic Devices in the Operating Room https://www.sciencedirect.com/science/article/pii/ S2405603017300365

Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.

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If Healthcare is a ‘Right,’ What’s Next?

Few laying on a gurney heading to surgery want “lowest bidder government operatives”

By PETER ROSENBERGER

One cannot help but admire those who persevere through medical school. For most, the journey begins as teenagers and weighs heavily on young minds as they slog through a difficult educational journey. Through uncounted classrooms and labs to often working multiple jobs eking out a living, these individuals push themselves in truly amazing ways. Enduring grueling hours in residency and fellowships, they press on toward the fixed goal of putting out their shingle in private practice, landing a job at a top university, working for research companies, or other related fields.

This herculean effort stems from core values of wanting to heal, make a better life for themselves, and achieve deepseated goals. Why else put themselves through such an arduous ordeal?

Add to that, nurses, nurse practitioners, nurse anesthetists, lab technicians, phlebotomists, radiology technicians, and others in the virtual army of medical support. They all sacrifice and work extremely hard to learn their individual skill sets in the healing arts.

Yet, political figures lead the charge in now saying the work these individuals perform is a right, akin to a birthright or a constitutional right. According to many politicians, fellow citizens (and even noncitizens) are entitled to the efforts of others. The acquired knowledge of achievers is now at the disposal of political figures.

If healthcare is a right, then the dedication, education, and sweat equity must be compensated fairly. Yet, politicians seem to now not only determine society is entitled to the products and services of others, but those same politicians grant themselves permission to determine the rate of compensation.

If politicians alone decide what is fair compensation, then what is the impetus for success? Reward is what inspires dedication and effort. Mediocrity doesn’t stand on a podium with a medal. When

a healthcare crisis hits, who looks for a mediocre healthcare provider?

Dictating remuneration for the skills of others invalidates the free market for those skills. This leads to the inevitable consequence of stunting the excellence participants require for those skills. When not paid commensurately for effort and ability, even the lowest on the wage spectrum concludes that “phoning” it in makes it easier.

In a free market, excellence is rewarded. In authoritarian constructs, excellence grows scarce.

Few laying on a gurney heading to surgery want “lowest bidder government operatives.”

Declaring healthcare a “right” allows politicians to grasp control of someone else’s hard work and abilities, and mete it out at their discretion. In classrooms across America, teenagers seeking to make a name for themselves as surgeons, for example, routinely hear that the field of their aspiration is a right to their fellow citizens. Even with politicians declaring free funding for education, the path remains brutal. Learning the end of that path means working under an externally determined threshold of success is hardly an inspiration to academic distinction—or a motivator to even enter the field.

Competing for no recognition, reward, or the ability to self-negotiate a return on investment leads to empty stadiums. Likewise, it will lead to empty surgical suites.

The logic of “healthcare is a right” seems to naturally extend to politicians allotting farmers’ produce and ranchers’ beef. After all, everyone must eat.

While legislators push bills allowing others the “right to die,” it seems the “right” to crematorium or funeral services can’t be far behind. After all, the mortality rate still hovers at one-hundred percent. Yet other than special individuals like Elvis, the government prohibits “backyard burials.” Instead, families must seek the expensive help of licensed and trained funeral workers. Those service providers also sacrificed and worked

hard to learn their skills.

Plumbing, electrical repair, fresh water—if allowed, services and products that politicians might deem as rights can comprise a lengthy list. When elected officials placate the desires of constituents at the expense of others’ hard work, training, and skills, a society careens from freedom to totalitarianism.

Access to medical services for the indigent is a noble thing. Medicaid, while not perfect, serves a great need.

However flawed and rife with fraud, Medicare remains embedded in our society. As a society, we can certainly vote and work to improve Medicare and to help the truly needy through a more effective Medicaid program.

Furthermore, many ways remain available to assist those with the important skills needed to better treat the sick and injured.

Classifying hard-earned skill sets, products, and services —their property—as a right to be dispensed by politicians to their constituents is far different than working together to solve a problem or address a need. Determining society is entitled to the labor and expertise of some shows great disrespect to their extraordinary achievement.

The nomenclature of “right” is far better suited to the Constitution.

Peter Rosenberger is the host of HOPE FOR THE CAREGIVER, a syndicated radio program heard weekly on 200 stations. For more than thirty years, he’s cared for his wife, Gracie, who lives with severe disabilities. @hope4caregiver www.hopeforthecaregiver.com

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The CAR of the Future: Speeding Past Cancer

By JOSHUA MANSOUR, MD

Have you heard about the futuristic ‘CAR’ that might soon be speeding past cancer?

No, this is not a new automotive car being released this spring, but instead is something even more exciting. This type of CAR is a cancer therapy that is making headlines and is now on the road to being one of the treatments of the future.

In a throwback to Henry Ford’s Model T, this medical innovation is called CAR Tcell therapy. The CAR stands for Chimeric Antigen Receptor. This type of cellular immunotherapy involves physicians extracting a particular type of white blood cell from the patient’s blood (T-cells) and then attaching them to one of these artificial receptors.

Once these cells are infused back into the patient they begin to multiply, and with guidance from the receptor, recognize cancer cells that contain their same antigen.

This is a cancer therapy that was discovered in 1989, but has not yet been put into high gear until recently. It is already changing how patients with blood cancers that have not been responsive to previous therapy are being treated. Although the technology has been described almost three decades ago, clinical implementation has not occurred until recently. Even though CAR T-cell therapy is not well known to the general public, it has been speeding along the medical highway, with no rest stop in sight.

This rapid pace is of great value because hematological malignancies are the fourth most common cancer in the United States. Non-Hodgkins Lymphoma is the most common of these in the United States and outcomes in aggressive and refractory subtypes are poor. Of this disease, the most common subtype is Diffuse Large B-Cell Lymphoma in which only small percentage of patients with relapsed disease or disease that was refractory to initial therapy is then cured with a stem cell transplant. Although this treatment has been approved for patients under the age of twenty-five with Acute Lymphoblastic Leukemia, until recently this type of therapy had been restricted to smaller clinical trials for other very advanced and aggressive diseases.

However, the remarkable rate of responses from these trials caught the eyes of researchers and physicians around the world.

These results have shown that patients who had failed conventional therapy were not only seeing their disease stabilize, but also saw a significant response. Recent trials have shown ongoing complete remission with duration ranging from 18-24 plus months. In early trials, there were even persisting CAR T-cells observed in great than 70% of patients remaining in response at 1 year. Durable responses continued to remain in patients with and without detectable persisting CAR T-cells. Although these responses can deepen and improve over time, it has also been seen

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in instances that the ongoing response of these cells can decrease when a higher amount of tumor burden is present.

So, is this exciting CAR of the future right for every patient? No. It depends on the individual, their disease, and several other factors. Plus there are still some side effects that patients should be aware of before they take this CAR for a spin. One of them is a “cytokine storm” or cytokine release syndrome (CRS) that about 70-90 percent of patients may experience. Think of it as the radiator breaking down, leading to overheating of your engine with severe flu-like symptoms of fever and body aches.

This occurs secondarily to the multiplying activity of the T-cells, leading to a dynamic immune response.

Another side effect, known as “CRES” (CAR T-cell Related Encephalopathy Syndrome), can begin a few days after infusion of the cells where patients become confused and disoriented. Think of it as a breakdown in the transmission. You are unable to mentally shift gears and form complex sentences and thoughts that you were able to once before. Just like when you take your automobile to a busy shop, it takes a few days for things to be back to normal. These adverse effects are reversible with the right mechanic and a skilled tune-up.

Joshua Mansour, MD is a board-certified hematologist and oncologist doing work in the field of Hematopoietic Stem Cell Transplantation and Cellular Immunotherapy.

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How Much Should You Really Spend On Medical Marketing?

By QUINTIN L. GUNN SR.

This is a question I get asked many times as a Practice Development and Medical Marketing Consultant.

The short answer is at least 20 percent of your monthly income.

But if you don’t have 20 percent of your monthly income to start with, my response is always shaped in the form of questions.

These questions are vital to establish a baseline for new patient acquisition and revenue creation. Additionally, having the answers to these questions will help you know how much to ask for in the shape of an SBA via a Small Business Loan...

How much revenue are you trying to gain?

What is your budget to drive that income?

Do you have a strong enough sales team to help you reach those goals?

Can any of the current staff or in-house equipment be used to take you to the future?

What timeline are you expecting to reach the income goals you are expecting?

These are all legitimate questions because they go to the heart of our approach when creating a medical marketing plan.

No Doctor or Practice Manager should start out on a long journey of prosperity without counting the cost and knowing the time it will take to reach those financial goals. Otherwise, your boat is out to sea without a compass or rudder to steer your direction and course.

If you’re starting from scratch, expect to spend more to catch up to the pack. If your goal is to exceed the pack, then expect to spend more to move ahead. We have found this aggressive approach can lead to certain success or it can lead to certain disappointment if you hire the wrong market-

ing company.

Hire a solid marketing team who can shape and share your vision as well as your goals.

The chosen marketing company has to be flexible enough to diversify and can use many of the latest tools. Additionally, they should stay up on the latest innovations in technology while using demonstrated marketing techniques and strategies.

Planning your course is the big picture. Plotting your course is the steps you will take to get there.

Setting up your marketing accounts is free, but an effective marketing strategy run by an experienced marketing organization isn’t cheap, nor it should be, because of the time it takes to set up those pages correctly. And yes, it does take time if it is to be done correctly.

So plotting your course before you start your journey, is essential. This allows you to prepare for the lumps and bumps, zigs and zags that most certainly will occur. After twenty years in medical marketing and advertising, it is clear to me practice groups and solo practitioners will surely encounter difficulty as you push toward your financial goals.

Having a defined goal and a budget is essential. You get out of your budget, what you put in your budget. If your budget is small, expect small results, if your budget is big expect, big results.

Hire or keep employees who can sell and execute, as well as willing to put their own sweat equity into your journey. Anyone who says to you it’s not my job, that person is not likely on your team.

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Google Adwords are designed for quick impact and allow you to jump to the front of the line.

Facebook is designed for engagement, brand building, consumer outreach and most importantly viral marketing.

It takes time...

You should have patience because all great things take time and anything that is going to last has to have a brick and mortar foundation.

If you don’t plan well, you’ll run out of both time and cash.

There will be moments of discouragement and certain setbacks, but consider it all as a learning opportunity. There can be no success in your field without mistakes or problems. Otherwise, how can you learn? Not (CONTINUED ON PAGE 22)

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Starting from scratch means you’ve taken the time to study your competition, your market, and your ability to perform at the highest level, with the top equipment and products.

You should have a baseline of opportunity every month of no less than fifty leads per month. A good marketing team will be able to help you create those leads through Social Media AdWords and Retargeting as well as Google AdWords and Retargeting, Blog Ads, Chat etc..

Because there are many tools to use, finding what works best will take some time which is why you need to budget for one full year of marketing. In most cases you should expect to see some return by the first quarter of your marketing endeavour.

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How Much Should You Really Spend, continued from page 21

even Superman started flying out the gate.

If you are reengineering a Practice.

Recap your history and identify what worked and what didn’t. What products and services were popular or not.

• What tools do you have to measure outcomes and results of marketing as well as sales results?

• Do you set goals for your team and departments - Each department is its own profit center!

• Take an inventory of your services • What types of products do you offer on your menu?

• Is your location and marketing demographics able to draw the type of clients you want?

• Upsells or secondary sales after the initial treatments • What’s your average dollar per transaction and how do you improve it, what products and services pair well together?

• Do you have passive income opportunities that your missing, skincare line or supplements that of a high grade and can be private labeled just for your brand?

Private Labeling is what we call passive income. This is revenue which is created that you don’t have to touch other than watching the dollars go into your account!

Finally, the team you started with and have now, can they be trained to transition to a more fee for service model ?

Your assignment after reading this article is to select a competent marketing individual or organization that has shown demonstrated results or who has a solid reputation for the industry or speciality you expect to work or specialize.

What you don’t want is a marketing company or consultant who says yes to everything without giving you the facts and or downside of things you propose or want.

Marketing companies are easy to find until you run out of cash. So talk to others and really listen. Select a person or company who is both ethical, focused, and knows the necessary elements to achieve success.

What I have found is sometimes the bird in the hand is worth more than the bird in the bush. It’s an old saying but applies when clients migrate from one marketing company after another.

Marketing is based on results over time. If you don’t have the budget to market and the willingness to be patient for your seeds to germinate than its best not to get involved.

Constantly changing marketing companies takes away marketing momentum and reduces the progress you may have already made, not to mention additional setup fees to start with someone new.

In this case, you will have to do what you have to do, until you get where you’re trying to go!

So the answer to the question: How Much Should You Spend On Your Marketing Budget? The answer can only be determined by your goals and the time you set to get there!

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

SocialMediaSolutionsforDoctors.com

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Different Routes of Administration of Medical Marijuana

By MICHAEL PATTERSON

Currently, the Florida Department of Health Office of Medical Marijuana Use (OMMU) does not allow for smokable marijuana flower (buds) to be used legally.

However, with the state of Florida losing the legal challenge to smokable flower in 2018, Governor DeSantis has demanded rules and regulations on smokable flower passed through the Florida legislature during the 2019 Legislative session which began March 5, 2019. Therefore, we will most likely see legal marijuana flower for medical marijuana (MMJ) patients later in 2019.

With marijuana flower becoming a reality and rules for implementing marijuana edibles coming any day, it will give MMJ patients more choice in the route of administration of the cannabis plant. As more patients begin asking physicians about these new routes of administration (regardless if the MD writes MMJ recommendations), it is beneficial to know the different effects each administration route has on the human body.

VAPOR - This is the most common method of ingestion of MMJ currently in Florida.

Cannabis oil or flower is heated to a vapor, via a portable battery or stand-alone device, and inhaled. According to Researcher Dr. Kari Franson at the University of Colorado Skaggs School of Pharmacy, the bioavailability of vaporizing cannabis is between 5-20 percent with peak concentrations affecting the patient within minutes. These effects last 1-3 hours depending on the patient and tolerance to cannabis. Vapor allows patients to

inhale cannabis without combusting the medicine.

too many edibles due to lack of education of the delayed effect of ingestion.

SMOKING - Has a bioavailability of 10-25 percent with peak effects occurring within minutes and lasting 1-3 hours depending on the patient and tolerance to cannabis.

OIL/TINCTURES - Has a bioavailability of 50-75 percent which requires less product to get the desired effect. Oils and Tinctures offer a more reliable dose of cannabis, without the need to smoke or inhale the medicine. Oils and tinctures have a delayed effect compared to smoking or vaping. Peak effects can take up to one hour to appear and can last up to 5 hours.

EDIBLES - Edibles are any food product that contains cannabis (cookies, gummies, brownies, pretzels, chocolate products, drinks, coffee, etc.) The regulation will only allow the maximum dose of 10 mg of THC per each item. For example, if you buy a package of 10 MMJ cookies which contain 100mg of THC, each cookie would have 10mg of THC. This standardization of dosing for edible products at 10mg per item will decrease the risk of ingesting too many cannabis products.

With the bioavailability between 50-75 percent, edibles allow users to experience the desired effect with MMJ from less product compared to smoking or vaping. However, edibles have even a more delayed effect (peak effects can take 30 min-2 hours to appear), which can lead to patients taking

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TRANSDERMAL PATCHES Since cannabis transdermal patches are relatively new, there is little research on bioavailability. Transdermal patches have been known to provide a steady dose of cannabis medicine up to 48 hours while applied. However, it is not well known how much of the medicine penetrates the dermal layer of skin and provides adequate amounts of medicine to the body to get the desired effect.

Other delivery methods that are developing, but still not widespread are: INHALERS WITH MEDICAL CANNABIS (similar to an asthma inhaler) WATER SOLUBLE CANNABIS - This will be added to all types of drinks (including water) to deliver cannabis without any odor of a typical marijuana plant.

POWDERED CANNABIS - Imagine taking a small individual pack of powdered cannabis (similar to Sugar, Equal, or Stevia) and mixing it into any beverage. Powdered cannabis will provide convenience, discretion, and proper dosing of the medicine.

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

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