Orlando Medical News May 2018

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“Weekend Survivors”

Interactive Healthcare Collaborative Launches in Orlando 48 hours of edge-of-your-seat ingenuity

Medical City (Orlando, Florida) was the recent epicenter of a unique forgathering of talents from two of the area’s most emerging industries: healthcare and interactive arts and sciences. The reported first-of-its-kind event in the United States, held at the GuideWell Innovation Center, brought together 200 patients, physicians,

ON ROUNDS

PHYSICIAN SPOTLIGHT Oral James, MD ... 3 THE LOWEDOWN ON HEALTH LAW

Administrative Defense Coverage and/or Administrative Proceedings Defense Coverage ... 6

HEALTHCARELEADER

Steve Sevigny, MD Talks Healthcare from a Candidate’s View ... 7

RADIOLOGY INSIGHTS

Breast Seed Localization: Is it Time to Retire the Wire? ... 9

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HEALTH PODCASTS PHYSICIAN VIDEOS

PhDs, RNs, and healthcare executives with programmers, graphic and sound designers, and other creatives and technologists.

Their mission was to prove that fresh perspectives, talent, and technologies such as augmented and virtual reality (AR/ VR) can spark a flame of relevant, exciting new solutions for health and medicine.

LEVEL I

Created by the organizers of two local community meetup groups known as Health Innovators and Indienomicon, the team’s programming appeared far from simple. To begin, the group of mostly strangers listened to thirty, 90-second concept pitches then quickly

disbanded to meet with pitch leaders and vote on their favorites. Once the top ideas were announced, attendees scurried to formulate teams on the fly, and then got straight to work. Their next objective - create and execute a work plan to build interactive prototypes that (CONTINUED ON PAGE 4)

The Medical Marijuana Doctor is In

By JASON BEEKEN Editor’s note: This is the first in a series of articles answering questions from physicians to help clear confusion and inform about the medical marijuana industry and becoming qualified as a certified prescribing physician.

Medical Marijuana in Florida just recently turned one year old! Amendment 2 was passed in November, 2016 with a with a resounding 71.32 percent of the vote, and allowed Florida to join with 29 other states (plus DC) who allow Medical Marijuana.

Before this vote, only low TCH cannabis was available - now THC of any content is available to qualified patients. Still, there are many who are not familiar with the process. Well… The Doctor is IN and we are here to help.

What conditions qualify a patient for Medical Marijuana?

First, the patient must see a qualified ordering physician to be evaluated. Then they must be a resident of Florida - or at least a seasonal resident. Along with that, the Amendment outlines the following qualifying conditions: ​cancer​, ​epilepsy​, ​glaucoma​ , positive status ​HIV​, ​AIDS​, PTSD​, ​ALS​ , ​Crohn’s disease​, ​Parkinson’s disease​, ​multiple sclerosis​, chronic nonmalignant pain caused by a qualifying medical condition or that originates from a qualified medical condition or other debilitating medical conditions comparable to those listed. Physicians are also able to qualify patients based on conditions similar to the ones listed above. An example would be Ulcerative Colitis - which

is not specifically listed as a condition - but could still qualify a patient based on the condition being similar to Chron’s.

If a patient has met the conditions, what happens next?

The next step, is setting the patient up in the Florida Department of Health Registry. Each certified physician has a profile on the website and each of their patients is listed under them on the site. The patients’ information is uploaded, which generates two emails that are sent to the patient. From these emails they then must upload proof (CONTINUED ON PAGE 24)

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PHYSICIANSPOTLIGHT

Oral James, MD

Committed to the community that had faith in him as a young man

Oral James, MD, moved to Central Florida to be closer to family in Miami and along the East Coast — and to make it easier for him to pursue one of his passions: giving back to the Caribbean community that raised him.

Born and raised in Jamaica, his childhood on the island influenced him heavily, and he’s determined to return the favor by volunteering with a nonprofit organization that provides medical care to the region.

Dr. James’ move also brought him to HCA’s Poinciana Medical Center, where he’s sharing his 30-plus years of experience in gastroenterology, hepatology and internal medicine.

He’s practiced at various hospitals in Texas and the Caribbean and lectured as a clinical associate professor at the University of Texas Science Center at San Antonio.

In addition to being board-certified in gastroenterology and internal medicine,

James is certified by the American Heart Association in Advanced Cardiovascular Life Support and by the American Red Cross in Basic Life Support. He also has his Educational Commission for Foreign Medical Graduates certification.

He’s a member of the American College of Gastroenterology, the American Gastroenterology Association, the American Society of Gastrointestinal Endoscopy and the Texas Medical Association.

We spoke with Dr. James and asked him about his work at Poinciana Medical Center (PMC), along with his passion project, Heart to Heart World Mission.

What’s happening new with your practice at PMC?

I’m excited about the new piece of equipment we’ve acquired at Poinciana Medical Center — an endoscopic ultrasound machine. This tool uses a camera on the inside of the gastrointestinal (GI) tract to examine internal organs, allowing us to evaluate the pancreas biliary tract and lymph nodes around the GI tract. We can also visualize the deeper layers of the intestinal wall, which is very useful in assessing the stage of cancerous tumors and in finding gallstones in the bile duct. In addition, this procedure allows us to take biopsies of lymph nodes and the pancreas. Poinciana Medical Center is one of the few hospitals in our area to offer this

procedure and I’m thrilled that Poincianaarea residents don’t have to travel far to have this procedure done. With other advanced surgical procedures in my field such as Nissen Fundoplication, Stretta and LINX prosthesis, some patients with hiatal hernias would benefit from surgery. These new procedures also allow ample opportunities for professional growth.

The LINX procedure was FDA-approved in 2012 and augments the Lower Esophageal Sphincter (LES) with a ring made up of a series of magnets. The magnets have sufficient attraction to increase the LES closure pressure, but also to permit food passage with swallowing. The patient should have absence of a large hiatal hernia for this procedure. Stretta, on the other hand, is an endoscopic procedure with a series of 56 treatments delivered across five levels with monopolar energy via a catheter. This increases the pressure at the LES. There is also another procedure called Transoral Incisionless Fundoplication (TIF) which also helps to tighten the LES. Aside from medical treatments, I’m a huge advocate of nutrition and weight loss.

More than 70 percent of diseases are related to diet, and obesity affects every part of the body. A healthy diet and regular exercise are key to preventing gallstones, pancreatitis and numerous other conditions.

The most common condition I encounter is gastroesophageal reflux, which

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is a condition closely associated with diet.

Available treatments include lifestyle and dietary modifications as well as medications. Some patients with gastroesophageal reflux also develop hiatal hernias.

Tell us about your mission to give back to those in Jamaica.

Growing up in Jamaica, I was always told, “You’re going to become a doctor.”

I kept those words in the back of mind as I worked my way through school.

It was my family’s faith in me that helped me make that prophecy come true. Now, I want to return the favor.

I work closely with a faith-based organization called Heart to Heart World Mission, a consortium of doctors, nurses and dentists as well as nonmedical professionals who volunteer to care for underserved patients in Caribbean countries, including Jamaica and Haiti. Heart to Heart teams bring their expertise, critically needed medications and a strong desire to give back to those less fortunate.

I’ve been going on mission trips with Heart to Heart for five years now and have had the opportunity to see and treat all types of patients.

Of course, we’ve all heard heartbreaking stories about impoverished countries.

But seeing the effects of poverty firsthand has changed me as a person and as a doctor. I see this change the most in my bedside

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HEALTH INNOVATORS Interactive Healthcare Collaborative Launches in Orlando, continued from page 1

FEATURED INNOVATORS AND WINNERS OF THE MeGa HEALTH JAM 1ST PLACE:

Boo Boo Snap

could potentially disrupt the way patients, caregivers, and clinicians experience and engage in healthcare. (Queue the Mission Impossible theme song…) They had less than 48 hours to complete the mission.

Getting to this point was a challenge of its own. Despite both being highly engaged in curating the local tech scene, the two group’s leaders, Kelli Murray and Kunal Patel were total strangers prior to the idea being posed.

“My hunch was that converging these very different groups of talent would, at a minimum, be met with skepticism; particularly by professionals in health and life sciences who tend to be apprehensive and by the book. I can say that because after 20 years in healthcare, I was dubious to the initial concept. Medicine’s reputation is serious business, not fun and games. But, after some research, I began to quickly realize that game design is a key to unlocking barriers for engagement, compliance, and experience. Maybe this is where the (healthcare) industry as a whole has failed to notice a tremendous opportunity,” said Murray, one of the region’s preeminent voices in the healthcare entrepreneur community and co-founder of Health Innovators.

The first step was finding the right mix of perspectives for the pre-event, affectionately known as the MeGa Night of Talks & Laughs. Adding an element of humor and lightheartedness was of critical value because the multi-night event required the right tone. This meant finding local healthcare leaders who not only had a unique lens for healthcare but also understood interactive technologies like simulation, video games, and virtual and augmented reality.

To the delight of a standing room only crowd, Haru Okua, MD, who is co-founder of SIMWARS, a board member of the Society for Simulation in Healthcare, and National Medical Director of SimLEARN at VHA, revealed that he is also, in fact, a gamer. Victoria Loerzel, RN, PhD, at UCF’s School of Nursing and recipient of a grant used to fund a serious game to control nausea and vomiting for seniors undergoing chemo, is also a long-standing game enthusiast, as is Jonathan Truong, CEO of Verapy, a self-described non-compliant physical therapy patient, who now creates virtual reality exercise games for a living.

To top it off, several local startups showcased their innovations while a comedian delivered a variety of jokes aimed directly at both the medical and gaming industries.

LEVEL II

Finding the right partners – those who see the possibilities and understand the immense talent based here in Central Florida – was also imperative. According to co-organizer and ideator, Kunal Patel of Indienomicon, “The concepts of gamification to drive better engagement as well as gaming technologies like AR/VR/ Apps are going to be increasingly prevalent in every industry, including healthcare. We knew the speed of prototyping and innovation produced and iterated over MeGa Health Jam would be faster than most in healthcare would be used to, and that was exciting.”

Almost from day one, local universities including Full Sail, FIEA, Nova, and Orange Technical College were on board as sponsors. Dr. Deborah Beidel, Director of UCF RESTORES, also seized the opportunity to apply advanced technologies such as virtual reality, which her organization already uses as a form of therapy to help improve the lives of combat soldiers suffering from PTSD. The world-famous EA Sports, creator of Madden NFL also supported the effort along with local simulation company ECS, and gaming technology companies Virtual Hammer, and CG Solutions, which has a game about fighting viruses in the human body.

From a provider perspective, the inaugural advisor pool was impressive.

Despite the low support by hospital systems, individuals from these organizations stepped right up. Physicians from Orlando Health, Nemours, Harvard, and Stanford along with MD entrepreneurs from KinderDoc and Symplast assisted and were adorned with red monogrammed stethoscopes to denote them as advisors. (To see the full list of advisors, go to www.megahealthjam.com.)

One hospital system, however, Florida Hospital, stepped beyond their traditional comfort zone to not only help offset some of the costs of the endeavor, but also had two of their top talents in innovation participate. Ashley Simmons, Director of Design Integration served as a health advisor and Richard Paul, of the Florida Hospital Innovation Lab provided a competitive, yet fun team-building improv activity to kick off the weekend; something that will be remembered by all.

Where else would you find a physician from Orlando Health and another from Harvard competing in a game of Rock, Paper, Scissors? Only here, folks.

LEVEL III

Of the 30 pitches, 17 concepts moved forward to form official teams. Concepts were surprisingly diverse and reached a cross range of interests including social responsibility to prevent student harm, human trafficking, and opioid addiction to anxiety, ADHD, emergency room throughput, meditation, radiology imaging, wound management, and physical therapy. Each prototype had a unique goal in mind to help users experience the psychological motivators that activated them through participation.

“These new concepts took a traditional, sterile industry and amplified it by leveraging rewards, art, and sound in a creative, immersive and interactive human experience,” said Murray.

For many health professionals, even those who understand the power of things like simulation and robotics, simply using the word “game or gamify” elicits a stigmatic response of skepticism. The reality is that now is the time to really start looking beyond traditional means of engagement. Everyone involved in health and medicine should get ready to embrace interactive technologies – AR/VR/Simulation and apps are here to stay and they are the future. It’s how brands will discover new connections with their consumers to educate and simultaneously delight them in some way.

“That’s why I was so excited for MeGa Health Jam,” said Nina Talley of MedSpeaks, adding, “it was designed to bring down the walls between the industries in a way that went beyond networking. We were seeing real time collaboration between highlevel minds in healthcare and an emerging generation of technologists, and our clinicians were absolutely blown away by what was able to be accomplished in such a short amount of time.”

So far, the results are very promising.

At least 7 commercialization meetings, 2 job offers, and a grant application are in the works!

“This event was a demonstration of what innovation in the healthcare space truly is. Viewing healthcare problems through the lens of the gaming community was an opportunity to see solutions that the traditional “answer finders” never would have found,” said Christine Certain, Director of Clinical Operations and Innovations for The Children’s Home Society of Florida.

The inaugural event was so successful that plans for MeGa Health Jam 2019 are underway.

See all the projects presented here at itch.io/jam/megahealthjam2018! Listen to the “This is Orlando” podcast by co-organizer Rob Coble at robcoble.org.

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No one likes to get shots, cuts, or Boo Boos. What if there was a way to be rewarded for getting a Boo Boo? That’s what the duo of Christine Wright and James Gaiser, graduate students of FIEA (Florida Interactive Entertainment Academy) set out to create.

When children get a shot or injury they often turn to a Band-Aid for comfort. What if instead of just a colorful flat image, it was an animated 3D image that spoke to the child?

What if a child could use their tablet to see an epic germ battle play out over their scraped knee or Dora the Explorer finding a clue and teaching them Spanish while their vaccination Boo Boo heals?

Their augmented reality (AR) innovation caught the eye of Fox News which recently covered the development. As winners, the creators received $10,000 in business services ranging from free office space at Orlando Game Space, commercialization services from MedSpeaks, legal business setup by Mia Mota, Esq., and booth space at this year’s OrlandoIX and Ontronicon 2019.

It’s a forward-thinking concept for something as mundane as bandages, which is why it placed first among a panel of judges ranging from Dr. Shayan Vyas, a Pediatric Medical Director, Matt McBride, a local entrepreneur of a telemed platform called Mend, and Nina Talley, a Millenial with a keen eye for usability.

Since winning on April 15th, Boo Boo Snap has continued to build upon the platform by adding advanced features and proprietary elements that turn this into a commercially viable company.

2ND PLACE:

Zen Bloom

An interactive meditation "game" that drives the building and blooming of your garden to relax you while extending the range of motion of your limbs using therapeutic exercises.

3RD PLACE:

bARk

Distraction therapy and anxiety reducing app for children and adults to play with an augmented reality based dog named ARchie.

AUDIENCE FAVORITE:

Fantastic Hands and Where to Catch Them

Using chiropractor-approved hand gestures, the patient is immersed in occupational therapy game play that encourages the extension of all five fingers and the hand/wrist in which the player can only progress with proper form.

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THE LOWEDOWN ON HEALTH LAW

sponsored by

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 healthcare 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 supervi-

sor 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-ofpocket 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 limit 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. Healthcare 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 healthcare regulatory and administrative claims and investigations. Simply stated, even if it costs additional dollars to purchase such coverage, healthcare providers and professionals are well served to consider purchasing such coverage which is generally much less expensive than paying for the defense of administrative and healthcare regulatory law investigations and proceedings out-of-pocket.

The Healthcare Team at Forster Boughman Lefkowitz and Lowe work to defend healthcare providers and professionals 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 car-

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FOR MORE INFORMATION regarding health care law and such matters please visit our website WWW.FBL-LAW.COM or call our office at (407) 255-2055.

rier panel. Florida Board-Certified Health Care Attorney Michael Lowe and Forster Boughman Lefkowitz and Lowe are recognized on several insurance carrier’s panels for defense of ADC/APDC matters.

The Healthcare Team at Forster Boughman Lefkowitz and Lowe 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 boardcertified health law attorney at Forster, Boughman, Lefkowitz & Lowe. 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.

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HEALTHCARELEADER

Steve Sevigny, MD District 6 Congressional Candidate Talks Healthcare from a Candidate’s View

By PL JETER

Steve Sevigny, MD, was born in Providence, RI, but moved to Sarasota when he was nine. The family owned a small business called The Trophy Shoppe and grew it into a landmark firm.

He attended the University of Florida as an undergraduate and medical student where he met his wife, Gina, also a med student. After graduation from medical school in 1994, they began residencies during which they both became chief residents, and then moved to Ormond Beach.

Sevigny, is a radiologist with Radiology Associates Imaging group headquartered in Daytona Beach, with practices at Halifax Hospital and imaging centers from St Augustine to Deltona. His wife is owner of Ormond Beach Dermatology.

He is a MSK fellow and has been in practice for 19 years. Sevigny serves on the board of directors of National Bank of Commerce (NCOM), Volusia/Flagler Easter Seals, and many other community organizations. He is running for U.S. Congress, District 6, which encompasses all of Volusia, Flagler, and parts of Lake and Saint Johns Counties. It is an open seat.

OMN: What experiences from your

own practice do you want to see

in national policy?

DR. SEVIGNY: In radiology, there have

been some recent policies that have clearly benefited patients. Most have been from programs started with the American College of Radiology and then continued to become national policy. In our practice, we begin reporting radiation doses prior to it being required. We used the national dose registry early on and continue to closely monitor our patient doses. That was a quality improvement program started by a specialty society that became law once the society could prove its usefulness. I prefer the medical societies driving the practice improvement aspect of regulations. Having underpaid junior staffers and interns on Capitol Hill with zero practical experience writing the rules is clearly suboptimal. We need people involved in the development of healthcare policy that understand how to get the best outcomes for patients.

Part of running for office is calling every physician you know to ask for financial support, in addition to moral support.

It is amazing to me how many physicians I speak to that are fed up with the pace of work and the paperwork that has taken over their days. Too many of my med school classmates are not even practicing

medicine any more. We must do better.

You’ve stated your support for a universal healthcare system. How do you see that system working... several elements to arrive at the goal or a single payer system?

We are the greatest, richest country in the world. We spend up to twice as much as every other country, yet we are the only advanced economy of the top 40+ that doesn’t cover everyone. That HAS to change. There are plenty of options including a recently announced Medicare E option. I’m not tied to any one plan, but my overarching goal is for universal healthcare. It needs to go beyond universal coverage. A middle-class family with a $12,000 deductible does not really have the healthcare security that they deserve.

What are your thoughts on increased price transparency (and how we should get there)?

Price transparency is a significant issue, more so with the hospitals and pharmacies. There have been some recent attempts in working with pharmacists and pharmacy benefit managers to develop more consumer-friendly legislation. When a customer enters the pharmacy, the pharmacist should have a duty to research

what is the best price for the customer. The PBM’s have way too much power including, at times in some states, putting a gag order on pharmacists. It’s no secret that Big Pharma spends hundreds of millions of dollars lobbying every cycle. We need a new generation of leaders that will put people before the entrenched paradigm of money and power. Consumers (patients) shouldn’t be wrought with fear every time they enter a doctor’s office or a pharmacy, or so fearful that they don’t even seek the treatment or medicine they need.

What are your thoughts on the trend of healthcare consolidation?

I believe the governmental regulations have played a significant part in that. I can’t remember the last independent, new physician practice that has started in our area. As an independent radiologist, it is concerning to see every physician employed by the major hospital systems.

Our Radiology practice has been successful through the years because we have always felt that we needed to be (CONTINUED ON PAGE 24)

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Shepherd’s Hope Honors Local ARNP with Volunteer of the Year Award To Shepherd’s Hope, Jamie Lynch, ARNP, is a real life super hero. Nurse practitioner with Orlando Health Heart Institute by day – weekly medical volunteer and chair of the faith-based nonprofit’s clinical program committee by night.

And, marathon runner and Iron Man competitor in his free time.

Last month, Shepherd’s Hope honored Jamie Lynch as Outstanding Volunteer Clinical Practitioner of the Year at its annual fundraising and volunteer recognition event, “Call to Hope.” In addition to raising $210,000 in one-time gifts and multi-year pledges, the event also highlighted the work of 2,800 volunteer medical and lay personnel like Lynch who, in 2017, provided 44,000 hours of free medical care to the uninsured and underinsured at Shepherd’s Hope’s five local health clinics.

Ronald “Jamie” Lynch grew up in Miami. Early on, family members who were pharmacists and physicians influenced his decision to pursue a career in healthcare. Then, following a volunteer stint in a hospital emergency department, he was hooked.

Lynch graduated from the University of Central Florida in 1987 with a Bachelor of Science degree in Nursing and earned his master’s degree in Nursing with honors from the University of Florida in 1990. He has also held leadership roles with local chapters of American Heart Association and American Association of Critical Care Nurses.

His entire career has been at Orlando Health, starting as a student nurse and, for the past 28 years, as the first nurse practitioner with the Orlando Health Heart Institute where he considers Irwin Weinstein, MD, a lifelong mentor and fellow super hero.

A pioneer in Central Florida’s nurse practitioner community, Lynch cofounded the Central Florida Advanced Nursing Practice Council in 1990. He also lectures nationwide on continuing education topics for nurse practitioners and physician assistants.

Fifteen years ago, Lynch became involved in Shepherd’s Hope as a medical volunteer. Today, he also serves as chair of the Clinical Program Committee and a member of the Board of Directors. Here, he shares his thoughts and experiences in the hope that other healthcare professionals will take up the cause and join him.

Q: Talk about the volunteer work you do

with Shepherd’s Hope.

I started in 2003, volunteering monthly at the now-closed Eatonville clinic, then transitioned to seeing patients at the Dr. Diebel, Jr. Memorial Shepherd’s Hope Health Center in east Orange County. I also do monthly cardiology/internal medicine clinics at the Diebel clinic and the Ocoee clinic in west Orange County to manage patients who have been diagnosed with cardiology issues.

In addition, I took over Pia’s role on the Shepherd’s Hope board of directors and co-chair of the Clinical Program Committee. The role of the committee is to support the recruiting, training, recognition and retention of all Shepherd’s Hope volunteers whose purpose is to ensure that the medical needs of eligible patients are met.

Q: Is there a memorable patient

encounter that is especially meaningful to you?

A recent example is the influx of Puerto Rican evacuees following hurricane Maria.

They arrived in Central Florida after being homeless and without power for weeks.

Many of them had a cardiology history.

Shepherd’s Hope met them at the airport, assessed their health situation, got them the immediate prescriptions they needed and then referred them to one of our clinics for outpatient follow-up.

More than half of these patients are Spanish-speaking only. When they arrive at the clinic, it can be a little fragmented between the interpreter, the scribe who is inputting notes, and me. They are often in despair and worried about their health problems; especially those who I see in the cardiology clinics. But when they realize we know how to treat them and have the resources to do so, it provides an incred-

Jamie Lynch (far right) received the 2018 Outstanding Volunteer Clinical Practitioner of the Year award from Shepherd’s Hope at its annual “Call to Hope” event in April. Also pictured (from left): Shepherd’s Hope Founder Dr. William S. Barnes, President and CEO Marni Stahlman, and Dr. Ruth McKeefrey, Shepherd’s Hope’s first volunteer executive director for whom the awards are named.

ible sense of relief for both the patient and their family.

Q: What would you tell other medical

professionals who may be interested in volunteering at Shepherd’s Hope?

It’s a rewarding opportunity to return to your roots and remember why you chose the medical profession. Thanks to the system Shepherd’s Hope has in place, including the scribes who are primarily pre-med students, medical volunteers can focus on listening to the patient and providing care without having to worry about every DRG category and all the other documentation that is required these days. It’s an incredibly gratifying experience.

“Access to quality healthcare for our neighbors in need has been the mission

of Shepherd’s Hope since 1997,” explains President/CEO Marni Stahlman. “We could not fulfill our work of caring for the uninsured and underinsured without people like Jamie Lynch.”

In recent years, the organization has been stretched far beyond its capacity.

Despite providing 19,575 patient visits and medical services in 2017, Shepherd’s Hope had to turn away another 900 patients because they didn’t have the resources to meet their needs.

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

Q: How did you become involved in

Shepherd’s Hope?

In the late 1990s, former Shepherd’s Hope board member Pia Valvassori was a public health clinician involved in starting the Healthcare Center for the Homeless and she recruited me to volunteer. Several years later, when their service model changed to a daytime clinic, I followed Pia to Shepherd’s Hope, and the rest – as they say – is history.

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RADIOLOGY INSIGHTS

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Breast Seed Localization: Is it Time to Retire the Wire?

LEENA KAMAT, MD

In those breast cancer patients who are injected with technetium 99m for the purpose of sentinel lymph node mapping, the unique radiation properties of the radioactive seed, which is typically Iodine-125, allows it to be distinguished. A handheld gamma detection probe can show the two peaks as distinct allowing one to confidently distinguish the localized breast lesion from the sentinel lymph nodes. Furthermore, real-time intra-operative monitoring of the detected gamma counts from the seed allows for more accurate lesion localization with lower incidence of positive margins and decreased need for repeat surgery than with wire localization.

Lastly, are radioactive seeds safe? Radioactive seeds are considered by the Nuclear Regulatory Commission to be safe for human exposure. As the seeds are used as point reference sources for localization rather than for therapeutic treatment, fewer seeds are used and the seeds remain within the patient for a limited time.

Both wire and seed localizations are performed by radiologists utilizing image guidance and done in the radiology department. The radiologists from Radiology Specialists of Florida at Florida Hospital are very well trained and experienced. We have radiologists specifically trained in breast imaging who diagnose imaging abnormalities of the

breasts, perform image-guided biopsies, and who perform wire and radioactive seed localizations prior to surgery. We keep up to date on the latest technology and information so that we can offer patients the best care.

The Florida Hospital Care Network delivers seamlessly connected healthcare services for all ages. For more in-

formation visit Somedaystartstoday.com.

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

How do surgeons know where to cut to remove a breast cancer that can’t be felt by hand? The purpose of this article is to provide special education about radioactive seed localization for breast abnormalities and its advantages over the traditional wire localization.

After appropriate diagnostic breast workup, a breast abnormality including cancer may need surgical intervention. If lumpectomy (partial mastectomy) or excision is pursued, then the area of interest in the breast will need to be localized prior to surgery to guide the surgeon. Localization, which marks the area to be removed that may be too small to be felt by hand, is done two ways: using a wire or a radioactive seed and placed using image guidance.

During wire localization, a wire is placed in the breast at the target site and done on the day of surgery. Seed localization is a procedure in which a tiny metal seed, about the size of a small sesame seed, is placed into the breast at target site. Radioactive seeds contain a small amount of radiation and can be placed several days prior to surgery as it stays in place in the breast. Since seeds are placed internally, with no external wires extruding from the skin surface, there is no risk RADIOLOGY SPECIALISTS OF FLORIDA Under the direction and guidance of Florida of wire dislodgement or migration with Hospital, Radiology Specialists of Florida is resultant loss of localization. fully dedicated to providing our community Wire localizations are restricted to with excellent medical imaging services. day of surgery;RADIOLOGY therefore, cases requiringSPECIALISTS OF FLORIDA wire localization cannot be scheduled until after there has been adequate time for wire Under the direction and guidance of Florida Hospital, Radiology Specialists of Florida is fully placement and transport of the patient to dedicated to providing our community with excellent medical imaging services.

WE PROVIDE the operating suite. A major advantage of seed localization over wire localization in• 24/7 Reads and accessibility Under the direction and guidance of Florida Hospital, Radiology Specialists of Florida is fully cludes the ability to place the seed in the • Continuity of care dedicated to providing our community with excellent medical imaging services. breast up to 5 days before surgery, which • State of the art technology greatly reduces scheduling conflicts. Seed • High Image quality Under the direction and guidance localization cases can be scheduled in theof Florida Hospital, Radiology Specialists of Florida is fully • Lowest Levels of Radiation operating room as the to firstproviding case of theour day.community with excellent medical imaging services. dedicated Additionally, patients who underwent seed • Trusted Florida Hospital Radiology localization at least one day before their surgery rated the convenience of the entire process significantly higher than those who had wire localization.

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Waiting Room Woes

Design Solutions for Improving the Waiting Room Experience

BY AMBER CLORE

While waiting room décor may not be the main influence for a patient to choose your practice, its will certainly affect their memory and feeling associated with your brand. Loyal patients and customers are the first to appreciate the benefits of a beautiful waiting room that promotes health, wellness and productivity – a human-centric experience. I admit there is no novel idea in creating an attractive space for patients and their caregivers to play the so-called “waiting game,” but it seems to be a challenge in healthcare and in most service industries.

With a world of technology at our fingertips and the high level of information/data gathering, there is an upward turn to utilizing these concepts in moving toward an emphasis on quality and comfort-ability. As the healthcare industry emphasizes its focus on the patient as a consumer, we are seeing an overhaul to enhance the experience a patient will have. After all, the waiting room is the first opportunity to tell patients who you are and what you will do for them.

Let’s take a moment to look at today’s waiting room. The waiting spaces are intended to be a place of comfort and information with a seamless healthcare experience. But all too often, we are encountered with uncomfortable seating arrangements, harsh lighting, and little access to knowledge. Unfortunately, healthcare is full of bad design. But with a little forethought and planning, it doesn’t have to be.

So, how can we make waiting spaces more accommodating? We’re focusing on some simple design concepts to help guide the way: Color Scheme, Space Plan, Lighting Control, Furniture, and Signage.

COLOR SCHEME

Starting with my best friend, color.

The first thing I notice in a healthcare office is the color scheme, be it pepto-pink or boring beige. Even the perfectly decorated waiting space can be uninviting if the color scheme is off putting. Choosing the correct color for your practice is vital for the feeling you want to portray to your patients. Opt for muted hues of blue, pink, violet, green or gray before letting boring beige in the building. These colors are calm and inviting and will keep your patients relaxed during their “stay.”

SPACE PLANNING

There is a high level of importance in space planning and way finding being shown in recent behavioral studies. Researchers have been examining the flow of the waiting room experience and have found that patients are left needing more information sources, privacy/personal space and an attention to the family gathering space. Therefore, a waiting space with a few 10

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different options and a level of multi-functionalism is key. You can create a more appealing environment with variety of spaces such as, family friendly nooks, areas for television and news watching and specific areas for professionals to plug in their laptops.

You can take it a step further by bringing technology to your patients to gather and deliver information. Using tablets provides a “one stop shop” for all the information of your practice at the patients’ fingertips.

LIGHTING CONTROL

This element will make or break the ambiance of a space…any space. Fluorescent lighting makes everyone a little uncomfortable and believe it or not, can lead to complaints about headaches. When there is a choice, natural light is the best light.

When natural light is limited or unavailable, you can select natural, muted bulbs that provide a similar type of light you would have in your home. Having the opportunity to create different lighting settings or “moods” throughout the day can enhance the user experience and promote health.

FURNITURE SELECTION

Comfort should be the most important aspect when selecting your waiting room furniture. Most people do not like being forced to sit next to a stranger, in a hard chair, with a bad TV blaring HGTV. But be aware that comfort will mean something different for each healthcare practice.

When we are designing spaces for people with sensitive backs we would typically use chairs with no cushions, but an OBGYN will require chairs with more cushion and comfort. The furniture in the waiting room should be cohesive and blend together. Mismatched furniture and uninviting seating arrangements are of the past.

SIGNAGE

Finally, a good communication plan is vital to keeping your patients informed.

The first step is letting them know what to do as soon as they arrive. A helpful “Check in at the front desk” or “Sign In Here” directive will start a relaxed process of navigating your waiting room process.

Let’s not forget the power of pampering! Thinking past the complimentary bottle of water, consider your waiting room guests are waiting for a spa appointment. But always remember, design should focus on how to make healthcare spaces more efficient and effective - with an upmost focus on health.

Amber Clore, ASID, is a Florida Registered Interior Designer (#ID6200) and owner of A.Clore Interiors located in downtown Sanford. The firm specializes in designing healthy spaces in Commercial and Residential environments. She is currently the President for the Florida North Chapter of The American Society of Interior Designers. Amber can be reached at amber@acloreinteriors.com or www.acloreinteiors.com

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Dr. Stephen Sevigny is Running for Congress Sixth District, Florida

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GrandRounds The Villages® Regional Hospital Wound Care and Hyperbaric Center Recognized With National Award

The Villages® Regional Hospital physicians, leaders, and clinicians gathered today to celebrate the Robert A. Warriner III, M.D., Center of Excellence award, which was given to the hospital's Wound Care & Hyperbaric Center for the fourth consecutive year. The Center has achieved patient satisfaction rates higher than 92 percent and a healing rate of at least 91 percent in less than 30 median days to heal.

"We are very excited to receive this prestigious award for our Wound Care Center in The Villages,” stated Bill Pfingsten, FACHE, vice president of ambulatory services for Central Florida Health, the parent organization of The Villages® Regional Hospital. "This honor gives great recognition to our staff and physicians for the care they provide. The patients we treat are often struggling with very difficult wounds and our Wound Care & Hyperbaric Centers may be their last chance at healing.”

The Villages® Regional Hospital Wound Care & Hyperbaric Center offers highly specialized wound care to patients suffering from diabetic ulcers, pressure ulcers, infections and other chronic wounds which have not healed in a reasonable amount of time. Advanced treatments include negative pressure wound therapy, bio-engineered skin substitutes, hyperbaric oxygen therapy, biological and biosynthetic dressings and growth factor therapies.

"If you are living with a wound that is slow to heal or hasn't healed at all, we can help,” commented Panthipa Laowansiri, MD, the center's physician and medical director. "Our mission is to share our wound care expertise everywhere we can, for anyone who would benefit, by the best means available.”

AMA Marks Milestone in Efforts to Create the Medical School of the Future

The American Medical Association (AMA) is marking five years of progress in its ongoing work to develop bold, innovative ways to improve physician training that can be implemented across medical education. The AMA, along with the Warren Alpert Medical School of Brown University, convened its 32 school Accelerating Change in Medical Education Consortium in Providence, R.I., this week to build on efforts underway to ensure future phy12

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sicians across the country are prepared to care for patients in the changing health care landscape.

Brown's Medical School is among this select group of schools that developed a new curriculum as part of the AMA's Accelerating Change in Medical Education Consortium to reshape medical education nationwide. Through the $1 million grant it received in 2013 to work with the Consortium, Brown created a first-inthe-nation program designed to train physicians who, with a focus on population and public health, can be future leaders in community-based primary care at the local, state or national level. This is an important innovation given that the modern health system will require physicians to think beyond caring for just an individual's health and take into account the health of a population to improve patient safety and health care quality.

"Since launching this bold effort nearly five years ago, the AMA and our 32-medical school Consortium have made significant progress toward ensuring future physicians are prepared to meet the needs of patients in the modern health system,” said AMA CEO & Executive Vice President James L. Madara, M.D. "This May, the first medical students to receive full training under the new curricula developed at some Consortium schools will begin to graduatedirectly impacting the way that health care is delivered to patients nationwide. During a period of rapid progress, new technology, and changing expectations from government and society, we believe these students will be better equipped to provide care in today's modern, technology-driven health care environment.”

Launched in 2015, Brown's new Primary Care-Population Medicine program is helping its students learn how to deliver care that meets the needs of patients in modern health systems-the main objective of "Health Systems Science,” the third pillar of medical education which was identified by the AMA Consortium that should be integrated with the two existing pillars: basic and clinical sciences. Brown was among the 11 founding Consortium schools to formalize the strategy and write a textbook to help physicians navigate the changing landscape of modern health systems, especially as the nation's health care system moves toward value-based care. The "Health Systems Science” textbook was released in 2016 and is being used by medical schools across the country-including Brown-to ensure future physicians learn about value in health care, patient safety, quality im-

Orlando Health South Lake Hospital Opens Expanded Emergency Room Orlando Health South Lake Hospital welcomed its first patients through the newly expanded emergency room entrance this morning.

The first phase of the expansion is completed, which includes a new, more easily accessible entrance, a larger family-friendly waiting area and eight additional patient rooms.

The second phase of construction also began today, which will renovate existing space in the emergency room so that when completed later this summer, will expand the number of patient rooms in the ER from 29 to 40. An additional shelled space is also being added to allow for future expansion when needed.

"This expansion allows us to continue to meet the growing emergency healthcare needs of south Lake County,” commented Jeffrey Fitch, MD, Emergency Department Medical Director and Chief of Staff at Orlando Health South Lake Hospital.

Emergency room visits at Orlando Health South Lake Hospital have continued to steadily increase over the past decade to well over 50,000 each year. The hospital was founded in 1947 and opened its current facility in 2000. When the new facility was opened in 2000, it had 12 emergency room beds and later

expanded in 2006 to 29.

"We have seen constant growth in our service area throughout the past two decades and we don't see it slowing down any time soon,” said John Moore, Orlando Health South Lake Hospital President. "We are proud to be the leading healthcare provider of emergent care in south Lake County and this latest expansion improves our community's access to care.”

Additional features of the expansion include a children's area in the waiting room, an expanded rapid treatment unit to allow boardcertified emergency physicians to quickly treat minor emergencies, a new triage area and a room dedicated to bariatric patients.

The entrance to the emergency department is still located off of Oakley Seaver Drive as it was previously.

This project is of three expansion projects currently underway for Orlando Health South Lake Hospital.

The hospital is also building two new free-standing emergency departments and medical pavilions in the north and south end of its service area, both of which will open this summer.

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GrandRounds provement, teamwork and team science, leadership, clinical informatics, population health, socio-ecological determinants of health, health care policy and health care economics.

"The support of the AMA Consortium has been critical to the development and success of our innovative Primary Care-Population Medicine program. In addition, all of our medical students now have instruction in health systems science, helping them to understand the broader context of health care in which they will be practicing. We are excited to welcome the AMA, representatives of the other Consortium schools, and leaders in medical education to Brown and Providence,” said Allan R. Tunkel, M.D., Ph.D., associate dean for medical education at the Warren Alpert Medical School.

The AMA launched its Accelerating Change in Medical Education initiative in 2013-providing $11 million in grants to fund major innovations at 11 of the nation's medical schools, including Brown's Warren Alpert Medical School. Together, these schools formed a Consortium to share best practices with a goal of widely disseminating the new and innovative curricula being developed to other medical schools. The AMA expanded its Consortium in 2015 with grants to an additional 21 schools to develop new curricula that better align undergraduate medical education with the modern health care system. These innovative models are already supporting training for an estimated 19,000 medical students who will one day care for 33 million patients each yearincluding an estimated 500 medical students in Rhode Island who will one day care for more than 900,000 patients annually.

The AMA will continue to work with more leaders and innovators from medical and health professions education to advance its efforts aimed at accelerating change in medical education to ensure future physicians are prepared to quickly adapt to the changing health care landscape and provide value-based care as soon as they enter practice.

Cyrus Diagnostic Imaging Now Offers Enhanced Patient Comfort and Power in MRI Exams

Siemens Open Bore MAGNETOM Skyra 3T MRI offers powerful, fast and patient-centric examinations Magnetic Resonance Imaging (MRI) exams have become one of the fastest growing types of medical diagnostic tests in the United States, due, in large part, to its ability to provide non-invasive diagnostic images of soft 13

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tissues, bone, fat and muscles and to help in the detection and diagnosis of a variety of health conditions, including orthopedic injuries, breast cancer, neurological disorders and cardiac diseases. And now, Cyrus Diagnostic Imaging announces the installation of a MAGNETOM Skyra 3T Open Bore MRI from Siemens Healthcare. In the past MRI exams have not always been comfortable for or well tolerated by certain patient groups, including the elderly, obese (up to 550 pounds) individuals or those who experience claustrophobia, excessive pain or limited mobility. This is due to the relatively small doughnut-like opening where the patient lies, called the bore, and the long tube-like structure of the machine, which can feel confining. However, the MAGNETOM Skyra’s large 70cm open bore – along with its short length (173 cm) can help reduce patients’ anxiety and help put them at ease. The accommodating features of the MAGNETOM Skyra, combined with 3 Tesla (T) magnet strength – the strongest clinically available– means that Cyrus Diagnostic Imaging patients can now enjoy a larger array of imaging options with high quality images. Another patientfriendly feature includes mood lighting on the system, which can help create a calming environment for patients in the examination room. The system is equipped with two exclusive Siemens technologies: Tim™ 4G and Dot (Day optimizing throughput). The combination of Tim and Dot improves the entire MRI workflow and delivers patientcentered care. The results are faster, more comfortable exams for patients.

Cyrus Diagnostic Imaging MAGNETOM Skyra was installed in April.

Dr. Denise Clark Named Senior Medical Director Of Vitas Healthcare For Lake And Sumter Counties VITAS Healthcare, the nation's leading provider of end-of-life care, named Denise Clark, DO, senior medical director of its hospice and palliative care program serving Lake and Sumter counties. Dr. Clark leads a multidisciplinary team that provides patients and caregivers the physical, emotional, social and spiritual support they need at the end-of-life.

Among the unique services Dr. Clark oversees are a palliative care program for patients with terminal cancer and a cardiac care program for patients with end-stage heart failure and other cardiac conditions, providing access to evidence-based cardiac care alongside holistic endof-life care.

"My goal as senior medical director is to work with my fellow clinicians in the Lake-Sumter community to ensure our patients receive end-oflife care that aligns with their wishes and values,” said Dr. Clark. "Moreover, I'm committed to educating patients, families, physicians and staff about the role quality end-of-life care can have in helping a patient achieve a comfortable and peaceful transition to their next journey.”

Board certified in family medicine and hospice and palliative

medicine, Dr. Clark joined VITAS in 2010 after two decades in private practice. Most recently she served as a medical director in central Florida.

In addition to her position at VITAS, Dr. Clark is on the faculty of Florida State University College of Medicine as a clinical assistant professor. She is also on the National Faculty of the National Board of Osteopathic Medical Examiners.

Dr. Clark received her doctoral degree in osteopathic medicine at A.T. Still University in Kirksville, Missouri, the oldest osteopathic medical school in the country. She completed her internship at Dallas-Fort Worth Medical Center, a residency in family medicine at Florida Hospital-East Orlando, and a residency in anatomic and clinical pathology at the University of Florida, serving as chief resident her third year.

VITAS began accepting hospice-appropriate patients in Lake and Sumter counties in January. Visit VITAS.com.

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GrandRounds Osceola Regional Educates More than 3,000 People on How to "Stop the Bleed"

Since adopting the "Stop the Bleed, Save a Life” program in August 2017, Osceola Regional Medical Center has educated more than 3,000 Central Floridians on critical bleeding-control skills.

Recent news events have highlighted the need for bystanders to be prepared to respond to medical emergencies. Launched in 2015 by the White House, Stop the Bleed is a national awareness campaign that prepares people to assist before professional help arrives. The training covers techniques such as dressing wounds, applying a tourniquet and correctly applying pressure.

The hospital's Trauma Services department has taught the class 72 times in eight Central Florida counties to people ages 6 to 95, with audiences including EMS agencies, churches, schools, hospitals, Boy Scouts and Girl Scouts. It has also held 15 "train the trainer” courses for prospective instructors.

Led by Osceola Regional's trauma educator, Michelle Rud, the initiative is part of a hospital-wide effort to care for critically injured patients and address preventable trauma deaths.

The hospital's Level II Trauma Center has treated more than 3,000 patients since opening in 2015, expanding access to treatment that often means the difference between life and death.

"We have been very encouraged by the public's response to our 'Stop the Bleed' trainings,” said Rud. "These skills are vitally important for people of all ages to learn, and our community has shown a significant interest in this education.”

Davide Carbone, CEO of Osceola Regional Medical Center, added, "Osceola Regional Medical Center is proud to educate our community on these critical skills. Our team is commit-

ted to keeping the Osceola community healthy and safe, and these classes play an important role in that mission.”

Hunter's Creek Medical Associates Expands to Celebration

Hunter's Creek Medical Associates, P.A. will bring top-quality medical care to Osceola County beginning in April 2018 with the opening of a new clinic at 2940 Mallory Circle, Ste. 202, Celebration, FL 34747. Ashley Walker, with Millenia Partners Commercial Real Estate, represented the tenant in the transaction.

Hunters Creek Medical Associates was started in March 2008 to provide care for the residents of the Orlando area. Thanks to their supportive patients, they have been able to grow their practice to serve over 5,000 patients. Dr. Jermania Estevez and Dr. Giovanni Hernandez continue to strive to be leaders in innovative medical practices and are one of the first clinics in the area to offer online health services to their patients. Their other office is located at 1110 Cypress Glen Circle, Orlando, FL 34741.

AMA Sees Progress in Declining Opioid Prescriptions, Urges Continued Focus on Evidence-Based Treatment

Patrice A. Harris, MD, MA, chair of the AMA Opioid Task Force, "A 22-percent decrease in opioid prescriptions nationally between 2013 and 2017 reflects the fact that physicians and other health care professionals are increasingly judicious when prescribing opioids. It is notable that every state has experienced a decrease, but this is tempered by the fact that deaths related to heroin and illicit fentanyl are increasing at a staggering rate, and deaths related to prescription opioids also continue to

From left, Dr. Kevin Sherin, DOH-Orange, Dr. Ann Ashley-Gilbert, Ms. Alfred Bookhardt, Art Howell, DOH-Orange]

Dr. Ashley-Gilbert Awarded 5th Annual Dr. Bookhardt Winner The Florida Department of Health in Orange County (DOHOrange) honored several deserving individuals from the community for their contributions and dedication to public health.

This year's Dr. Alfred L. Bookhardt, M.D. Health Equity Award recipient is Ann AshleyGilbert, M.D. from the Altamonte Women's Center. Dr. Ashley-Gilbert is recognized for her dedication to serving residents of Orange County for over 38 years and providing obstetrical and gynecological care to migrant and poor women of Central Florida.

The annual Bookhardt award was created by the DOH-Orange as a way of recognizing an Orange County physician for their commitment to increasing access to health care with a goal of achieving health equity in Central Florida.

Also at the ceremony, DOH-Orange recognized individuals for their effects in the community to serve

and help reduce disparities in health and health care. The Florida Department of Health in Orange County congratulates this year's Health Equity Award winners: Muriel Jones, Federation of Families of Central Florida Angus Bradshaw, Jr. Miracle of Love, Inc. Kenard D. Lang, Kenard Lang Foundations Larry K. Williams, Simeon Resource Center for Men Dr. Frank Thompson, The Worship Center Orlando Dr. Alfred L. Bookhardt (19282014) began practicing in Orlando during the Civil Rights Movement.

He treated African-American patients who were refused care by white physicians. He also co-founded the Central Florida Medical Society and Guardian Care, the first long-term care facility for AfricanAmericans in Orlando.

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GrandRounds rise. These statistics again prove that simply decreasing prescription opioid supplies will not end the epidemic.

We need well-designed initiatives that bring together public and private insurers, policymakers, public health infrastructure, and communities with the shared goal to improve access and coverage for comprehensive pain management and treatment for substance use disorders.

"Additionally, it is a sign of progress that IQVIA reported an increase in new treatment starts for medication assisted treatment (MAT) for patients with opioid use disorder, nearly doubling from 44,000 in December 2015 to 82,000 in December 2017. This evidence-based treatment can slow and even stop this epidemic. Physicians and other stakeholders accept that bold action is needed. We go where the evidence leads us. We all must take care that policies and practices don't restrict access to one alternative for pain relief without increasing access to comprehensive, multidisciplinary pain care, including non-opioid-based options."

In 2015, the AMA launched a Task Force to Reduce Opioid Abuse and continues to work with state medical societies to address legislation and regulation ranging from developing effective prescription drug monitoring programs, continuing medical education, restrictions on treatment for opioid use disorder as well as enactment of naloxone access and Good

Samaritan overdose protections.

To learn more about AMA efforts to end the opioid epidemic, visit endopioid-epidemic.org and AMA Wire.

The Villages® Regional Hospital Opens Brand New 3-D Digital Vascular Surgery Suite

This week, The Villages® Regional Hospital cut the ribbon on its new digital vascular surgery suite, which features the revolutionary GE Discovery Duo 2 operating table and allows surgeons to perform complex heart and vascular procedures with unprecedented mobility and precision.

"The addition of this suite represents the next generation of surgical innovation right here in The Villages®,” says Don Henderson, president and CEO of Central Florida Health, the notfor-profit parent organization of The Villages® Regional Hospital. "The hybrid operating room is set up for both minimally invasive and more complex cases, with the goal of efficiency and better outcomes post-surgery. The new robotic unit moves with the doctors to better detect any abnormalities that might come up during surgery.”

The digital vascular surgery suite features a free floating mobile operating room table with power assisted motion. It provides surgeons with the most precise 3D imagery available to improve accuracy, lessen the amount of time it takes for each surgery, and

get patients back to their lives as quickly as possible.

The Villages® Regional Hospital's Perioperative Services Department currently provides a wide range of surgical services, including neurological, thoracic, vascular, orthopedic, and general surgery. This new technology comes with a number of benefits for surgeons and patients alike.

Patients will experience less time in surgery, up to a 99 percent reduction in radiation doses, and fewer postsurgery complications.

"The impact for patients and families is profound,” continues Henderson. "They will have less pain, a faster recovery, and an earlier return to a meaningful life. And instead of sending patients out of the local area for highly complex vascular surgery, we can keep them here, eliminating the stress and expense of travel. It opens up a world of possibilities for our community.

Florida Wound Care Doctors Open Orlando Wound Institute

Florida Wound Care Doctors is proud to announce the opening of Orlando Wound Institute, Central Florida's first independent, full-service wound care and hyperbaric center. Orlando Wound Institute seeks to increase access to quality wound care for those suffering from nonhealing wounds in Central Florida.

Services offered at Orlando

Wound Institute include but are not limited to: hyperbaric oxygen therapy, vascular testing, customized diabetic foot off loading, total contact casting, support surface evaluation, edema management therapies, nutritional support, comprehensive local wound care, advanced cellular therapies and patient/caregiver educational support. Additionally, participation in clinical research allows Orlando Wound Institute to employ cuttingedge technologies while supporting the advancement of science in wound healing.

Orlando Wound Institute seeks to serve patients who will benefit from specialized wound care. These include people with conditions such as diabetes, poor blood flow, problems with swelling or other chronic conditions, who are particularly at risk for delayed wound healing; however, anyone with a wound that is not healing properly can benefit from specialized wound care. Early intervention by a wound specialist helps prevent serious complications such as infection and amputation and restores quality of life to those who suffer from wounds.

Orlando Wound Institute is located by Orlando International Airport, at 6200 Lee Vista Blvd. Suite 250. For more information, please visit www. orlandowoundinstitute.com.

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Annual "Call to Hope” Event Raises Funds, Honors Volunteers More than 400 corporate and community citizens gathered for Shepherd's Hope's annual fundraising and volunteer recognition event.

The "Call to Hope” breakfast at the Rosen Centre Hotel raised $210,000 in one-time gifts and multi-year pledges for the faith-based nonprofit celebrating its 21st anniversary. The event also highlighted the work of volunteer medical and lay personnel who aid in providing free medical care to the uninsured and underinsured at the organization's five local health clinics.

Shepherd's Hope is a vital safety net health care provider for the estimated 450,000 Central Floridians who do not have health insurance.

In 2017, 26 percent of Shepherd's Hope patients reported they had lost their health insurance in the last six months to a year, and the number of patients who are children jumped from 7 percent to 17 percent.

"Access to quality health care for our neighbors in need has been the mission of Shepherd's Hope since 1997. Since then, we have been

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stretched far beyond what was even dreamed of on that day in February when the first patient arrived at our door,” said President/CEO Marni Stahlman. "Despite providing 19,575 patient visits and medical services in 2017, we still had to turn away another 900 patients because we didn't have the resources to meet their needs.”

Many of Shepherd's Hope's patients are low-wage, working families who struggle to afford basic housing and living needs. Far too often, they forgo medical care due to financial limitations or use area hospital emergency departments to access care.

"Shepherd's Hope makes it possible for these patients to find hope and healing while also mitigating the staggering financial impact to our community,” Stahlman added.

The "Call to Hope” event also honored the work of 2,800 Shepherd's Hope volunteers who contributed 44,000 hours equal to $2.4 million in in-kind services in 2017. Four volunteers received special recognition with the Dr. Ruth McKeefrey Volunteer of the Year Award, named in

honor of Shepherd's Hope's first volunteer executive director. They are: 1. Outstanding General Volunteer of the Year: Faryal Mohammed 2. Outstanding Volunteer Nurse of the Year: Donna Breit, R.N. 3. Outstanding Volunteer Clinical Practitioner of the Year: Jamie Lynch, ARNP 4. Outstanding Physician of

the Year: Dr. Jeff Thill The sponsorship support of ABC Fine Wine & Spirits, Enterprise Holdings Foundation, Florida Hospital, Orlando Health, The Martin Andersen-Gracia Andersen Foundation, Inc., and Rosen Centre helped to offset the costs of the event, allowing more of the dollars raised to go directly to patient services.

Watch this year's "Patient Story of Hope” on YouTube.

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GrandRounds Community Health Centers Honored by CDC

Community Health Centers, Inc., has been recognized by the Centers for Disease Control and Prevention's (CDC) National Center for Immunization and Respiratory Diseases (NCIRD) and the CDC Foundation for efforts to protect the health of children through vaccination. Community Health Centers received the CDC Childhood Immunization Award Champion for the state of Florida.

According to the CDC, the success of our nation's infant and childhood immunization programs is a direct result of the efforts of childhood immunization champions, like Community Health Centers. Our Champions' dedication is crucial to creating community partnerships, working towards policy advancements, finding creative solutions to immunization challenges, counseling parents and educating and raising awareness of the importance of childhood immunization.

"I gladly accept this award on behalf of all Community Health Centers' team members. It is indeed a proud moment and one of the most meaningful accomplishments I will have in my career. Since I was 11 years old I knew I would dedicate my life to helping children and this recognition is quite poignant for me. I recognize this would only be possible with the work of our entire team! It is truly a great honor for our organization,” Debra Andree, MD, Chief Medical Officer, Community Health Centers. "Under Dr. Andree's leadership, our team members strive to improve health outcomes for our patients and it is an honor to receive this recognition,” adds Margaret Brennan, President/CEO of Community Health Centers.

Nemours Chief of Neurology Receives 2018 Sidney Carter Award in Child Neurology

Richard S. Finkel, M.D., the chief of neurology at Nemours Children's Hospital in Orlando, Fla., was honored with the American Academy of Neurology's 2018 Sidney Carter Award in Child Neurology, in recognition of his and the Nemours Children's Hospital Division of Neurology's achievements in treating children with muscular dystrophy (MD) and spinal muscular atrophy (SMA).

Dr. Finkel joined the Nemours Children's Hospital Division of Pediatric Neurology in April 2012. Since then, he has led a division of pediatric professionals that includes neurologists, physical therapists and other experts who provide care for infants and children with conditions that affect the brain, spine and nervous system. Children and infants with neuromuscular disorders are treated at the Nemours Children's Hospital Muscular Dystrophy Clinic, Central Florida's only Muscular Dystrophy Associationcertified clinic.

"I'm honored to be receiving this prestigious recognition,” said Dr. Finkel. "It's both rewarding and humbling to work so closely with my families. My inspiration comes from the patients I get to see develop and flourish through the years.”

The Nemours Division of Pediatric Neurology participates in a wide range of clinical trials and other studies to improve care for children and families worldwide who are affected by muscular dystrophy and other neuromuscular disorders. At the end of 2017 and in early 2018, Dr. Finkel

11th Annual Ms./Mrs. Corporate America Competition Crowns Lifetime Queen in Orlando The Orlando area's own DiAnne Elise, a professional in healthcare marketing and public relations, business communication author, speaker, coach and trainer in the areas of branding, public relations, and marketing strategy was named a Ms. Corporate America (MCA) Lifetime Queen. Di-Anne's passion is to empower businesses and individuals to achieve positive results through public communication.

The MCA Organization's mission is to mix business and beauty, and provide a platform for women to promote themselves, enhance selfconfidence, strengthen leadership skills, accomplish personal and professional goals and establish friendships with other professional women. published studies in the New England Journal of Medicine on the new drug, nusinersen. This drug helps infants and children with SMA to live longer and gain motor function.

"Babies with this debilitating and deadly disease were destined to have a short lifespan and limited motor function,” said Finkel. "This study shows nusinersen is life-altering for families touched by this genetic disorder.”

Prior to the nusinersen trials, spearheaded by Dr. Finkel, there were no targeted drug treatments for SMA. In December 2016, after reviewing

Not only does the MCA Organization represent the professionalism of women across America, it represents a woman's strength, courage, confidence, dedication and commitment to their family, career and community.

The MCA Competition is the only unique competition that highlights professional women making their mark in her-story (whether they work in a corporate domain or manage their own business). The competition mixes business with beauty and provides a perfect platform to address the lack of diversity and gender equality for women within the business and Corporate America sector.

an analysis of interim data from the study, the FDA approved nusinersen.

It is now available under the brand name Spinraza, for use in patients of all ages and with all types of SMA. The new therapy demonstrates the life-saving possibilities of "precision medicine” for patients with devastating chronic diseases.

Dr. Finkel is receiving the award at the 2018 American Academy of Neurology Annual Meeting, which is currently taking place in Los Angeles, April 21-27.

Ashley Walker Joins Millenia Partners' Medical Office Division

Millenia Partners, a full-service brokerage firm, announces Ashley Walker has joined the company's Medical Office Division as Sales and Leasing Associate. Ashley joined the team in the fall of 2017, bringing with her a successful background in healthcare commercial real estate.

"Ashley is a confident, knowledgeable, intelligent and hard working professional with exceptional character. I'm extremely proud to have Ashley on the team. She's a real deal maker!!” said Brian Grandstaff, Principal of Millenia Partners.

Ashley has extensive experience in working with physicians to buy, sell, and lease medical space as well as negotiating lease and purchase terms. She prides herself on building relationships which has added to her success and her reputation of leading (CONTINUED ON PAGE 17)

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GrandRounds her physicians through the process from start to finish.

"I look forward to combining my experience in the healthcare commercial real estate industry with Millenia Partners who have spent the last 25 years building a fantastic reputation in all phases of development, brokerage, asset management, and investment sales of retail and office properties. I'm honored to be a part of such a dynamic, reputable team."

-- Ashley Walker Ashley earned her bachelor's degree from the University of South Alabama in Mobile, AL. She is a licensed commercial real estate salesperson in the state of Florida. An active voice in the commercial real estate community, Ashley is an active member of Commercial Real Estate Women (CREW) and Medical Office Resources of Florida (M.O.R.O.F.).

UCF College of Medicine/ HCA Consortium Announces New Transitional Year Residency Program

A new Transitional Year Residency Program, based at North Florida Regional Medical Center in Gainesville, FL has received initial ACGME accreditation and is seeking immediate applicants.

This program is part of the UCF College of Medicine-Hospital Corporation of America North Florida Division Consortium seeking to add more than 600 residency slots to Florida by 2020. In the last three years, the consortium has added 21 graduate medical education programs that are currently training about 250 physicians in Central and North Central Florida.

The addition of the Transitional Year program will increase the number of programs to 22.

The Accreditation Council for Graduate Medicine Education (ACGME) approved the Transitional Year Residency program for 13 residents per the one-year program. The program will be directed by Dr. Matthew Calestino, who is also Associate Program Director of the Internal Medicine Residency Program at North Florida Regional Medical Center.

UCF and HCA started the residency programs to help address Florida's and the nation's physician shortage.

Dr. Calestino noted that a 2014 Florida workforce report showed that by 2025, Primary Care will be one of the physician specialties with the highest shortage - a deficit of about 2,000 physicians statewide. "The faculty, staff and residents in this new UCF/ HCA Residency have the opportunity to make a major impact on healthcare

Goodbye Radios, Hello iPads: Paramedics, ER Staff use New App to Expedite Patient Care in North Florida by providing more services and more practitioners in the coming years,” he said.

North Florida Regional Medical Center is a 432-bed, full service medical and surgical acute care center and one of the nation's top performing hospitals on key quality measures as recognized by the Joint Commission.

It is an accredited Chest Pain Center and a Blue Distinction Center for Knee and Hip Replacement, Spine Surgery and Bariatric Surgery.

The program will be looking to take residents by July 2018. Applications should be submitted through Veronica Stehouwer, GME Coordinator/Interim Transitional Year Program Coordinator, North Florida Regional Medical Center, at Veronica.Stehouwer@hcahealthcare.com. Qualified applicants will be selected for interviews.

DOH-Orange Offers Additional Immunization Locations

To meet the growing need for immunizations in Orange County, the Florida Department of Health in Orange County (DOH-Orange) now offers immunizations services at three additional locations.

DOH-Orange offers immunization services on the followings days and at these DOH-Orange locations: Mondays: Eastside 407-858-1444 12050 East Colonial Drive Orlando, FL 32826 Tuesdays and Fridays: Hoffner 407-858-1444 5449 S. Semoran Blvd.

Orlando, FL 32822 Wednesday and Thursdays: Westside 407-858-1444 6218 West Colonial Drive Orlando, FL 32808 Our main Immunization Clinic is located at the Central facility, 832 West Central Boulevard in Orlando.

The hours of operation are 8:00 am until 4:00 pm, Monday through Friday. To make an appointment at the Central location, please call 407-8581444. Walk-ins are welcome.

Immunization services are free to children 18 years of age and under at any of our facilities.

Visit the DOH-Orange web site for more information on the required documents for the immunization services at http://orange.floridahealth.gov/.

When paramedics rush a patient to the hospital, they traditionally rely on radios to communicate critical information to the emergency department team standing by.

But now, Florida Hospital and local fire departments are debuting an app that allows first responders to quickly provide the patient's vitals, crucial information, videos and pictures while en route.

Having this full clinical picture allows the hospital to efficiently manage resources and accelerate patient care.

"It was hard to believe that in 2017 radio was still the main communication form in the emergency medical services environment,” said John Hui, Twiage CEO. "With this new app, first responders can upload all the information about a patient in less than 30 seconds.”

The new technology started as an initiative to provide better care to stroke patients, but after seeing its potential, Florida Hospital decided to implement it throughout

the system to offer expeditated care to all patients.

The Apopka Fire Department is the first in Florida to deploy this new app, and other agencies are expected to join the initiative in upcoming months.

"Twiage allows the hospital to know our exact time of arrival, thanks to a real-time GPS system,” said Apopka Fire Capt. Wil Sanchez. "We can also transmit photos and videos, allowing the staff at the hospital to know in real time what we are actually dealing with.”

Twiage has been used in Apopka for about two weeks and the clinical teams are already seeing the benefits.

"What I love about the program is that you don't have any confusion with it. This gives us time to prepare for the patients, and make sure we have a room ready when they get here,” said Christopher Willson, assistant nurse manager at Florida Hospital Apopka.

Central Florida Health Named to Becker's 150 Top Places to Work in Healthcare

Central Florida Health, the 636bed not-for-profit healthcare system comprised of Leesburg Regional Med(CONTINUED ON PAGE 18)

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GrandRounds ical Center and The Villages® Regional Hospital, announced today that it has been named to the Becker's Healthcare 2018 "150 Top Places to Work in Healthcare” list. This is the fourth consecutive year the organization has received this prestigious recognition.

The organizations featured on this list offer benefits and opportunities for employees to build successful careers above and beyond the average healthcare provider or company; they encourage professional development and promote leadership from within. Many members of the list offer unique wellness and personal benefits to ensure employees strike a positive work/life balance as well as employee recognition programs to highlight their accomplishments.

Lake Nona Announces New Dental Office Building

Lake Nona is pleased to announce the construction of an all-new dental office building on the northwest corner of Narcoossee Road and Tavistock Lakes Boulevard. The building will be

anchored by Celebration Pediatric Dentistry and Tringas Orthodontics.

The 10,500-square-foot building welcomes specialized dental services to the Lake Nona community including pediatric care and orthodontics, providing residents with new dental options for themselves and their families.

With two other locations in Celebration and Winter Garden, Celebration Pediatric Dentistry provides expert dentistry for children and adolescents in a child-friendly environment. The dental team of Drs. Michael, Jonathan, and Andrew Gooch focuses on preventative care serving infants, children, and teens.

Tringas Orthodontics utilizes the latest technology, including clear aligners, digital scanners and 3D printing, to provide exceptional outcomes in a warm, caring and friendly environment.

Dr. Tringas has established practices in both Windermere and Celebration.

The building is scheduled to break ground this spring with a projected opening for patients in fall 2018.

Orlando's Debra Andree, MD, Receives Federal Recognition for Contributions to Childhood Immunization Debra Andree, MD, Chief Medical Officer at Community Health Centers, Inc., has been named Center for Disease Control and Prevention (CDC) Childhood Immunization Champion for her outstanding efforts to promote childhood immunization in our community. Dr. Andree is recognized for her efforts teaching staff, medical students, and parents about the importance of vaccines.

Debra Andree, MD, is the Chief Medical Officer of Community Health Centers, a non-profit organization that provides healthcare services to children and adults regardless of insurance status. She works closely with the Florida Department of Health in Orange County to review immunization coverage reports and identify factors that could

negatively impact rates, such as vaccine shortages, staff education, and parent education.

"Dr. Andree is an extraordinary role model for pediatric care and immunization best practices, and is well deserving of this honor,” said Dr. Kevin Sherin, DOH-Orange Health Officer. "She leads the Florida State University College of Medicine pediatric clerkship, serves as medical director of Community Health Centers and is a master clinician and role model for residents and medical students.”

Debra Andree, MD said, "Dr. Kevin Sherin and the Florida Department of Health in Orange County have consistently worked to promote and further all efforts with childhood vaccination for optimal preventative care.”

YOUR SEMINOLE COUNTY MEDICAL SOCIETY LOBBYING TALLAHASSEE FOR YOU & THE PRACTICE OF MEDICINE!

2018 POSITION STATEMENT SUPPORT: Appropriate Utilization of Opioids - SB 8 (Benacquisto) HB 21 (Boyd) - SB 458 (Bean) One of the greatest challenges facing communities across the country is the crisis with opioid use and treating dependency. The SCMS supports restrictions in the supply of opioids. The SCMS has been working with the Seminole County Task Force to educate physicians on appropriate prescribing of these highly addictive medications as well as supporting treatment professionals and law enforcement in educating and protecting the public. The SCMS does have concerns with the potential ramifications to the health of some patients that may need opioids to recover from major trauma or for end-of-life care and is working to institute appropriate safeguards to balance the needs of appropriate pain relief while limiting the supply on the streets.

Right Medicine, Right Time – SB 98 (Steube) HB 199 (Harrison) The SCMS supports efforts by patient advocates to ensure that appropriate prescriptive treatments are based on a physician’s recommendation. Each year, thousands of Floridians are subjected to “fail first” protocols, whereby insurance companies impose their own treatment decisions ahead of treating physicians’ medical judgment. This causes delays in care that can lead to unnecessary hospitalizations and sometimes devastating consequences for patients. Florida needs legislation that allows physicians and patients to override step therapy protocols when deemed medically necessary and in patients’ best interests. In addition, if a patient is currently stable on a drug, step therapy should not be required to continue usage of that drug because of changes in a health care benefit or plan. Finally, the FMA supports shortening the amount of time for a step therapy override to be granted. It is time to stop insurance companies from practicing medicine and getting in the middle of the patient-physician relationship.

Retroactive Denials – SB 162 (Steube) HB 217 (Hager) The SCMS supports legislation that eliminates the ability of insurance carriers to retroactively deny claims when they have provided a physician with authorization and the physician renders that service in good faith.

Maintenance of Certification – SB 628 (Grimsley) and HB 81(Gonzalez) The SCMS supports legislation that prohibits the Board of Medicine, Department of Health, a health care facility, or an insurer from requiring maintenance of certification or recertification as a condition of licensure, reimbursement, employment, or admitting privileges for a physician who practices medicine and has achieved initial board certification in a subspecialty as recognized in the Florida Statutes.

Ambulatory Surgery Centers and Recovery Care Centers – SB 250 (Steube) HB 23 (Renner and Fitzenhagen) - Expands ASC Services providing that patients must be discharged within 24 hours (eliminates no overnight stay language). This is similar to the definition used by the Federal Government (CMS) as well as a majority of the states across the US. Creates Recovery Care Centers and provides statutory framework for Recovery Care Centers with a limited stay of up to 72 hours. Requires all RCC’s to include patient education, nutrition, pharmacy, and additional required services to comply with state law.

Direct Primary Care – Less Paperwork, More Care – SB 80 (Lee) and HB 37 (Burgess & Miller) One of the most promising developments in health care delivery in recent years has been the Direct Primary Care (DPC) movement. DPC is an alternative to the traditional fee-for-service model in which patients are charged a simple, affordable flat monthly fee for comprehensive coverage of all primary care services. DPC physicians have been able to control costs by preventing chronic illnesses and reducing administrative expenses. The SCMS strongly supports legislation which would allow DPC to grow by defining direct primary care agreements as a medical service outside the scope of insurance regulation.

OPPOSE: Scope of Practice Expansions The SCMS is concerned with proposals that either have already been filed, or likely will be filed for debate in the upcoming legislative session that would expand the scope of practice for non-physicians. SB 524 (Brandes) and HB 431 (Plasencia) have already been filed which will enable pharmacists to diagnose and treat the flu and strep under protocols developed by a physician. We also anticipate legislation that will enable optometrists to perform laser surgery.

PIP Repeal – SB 150 (Brandes) and HB 19 (Grall) The SCMS supports maintaining the current automobile no-fault system due to the potential harm that can be caused to our emergency and trauma system in return for minimal financial relief for consumers. The Pinnacle study released in 2016 notes that drivers in Florida would save $82 a year with the repeal of PIP. However, without PIP or some other form of mandated emergency med pay coverage, more injured drivers and passengers would rely on commercial insurance to cover the cost of their medical care while they litigate fault in the accident. Most patients carry commercial coverage with far higher deductibles and co-pays that would have to be utilized for care currently provided under their PIP benefit. Emergency Physicians and On-Call Specialists would likely face increased unfunded care and extended delays in reimbursement as fault is determined in each accident. While the current PIP system is far from ideal, it does provide a relatively in-expensive medical benefit that contributes significantly to our current trauma system.

Become a Component of the Solution…Renew or Join YOUR Seminole County Medical Society 18

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THE HR LADY

sponsored by

y d a L R H THE

By WENDY SELLERS, MHR, MHA, SHRM-SCP, SPHR

Q: I am a small business and am struggling to find reliable and experienced employees. What advice do you have?

The war on talent is here - this war actually arrived several years ago. High paying, stable jobs are widely available, and people are feeling comfortable to look for what they believe is a better opportunity.

First, do your due diligence before starting the recruiting process. Determine what the current market rate really is for the position. You can obtain compensation survey data at no cost from the Bureau of Labor Statistics at this website https:// www.bls.gov/ncs/. You may also want to obtain compensation survey information from an association related to your industry such as PhysicianPractice.com.

Second, be crystal clear about the job. During the hiring process, one major reason companies inadvertently hire the wrong people is because it is not clear what skills or attributes they are looking for. Creating basic job descriptions for every role in the company will save time, money and painful experiences for all involved.

Third, allocate plenty of time to find and screen and interview qualified candidates. Often the manager tasked with filling the position is stressed, carrying a heavy workload and feels rushed to fill the position with any warm body. In order to avoid hiring the wrong candidate, time must be allotted to hiring managers so that they can take an appropriate amount of time to find the right types of candidates, ask the right questions, get the right people involved in asking those questions and to finally give realistic job previews to the top candidates.

Finally, spend the extra money and use professional resume sourcing sites such as LinkedIn and Indeed.com. However, if you have never recruited before, call an expert. You can use a staffing agency or professional recruiting firm. CareerSource is free for employers and employees to use – paid by tax dollars. Finding qualified candidates should not, I repeat should not, be taken lightly. It is time consuming and stressful. Good luck.

Q: Why do Millennials job hop?

Millennials, age 22-37, depending on what resource you review, are not afraid to change jobs. Why? Loyalty by employers has all but vanished. Millennials have 19

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seen their parents and grandparents get laid off during the most recent recession, struggle to pay bills and obtain a new job with equivalent pay and benefits of their previous job. The older Millennials themselves graduated college often with master’s degrees and were unable to find low paying full time jobs for close to a decade.

They pieced together part time jobs and side gigs to pay their student loans and had no choice but to move back in with their parents. Many opened their own businesses and became entrepreneurs.

Did they give up? No. Yet they did take off the rose-colored glasses that the world tried to sell them and started looking out for themselves. Call it selfish if you will; I call it survival.

Millennials are not afraid to leave a dead-end job that has little to no hope for a pay increase, career advancement or a sense of satisfaction and accomplishment. While Baby Boomers and Generation X would stick it out and be miserable because of their home life responsibilities, Millennials have made decisions to delay families and home ownership – not always by choice but by financial necessity. While it is true for any generation that changing jobs will get you on average an 8-10% pay increase, Millennials are not just changing jobs due to pay. They want fast career growth and I do not blame them. They are the most educated generation in the workforce; why should they have to wait ten years for career growth opportunities like their older peers have when they can have it in two years at another organization.

What can you do to retain Millennials? Mentoring, coaching and professional development are the keys to retaining younger workers; just don’t expect to keep them forever. Those days are long gone for all generations. Millennials want to work in a positive environment where they can be part of something (your vision). So, make it happen. Company culture is more important than pay for almost any generation.

assume someone else is teaching our colleagues, employees or even our children only to find out that they are not being taught a common set of skills, ranging from cooking and sewing, to typing and using shorthand, to writing thank you notes. Coaching and mentoring is needed, as well as good old-fashioned communication! Often the skill isn’t passed down or taught because it is a skill that is becoming obsolete or is now done in a different manner. For example, technology has taken over a great part of written communication, therefore not as many younger people have great handwriting skills. In fact, most schools are not even teaching kids how to write in cursive. Does that mean they have no common sense? Well, it depends who is saying that. They do not have a common set of skills as their grandmother, but they do indeed have a common set of skills as their siblings.

Here’s the point: common sense isn’t a sense at all. It’s a set of skills. Skills are activities that we learn so well that they become automatic. Walking, writing cursive and driving a car are skills that must be learned. Once we have learned and practiced those skills, they become second nature or just common sense. Passing along common sets of skills and expected behaviors requires dedication by groups of skilled people to take the time to train and coach less skilled people.”

Wendy Sellers, “The HR Lady” is the COO of BlackRain Partners, a business consulting company. She has a master’s in healthcare administration, a master’s in human resources, SHRMSCP and SPHR certifications and is also a licensed Florida 2-15 life and health agent which she uses solely to advise and educate BlackRain’s clients.

Visit www.blackrainpartners.com

People. Performance. Profit.

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

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

Do you want consistent Best Practices & Procedures?

Do you want your managers to hold staff Accountable?

Do you want to Improve Customer Service?

WWW.BLACKRAINPARTNERS.COM

Q: Why do my employees have no common sense!

Common sense is not a sense. Common sense is a set of skills that have been taught. I discuss this very topic in my book in the following: “She has no common sense! We have all used this phrase, admit it. But let’s get to the heart of the matter. The problem is that what is “common sense” for one generation doesn’t always get passed along to the next generation. Why? Because osmosis doesn’t work with humans. We often

Change Starts Today Call us 407.367.0883 #Leadership #Engagement

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AI and Machine Learning… the New Cybersecurity Frontier Healthcare is embracing AI and ML on several fronts

By RON FRECHETTE

It is estimated that about half of the world’s population watched the 2018 Olympics in Pyeongchang, South Korea.

An audience of that size tends to attract some of the largest and most innovative companies on the planet to advertise. If you happened to tune in, you may have seen Microsoft’s “Empowering Innovation” commercial featuring hip hop artist, Common, who formally introduced the world to the power of artificial intelligence (AI).

The commercial opens with Common on-stage professing that through AI technology, we have more power at our fingertips than entire generations that came before us. The final question he poses is, “What are you going to do with it?” Great question to pose to a worldwide audience… depending on who is listening. The motives of viewers can vary widely from the young promising data scientist at MIT, to the cyber threat actor working feverishly to launch the worlds next greatest cyberattack. The question for us is, “How will the power of this technology affect our lives as we venture further into the Digital Age?”

ARTIFICIAL INTELLIGENCE AND MACHINE LEARNING DEFINED Artificial intelligence (AI) is the capability of a machine to imitate intelligent human behavior. Machine learning (ML) is one of the hottest fields in computer science today. ML utilizes sophisticated algorithms that teach computers to learn without being explicitly programmed. It involves feeding huge amounts of data to an algorithm that allows a machine to adjust itself and improve on its own. Think Terminator!

Last month, we introduced our readers to digital footprints. We discussed how our digital footprints contain sensitive data that we must learn to protect before launching into cyberspace. If our personal and professional data gets into the wrong hands, it could cause serious harm throughout our entire lives. Since the beginning of the internet, the amount of data the world has launched into cyberspace has grown at astounding rates.

Data science experts estimate that every two days we create as much data as we did from the beginning of time until 2000. They also estimate the volume of online data will grow from around 5 zettabytes today to 50 zettabytes by 2020. This is where the term “Big Data” comes from.

HOW BIG DATA PLAYS A ROLE IN AI & ML TECHNOLOGY AI & ML rely heavily on consuming Big Data to create complex algorithmic data models. These models have enabled computers to recognize data patterns much more accurately and quickly than 20

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humans. This is how Netflix can suggest movie’s you would most likely enjoy watching. Self-driving cars, computers predicting stock market trends, winning Jeopardy, and the creation of digital personal assistants like Siri, and IBM’s Watson were all developed using artificial intelligence and machine learning.

THE HEALTHCARE INDUSTRY IS EMBRACING AI & ML ON SEVERAL FRONTS There are apps that exist today that converse with patients to explain lab results. AI based virtual healthcare assistants that measure vocal tones to detect depression and potential chronic issues like heart disease. IBM and UC San Diego recently launched an aging-based AI center that will use ML algorithms to better understand the microbes that live in the human body. The project objective is to increase and extend the quality of life and independence for aging populations. The possibilities of AI & ML increasing our quality of life are endless.

SECURITY BENEFITS AND RISKS OF AI & ML From a cybersecurity standpoint, AI & ML technology offer security professionals great promise in protecting our private information in cyberspace. On the other hand, it also creates a new platform for attackers to

exploit for malicious purposes. Below are a few benefits and threats to be aware of:

SECURITY BENEFITS Determining Safe Device Behavior – AI & ML have the capability to monitor general network usage patterns which allows it to identify and block malicious activity faster.

Monitoring Data Exchanges – Data sharing is critical for the success of any business. Monitoring these activities can be impossible task. AI & ML can identify something as suspicious, categorize legitimate threats and self-adjust its monitoring filters to stop a breach before it causes damage.

Predict Threats Based on Historical Data – AI & ML systems are proficient at examining large amounts of data and adjusting themselves to predict potential attacks based on historical trends.

SECURITY THREATS Using AI & ML for Creating Malware - The first example of using AI & ML for malware creation was presented in 2017 in a paper entitled “Generating Adversarial Malware Examples for Black-Box Attacks Based on GAN.” Smart Botnet Attacks - Fortinet reports that 2018 will be the year of self-learning ‘hivenets’ and ‘swarmbots’, in essence the belief that ‘intelligent’ IoT devices can be

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commanded to talk to one another and attack vulnerable systems at much larger scales than we have seen in the past.

Smarter Spear Phishing Email Attacks – AI & ML will be used to target high-net worth individuals by weaponizing data science for more effective social engineering campaigns.

Infecting ML & IA Security Engines – this is essentially infecting the ML/IA system used for security and rendering it ineffective or harmful.

AI & ML is undoubtedly the new frontier in cyberspace. How we decide to act on the knowledge we gain will determine the degree of benefits and consequences we experience.

I refer to the words Mr. Common so boldly professed, “Through AI, we have more power at our fingertips than entire generations that came before us. What are you going to do with it?”

Ron Frechette, Co-Founder & Managing Partner of GoldSky Security is a cybersecurity and healthcare entrepreneur. He co-founded GoldSky Security, LLC. For questions, he can be reached at ron.frechette@goldskysecurity.com or send a tweet @GoldskyRon.

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Why is Technology Failing so Far as the Solution to Healthcare Ills?

By GIRI VENKATRAMAN, MD, MBA

Technology is often presented as the key to solving all of mankind’s problems – but has not lived up to its promise in healthcare. Even companies such as Google and Microsoft have attempted and failed. IBM’s Watson which won a “Jeopardy” contest has not made any significant inroads into healthcare – MD Anderson, a leader in national and world-wide cancer care gave up on its IBM Watson investment.

The use of technology has made a sea-change in other industries. A good example is banking. Most routine banking activities can now be done electronically. The occupation of “bank teller” has changed considerably – most of us cannot recall the last time we physically entered a bank. In most industries, adoption and use of technology leads to improving, enhancing or changing work flow, which are often better than the status quo: so the way we do something is better and different.

Unfortunately, often the consequence of this is a loss or re-configuration of an occupation. For example, before direct deposits in the bank, bank tellers were often very busy on Friday afternoons to deposit checks. Most of us use ATMs currently to withdraw money – so the need for a teller or a human being is not as critical.

Healthcare is the glaring exception to this. Current medical records and charting systems do not optimize the physicians’ workflow and, interestingly, adoption of technology in healthcare has not made the process more efficient or led to any enhancements or improvements of workflow. Not only has adoption of technology not made life easier for physicians but quite a few have to resort to transcription services to keep their records up to date

they were not penalized. A timeframe to adopt and implement healthcare technology would have potentially led to better systems designed to optimize patient care and flow. The other downside to this was that only well-capitalized, big firms were able to meet the standards, causing, potentially a lack of creativity.

2. Health IT sunk cost. Unfortunately, since adoption of these systems was expensive (because of the mandates), hospitals and systems are reticent to adopt new systems. The new technologies that are adopted invariably are designed to cut costs and to optimize billing but not clinically focused.

Why has technology use not lived up to its promise in healthcare – what makes healthcare different? The fundamental problems are with the software as it stands now, 3. The software, especially ones adopted by systems or hospitals) is a “one-size fits all” system. But unfortunately healthcare does not fit into this paradigm. The daily clinical requirements for an orthopedic surgeon are vastly different from those of a cardiologist.

Often these systems are very expensive to implement, and, often, physicians and their care team do not achieve or recover their baseline vol-

umes leading to impaired access.

4. The software is optimized for billing, not clinical care; therefore “documentation” of the clinical encounter to enhance billing unfortunately becomes the focus. Often it takes longer and more effort to perform even routine clinical activities. The entire care team spends an inordinate amount of time on computer work not clinical.

Many studies have demonstrated this unfortunate fact.

Current EMR systems and the administrative burdens have been shown to be a major source of physician frustration and burnout.

In summary, healthcare at its core remains a human endeavor requiring human interaction. A good physicianpatient relationship, which is essential to high quality care, will not change and will be hard to replace with technology – this is the core reason why smart people and inventors in Silicon Valley and other areas have been unable to truly come up with a “disruptive innovation”.

So, as physicians, are we doomed to the status quo? There may be some hope with companies like WalMart, Amazon, Berkshire Hathaway and JP Morgan entering the healthcare arena will hopefully address the healthcare IT issues as well. My hope is that they will adopt physician and frontline provider input and implement technology that is not an impediment to state of the art care.

Since these are well-capitalized companies, large-scale system-wide technology adoption is a possibility.

Giri Venkatraman, MD, MBA, is an ENT specialist and Associate Quality Officer at Dartmouth-Hitchcock Medical Center. He can be reached at giri.venkatraman@gmail.com

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Why does healthcare remain an exception to achieving the benefits of technology?

1. Top down implementation. Unfortunately, most of the current technology adoption is a government mandate: The MMA, HITECH act and the ACA all mandated rules for technology adoption and use. Rather than technology being designed to fill a clinical need, acquiescence to rules and mandates became the driving force behind technology adoption.

An example of this phenomenon is “meaningful use”. Meaningful use (MU), in a health information technology (HIT) context, defines minimum U.S. government standards for using electronic health records (EHR) and for exchanging patient clinical data between healthcare providers, between healthcare providers and insurers, and between healthcare providers and patients. So as long as providers and administrators were able to document “meaningful use”, 21

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US Attorney Eyeing Healthcare Fraud in Central Florida Practical steps providers need to take for compliance

By A. LEE BENTLEY, III, AND JASON MEHTA

In the past month, the U.S. Attorney’s Office for the Middle District of Florida—the primary federal law enforcement authority in Central Florida—has announced a series of healthcare-fraud related developments. These developments are an ominous sign of ramped-up enforcement in the region.

For example, in late March, the U.S. Attorney’s Office announced that it was joining a healthcare fraud lawsuit against Central Medical Systems, LLC (Central Medical), the national leader in medical supply equipment for wound care, which has its global headquarters in Orlando. In a press release, the Department of Justice (DOJ) alleged that Central Medical used its software to manipulate orders, thereby billing “Medicare for thousands more products than it had purchased.” The lawsuit was originally filed by a whistleblower, but DOJ is now actively prosecuting the matter.

Less than a week later, the office announced that it successfully convinced a court to order an Orlando-based company to stop distributing drugs that purportedly could help treat or prevent a host of serious conditions or diseases. According to the press release, the Orlando company (MyNicNaxs LLC) made claims about its drugs even when those claims were not rooted in science.

These two civil prosecutions in the past month underlie a far more significant fact: DOJ is continuing to aggressively identify and prosecute healthcare providers for perceived fraud. And nowhere is this focus growing more sharply than in Central Florida. Just last year, DOJ added a dedicated healthcare fraud prosecutor to the Orlando area, precisely because of concerns of growing fraud.

This additional scrutiny, in many ways, is justified. As readers will know, healthcare expenditures in this country have been growing precipitously and some estimates now suggest that healthcare constitutes one-sixth of the nation’s economy.

A large source of that spending growth is driven by healthcare fraud, waste, and abuse.

To be sure, the vast majority of healthcare providers are honest, hardworking, and ethical. It is a very small percentage of providers—perhaps, less than one percent—that fall within the ambit of prosecutors’ watchful eyes. But, for these unscrupulous few, DOJ continues to be focused on healthcare prosecutions.

While DOJ continues to do its job in enforcing the myriad of healthcare rules and regulations, providers would be wellserved by reviewing their internal procedures and compliance controls before 22

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DOJ comes knocking. Whether you are a durable medical equipment provider, a pharmacy, a healthcare provider, or any other regulated party, the time for internal due diligence is now. Some practical suggestions include: • Carefully review your billings to the federal healthcare programs, such as Medicare, Medicaid, and TRICARE, over the past few years. Look at the data both on an individual and aggregate level. If there are sudden spikes or new procedures being billed, make sure you can explain those changes and the medical necessity for these new procedures.

• Review your agreements with outside vendors, ancillary providers, and other third parties. Make sure that the agreements comply with the Stark Law and the Anti-Kickback Statute. In particular, providers should ensure that these arrangements are rooted in fair-market values and are not designed to steer or induce referrals of federal healthcare program business.

• Periodically make sure that your employees are trained about basic compliance—cover issues such as HIPAA privacy protections, the need be vigilant about potential kickbacks, and similar topics. Compliance training is rarely fun, but it is always important. Keep compliance training fresh and relevant.

And make sure employees know that they will be rewarded, not punished, for reporting potential problems to management.

• Lastly, make sure you familiarize yourself with the many regulations that govern healthcare. Modern medicine—particularly when dealing with the federal government payors such as Medicare or Medicaid—is an immensely regulated profession. Providers, whether they be doctors, nurses, or even administrative officers, would be well-served by reviewing the applicable rules and making sure that they are fully in compliance.

As former prosecutors, we commend our former colleagues for their pursuit of unscrupulous actors. We know, firsthand, that the work of law enforcement is critical. We also know that most health-

care practitioners are ethical and honest.

Ultimately, by performing internal due diligence before regulators ask questions, providers can best defend themselves and prevent unwanted protracted investigations. While internal compliance is sometimes viewed as an unwanted expenditure of time and resources, in this age of highly regulated medicine, an ounce of prevention is worth a pound of cure.

A. Lee Bentley, III, is the former U.S. Attorney and Jason Mehta is a former Assistant U.S. Attorney (AUSA), both for the Middle District of Florida, which covers Orlando and stretches from Tampa to Jacksonville. As U.S. Attorney, Bentley oversaw a rapid expansion of healthcarerelated prosecutions, ultimately resulting in more than $800 million of recoveries for taxpayers in his last year in office. As an AUSA, Mehta personally recovered nearly a quarter of a billion dollars for taxpayers, the vast majority related to healthcare prosecutions. Both now are partners in the Government Enforcement and Investigations Practice Group at Bradley Arant Boult Cummings LLP in Tampa, Fla., advising clients on healthcare compliance.

Bentley can be reached at lbentley@bradley.com. Mehta can be reached at jmehta@bradley.com.

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Why to Care About Self-Care

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By ANGELINA WHALEN

It’s no secret that those who practice healing or caregiving professions are at high risk for burnout. Spending the majority of your time “other” centered can often leave you with little to nothing left in the tank for your family let alone yourself. Selfcare, though seemingly simple enough to implement, is often left at the very end of the day’s To-Do List. As a mental health professional myself, I don’t fail to see the irony in the fact that I am much better at caring for others than I am myself. Another observation though, is that I am a far better therapist (mother, wife, friend, etc.) and thus produce better outcomes for my clients, when I am practicing consistent self-care.

Self-care yields the most positive results when it is incorporated throughout the day, versus occurring as a single event in the day (i.e.

“I exercised today, so I took care of myself ”). While any activity spent filling yourself up is time well spent, I’m suggesting more of a culture shift in how we prioritize ourselves in the thick of taking care of everyone else. This starts with something as simple as bringing more awareness to ourselves. I’m speaking for instance, about the times you wind up at the end of your shift having failed to take care of your own basic needs such as eating, drinking water, or even using the restroom (you know it happens!). Surely your body and mind were giving you signs that you needed to do these things, but you were either too busy to be aware of them or you chose to ignore them. Becoming more mindful of your own thoughts, feelings, physiology, and needs throughout the day is a fantastic first step in your quest to live and practice from a full cup.

Creating structure in the chaos is another helpful way to prioritize self-care.

As a medical provider, it’s unlikely that you spend each day in exactly the same fashion. There are cancellations, last-minute bookings, emergencies, complex patient needs, and office/personnel issues among other things that can cause your days to fluctuate. This doesn’t even include all the things that can occur before you even 23

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show up to work! Finding ways to create – and stick to – a routine or schedule can decrease stress levels and promote opportunities for self-care. At work this might look like scheduling break/lunch times into your calendar or even setting recurring alarms on your device to remind you to take care of you. Forcing yourself to get outside of the office to eat, go for a walk, or just breath and soak up some Vitamin D is always beneficial in ensuring you spend your down time productively.

While creating structure in the workplace is important, this concept might be most practical in making the most of the time you have available before/ after your shift. Maybe you start each day by preparing breakfast, enjoying a cup of coffee, or going for a run. Maybe before bed you read a book, listen to some music, or write in a journal. How you spend your “you time” will depend on your unique interests but the point is to intentionally designate time, in at least 15 minute increments to be spent uninterrupted and maybe even alone for the sole purpose of YOU. This time will always serve you best if it is spent in the absence of phones, laptops, or anything that can lead to work. If you are feeling extra adventurous, you can even incorporate one of these 15-minute time slots into the middle of your work day.

As a physician, it is important to remember that you are in a leadership role regardless of where or what you practice.

As such, you play a huge part in setting the tone and vibe for your staff and patients, more so with you do than what you say. Encouraging self-care activities for all staff members and asking them to hold you accountable too is a great way to cultivate a positive work environment while keeping you on track with your self-care goals. Your patients will always pick up on the subtle things, and presenting them with the best version of yourself is not just good business, it’s good self-care.

Angelina Whalen is a Licensed Clinical Social Worker and owner of Valor Counseling, LLC, in Lake Nona. She is passionate about mental health, and reducing the stigma that still surrounds it by raising awareness and through serving her community. Contact Angelina at Angelina.valorcounseling@gmail.com.

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The Medical Marijuana Doctor is In, continued from page 1 of residence (Florida Driver’s License or ID) and pay the $75.00 processing fee.

The Department of Health has recently made changes that allow these functions to all be done online, however if the patient chooses, they may still handle these tasks through the mail. According to the DOH website, the average processing time for online applications is 17 days. This is a generous figure as we still see about a 30 day turn around on the processing. When the patient’s information is approved, they will receive an email confirmation that states their approval and delivers their ID card.

Once this email is received, the patient will

be able purchase their medicine. The patient will eventually receive an actual card to use, which can take another 1 to 4 weeks.

The patients can use their email approval as long as needed.

Where do patients purchase their medicine?

Medical marijuana can only be purchased at licensed marijuana treatment centers, also known as dispensaries. These centers are typically nothing like what most people think. In fact, many patients say it is very much like going to the Apple Store at the mall. Very clean, very professional and highly secure. Currently there are two treatment centers in Orlando, with more on the way. Unfortunately, there are counties that have voted not to allow the centers, making

it more difficult for patients to obtain their medicine. All of the Treatment Centers do offer home delivery to anywhere within the state to help patients who are not in close proximity of a center. Current forms of the medicine include a liquid inhalation method, liquid tincture, capsules, nebulizers, suppositories, and even transdermal patches. Edible products will be available in the coming months.

We will continue to help you to understand the process as a whole with additional articles. Additional information may be obtained at MARIJUANADOCTOR.COM as well as Floridahealth.gov (office of medical marijuana use).

Jason Beeken is the manager of the Marijuana Doctor location in Orlando. He can be reached at Jason@marijuanadoctor.com

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HEALTHCARELEADER Steve Sevigny, MD , continued from page 7 the best we could be, better scanners, fellowship trained radiologists, specialty reads, beautiful centers, and exceptional employees. True competition means better care for our shared patients.

What about site neutral payments? What is your view of the optimal way to reimburse the different types of providers?

Giving hospitals more favorable reimbursement over physician-owned facilities only hurts the patient. The power pendulum between hospitals and physicians has become completely one-sided. Physicians have allowed the hospitals to dictate key healthcare policy by our political inactivity. As President of the Volusia County Medical Society this year, I have reached out to so many hospitalemployed physicians in the hopes to get them back involved. We have increased our membership with great programs, but still there are too many physicians who just punch the clock and have given up. The county medical societies have all felt the decreasing memberships.

Do you favor revoking the tax-exempt status on nonprofit hospitals that abuse it, and at what point do you consider abuse taking place?

The Affordable Care Act has made the majority of hospitals more profitable than they ever imagined. The implied deal was that then they would open up community health centers and step up their primary care efforts to work on getting healthcare costs down across the system.

Unfortunately, that did not happen. In fact, numerous hospitals have decreased their indigent care efforts. Since Florida rejected Medicaid Expansion, those factors have been blunted in our state. The “nonprofit” hospitals have used this windfall to build more physical facilities and hire more administrators to comply with increasing regulations. Politics aside, the state’s healthcare has significantly suffered due to the lack of Medicaid Expansion.

What roadblocks do you see, from the large hospital systems, for the changes in policy you’d like for the country?

Physicians need to support/elect more physicians to office to fight for the independent practice of medicine. Political parties aside, a physician will understand the issues better and will represent physicians better. We need more people inside the political system that understand patient care and the realities of being a doctor.

For decades, PHARMA and others have used the political system, mastered it even, to drive their profits upwards with little regard for the patients or doctors in the healthcare system. To reverse that trend, we need to learn to use the political system just as well. We have numbers on our side, everyone needs healthcare.

What are your thoughts on MACRA and the future of the independent practice of medicine?

One of the primary reasons that I am running is the current level of stifling regulation and the reimbursement threats that are coming from the MACRA/ MIPS implementation. I understand the concept of quality versus quantity, but the current methods are useless. In Radiology, the quality measures are more based on the vocabulary used in reports with no regard for the true quality of practice.

I have heard from many clinicians how much more time they have to spend on the administrative side of patient care rather than the actual care of patients. The threat to reimbursements in two years based of your performance this year without any current feedback mechanism is causing anxiety across the country with physicians.

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