Orlando Medical News May 2019

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Accessing the Spectrum of Quality Care Reflections on Women’s Health as ACOG Wraps its Annual Meeting The American College of Obstetricians and Gynecologists (ACOG) has just wrapped its 2019 Annual Clinical and Scientific Meeting. The theme for this year’s gathering was “Accessing the Spectrum of Quality Care.”

The conference also set the stage for leadership transition. ACOG President

ON ROUNDS

PHYSICIAN SPOTLIGHT Cesare Peraglie, MD ... 3

THE CYBERSAFE PRACTICE CyberSecurity for Dummies ... 5

WHITE GLOVE CONCIERAGE ESTATE ACQUISITIONS

with Betsy Newman, VP, Senior Mortgage Originator & Lisa Owens, PLLC, Realtor® ... 6

MEDICAL CITY Time for Self ... 7

The STATES Act and its Potential Effect on Florida ... 21

LOWEDOWN ON HEALTH LAW

Innovations in Healthcare Technology ... 22

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Lisa M. Hollier, MD, MPH, FACOG, welcomed colleagues to the 67th annual meeting before passing the gavel to 201920 President Ted L. Anderson, MD, PhD, during the annual business meeting.

Immediate Past President, Hollier shared thoughts on the past year as she led the organization of more than 58,000

members.

What were some of the key issues addressed during the meeting and over the past year?

Dr. Hollier: This year’s meeting’s theme – Accessing the Spectrum of Quality Health Care – included an information-packed

program that addressed the most timely and challenging topics our members face as Ob-Gyns. Healthcare access has been a key component of everything we’ve been working on during my year as president, so having access as a focus of the meeting was vitally important.

(CONTINUED ON PAGE 2)

HEALTHCARELEADER

Getting a Handle on One’s Own Health Mary Pigatti, CEO eMindful

eMindful recently announced its newest leader, Mary Pigatti, as Chief Executive Officer. The company offers evidence-based mindfulness programs that improve health outcomes and reduce healthcare costs.

During Pigatti’s 25 years of leadership, her top priority has been employee and client happiness as she’s focused on organizational growth, innovation and investments for digital health and performance solutions.

She steps in at a time where the concept of emotional health in the workplace is seeing a paradigm shift. In fact, a recent random-

ized study conducted by Aetna shows that for every $1 invested in employee health, an organization sees a $9.63 return.

Prior to joining eMindful, she served as Chief Executive Officer of Retrofit, Inc., a leading provider of personalized, weight-management and disease-prevention programs, and in 2018, led the company through a successful acquisition by Livongo Health, Inc. We asked Pigatti for her insight on the impact of mindfulness in the workplace, how it influences her decision-making

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as a leader and the mindfulness practice she commits to, which includes walking 30,000 steps a day.

Why did you choose eMindful as the next step in your career?

What excites me most about joining eMindful is the opportunity to bring eMindful’s evidence-based programs to millions of people and help employers and health plans build sustainable cultures and great places to work, leading to great business results.

(CONTINUED ON PAGE 4)

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Accessing the Spectrum of Quality Care, continued from page 1 Access to quality healthcare is a key to ensuring the health of women. ACOG is pursuing policy and legislative solutions to address the rising rate of maternal mortality and severe maternal morbidity in the United States. This includes advocacy for Medicaid coverage for women up to a year postpartum, support for state perinatal quality care collaboratives, support for efforts to reduce racial and ethnic disparities in maternal health outcomes, and support for the Alliance for Innovation on Maternal Health (AIM), a national data-driven maternal safety and quality improvement initiative to improve maternal outcomes in the U.S. ACOG has always supported access to affordable healthcare, and we will continue to oppose every attempt to roll back critical women’s health gains in the Affordable Care Act, particularly for women with preexisting conditions. We also continue to oppose efforts to deny access to reproductive healthcare and access to qualified providers through the Title X Family Planning Program. Title X is the only federal program exclusively dedicated to providing low-income patients with access to family planning and preventive health services and information.

Recent actions by the Administration to change Title X will limit access to vital healthcare services to low-income women, men, and adolescents. These actions restrict information that physicians can provide to their patients, weaken safeguards that ensure that Title X-funded programs offer evidence-based contraception, and impose medically unnecessary requirements on healthcare facilities that will exclude qualified providers from offering care to low-income women.

Last year, ACOG and other leading medical groups actively opposed these proposed changes and submitted public comments to the U.S. Department of Health and Human Services. On April 9, 2019, ACOG and leading medical groups filed amicus briefs in several cases across the country in support of states’ and organizations’ motions for preliminary injunction to stop the recently issued changes to Title X from going into effect.

What key clinical areas were explored during the recent meeting?

The trifecta clinical seminars covered topics that are most important to ACOG members, including endometriosis, genetics, substance use disorder and traumainformed care, and DVT prophylaxis.

This year we had a new session, EdTalks, which were three powerful, 10-minute presentations followed by a Q&A panel with the speakers. The EdTalks topics covered financial models, reproductive endocrinology and infertility, menopause, microbiomes, polycystic ovary syndrome, the annual well-woman visit, sterilization, and the environment. This was all in addition to more than 700 scientific ePosters with cutting-edge research in women’s health.

Maternal mortality rates have been a big part of your efforts as ACOG president, what are your thoughts on improving care?

The United States is the only developed country with a rising maternal mortality rate. This has been a tremendous impetus for change. My Presidential Program at the meeting and all of my presidential initiatives focused on implementable solutions to eliminate preventable maternal mortality.

We are seeing changes in the leading causes

of maternal mortality. With reductions in pregnancy-related deaths due to hemorrhage and hypertension, we are seeing that cardiovascular disease and cardiomyopathy are the leading causes.

Fortunately, we know from maternal mortality review committees in states across the country that as many as 60 percent of maternal deaths are preventable. Because of the important role of cardiovascular disease in maternal mortality, a large part of my presidency was dedicated to updating ACOG’s clinical guidance on pregnancy and heart disease. Cardiovascular disease and cardiomyopathy account for about 1 in 4 maternal deaths and disproportionately affect black women. I am proud to say that the dedicated, multidisciplinary members of my presidential task force completed comprehensive guidance on this topic that covers screening, diagnosis and management of cardiovascular disease in pregnancy and the new Practice Bulletin was released during the annual meeting.

ACOG members have also been working hard across the country to promote a culture of safety in hospitals, particularly in labor and delivery units. With the infrastructure and support provided

by AIM, hospitals are implementing standardized, evidence-based practices that reduce complications and improve women’s outcomes. AIM is a national data-driven maternal safety and quality improvement initiative to reduce maternal mortality and severe morbidity. Over the last several years, and with an additional $10 million grant from the Health Resources and Services Administration, the AIM program has grown and now enrolled 26 states … and counting. Our goal is to have participa-

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tion from all 50 states, and I am confident that we will do it.

During the national meeting, you passed the gavel to Dr. Anderson.

Could you share some reflections on your time leading this organization over the past year?

ACOG has made incredible progress on behalf of patients and our members in just one short year. Our committees have created and updated our clinical guidance.

We’ve developed and created programs and education that help our members implement our Practice Bulletins and Committee Opinions in their clinics and in hospitals. ACOG members have taken to the Hill and gone to their state legislatures to ensure the leading voices of women’s healthcare are heard and influence legislative and regulatory policies. It’s been a year of accomplishment, and I am so proud to have handed the gavel to Dr. Ted Anderson as our 70th president of ACOG. I’m really proud of the advocacy work we’ve done with our partners to get better data on the causes and contributing factors to maternal mortality. We recently celebrated the passage of the Preventing Maternal Deaths Act, which was subsequently signed into law in December. ACOG staff, along with our dedicated members, spent nearly 10 years advocating for this important legislation that will now ensure funding and infrastructure for state-based maternal mortality committees. I’m thrilled that I could help usher this bill across the finish line and that it became law during my tenure.

To help ensure that advocacy holds a central role in our organization and our specialty, I created the ACOG Annual Junior Fellow College Advisory Council Advocacy Leadership Training program. This innovative and immersive program offers exclusive opportunities and experiences to our next generation of ob-gyn leaders, our JF chairs.

We’ve also invested in our Levels of Maternal Care program this year. The initial guidelines were developed and published in 2015 and were designed to promote collaboration among maternal facilities and healthcare providers with the goal that pregnant women receive care at a facility appropriate for their risk. ACOG and the Society for Maternal Fetal Medicine (SMFM) have worked together to develop and pilot the levels of maternal care verification program. The lessons learned from the pilot were published this year.

Any other thoughts on the state of healthcare for women?

Healthcare providers and facility leaders can all make a difference — can all do more to improve the health of women. There are so many opportunities to implement policies, procedures, and guidelines that are effective in promoting better outcomes.

We know that women’s lives are worth saving, and we need to focus on our common goals. Together, we must make women’s healthcare a national priority and ensure that women have access to the spectrum of high-quality healthcare.

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PHYSICIANSPOTLIGHT

Moving Patients in the Right Direction Cesare Peraglie, MD

With a father and grandfather who were both physicians, Cesare Peraglie felt destined to pursue a career in medicine.

As a child in south Texas, he shadowed his father, who was an OB-GYN, while he made his rounds or performed surgery.

“I got to see how doctors interacted with patients and talked with different types of people,” he recalled. “l learned that succeeding in medicine is all about establishing relationships and caring for your patients.”

Finding a Calling

Peraglie went to medical school at Texas Tech, where he also performed his surgery residency. He thought about becoming an OB-GYN like his father, but that plan changed when a trauma surgery professor took him under his wing.

During his training, Peraglie completed bowel surgeries for trauma and cancer patients, and he took an interest in colon and rectal surgeries. At the time, minimally invasive surgery was an emerging field primarily used for gallbladder and appendix surgeries, but under the guidance of his mentor, he was able to experience laparoscopic colon surgery before it was recognized in the medical community.

“I cared for many patients recovering from large incisions after surgery,” he said, “and I realized less-invasive techniques could provide better results.”

Peraglie completed a fellowship in minimally invasive surgery in Kansas and another in colorectal surgery at Grant Medical/The Ohio State University. After completing these fellowships, he went into private practice in Las Vegas as a colorectal surgeon.

Center offers a full spectrum of minimally invasive colorectal procedures.

“We often deal with misdiagnosed or mistreated issues, as well as complicated conditions such as inflammatory bowel disease,” Peraglie explained. “It’s important to have specialists who understand the nuances of this region of the body and have the experience to render appropriate diagnosis and care. We want to offer patients the best chance for a cure with good function, which will preserve their quality of life.”

A New Lease on Life

Similar considerations also apply in bariatric surgery, where procedures require intervention and follow-up over time.

“Bariatric surgery is a surgical tool for patients; it doesn’t necessarily cure them of obesity,” he notes. “We’re providing the jumpstart that encourages them to form healthy habits, make lifestyle changes and resolve medical issues — all of which are critical for long-term success.”

Someone who’s severely overweight, notes Peraglie, may try to eat right and exercise, but they struggle because they have sleep apnea, chronic obstructive pulmonary disease or high blood pressure.

“When you offer surgery, you start a cas-

cade of beneficial effects, including loss of retained fluid, decreased joint pain, improved breathing and resolution of obesity-associated illnesses.

“They can bend down and tie their shoes, sit in a restaurant booth and play with their kids,” he added. “It’s truly lifechanging.”

Although he offers surgical options, Peraglie is one of a few surgeons in the country who perform mini-gastric bypass surgery (MGB/OAGB). He became interested in this procedure when he realized the advantages that it offered over other traditional procedures. “With the MGB/ OAGB, we are able to offer patients one of the only procedures that is not only highly effective and durable but also easily reversible and revisable. Patients are typically in surgery an hour or less and the majority are able to go home the following morning,” he said.

“We’re able to induce remission in these comorbid conditions after addressing the hormonal effects of obesity,” he explained.

“Mini-gastric bypass surgery induces hormonal changes that act both on the pancreas

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While in Las Vegas, Peraglie operated on a woman whose daughter worked as a nurse for a bariatric surgeon.

Through that connection, he became interested in bariatric surgery and completed a year of training in that specialty.

In 2004, he was invited to Central Florida to train another surgeon and was ultimately offered a permanent position at a Polk County hospital in 2006. He recently joined the team at Poinciana Medical Center, where he serves as a colorectal and bariatric surgeon.

“Joining Poinciana was a ‘groundfloor’ opportunity,” he asserts. “It’s a newer facility in a growing area, and we’re able to offer specialties not available before, which allows us to keep patients in their communities.”

Previously, many patients had to drive to Celebration, Kissimmee or Orlando to receive specialized care, but this is no longer necessary, because Poinciana Medical 3

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and the intestine to naturally fight diabetes. Many of my patients can stop or reduce their diabetes medications quickly.”

Peraglie has performed thousands of bariatric surgeries, both primary and revisional and has published on high-risk patients, including those who are morbidly obese and those over age 60. He is a current and longstanding member of numerous societies including the American Society of Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO).

Outside of work, Peraglie enjoys spending time with his wife, 10-year-old son and practicing Brazilian jiu-jitsu. He counts himself fortunate to have a career he loves — and one that makes a tremendous difference in the lives of his patients.

“We’re treating diseases that affect a person’s lifespan,” he said. “We’re not only improving their life expectancy but giving them back the ability to perform everyday tasks. We’re giving them a brand-new lease on life.”

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HEALTHCARELEADER | Mary Pigatti, MD, continued from page 1 Distractions and mindlessness are costing employers $300 billion annually in lost productivity, and almost $200 billion in stress-related-illness expenses. eMindful’s solutions delivers the ROI needed to combat these problems head on.

What does eMindful do? eMindful is a leading provider of evidence-based mindfulness programs that improve health outcomes and lower healthcare costs by helping individuals and teams optimize their emotional health and lead happier, healthier and more productive lives. Our proven programs apply mindfulness skills to help individuals manage chronic conditions such as stress, anxiety, weight, chronic pain, cancer, and other chronic conditions.

What makes eMindful different?

What sets eMindful apart are our purpose-driven mindfulness solutions and 10 years of life-changing results. Across our book of business, 29 percent of participants reduce their overall stress, 55 percent of participants see a reverse in their Metabolic Syndrome and 20 percent of participants report an improvement in sleep.

What makes a good leader?

What’s your leadership style?

Good leaders understand that they have the unique opportunity to make a difference in the lives of others. In terms of my leadership style as a CEO, creating a culture of employee happiness as well

as a work environment where employees are empowered and inspired to show up as their best selves has always been my number one priority. If our employees are happy and fulfilled, our clients, participants and investors will see that translates directly into ROI. I also believe a good leader builds a connected and collaborative culture aligned around the vision and values. As a leader, I am intentional about hiring diverse people, playing up their strengths and reinforcing communication between teams at all levels. For example, I use weekly pulse surveys to engage in an ongoing dialogue with our employees and apply employee feedback to shape the culture and implement programs that are most valuable to employees. We also leverage the latest technologies to ensure access and collaboration.

Finally, I approach every day as a new day – leadership is a daily choice.

What are 3-5 leadership principles you have discovered and executed that have contributed to the success of your organization?

Prioritize your happiness and those around you.

Only you know what fulfills you. Find what that is and make it a priority in your life and values. As a CEO, employee happiness has always been my number one priority.

Surround yourself with an amazing leadership team you can learn from and listen to them.

Hire exceptional talent that can help others be exceptional.

Focus on the customer and listen to them.

Make time to think. Carving out time in

your day to think is what ignites those “aha” moments that can have positive implications for your personal or professional life.

How do you inspire others to be successful?

I inspire others by creating a sense of community that allows everyone to thrive.

This community is one where people’s voices are heard, and they are empowered to make decisions on their own. I also am a true advocate for personal growth and continually challenge myself and others to improve by constantly raising the bar for success.

Additionally, I don’t miss an opportunity to recognize and celebrate accomplishments. I also make sure to prioritize my own happiness and encourage others to do the same. If we are happy, we are more likely to excel personally and professionally.

Can you elaborate on the importance of mindfulness in the workplace and in general?

Simply, mindfulness allows us to take a step back and observe our emotional state. From that awareness, we can build a toolkit to manage our emotions and behavior. Stress is a common workplace ailment, and by applying a mindfulness practice we can see several physiological

benefits including lowered blood pressure, improved memory, and reduced depression and anxiety.

Businesses, like Aetna, Google and General Mills, are seeing the short-and long-term results by implementing mindfulness programs. They’re seeing a decrease in healthcare claims as well as an increase in engagement, productivity and retention.

How do you integrate mindfulness as part of your routine, and how does it influence your leadership?

Integrating mindfulness starts with my consistent morning routine. It includes eating a healthy breakfast, identifying what I am grateful for, listening to positive songs like I’m Blessed by Martina McBride, and getting on my walking desk – I try to walk 30,000 steps a day. I also prioritize sleep and do a lot of self-reflection about my own emotions, habits, behaviors and blind spots.

As a leader, mindfulness allows me to be fully present with employees, noticing their strengths and successes. I empower decision-making, collaboration and creative problem-solving and compassion. As a leader, practicing mindfulness, helps me focus, make thoughtful decisions and be intentional with my time.

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THE CYBERSAFE PRACTICE

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CyberSecurity for Dummies How to be prepared for the current and coming threats

By BRETT JAFFEE

the event that they do get in.

To first properly posture and prepare for the existing and future Cybersecurity threats, you must accept the following 5 statements as true.

Ransomware Is Big Business

Between 2016 and 2017, ransomware sales on the dark web grew from $249,287 to $6,237,248, a growth rate of just over 2,500 percent. According to the FBI, ransom payments extorted total about $1 billion in 2016, up from $24 million in 2015.

The technique is locking or encrypting files and then demanding ransom. It has evolved from traditional cyber-crime business models of merely stealing data or taking down networks.

Rather than peddle stolen data on the black market, cyber-criminals have opted instead to go direct to the customer, so to speak, which significantly shortens the attack life cycle and overhead and delivers money more quickly.

Not All Hackers Are Created Equal

You can stop most of the bad guys, but not all of them. If China, Russia, or the like want your info, they are going to get it. This is a hard truth of the situation. In addition to having to deploy systems that prevent hackers from getting in, your organization has to be prepared in

It Matters to YOU

Your level of compliance to HIPAA requirements matters to your business. In addition to that, how you handle, protect and preserve your customers’ non-HIPAA data matters. How you can and do interface with your patients matters. How you can and do interface with your employees matters.

Not All Threats Are External

Many times, hacks or breaches originate from inside an organization.

Sometimes intentionally by a company employee with a personal agenda and sometimes unintentionally by a company employee who’s simply made a mistake or just exercised poor judgment.

Mother Nature Is Unstoppable

A tornado, earthquake, flood, hurricane or sinkhole that collides with your place of business can be catastrophic to your business and, at best, incredibly disruptive.

After you accept the prior statements as truth, you can begin to adjust your own posture to prepare for what comes. Preparing your organization so well that it is a minor event instead of a major system shutdown, or a public relations nightmare and/or a very costly fix.

Understanding how to shore up your Cybersecurity posture and readiness be-

gins by understanding all your vulnerabilities. Threats come from outside and inside your organization. Training should reflect this. External/internal threats can be both unintentional and intentional and either can be devastating to the organization.

In the event of a business disaster (natural, system, ransomware, grid or otherwise), how fast can your business get back up and running? What needs to be done if/when that happens? What needs to be done before that happens? A business should not be operating today without the answers to these questions. The sad truth for doctors today is that a physician does not have to wonder if they will be targeted. It’s a matter of when and how bad it is. Fortunately, the solutions are not at all too difficult to implement.

8 Signs Your Business Is Vulnerable and Unprepared • Your office does not have a mechanism in place to detect and alert in the event of any cyber breach.

• Your office employees have not been properly trained/instructed to recognize cyberattack/phishing attempts. (Your company has not, in an official way, communicated proper strategies and techniques to protect information assets.)

• Your office has extra levels of security for Privileged Roles (System administrators, HR, CFO, CEO etc.) but your office does not log

Do you ever Wonder if your practice’s secrets are NO LONGER Secret?

2018 Was a Record-Breaking Year for Healthcare Data Breaches https://www.hipaajournal.com/analysis-of-healthcare-data-breaches/ When was your last Cyber Checkup? ”It’s been awhile” is pretty common!

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and monitor privileged activities.

• Your office’s backed-up data is stored at the company’s central location.

• Your office does not have a tested disaster recovery and business continuity plan.

• Your office does not monitor changes to critical systems and data.

• Your office does not conduct periodic vulnerability assessments of its IT infrastructure, applications and endpoints.

• Your office has no advanced network defense and insider threat mitigation tools in place. (e.g. IDS/IPS, Proxy Servers, Content Filters, Mail Security, APT, DLP).

What should an office do first?

Get Help! Your office is an expert in what your office does. Find an expert in Cybersecurity or Secure IT and let them map it out for you. Walk you through it.

The business is too valuable, and most offices don’t have the time and resources to keep up in an area that is not their central focus. Don’t ask your electrician to educate themselves on auto repair and then fix your car. Go find a good mechanic first!

Implement security to get the biggest bang for the buck. Studies show that over 90 percent of cyber incidents could have been prevented if organizations implemented 5 security controls. SANS institute’s top 5 controls is a great start. Read here.

Be realistic in your approach. No matter how knowledgeable and aware your staff is regarding cyber hygiene, and no matter how good your firewall or other security tools, have a good continuous monitoring program to timely detect any incidents you may have.

M Brett Jaffee is VP of Sales for NSG and has over 25 years of experience selling and marketing primarily to Fortune 1000 companies. Brett began his career with Electronic Selection Systems in 1994. Helping grow their business from 5 employees and 1 million in revenue to 300 employees and 36 million in revenue. Acquired by Thompson Corporation in 1999 and changing their name to AlignMark, Brett opened many new markets, Midwest, West Coast, Southwest, and vertical markets in Retail and Real Estate. Working with General Motors, UPS, Dow Chemical, AT & T, Bank America, and many others, Brett has demonstrated a long history of providing customer solutions.

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

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

As a Realtor®, I am often asked questions about the real estate market. Here are a few: What is the market doing with single family homes?

• Sales of single-family homes increased to 593 during the week of Apr 21, from 544 the week prior • The median price of single family homes decreased to $255,000, a change of -1.4 percent • The number of single-family home foreclosure transactions remained constant at 14 • The number of single-family home shortsale transactions increased to 5 from 3 the week prior • Single-family inventory decreased by 1, and now sits at 6,933

• Has been employed as a non-resident for < 12 months • Medical Doctor degrees only (MD,DPM or DO degrees) Note: A psychiatrist is eligible but must be a medical doctor, as defined above, and be licensed.

What are the requirements of an Established Doctor: An established doctor/dentist is defined as a doctor/dentist who has been employed as a Non-Resident/Intern/Fellow for at least 12 months by a hospital, physician group

or facility OR has been self-employed as a medical doctor/dentist for at least 2 years.

• Licensed medical doctor/dentist (MD,DPM, DO, DDS or DMD degrees) who has completed residency AND • Employed by a hospital, physician group or facility as a Non-Resident/Intern/Fellow > 12 months OR • Self-Employed for at least 2 years OR • Teaching at a medical institution Note: A psychiatrist is eligible but must be a medical doctor, as defined above, and be licensed.

What are the designations needed for the Physician Financing: Licen sed medical doctor/dentist (MD,DPM, DO, DDS or DMD degrees) The Loan to Value matrix for Physician Financing is as follows: Loan Amount Financing %

Up to $750,000 $750,001 - $1,000,000 $1,000,001 - $1,500,000

Up to 100% Up to 95% Up to 85%

What is the market doing with condos, townhomes and villas?

• Sales of condos, townhomes, and villas decreased to 158 during the week of Apr 21, from 176 the week prior • The median price of condos, townhomes, and villas increased to $178,750, a change of 0.4 percent • The number of condo, townhome, and villa foreclosure transactions decreased to 0 last week, from 5 the week of Apr 14 • The number of condo, townhome and villa short-sale transactions increased to 1 from 0 the week prior • Condo inventory increased by 4, and now sits at 1,863 Is it a good time to sell?

The Orlando region is #1 in the nation for job growth for four consecutive years.

The Bureau of Labor Statistics, states Orlando, Kissimmee and Sanford continued to grow as the fastest job market in 2018.

There were 41,800 jobs increased by 3.3 percent compared from December 2017 to December 2018. Florida gained 213,600 jobs and increase of 2.5% during the same time period. It grew 2.0 percent nationally over the year.

It is a great time to put your home or investment property on the market. Based on these statistics, we are seeing an influx of families relocating to the Orlando area for job opportunities. I truly enjoy working with families relocating and searching for their next season of life.

Statistics and data was supported by the Orlando Economic Partnership and Orlando Regional Realtor Association.

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

• In residency or set to begin new residency within 90 days of closing OR 6

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EOCC MEDICAL CITY

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Time for Self

By DOROTHY HARDEE, Chamber Administrator

The month of May, named for Greek goddess Maia, is a time for renewal, regrowth and a celebration of motherhood throughout the world. It is also National Women’s Health month, the perfect time to focus on yourself or the special women in your life. Despite an entire month dedicated to women, why is it so difficult for women to put themselves first?

Rojke Hasseldine explained it as a “generational female history where women’s needs have been deliberately silenced and denied” during what she describes as “The Culture of Female Service.” The term covered a vast belief that females are “the nurturing gender” whose role was to care for the family and community with no need for reciprocal care. Breaking the cycle, putting yourself first can be difficult but as I found over time necessary to be my best self.

As a young mother, my husband and sons celebrated Mother’s Day inviting our family over for a special dinner. While time spent with extended family was cherished, the pre- and post- preparations were often exhausting. After a decade, I pronounced that if the day was truly all about me, then

I would do something just for myself, by myself for the weekend; so, I headed to the beach. After the shock and awe wore off, my family understood that giving me this moment in the sun allowed me to unplug, coming home with my sanity intact, aka “Happy wife, happy life.”

Healthy Women contributor, Judy Freedman echoes the mantra of her yoga teacher, “We are all human beings and we should spend more time being, instead of constantly doing.” She suggests a few ways to honor your commitment to yourself is by: • Doing daily exercise; • Eating your fruits and vegetables; • Taking time to smell the roses; • Talking or listening to your friends; • Sleeping more.

Healthy behaviors contribute to better physical and mental health but should

not be absent of important preventive screenings and vaccines. The value in caring for yourself is that it keeps you healthy to continue supporting the health and well-being of your family. This was never so true as it was when a woman I met briefly, (caregiver for her three grandchildren) hesitated to get a mammogram, fearing the worst. Reminding her that these children needed her, she pushed her fear aside stepping into the mobile mammography van. Her results were clear and her mind at ease. Remember, if you don’t do it for yourself, do it for those you love.

It is important to follow recommendations for cancer screening tests, giving you the best chance of finding cancer as early as possible. The American Cancer Society recommends: (CONTINUED ON PAGE 8)

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UPCOMING LUNCHEONS: June 19th – Ann Shortelle, Ph. D (SJRWMD) “Florida’s Water Future” JULY 17TH Orlando City Mayor Buddy Dyer JULY 19TH OPTIC: Big Data Advantages & Capabilities AUGUST 21ST Dr. Sandy Shugart “Valencia College Public Safety Village” SEPTEMBER 18TH Orange County Mayor Jerry Demings Please visit www.EOCC.org for a complete listing of January’s 18+ Events 7

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OUR EXPERTISE INCLUDES: Swallowing disorders • Unexplained Abdominal Pain • Complex Liver Diseases • Constipation Inflammatory Bowel Diseases • Colon Cancer Screening • Colorectal Surgery • Fecal Incontinence

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EOCC MEDICAL CITY • Staying away from tobacco • Getting to and keeping a healthy weight • Get at least 150 minutes of moderate or 75 minutes of vigorous intensity activity each week • Eating healthy • Limiting alcohol intake In addition to cancer screenings, the Center for Disease Control and Prevention (CDC) recommends an adult immunization schedule based on age and medical condition and the U.S. Preventive Services Task Force offers an Electronic Preventive Services Selector offering evidence-based recommendations in the era of the Affordable Care Act based on age and gender.

Now that you know what screenings you should consider, where do you turn? Orlando Health makes preventive and wellness easy, offering a comprehensive and convenient range of services for women of all ages including preventive screenings, weight management, stress reduction, fitness classes and more.

AdventHealth embraces wellness at every age and stage offering wellness for the whole-person designed to fit you, from well-women care, imaging, diagnostics and testing, heart health, care network and so much more.

For Women Veterans, the Orlando VA Medical Center has you covered with their Whole Health System offering proactive and personalized healthcare, empow-

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ering women to achieve their greatest level of health and well-being.

In the heart of Lake Nona the UCF Health College of Medicine Practice offers Internal Medicine physicians trained in the art of diagnosing, treating and preventing diseases. They will evaluate your overall wellness, educating you on appropriate screenings and tests based on age, gender, family history and unique circumstances.

Your physical health is critical, but what constitutes a “Healthy Business?” A periodic business health assessment like your screenings, should be a staple of your ongoing business plan cycle. Assess your business honestly and accurately to determine the true picture.

Take the time to determine where your deficiencies lie, whether it is chasing customer payments, spending time and resources on repair and maintenance and how you can improve your skills to manage your business better. It is the first step toward the “clean bill of business health.”

Looking to connect and grow your business? Consider joining the East Orlando Chamber of Commerce (EOCC) family. With health benefits for members, targeted networking opportunities, concierge services and benefits you can count on, the EOCC is the place to call home.

Give us a call at 407-277-5951 or visit our website at eocc.org for more information.

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GrandRounds Four UCF College of Medicine Students Awarded Order of Pegasus

Ponte Health Properties Releases Renderings of Downtown Complex Three undergraduates in the Burnett School of Biomedical Sciences and a fourthyear M.D. student were among 22 UCF students inducted Wednesday into the Order of Pegasus, the university’s most prestigious student honor.

Awardees are chosen based on exemplary performance in academic achievement, research, university involvement, leadership and community service.

The honorees are: Raquel Arthuzo Arthuzo is senior majoring in biomedical sciences at the Burnett School. Working with faculty researcher Dr. Alicja Copik, she has conducted research in using the body’s “natural killer” cells to fight cancer.

During her time at UCF she has been part of the LEAD Scholars Academy and has participated in the Program for Undergraduate Research experience. She has done two medical mission trips to Peru and one public health trip to Nicaragua, which she says have helped develop her passion for global healthcare.

Arthuzo says her UCF experience has been one of knowledge, growth and opportunity. “UCF has given me all the resources to reach my highest potential, while at the same time reminding me to use my skills to help those around me,” she said. “I had the opportunity to pursue my passions but also found new passions along the way.”

After graduating in spring 2019, Arthuzo will apply to medical school to pursue her dream of becoming a neonatologist.

Marley Denierio Denierio is pursuing dual degrees in biomedical sciences and anthropology (College of Sciences), as well as a minor in biology. She is a LEAD Scholar and member of The Burnett Honors College, Honors Congress, National Society of Leadership and Success, and the American Medical Student Association.

As an anthropology major, she studied bone fragments from ancient Peruvian societies to determine their migratory patterns, the spread of diseases, and the overall health of cultures during specific time periods.

As an honors peer advisor, honors orientation ambassador and peer mentor, Denierio assisted students in acclimating to UCF and achieving academic success.

“I understood that UCF means opportunity; but, before coming here I was unaware of what that really meant,” she said. “I could not have anticipated the personal growth and leadership development that I would experience, nor, the life-changing impact of my mentors, professors and administrators.”

After graduating from UCF this spring, Denierio plans to pursue a MD or PhD in preparation for a medical career with a global health organization.

Tyler Janz Janz graduates with his M.D. this May and thanks UCF for the opportunity to participate in medical research early in his College of Medicine career.

Janz, who suffered from chronic ear problems in his childhood, has focused his research on otolaryngology, a surgical sub-

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specialty that deals with conditions of the ear, nose and throat. After his third year of medical school, he spent a year doing clinical research at the Medical University of South Carolina, identifying reasons for delay of post-operative radiation therapy among head and neck cancer patients. He also researched the psychosocial impacts of head and neck cancer patients receiving treatment. Janz has also spent the last eight years designing a cost-effective device to help patients with eustachian tube dysfunction. The device aims to help dilate the eustachian tube to improve functioning and is currently awaiting patent approval.

“Being a part of a school that is constantly advancing in both the curriculum and clinical exposure has been integral to my education,” Janz said. “I am very blessed and honored to have been able to attend such an amazing medical school.”

After leaving UCF, Janz will begin his residency training in otolaryngology at the University of Texas Medical Branch in Galveston, Texas. His goal is to become a holistic physician who incorporates community service, innovation, and research to further advance medical care for patients.

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Mansoor Qureshi Qureshi, a senior biomedical sciences major is a member of the Burnett Honors College and the LEAD Scholars Academy. At UCF he has been extensively involved in the Honors College serving as a team leader, orientation ambassador, and as an Honors Congress philanthropy committee member.

He has also helped guide other students as a COMPASS mentor, teaching assistant for the Burnett School of Biomedical Sciences, and peer mentor for the Office of Undergraduate Research.

He thanks UCF for providing him with a framework for personal, professional and academic growth. “I am grateful for my mentors, who have been instrumental in helping me find my path. Their passion for discovery and their attitude as life-long learners sparked my interest in research,” he said.

“They encouraged me to step out of my comfort zone and to start working towards my goals instead of worrying about failure.”

After graduating this year, he plans to attend medical school, and hopes to improve healthcare delivery and public health education while providing care to underserved communities.

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GrandRounds Orlando Health Selected as One of The Best Places to Work in Health Care and Biopharma

Orlando Health has been selected as one of the 2019 Best Workplaces in Health Care and Biopharma by Great Place to Work and FORTUNE. The healthcare system took the number 25 spot on a list of 35.

The rankings considered feedback representing almost 730,000 employees working at Great Place to Work-Certified organizations in the healthcare and biopharma industry. Great Place to Work, a global people analytics and consulting firm, evaluated more than 60 elements of team members’ experience on the job. These included the extent to which employees trust leaders, the respect with which people are treated, the fairness of workplace decisions, and how much camaraderie there is among the team. Rankings are based on employees’ feedback and reward companies who best include all employees, no matter who they are or what they do for the organization.

“We are extremely pleased to be recognized as one of FORTUNE’s best health care organizations in the U.S. for employees,” said David Strong, president and CEO, Orlando Health. “The fact that team members’ responses are responsible for the rankings makes this recognition even more memorable. It speaks to the entire team’s collective successes in helping to make Orlando Health a great place to work.”

Orlando Health team members cite data transparency and a relentless focus on goals as two of the reasons the organization is a best place to work. The two traits have enabled positive changes throughout the organization and empowered team members to generate new and even better ideas for driving innovation and improving the quality of care provided to patients at its hospitals, physician practices and outpatient clinics.

• Orlando Health advances in care and technology in 2018 include • Orlando Health earned a four-star rating from the Centers for Medicare & Medicaid Services, becoming the highest rated hospital system in Central Florida.

• Orlando Health Orlando Regional Medical Center’s Burn Center achieved verification as an adult burn center by the American Burn Association, becoming

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

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Orlando Health Welcomes New Director of Customer Experience Programs the only verified burn center in Orlando.

• Orlando Health UF Health Cancer Center – Health Central Hospital became the first cancer treatment facility in Central Florida to offer the new cancer-fighting technology called MRIdian® which enables oncologists to view and track tumors during radiation treatments, allowing physicians to make immediate changes to treatment.

• Orlando Health’s Simulation Program earned accreditation from the international Society for Simulation in Healthcare; recognizing the healthcare organization for teaching/education and systems integration to provide ongoing learning for clinicians to care for patients.

• Orlando Health opened four freestanding emergency rooms in the area, expanding access to hundreds of thousands of residents in Lake, Orange and Osceola counties, and began construction on a fifth facility in Seminole County.

• Orlando Health Winnie Palmer Hospital for Women & Babies became the only hospital in Florida to offer spina bifida fetal surgery.

• Five Orlando Health hospitals were recognized by The American College of Cardiology for their demonstrated expertise and commitment in treating patients with chest pain based on rigorous onsite evaluation of the staff’s ability to evaluate, diagnose and treat patients who may be experiencing a heart attack. Orlando Health Orlando Regional Medical Center, Orlando Health Dr. P. Phillips Hospital, Orlando Health – Health Central Hospital, and Orlando

Orlando Health is pleased to welcome Brad Kennedy to the organization as director of customer experience programs. Mr. Kennedy began his position Tuesday, April 9. In this new leadership position, Mr. Kennedy will direct a variety of initiatives to bring to life the “Orlando Health Way” – an approach to delivering an outstanding patient experience that’s built on a foundation of high-quality medical care, compassion, empathy, service and collaborative, lifelong relationships.

“We are extremely pleased to have Brad join the organization,” said Ken Kozielski, vice president of customer experience for Orlando Health. “He is an accomplished individual who excels in his field.”

Mr. Kennedy comes to Orlando Health with over 10 years of experience in customer engagement across the entertainment and hospitality sectors. Prior to joining Orlando Health, he was responsible for driving the development, presentation and recommendations of customer

insight strategies at Wyndham Destinations. Mr. Kennedy has also served in corporate alliance and events management positions at Six Flags Great Adventure in New Jersey and with the Philadelphia Eagles NFL franchise.

Mr. Kennedy earned a Bachelor of Science degree in sports management and marketing from Marshall University in Huntington, WV where he was captain of the university’s division-1 men’s soccer team.

Health South Lake Hospital were awarded Chest Pain Center Accreditation with Primary PCI and Orlando Health South Seminole Hospital was awarded Chest Pain Center Accreditation.

• Orlando Health’s heart care earned the highest quality rating from The Society of Thoracic Surgeons which awarding the healthcare system with a 3 star rating for coronary artery bypass surgery and aortic valve replacement with coronary artery bypass surgery.

Central Florida Regional Hospital Expands RobotAssisted Surgery Capabilities

Central Florida Regional Hospital recently expanded its surgery offerings with the addition of the da Vinci Xi robotic surgical system, an advanced tool for minimally (CONTINUED ON PAGE 11)

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GrandRounds continued from p.10 invasive surgery. This is the second robot the hospital has added since 2013, allowing for increased patient volume in complex procedures.

Robot-assisted surgery is one of the most effective surgical treatments available, giving patients an alternative to traditional and laparoscopic procedures. Surgeons can perform complex and delicate procedures through small incisions, allowing patients to heal faster and with fewer post-operative complications and less pain. With the assistance of this cuttingedge technology, Central Florida Regional Hospital physicians have an increased range of motion and enhanced visuals during general, gynecological, urological and thoracic surgery.

“At Central Florida Regional Hospital, providing the best patient care and surgical outcomes are our priority,” said Trey Abshier, CEO of Central Florida Regional

Hospital. “By expanding our innovative robotics program, we’re able to increase the number of patients we serve.”

Patients should consult with their physicians to learn if they are candidates for robotic-assisted surgery.

St. Cloud Regional Medical Center Designated as Primary Stroke Center

St. Cloud Regional Medical Center has been designated as a Primary Stroke Center by the Agency for Healthcare Administration (AHCA).

This designation is based on standards set by AHCA that distinguishes hos(CONTINUED ON PAGE 12)

Orlando Health Nurses Receive National Recognition

Four Orlando Health nurses were recently recognized for their unique contributions to the nursing profession. Susan Fowler, PhD, RN, CNRN, FAHA was named Researcher of the Year by the National Association of Clinical Nurse Specialists (NACNS). The award acknowledges nurses for accomplished sustained programs of research that significantly contribute to advancing the theory and practice of nursing.

Dr. Fowler’s body of research includes an examination of new graduate nurses’ experiences in a nurse residency program; the training, planning and preparation nurses need to ensure the safety of hospitalized children with tracheostomies; and the novel use of a nurse-led stroke-responder telemedicine system.

In addition, two Orlando Health nurses were inducted into the inaugural class of fellows in the Clinical Nurse Specialist Institute, an arm of the NACNS that develops and promotes the charitable, educational, innovative clinical practice, and scientific purposes of the NACNS. Daleen Penoyer, PhD, RN, CCRP, FCCM, and Patricia Geddie, PhD, APRN, AOCNS, who are members of Orlando Health’s Center for Nursing Research, are two of members of the inaugural class of 38. Dr. Penoyer has conducted research into the impact different types of care on ventilator events have on patient discharge outcomes and the impact multidisciplinary and multimodal care has on sepsis outcomes. Dr. Geddie’s research focuses on predictors of

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unplanned hospitalization in older adults with cancer. Dr. Geddie has also been recognized as Advanced Oncology Clinical Nurse Specialist (AOCNS®) of the Year by the Oncology Nursing Society (ONS) and as an Outstanding Alumni, Education from University of Central Florida College of Nursing.

A fourth Orlando Health nurse, Joy Parchment, PhD, RN, NEA-BC is the recipient of the American Organization of Nurse Executives (AONE) Mentor Award.

The award recognizes nurses in executive practice who have been exemplary in supporting the professional development of his or her colleagues by serving as a mentor or advisor. Dr. Parchment serves as director of nursing strategy implementation and the Magnet® program at Orlando Health. She has served as a mentor/advisor in numerous capacities including oneon-one mentoring, mentoring numerous chairs of the Nurse Practice Council, and advocating for ongoing programs for nursing leadership development while personally developing multiple offerings.

For over a decade, Dr. Parchment has been instrumental and invested in leadership development of nurses.

“We are extremely proud of these nurse leaders,” said Jayne Willis, MSN, RN, NEA-BC, CENP, chief nursing executive and vice president, Orlando Health. “They are to be commended for the countless contributions that make to our organization and to our patients.”

Patient-focused Cardiothoracic Surgeons Caring for Greater Orlando The Florida Heart & Lung Institute has several locations extending from Orlando to Pensacola. Through this partnership, we are able to deliver a patient-focused experience in which every provider is dedicated to excellence. We offer a comprehensive range of services specializing in heart and lung surgery, including minimally invasive and robotic surgical interventions.

Wade Fischer, MD Cardiothoracic Surgeon Medical degree: Tulane University Residency: Cleveland Clinic Cardiothoracic Sugery Fellowship: SUNY Downstate, Brooklyn, NY Board Certified, American Board of Thoracic Surgery Diplomat, American Board of Surgery

Hiep C. Nguyen, MD, FACS Cardiothoracic Surgeon Medical degree: University of Texas Medical Branch Residency: New York Medical College Cardiothoracic Sugery Fellowship: New York University Board Certified, American Board of Thoracic Surgery Diplomat, American Board of Surgery

720 West Oak Street, Suite 360, Kissimmee, FL 34741 (407) 846-0090 | www.OsceolaHeartandLung.com Affiliated with Osceola Regional Medical Center’s Heart and Vascular Institute

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GrandRounds continued from p.11 pitals with infrastructure, staff, and training to receive and treat acute stroke patients.

At a Primary Stroke Center, patients can be assured of certain standards regarding diagnosis, prevention, treatment and rehabilitation, with the ultimate goal of reducing the time between stroke onset and treatment. Primary Stroke Center designation is measured on improvement performance and recognizes hospitals that meet national guidelines and manage care for quality outcomes of stroke care. St. Cloud Regional Medical Center recently contracted with Specialist on Call to provide teleneurology services, in collaboration with Active Staff physicians at the hospital, to further improve timely access to care.

According to the American Stroke Association, warning signs of a stroke include: sudden numbness or weakness of the face, arm or leg, especially on one side of the body; sudden confusion, trouble speaking or understanding; sudden trouble seeing in one or both eyes; sudden trouble walking, dizziness, loss of balance or coordination; and sudden, severe headache with no known cause. Patients are advised to go to a Primary Stroke Center first and receive stroke care when experiencing any of these warning signs.

“I’m pleased to announce our designation as Primary Stroke Center,” states Brent Burish, CEO of St. Cloud Regional Medical Center, “St. Cloud Regional Medical Center has demonstrated that we have the properly trained staff, working together with physicians, to quickly and accurately assess and treat a stroke patient in a timely manner, which will ultimately improve our patients’ recovery.”

Stroke accounts for about 1 out of every 19 deaths, ranking No. 5 among all causes of death in the United States, according to the American Heart Association/American Stroke Association. On average, someone suffers a stroke every 40 seconds; someone dies of a stroke every four minutes; and 795,000 people suffer a new or recurrent stroke each year.

For more information on Stroke Care or Emergency Services provided at St. Cloud Regional Medical Center, visit StCloudRegional.com.

Orange County Residents and Visitors Urged to Get Vaccinated Against Measles

With the increase in measles cases across the US, the Florida Department of Health in Orange County (DOH-Orange) is urging Floridians and visitors who have not been immunized to get vaccinated. Although measles was thought to be eradicated in the United States in 2000, the disease has reappeared in recent months in the form of outbreaks in several states. The Centers for Disease Control and Health

We Need Your Help!

Protection defines a measles outbreak as three or more cases. As of April 17, 2019, one measles case has been reported to the Florida Department of Health.

New Technology for Spinal Surgery Debuts at Heart of Florida Regional Medical Center

Heart of Florida Regional Medical Center is the first hospital in Florida to debut a new spinal surgery procedure that does away with the need for numerous xrays throughout the surgery and reduces the time the patient is under anesthesia.

The new procedure, which uses a camera that is linked to a computer screen that highlights the area, makes it easier for the physician to install any implants or fix an injury.

“It is like GPS for spinal surgery,’’ said orthopedic surgeon Geoffrey Stewart, M.D. “The image guided technology helps map out the area where the surgery will be performed and it eliminates the need for taking x-rays throughout the procedure which reduces the amount of radiation the patient receives.’’

Dr. Stewart said he also likes how the new procedure helps reduce the amount of time the patient is in the operating room. He said the streamlined surgery can get patients in and out quicker.

“It really does help with the flow in the operating room,’’ Dr. Stewart said. “Not having a patient under anesthesia as long and not having the added time of constantly taking numerous traditional x-rays of the patients is more efficient.’’

Dr. Stewart has already performed several of the procedures at Heart of Florida and is happy to report that his patients are pleased with the results.

Ann Barnhart, CEO of Heart of Florida, said she is thrilled to be able to offer this new technology at the hospital.

“Patients no longer have to travel to another state to have this procedure done.

They can come here and have it done and not have to worry about the logistics or hassle of going someplace else to have their spinal surgery,’’ Barnhart said. “We are excited to be able to continue bringing cutting edge technology to our patients.’’

For more information on the new surgical procedure, please visit our web site at HeartOfFlorida.com.

New Family Medicine Physician Joins Heart of Florida Group

Heart of Florida Physician Group would like to welcome board-certified Family Medicine physician Baoquang Le, D.O. to the practice.

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

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

SHARE YOUR PASSION: Help those in need of hope and healing in our community by joining the over 2800 clinical and non-clinical volunteers at Shepherd’s Hope.

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

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GrandRounds

Shepherd’s Hope Appoints New President and CEO

continued from p.12 Dr. Le joins the primary care physicians located at the MedEPlex medical offices at 410 Lionel Way, Davenport. He will begin seeing patients on May 1. Dr. Le treats patients from 12 months to senior adults. He is fluent in Vietnamese.

“We are excited to have Dr. Le join our physician group,’’ said Heart of Florida CEO Ann Barnhart. “Families are his specialty. He is very dedicated to his patients and making sure they feel they are a part of their health care plan.’’

Dr. Le said he is thrilled to be joining the Heart of Florida team.

“The health care of my patients is my priority,’’ Dr. Le said. “I want to make sure they are an active participant in their health care plan. I want to make sure they know they have a voice in their care.’’

Dr. Le said his empathy, thoroughness and love for continuing education are his best qualities and help ensure that he is offering the best care for his patients.

“I want to achieve the optimal health outcome for my patients and educate them on how to achieve and maintain that optimum health,’’ he said.

Dr. Le treats patients with chronic illnesses such as COPD, high blood pressure, high cholesterol and Diabetes as well as offering well care visits, school and sports physicals and immunizations.

He said he enjoys making sure his patients are well informed about healthy lifestyle habits as well as diet and exercise.

With same-day appointments and a special knack with children, Dr. Le takes your family’s needs to heart. To make an appointment with Dr. Le, please call 844634-3627 or visit our web site at HeartOfFloridaPhysicianGroup.com.

AMA Applauds New Federal Primary Care Payment Models that Promise to Improve Care

The American Medical Association (AMA) today commended the U.S. Department of Health and Human Services on their announcement that many primary care practices will be able to receive improved Medicare payments beginning next year through new payment models.

“Providing adequate financial support for high quality primary care must be an essential element of any strategy to improve the quality and affordability of our country’s healthcare system, said Gerald E. Harmon, MD, Immediate Past Chair of the AMA Board of Trustees. “Many primary care physicians have been struggling to deliver the care their patients need and to financially sustain their practices under current Medicare payments. The new primary care payment models announced today will provide practices with more resources and more flexibility to deliver the highest-

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quality care to their patients.”

Health and Human Services Secretary Alex Azar made the announcement at the AMA’s Washington Office during a meeting to discuss primary care delivery attended by more than 200 representatives of medical specialty societies and other stakeholders. He was joined by Centers for Medicare and Medicaid Services Administrator Seema Verma and Deputy Administrator and Center for Medicare and Medicaid Innovation (CMMI) Director Adam Boehler.

They announced that CMMI will be inviting primary care practices to participate in several new alternative payment models that will allow primary care practices to provide new types of services to their patients that are not supported by current Medicare payments.

Innovative physicians have used grant funding to demonstrate that providing more convenient access to practices, enhanced care management for patients with chronic diseases, in-home services for patients with acute conditions, and palliative care for patients with advanced illnesses can significantly improve the quality of care for patients while reducing total health care spending. These new payment models have the potential to allow many more primary care physicians to deliver these highvalue services to their patients while also saving money for the Medicare program.

The AMA also commended Secretary Azar for basing the new payment models on proposals developed by practicing physicians and incorporating recommendations from the Physician-Focused Payment Model Technical Advisory Committee (PTAC).

“Secretary Azar has said that the best ideas for improving outcomes often come from individuals and organizations on the front lines of the health care delivery system, and we agree,” said Harmon. “PTAC has identified a dozen payment models developed by physicians that it believes merit testing or implementation by HHS, and we hope today’s announcement will be the first of many efforts to implement PTAC’s recommendations.”

AdventHealth Announces First-of-its-kind Florida DNA Study

If you knew you carried genes that could increase your risk of an early heart attack, would you change the way you eat?

Exercise more? Stop putting off your annual checkups?

AdventHealth researchers are hoping to find out how genomics impacts personal health decisions with a first-of-its-kind DNA study in Florida — “WholeMe” — that will empower consumers with potential lifesaving information about their heart health.

“We believe personalized medicine that focuses on the whole person is superior health care,” said Daryl Tol, president and CEO of AdventHealth’s Central Florida Divi-

Shepherd’s Hope, Inc. has appointed Pamela Gould as President and CEO. In this role, Gould will facilitate innovative initiatives for programs, services and partnerships to continue the non-profit’s mission to provide access to free health care for the uninsured and underinsured.

“As the largest Free and Charitable Clinic in Florida, Shepherd’s Hope is poised to expand its impacts beyond our existing five health care centers in Central Florida,” said Gould. “Together, our leadership, team, volunteers and supporters will build upon our model of success, providing free, essential primary and secondary/specialty medical care to the underserved,” she said.

With over 30 years of executive experience in the healthcare, hospitality and entertainment industries, Gould will guide Shepherd’s Hope’s strategic growth, focusing on fundraising, community partnerships, program development and supporter engagement.

Gould has developed and managed successful programs for both profit and non-profit entities, including Health Central Foundation, Orlando Health, Dave’s House, Island One Foundation and West Orange Chamber of Commerce.

First elected in 2012, she has served as the Board Member for District 4 on the Orange County Public School Board. In

sion. “Nothing is more personal than your DNA. If we’re going to fulfill our promise to consumers to care for them as a whole person, with an emphasis on wellness, genomics must play a role. WholeMe is an exciting first step for AdventHealth and we’re thrilled to bring this project with Helix to Florida.”

The importance of genomics in the future of medicine was highlighted by AdventHealth during the announcement of its rebrand last summer. Researchers will learn from the WholeMe study how genomics can be successfully integrated into health care to prevent, diagnose and treat diseases.

The study is made possible through a new partnership between AdventHealth and California-based personal genomics company Helix.

Ten-thousand people will have the opportunity to join WholeMe, in which Helix will sequence their DNA and every participant will be screened for the genes linked to familial hypercholesterolemia, known as “FH.” FH is a life-threatening genetic condition that causes high cholesterol. If left untreated, it can lead to cardiovascular disease, including a heart attack, even in young adults.

Helix uses proprietary next-generation sequencing technology, called Exome+, to enable health systems and research institutions to deliver scalable and impactful genomic services to the communities they serve, driving a higher standard of care. The company also created the first marketplace for DNA-powered products where people can explore diverse and uniquely person-

2014, she was appointed as the school board’s representative on the education foundation board. In 2015, she received the 2015 STAR School Board Member of the Year award from the Consortium of Florida Education Foundations. This award recognized her efforts in building stronger relationships and better alignment between the education foundation, the school district, individual schools and the community.

“Pam’s proven leadership in developing advocacy programs that further the visions, policies and efforts of nonprofits will steer Shepherd’s Hope as we develop new opportunities through technology, partnerships and services,” said Chirag Kabrawala, Chairman of the Shepherd’s Hope Board of Directors.

alized products developed by high-quality partners.

Helix is also a partner in the Healthy Nevada Project — a study similar to WholeMe. To date, 115 Healthy Nevada participants learned of their FH risk through genomic screening, and more than 90% of them would not have been diagnosed under current medical practice.

“We are excited to leverage our end-toend solution for large-scale population health in support of AdventHealth’s WholeMe Program,” said Justin Kao, co-founder and senior vice president of Business Development and Partnerships of Helix. “By combining clinical screening for actionable disease, long-term research driven by the breadth and depth of our Exome+ assay and worldclass consumer engagement tools that are proven to stimulate rapid enrollment, we believe that Helix and AdventHealth are poised to make a significant impact on precision medicine in Florida.”

AdventHealth researchers are slated to begin recruiting for WholeMe in July, more details around participation will be shared then. Participants will also learn about other traits that may impact their health such as lactose and gluten tolerance, magnesium and calcium levels.

While the study is open to all adults who live in Florida, the enrollment sites will be based in the Orlando area. Researchers will check in with participants six months after they receive their DNA results. There is no cost to join the study. orlandomedicalnews

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GrandRounds UCF Lake Nona Medical Center Hosts “Topping Out” Celebration

In Latest Expansion Project, Adventhealth Kissimmee Will Add 3 Floors, 80 Beds

HCA Healthcare’s North Florida Division and the University of Central Florida College of Medicine hosted a “toppingout” ceremony for UCF Lake Nona Medical Center today, marking that the hospital reached its maximum height. Construction crews, UCF College of Medicine faculty and students, and guests signed the final steel beam before it was placed at the top of the building.

Slated to open by the end of 2020, the hospital strives to represent the future of medicine in Central Florida while delivering outstanding training for physicians.

Facility plans include clinical research and a learning environment for medical students, future residents and fellows.

“Today’s topping-out ceremony marks a bright future for physicians, students and

Central Florida residents,” said Wendy Brandon, CEO, UCF Lake Nona Medical Center. “This is an exciting milestone in achieving our vision of a beautiful, high tech hospital of tomorrow, and a place of hope and healing for the Lake Nona community and beyond.”

“Our new hospital is the next step in fulfilling the dream of creating an Academic Health Sciences Center that will enhance healthcare, education and research efforts in our community,” said Dr. Deborah German, vice president for health affairs and dean of the UCF College of Medicine.

Layton Construction is the contractor on the project, which began in 2018. The 204,079-square-foot, 64-bed facility is expected to create more than 300 jobs when it opens late next year.

AdventHealth Kissimmee is launching another major expansion.

The campus’s three-story patient tower will soon be getting an additional three floors. Preliminary work has begun on an elevator shaft, with actual tower construction expected to begin in the fall.

The $84 million project is the latest in a series of improvements on the campus at 2450 N. Orange Blossom Trail, including: • an expanded emergency room, which that opened in 2014; • the existing three-story, 80-bed patient tower, which opened in 2015; • and a major expansion of the surgical suites, which is in progress and expected to be completed in January 2020.

The floors are expected to open in the fall of 2021, bringing the campus bed count to 240.

“This investment illustrates our commitment to the health of the Kissimmee

community,” said AdventHealth Kissimmee CEO Sheila Rankin. “We are dedicated to providing whole-person care close to home for the growing population of Osceola County in the years to come.”

Rapid population growth has contributed to the need for additional capacity at the campus, as reflected in the number of patients seen at the campus: In 2018, AdventHealth Kissimmee had about 9,000 admissions and more than 67,000 emergency room visits.

The three new floors, totaling 123,000 square feet and containing 80 private rooms, will be built atop the existing three-story patient tower.

ESa is the architect on the project, and Brasfield & Gorrie is the general contractor. The project is expected to generate 500 construction jobs. The number of hospital jobs generated has not yet been determined.

New AMA Study Shows Employed Physicians Outnumber Self-Employed Physicians for First Time For the first time in the United States, employed physicians outnumber self-employed physicians, according to a newly updated study on physician practice arrangements by the American Medical Association (AMA). This milestone marks the continuation of a long-term trend that has slowly shifted the distribution of physicians away from ownership of private practices.

Employed physicians were 47.4% of all patient care physicians in 2018, up 6% points since 2012. In contrast, selfemployed physicians were 45.9% of all patient care physicians in 2018, down 7% points since 2012. Changes of this magnitude are not unprecedented. Older AMA surveys show the share of self-employed physicians fell 14% points during a six-year span between 1988 and 1994.

Given the rate of change in the early 1990s, it appeared a point was imminent when employed physicians would outnumber self-employed physicians, but the shift took much longer than anticipated.

The AMA’s research notes this example and suggests “caution should be taken in

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assuming current trends will continue indefinitely.”

The majority of patient care physicians (54.0%) worked in physician-owned practices in 2018 either as an owner, employee, or contractor. Although this share fell from 60.1% in 2012, the trend away from physician-owned practice appears to be slowing since more than half of the shift occurred between 2012 and 2014.

Concurrently, there was an increase in the share of physicians working directly for a hospital or in a practice at least partly owned by a hospital. Physicians working directly for a hospital were 8.0% of all patient care physicians, an increase from 5.6% in 2012. Physicians in hospitalowned practices were 26.7% of all patient care physicians, an increase from 23.4% in 2012. In the aggregate, 34.7% of physicians worked either directly for a hospital or in a practice at least partly owned by a hospital in 2018, up from 29.0% in 2012.

Younger physicians and women physicians are more likely to be employed.

Nearly 70% of physicians under age 40 were employees in 2018, compared to

38.2% of physicians age 55 and over.

Among female physicians, more were employees than practice owners (57.6% vs.

34.3%). The reverse is true for male physicians, more were practice owners than employees (52.1% vs. 41.9%).

“Transformational change continues in the delivery of health care and physicians are responding by reevaluating their practice arrangements,” said AMA President Barbara L. McAneny, M.D. “Physicians must assess many factors and carefully determine for themselves what settings they find professionally rewarding when considering independence or employment. The AMA stands ready to assist with valuable resources that can help physicians navigate their choice of practice options and offers innovative strategies and resources to ensure physicians in all practice sizes and settings can thrive in the changing health environment.”

As in past AMA studies, physicians’ employment status varied widely across medical specialties in 2018. The surgical subspecialties had the highest share of owners (64.5%) followed by obstetrics/

gynecology (53.8%) and internal medicine subspecialties (51.7%). Emergency medicine had the lowest share of owners (26.2%) and the highest share of independent contractors (27.3%). Family practice was the specialty with the highest share of employed physicians (57.4%).

Despite challenges posed by dynamic change in the health care landscape, most physicians still work in small practices. This share has fallen slowly but steadily since 2012. In 2018, 56.5% of physicians worked in practices with 10 or fewer physicians compared to 61.4% in 2012. This change has been predominantly driven by the shift away from very small practices, especially solo practices, in favor of very large practices of 50 or more physicians.

The new study is the latest addition to the AMA’s Policy Research Perspective series that examines long term changes in practice arrangements and payment methodologies. The new AMA study, as well as previous studies in the Policy Research Perspective series, is available to download from AMA website.

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Orlando Health Becomes Founding Sponsor of the National Pulse Memorial & Museum Orlando Health has become the first sponsor of the National Pulse Memorial & Museum. The $1 million sponsorship will be used for project construction as well as for the establishment of an endowed scholarship that is healthcare related. The scholarship will be named for one of the 49 victims fatally wounded in the 2016 attack.

“Our sponsorship of this tremendous project is a natural outgrowth of our experience,” said David Strong, president and CEO, Orlando Health.

“The events surrounding June 12, 2016 were life-changing for our entire organization and will never be forgotten. The work we did, the healing we witnessed, and the renewal we experienced has become part of Orlando Health and part of all of our lives. We proudly support the onePULSE Foundation as it embarks upon this ambitious project.”

As part of the sponsorship, Orlando Health will receive naming opportunities, special recognitions, and invitations to participate in special events.

“We are excited about this new partnership with Orlando Health,” said onePULSE Foundation CEO Barbara Poma. “On that tragic night in June 2016, the doctors and staff of Orlando

Health treated 44 patients, going above and beyond to care for those brought through their doors. Additionally, they forgave the medical bills for each of those patients, and since then they have worked with our Foundation to continue to support the families and survivors. This sponsorship is just one more example of their dedication to our work, to the community of Orlando, to the survivors and families, and to the memory of the 49 Angels. We cannot express how thankful we are for their support.”

With an estimated cost of $45 million, the National Pulse Memorial & Museum will consist of three elements; a memorial to be located on the site of the existing nightclub building, a museum which will house approximately 7,000 artifacts, and a survivor’s walk that will connect the memorial to Orlando Health’s Memorial Paver Garden located one block south of the Orlando Health Orlando Regional Medical Center’s emergency department entrance. The walkway, to be named the Orlando Health Survivors Walk, will extend further north towards the Dr. Phillips Center for the Performing Arts in downtown Orlando.

NYC Developer Taps PONTE HEALTH to Co-Develop and Manage 30 Acres in Sarasota, Florida Although unclear as to the ultimate use of the property, PONTE HEALTH has accepted a NYC Developer’s invitation to Co-Develop and Manage 30 acres in Sarasota, Florida.

Ponte, Lead Developer and Architect at PONTE HEALTH, has confirmed it will be a new advanced medical complex concept, and although will be partnered with, will likely not necessarily be related to VERTICAL MEDICAL CITY; VMC late this past week locked down its second closing at 424-434 South Wabash Avenue

in the Loop, one block front Grant Park and a few feet from the Chicago Public Library and the L, a prime spot in Downtown Chicago.

Sarasota, Florida, a coastal community just South of Tampa, has a median resident age of 47 years old, and is home to Doctors Hospital of Sarasota, a private facility, and HealthSouth Rehabilitation, among other medical and care service providers.

For more about the firm online: www.pontehealth.com

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John Kelly Publisher; Orlando & North Florida Medical News 407-701-7424, JKelly@orlandomedicalnews.com 15

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John Singleton Founder, Red Fang Marketing 352-442-6674, John@redfangmarketing.com orlandomedicalnews

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Early Detection Could Help Mitigate Looming Non-alcoholic Fatty Liver Disease Epidemic

By GUY NEFF, MD, MBA

Fatty liver disease is a silent epidemic, affecting millions of Americans and imposing significant financial burden on the U.S. healthcare system. Not simply a result of alcohol consumption, as many believe, non-alcoholic fatty liver disease (NAFLD) is the most common type of liver disease in the Western world -- associated with obesity, insulin resistance, diabetes and other metabolic risk factors and directly related to too much fat in the liver cells.

While Florida has the 15th lowest adult obesity rate in the nation, it has the 13th highest obesity rate for youth ages 10 to 17, and the overall obesity rate is up from 11.4 percent in 1990 to 28.4 percent in 2018.

The American Liver Foundation estimates that about 100 million Americans -- over 30 percent of the U.S. population -- have NAFLD. NAFLD encompasses a spectrum of disease, ranging from-simple steatosis, to steatosis with inflammation (nonalcoholic steatohepatitis or NASH), to NASH plus advancing fibrosis to cirrhosis.

More than one-third of children and adults in the United States are obese and more than 20 million Americans have diabetes, resulting in a large at-risk population for NAFLD. Approximately two to five percent of patients with NAFLD progress to NASH, among whom a subset will develop cirrhosis and cirrhosis-related complications including hepatocellular carcinoma (HCC).

If this trend continues, NAFLD will become the main indication for liver transplants in the country, with the number of healthy livers available for transplants likely to decline. Children as young as five are also developing fatty liver disease through over consumption of sugars, sodas, fructose, corn syrup and lack of exercise.

Identifying At-Risk Patients An interim look at an ongoing study of 10,000 patients with no history of liver disease was conducted in communitybased endoscopy centers by the Florida Research Institute (FRI) a division of Florida Digestive Health Specialists (FDHS). Only 43 percent of patients evaluated had what is considered normal livers based on a FibroScan® assessment alone, while the remainder had some form of liver abnormality, ranging from elevated liver fat to liver fibrosis, including 13 percent suspected of having undiagnosed liver fibrosis or cirrhosis. Important to note is that the vast majority of patients had no symptoms. While further workup 16

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is recommended to confirm the extent of liver disease in these patients, this analysis of the first 367 patients suggests a significant rate of undiagnosed NAFLD in the population studied.

This prospective study evaluated patients, with no history of liver disease, undergoing routine endoscopic procedures between June 2017 and January 2018 versus a matched control of patients not undergoing a liver health assessment. Patients were risk stratified based on FibroScan®, which utilizes Vibration Controlled Transient Elastography (VCTE™) and CAP ™, surrogate scores of liver fibrosis and liver fat, respectively. The study team examined electronic medical records within 90 days after the procedure to determine and compare prevalence of NAFLD. Results showed 53 percent of patients studied had excess fat in their livers as identified by the CAP, of which 64 percent likely had grade 3 liver fat, as identified by a CAP score of ≥279 dBm. More concerning, only 43 percent of patients evaluated had what we would consider normal livers (stiffness <7kPa and CAP <248dBm). These results underscore the importance of identifying asymptomatic patients who may be at risk for advancing disease for earlier intervention. It is alarming to see this high prevalence of disease, a dramatic rise from our observations in the last decade and indicative of the critical need for ongoing assessment.

These results underscore the importance of identifying asymptomatic patients who may be at risk for advancing disease for earlier intervention, while the increasing prevalence of disease shows the importance of regular assessment.

NAFLD can be reversible if caught in the early stages and accompanied by lifestyle changes. What’s more, simple screening and early detection with available non-invasive technologies can help to prevent more serious conditions, such as end-stage liver disease or liver cancer.

Risk Factor for Pre-Diabetes NAFLD is the result of poor eating habits and a sedentary lifestyle. In some cases, the fat in the liver cells builds up to the point where the liver cells swell and eventually cause inflammation. But there are usually no symptoms at this point. A recent study suggested that prediabetics with fatty liver were twice as likely to progress to overt type 2 diabetes as prediabetics without NAFLD. Nationally, more than half of adults with NAFLD are obese, and 30 percent or more are overweight. Conversely, overweight or obesity is responsible for causing about 85 percent of fatty liver disease. Unfortunately, obesity is also a risk factor for diabetes.

Obesity can contribute to insulin resistance, which results in a buildup of blood sugar and increases the amount of free fatty acids circulating in the blood or accumulating inside the liver cells. The Hepatitis B Foundation also advises that buildup of fat in the liver is common in those with Type 2 diabetes, increasing the risk of liver cirrhosis and liver cancer. Furthermore, NAFLD has been found to be a strong and independent risk factor for prediabetes in the general adult population.

This combination of conditions can be pernicious, especially because until the extent of cirrhosis from NAFLD becomes quite severe, it has no symptoms. If you have it, most likely you have no clue that your health is deteriorating. With the ad-

2019 Annual

vent of screening and greater focus on preventive care, this situation is changing.

The Value of Non-Invasive Screening Methods A growing number of healthcare providers have started adopting non-invasive screening methods that can detect NAFLD in the absence of indications or warning signs. FibroScan® is one such innovation. This rapid and painless approach can be performed in the doctor’s office as part of an annual exam, and is covered by Medicare, Medicaid and other insurance plans.

A 10-minute screening offers quick insight into liver health – measuring liver fat content and liver stiffness (associated with fibrosis and cirrhosis). Test scores provide immediate information the physician can use to make a referral to a specialist or recommend additional assessments. In fact, a yearly NAFLD screening may become standard practice similar to a mammography or A1C blood sugar testing.

The point of these screening tools is that they can measure the amount of liver stiffness and fat to better target more expensive or more invasive diagnostic procedures – saving time and resources for people who don’t need to undergo additional assessment. FibroScan® is a viable option for screening; its portable, can be operated by a medical assistant and interpreted by the healthcare professional at the point of care delivery, making it a valuable accompaniment for managing patients.

Guy Neff, MD, MBA, is the Director of the Florida Research Institute

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The Promise and Dangers of Stem Cell Therapy

By QUINTIN L. GUNN SR.

Stem Cell Therapy and Regenerative Medicine is a very exciting and emerging field of medical science for patients. It provides an alternative option to traditional treatments or before surgical procedures are performed or recommended. The U.S. has now caught up and is becoming a leader in these most innovative medical procedures. As a result, doctors now have the opportunity to make a real difference in improving chronic disease whether it be systemic, orthopedic, autoimmune or neurologic using patients own healing and regenerative powers.

Using regenerative medicine and stem cell-based products such as Amniotic Fluid, Exosomes, Wharton’s Jelly, and or patient-derived Bone Marrow Aspirate, or Adipose-Derived stem cells, doctors are seeing tremendous improvements for patients with chronic health issues.

Medical doctors who started their training in Regenerative Medicine and Stem Cells years ago have seen first-hand the life-changing effects that these treat-

ments are having on their patients. Whereas traditional medicine has certain and specific limitations along with higher cost.

As great as these new regenerative medicines and stem cell treatments have proven to be, we are now seeing many nonqualified persons without proper training or education seeking to profit from those suffering from various painful conditions.

These profiteers seem to target the elderly and others by blanketing their local markets with ads and social media post promising miracle cures.

Unfortunately, there are a high number of chiropractors who are now caught up in giving patients misinformation to generate profits. Some have gone so far as to suggest that amniotic fluid contains stem cells which scientifically is just not true or accurate.

Let there be no mistake, the field of Regenerative Medicine and Stem Cell Therapy do require specialized training, education, and skill. It is not a matter of just simply injecting solutions into a patient’s joints or pain sites and having a miracle occur. The proper injection is

paramount in getting positive results. Follow up care is also needed, and a medical treatment plan is required to ensure patients have the best possible outcomes.

Below is a list of medical practitioners who are most likely educated, skilled, and or trained to perform certain stem cellbased procedures: Physical Medicine and Rehabilitation Doctors Interventional Spine and Sports Doctors Orthopedic Surgeons Anesthesiologists Sports Medicine Fellowship Trained Doctors Neurosurgeons Pain Management Doctors Cardiac or Thoracic Surgeons Other Surgical Specialties Prospective patients should know, chiropractors, nurse practitioners or a physician assistant are not likely trained or licensed to perform stem cell treatments or injections.

In many cases, some of the abovelisted providers are misinformed about

what they are actually promoting as patient care. Only using what are called homologous treatments such as Amniotic Fluid because they cannot obtain the living cells from the patient directly using a sound medical process like Bone Marrow extraction or adipose-derived stem cells.

We are also learning, that fees for some of their listed treatments and services are charged at 2-3 times more for certain procedures which fall outside of the scope of what is usual and customary for say a joint injection for knees, elbow, ankle or back.

Many recent patient complaints are confirming the FDA’s worst fears and creating a bad impression related to regenerative medicine and stem cell treatments.

Patients are reporting that some chiropractors are using non-specialized doctors and contracting them as a Medical Director so that they can carry out the process of selling services. In some cases, they are not really interested in helping the patients but are more interested in making profits. Using misinformation and profi(CONTINUED ON PAGE 21)

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THE HR LADY

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y d a HR L THE

The Other F Word: Feedback

By WENDY SELLERS, The HR Lady® Generally speaking, managers do a really bad job at telling people what we think about their performance and how they should do better. As managers, we get tied up in the “why” something didn’t work and should really be focusing on the “what” – as in what do you actually want to happen? “What” is much easier to explain and has concrete terms while the WHY could just be conceptual.

There are three business theories we accept as certainties: the theory of truth, learning and excellence. The theory of truth basically says that others are aware of your weaknesses even when you are not. Others know when your suit or dress doesn’t look good and you rely on them to tell you. The theory of learning states that when you lack a certain knowledge, skill or ability, you rely on those around you to teach them to you. And the theory of excellence is the belief that great performance is universal, analyzable and describable and that once defined we can improve your shortcomings with feedback from someone else.

It turns out these theories are false.

Feedback is unreliable. It is based on what you – the rater - thinks is good or bad, positive or negative. And you might be an idiot. Your idea of dressing well might be awful, or you may not want to speak up to your friend. Your attempt at teaching others may be confusing or you may blabber on making no sense. Your view of excellence may be unrealistic, or you may be using terms others do not understand. Of course, we also have these crystal-clear rating systems (sarcasm intended) that mean absolutely nothing and are a complete insult to both the manager and the employee. If you as a manager are intentionally rating someone average or poor and they are still employed on your team, guess what? You are an idiot! Why did you wait 12 months to tell them? Why are they still employed? What are you still employed?

Managers believe that feedback has magical ingredients that accelerate growth. Well, no it doesn’t. We all know that a bloody mary’s magical ingredient is vodka - not pickled vegetables or even bacon. Although these items make the drink more enjoyable, without the vodka, you would simply be drinking tomato juice 18

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with... The magical ingredient for learning is not adding to something that isn’t there. Learning is recognizing, reinforcing, refining what is already there. Therefore, feedback on what is already there is needed. For example, you can provide all the feedback you want on your employee’s inability to speak French, but it won’t change his or her ability or desire to speak French.

Criticism is not feedback. Criticism assumes your way is the better way and inhibits the brain from learning. Attention to weaknesses actually smothers their brains. Your brain responds to critical or negative feedback as a threat and narrows its activity. In a scientific study, students hooked up to MRIs were asked what they were doing wrong and what needed to be fixed – their sympathetic nervous system lit up. The sympathetic nervous system prepares the body for intense physical activity and is often referred to as the fight-or-flight response. When students were asked about their dreams and how they might achieve them, their parasympathetic nervous system lit up. The parasympathetic nervous system has almost the exact opposite effect. This stimulates a sense of well-being, and even better immune system functioning. So, it’s good for your health claims too! The study also argues that arousing the PEA is critical when creating or affirming a personal vision. The PEA is an endogenous stimulant of the human brain that amplifies the activity of major neurotransmitters for increased longevity, slower aging, higher performance, a sense of well-being, and a renewed youthful-functioning body.

Again, all positives for your health insurance claims.

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

be crystal clear.

Instead of saying “can I give you my feedback?” say “here is my reaction to what just happened.” Or instead of “you need to be more responsive” …try “when I don’t hear from you, I worry we are not on the same page.” Or instead of “you lack strategy” …try “I am struggling to understand your plan.”

Throw in some positive emotion, compassion and change the game. Provide positive feedback that focuses on their strengths and abilities they already have or are capable of obtaining.

If you are giving feedback until you are blue in the face and getting nowhere, well then you might be part of the problem.

Wendy Sellers has a master’s degree in Human Resources, a master’s degree in Health Care Administration, is a passionate HR Consultant, Leadership Coach, author, and speaker. She has worked with hundreds of corporations and associations conducting management training, leadership development, and HR advisory services. She has experience as an HR Executive and Practitioner, an HR Advisor, a Board Member, and an adjunct faculty member.

In additional to her formal education, Wendy is HR certified as an SHRM-SCP and SPHR, is health/life insurance licensed, is a Dale Carnegie course graduate, and is an active and past board member and volunteer for multiple non-profits and a National Speakers Association professional member. She also teaches the SHRM certification course.

Visit www.thehrlady.com

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

Short-Staffed Nursing Homes See Drop in Medicare Ratings Results mixed in Marion, Lake and Sumter Counties; big differences between North and South Florida The federal government accelerated its crackdown on nursing homes that go days without a registered nurse by downgrading the rankings of a tenth of the nation’s homes on Medicare’s consumer website, new records show.

In its update in April to Nursing Home Compare, the Centers for Medicare & Medicaid Services gave its lowest star rating for staffing — one star on its five-star scale — to 1,638 homes. Most were downgraded because their payroll records reported no registered-nurse hours at all for four days or more, while the remainder failed to submit their payroll records or sent data that couldn’t be verified through an audit.

“Once you’re past four days [without registered nursing], it’s probably beyond calling in sick,” said David Grabowski, a health policy professor at Harvard Medical School. “It’s probably a systemic problem.”

It was a tougher standard than Medicare had previously applied, when it demoted nursing homes with seven or more days without a registered nurse.

“Nurse staffing has the greatest impact on the quality of care nursing homes deliver, which is why CMS analyzed the relationship between staffing levels and outcomes,” the agency announced in March. “CMS found that as staffing levels increase, quality increases.”

The latest batch of payroll records, released in April, shows that even more nursing homes fell short of Medicare’s requirement that a registered nurse be onsite at least eight hours every day. Over the final three months of 2018, 2,633 of the nation’s 15,563 nursing homes reported that for four or more days, registered nurses worked fewer than eight hours, according to a Kaiser Health News analysis.

Those facilities did not meet Medicare’s requirement even after counting nurses whose jobs are primarily administrative.

CMS has been alarmed at the frequency of understaffing of registered nurses — the most highly trained category of nurses in a home — since the government last year began requiring homes to submit payroll records to verify staffing levels. Before that, Nursing Home Com19

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pare relied on two-week snapshots nursing homes reported to health inspectors when they visited — a method officials worried was too easy to manipulate. The records show staffing on weekends is often particularly anemic.

Bottom of Form CMS’ demotion of ratings on staffing is not as severe as it might seem, however.

More than half of those homes were given a higher rating than one star for their overall assessment after CMS weighed inspection results and the facilities’ own measurement of residents’ health improvements.

That overall rating is the one that garners the most attention on Nursing Home Compare and that some hospitals use when recommending where discharged patients might go. Of the 1,638 demoted nursing homes, 277 were rated as average in overall quality (three stars), 175 received four stars, and 48 received the top rating of five stars.

Still, CMS’ overall changes to how the government assigns stars drew protests from nursing home groups. The American Health Care Association, a trade group for nursing homes, calculated that 36% of homes saw a drop in their ratings while 15% received improved ratings.

“By moving the scoring ‘goal posts’ for two components of the Five-Star system,” the association wrote, “CMS will cause more than 30 percent of nursing centers nationwide to lose one or more stars overnight — even though nothing changed in staffing levels and in quality of care, which is still being practiced and delivered every day.”

The association said in an email that the payroll records might exaggerate the absence of staff through unintentional omissions that homes make when submitting the data or because of problems on the government’s end. The association said it had raised concerns that salaried nurses face obstacles in recording time they worked above 40 hours a week. Also, the association added, homes must deduct a half-hour for every eight-hour shift for a meal break, even if the nurse worked through it.

“Some of our member nursing homes have told us that their data is not showing

Look Up Data on Facilities in Your Area Click here for a list of local (Marion, Lake and Sumter Counties) and statewide facilities and how they compare in staffing.

Source: KHN analysis on data from the Centers for Medicare and Medicaid Services. Kaiser Health News is a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

up correctly on Nursing Home Compare, making it appear that they do not have the nurses and other staff that they in fact do

have on duty,” LeadingAge, an association of nonprofit medical providers including nursing homes, said last year.

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

Finding a New Home, Bridging the Americas

“I would hear people say, ‘someone passed from Sheyla Zelaya Aragon, MD, President, Lake-Sumter Medical Society being poor.’

The truth was As a young student, which discoveries Can you share insight into the challenges of Sheyla Zelaya Aragon, MD, was very upsetting to me.” stood out the most? opening a practice as a young physician? recently installed as president of LakeSumter Medical Society. By itself, that’s not huge news. But based on her journey from war-torn Nicaragua amid political changes to leader of the local medical society is very much newsworthy.

North Florida Medical News asked Aragon what it was like growing up in Nicaragua, her adolescence filled with community medical mission work, her sometimes-difficult road to medical education completion, and how she landed in Leesburg.

Tell us how growing up in Nicaragua impacted your interest in pursuing the practice of medicine.

SZA: Growing up in Nicaragua was key for me to realize I wanted to be a physician. I was raised in a rural town with little access to healthcare. The community health center had only an on-call nurse and a physician who was a sixth-year medical student fulfilling social medical service to graduate. Emergencies were transferred to the next hospital, which was 21 kilometers (13 miles) away.

Instead, folk medicine was practiced in my hometown. Interestingly, a lady who owns a local general store would dispense medical advice and sell over-the-counter medications – plus or minus available antibiotics. When anyone spoke of feeling ill, even my father would say, ‘see what the general store owner can offer you.’ Living there facilitated benign advice. When their illness didn’t improve, they were rushed to the community health center and then the hospital when it became a life-threatening emergency.

Even though you moved to the U.S. when you were a toddler, your family returned to Nicaragua after the revolution. Tell us about living in both worlds.

SZA: In the 1980s, I translated for my mom at doctors’ appointments in Florida at Jackson Memorial Hospital. After the revolution at the beginning of the 1990s, my family returned as the country was putting itself back together.

Throughout my adolescence, I was exposed to both worlds and noticed the great need for medical professionals in Nicaragua. My vacation and spare time was spent rebuilding schools, buying books and distributing educational material and supplies. I participated with my church on health trips, where volunteer physicians and dentists visited our rural areas to provide services. But medicine was always scarce. For me to get up-to-date medical literature, I purchased books from the U.S. Those experiences shaped me to pursue the practice of medicine as my passion.

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SZA: I saw first-hand how many diseases could be prevented with safe and clean water, and how many deaths could be prevented with access to healthcare and medicine. I would hear people say, ‘someone passed from being poor.’ The truth was very upsetting to me.

Tell us about your medical education and decision to specialize in internal medicine, and subspecialize in nephrology?

SZA: By the time I decided to pursue medical school, I wasn’t sure between pediatrics versus internal medicine until my third year in medical school with direct patient care. I enjoyed my internal medicine rotations. Then, it wasn’t until I came to the U.S. through the William Harrington Program at Jackson Memorial Hospital at the University of Miami that I fell in love with nephrology. My first classes focused on podcytes, glomerular diseases and dialysis. My Nicaraguan education hadn’t taught me in depth the biochemistry of electrolyte disorders and nephrology research. Nicaragua had one or two nephrologists that had studied abroad.

Once again, the monetary barrier for dialysis wasn’t an option. The lifechanging event that made me realize I was meant to be a nephrologist occurred when a family member ended up in end stage renal disease. Unfortunately, he passed.

What brought you to the Leesburg area and why did you choose to open a clinic?

SZA: I was idealistic. I wanted to create a bridge between the U.S. and Nicaragua to share medical knowledge. As I engaged with my studies for the U.S. medical license and ECFMG certification, much was changing in Nicaragua. Unfortunately, in 2007, political parties changed. Once I secured my medical residency in the U.S., the Nicaraguan Ministry of Health made it almost impossible for me to train until lastminute permission was granted to continue my education in the U.S. During my residency and fellowship years, returning to visit family in Nicaragua was becoming most uncomfortable with Nicaraguan immigration. That’s when I decided to pursue my medical career in the U.S. I ended up in Central Florida through the Conrad 30 Program that permits foreign medical graduates to work in underserved medical areas and offer healthcare to our most needed communities. I realized that no matter where I am, I can still do what I love with a purpose. There’s no better place than in this beautiful rural community where I have been welcomed. If you look at the statistics, we have poverty, illiteracy and social challenges to overcome.

SZA: During the process of opening a practice, I wished for instructions. Not all the answers were available through Google searches.

The greatest help came from engaging with community doctors. Unfortunately, one of the things I figured out on my own was that one medical provider is offered a standard fee schedule from the insurance companies. I realized that collaborating with other providers is equivalent to strength and gives young physicians like me the chance to succeed.

(Aragon has hospital affiliations with Advent Health at Waterman, Central Florida Health Alliance: LRMC and TVRH, and Select Hospital: Promise at the Villages.)

You were recently inducted as president of the Lake-Sumter Medical Society.

What has moved you to become so involved in the medical community, and what are your goals and hopes during this two-year commitment?

– Sheyla Zelaya Aragon, MD.

SZA: My inspiration to open a practice came from doctors in the community that I met through the Lake Sumter Medical Society. Patients are my motivation. My hope is that through the experience of our members, we can identify more potential physician members, including young physicians.

Nonmembers who have questions or need advice are free to call us. We’ll direct you to the best person. Our goal is your success!

What else makes Central Florida special?

SZA: Something very special that made Central Florida my home is that I’m close to my siblings and their children. They visit from the north, south, east and west of the state. We’re ensuring our future generations will see the importance of being raised with a sense of community and togetherness.

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Website Design & Mobilization • Search Engine Optimization • Blogging • Press Releases Online Practice Reviews (Reputation Management) • Marketing & Referrals Content, Newsletters & Contributing Editorial • Staff Training & Development • Employee Review Process

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The STATES Act and its Potential Effect on Florida Medical Marijuana (MMJ) patient growth will increase faster than expected - As of April 10,

By MICHAEL PATTERSON

With over 93 percent of Americans approving medical marijuana and over 60 percent approving full legalization of cannabis at the federal level, there is very little “political risk” by either party to move legislation through Congress to legalize marijuana, in some fashion. The STATES Act was recently reintroduced in the Senate and has over 20 cosponsors. The STATES act would keep marijuana illegal at the federal level but allow for states to operate legal cannabis industries without US government interference and allow banking to all marijuana businesses without reprisal.

The act would amend the Controlled Substances Act so that states and Indian tribes complying with state or tribal law would no longer see many of the act’s provisions apply. But it would continue to prohibit the endangerment of human life while manufacturing controlled substances and bar anyone under age 18 from working in the marijuana industry.

Other areas of the STATES Act include prohibiting the sale or distribution of marijuana to people under age 21 and prohibiting the sale or distribution at federal transportation facilities like truck stops and rest areas.

The Government Accountability Office would be ordered to study the effects of legal marijuana on traffic safety and states’ testing standards and clarify banking and financial regulations between states where marijuana is legal and the federal financial system.

The measure has support from a host of various banking, civil rights and drug policy organizations.

Senator Corey Gardner (R- Colorado) who introduced the bill said a few weeks ago that Trump had reiterated his support for this year’s measure. “The President has been very clear to me that he supports our legislation. He opposed the actions that were taken by the Attorney General to reverse the Cole Memorandum, and believes that we need to fix this

Stem Cell Therapy, continued from page 17

teering seems to be the trick of their trade.

Their patients are not seeing the results that were promised and become disillusioned with stem cell therapy as an option, which can create a significant and ongoing change in this emerging field. This is a huge detriment and gives a bad name to the Field of Regenerative Medicine and Stem Cell Therapy.

As a doctor, Dr. Cherukupally of Regenerative Sports Spine and Spa has dedicated well over 19 years in the field of 21

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MAY 2019

2019, there are over 267,000 MMJ patients in Florida. The most common reasons given for people not to seek a Physician recommendation for MMJ are the illegality (at the federal level) and cost.

With the passage of the STATES Act, the perception to the public will be that marijuana is now legal, which will facilitate fewer moral dilemmas with taking the medicine, therefore increasing the number of patients.

Recreational Marijuana will come sooner than later - If the federal government

and that is why he believes the STATES Act is the right way to do this,” Gardner said in the news conference announcing the measure.

Attorney General William Barr testified on April 10, 2019 that his staff is looking into the STATES Act and will provide comment soon. “Once we get those comments, we’ll be able to work with you on any concerns about the STATES law,” Barr told Congress. “But I would much rather that approach, the approach taken by the STATES Act, than where we currently are.”

Barr said he would still favor a rule that barred marijuana federally but said he was open to a different approach. “Personally, I would still favor one uniform federal rule against marijuana, but if there is no sufficient consensus to obtain that, then I think the way to go is to permit a more federal approach so states can make their own decisions within the framework of federal law, so we’re not just ignoring the enforcement of federal law.”

Effect of STATES Act on Florida With so much support from industry groups on all sides and bipartisan members of Congress, the STATES Act has a high probability of passing and becoming law. If so, how would it affect Florida?

Interventional Spine and Sports Medicine, Non-Surgical Orthopedics, as well as an additional four to five years of training in Regenerative Medicine. Most recently, she completed an advanced training program through Boston BioLife one of the premier Hands-On Training organizations for Regenerative Medicine and Stem Cell Training. She has yet to come across a chiropractor, nurse practitioner or a physician assistant that are actually trained to do any joint injection procedures or spine procedures. And most are learning through patient trial and error, if at all.

We hope that all patients who are re-

will not intervene in state-run marijuana businesses, then Florida will have more pressure to legalize recreational cannabis so as not to get left behind by other states.

The STATES Act will force state legislatures to pass recreational marijuana due to all the economic benefits such as increased employment and tremendous amounts of tax revenue.

Marijuana and Hemp banking will skyrocket -

Currently, it is extremely difficult to get a bank account if you own a marijuana business. Even hemp businesses have difficulty because most bankers don’t understand that hemp is fully legal under federal law and they think hemp is marijuana (which it is not). Currently, there is only one bank, Lafayette Bank, in Florida who has publicly admitted they take marijuana money. By opening up banking, you open up access to capital and facilitate increased investment into Florida businesses.

More acceptance of MMJ by medical professionals - With prohibition coming to an end,

major Florida healthcare providers must begin to allow MMJ to be used inside their hospitals, nursing homes, and assisted living facilities. This will spur new opportunities for medical professionals to specialize in compliance relating to MMJ use in these large healthcare establishments.

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

searching into these treatments pay more attention to who is doing the procedure and what they are injecting. By so doing they will avoid the nightmare of being given a bad treatment protocol or at its worst make a bad health situation become a crisis.

(We have listed only a few resource materials in this brief article, but there is plenty available online.)

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

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LOWEDOWN ON HEALTH LAW

presented by

LOWE & EVANDER, P.A.

Innovations in Healthcare Technology

By BRIAN C. EVANDER, Esq., and MICHAEL R. LOWE, Esq.

Technological advances continue to grow exponentially, and the healthcare industry is no exception. Whether streamlining healthcare operations through new system designs and software, lowering costs and enhancing quality of care through new devices and procedures, or utilizing new solutions in marketing personalization such as through artificial intelligence or blockchains, healthcare technology in 2019 is set to take a huge step forward.

For instance, the telehealth industry is on the rise both in Florida and the nation as a whole. The ability to receive clinical care long-distance has been warmly received by patients. The increased accessibility to health care providers, coupled with the ability to sidestep potential delays they might otherwise face due to busy lifestyles if the patient were required to travel to a provider to receive care, has led to exponential growth in the telehealth field. The telehealth industry is projected to reach $3.5 billion in revenue by 2022.

One significant hurdle to telehealth’s growth has been lack of resources – specifically, lack of digital devices such as tablets and computers. This has led healthcare providers to increasingly rely upon patients to provide and use their own smart devices to access telemedicine apps and provide data to the providers. These devices include smartphones as well as a variety of everyday devices that are connected to the internet. Such internetready everyday devices, referred to as part of the Internet of Things (IoT), include wearing technology such as smartwatches and sensors that track a patient’s movement, heart rate, and a variety of other data. Patients with lifestyle diseases such as diabetes are increasingly turning to wearable technology (for instance, Fitbit) to monitor their glucose, physical activity levels, heart rate and sleep patterns, and both patients and healthcare providers are able to use this data to better understand the patients’ health conditions.

IoT devices can assist healthcare providers in a variety of additional ways. A doctor can remotely monitor a post-op patient’s condition, for instance, or a hospital administrator can utilize wearable sensors to track bed occupancy rates as patients enter and exit the hospital. Even an entire subbranch of telemedicine technology devoted to monitoring patients recovering from a stroke, telestroke technology, has emerged. From 2014 to 2018, patient use of mobile and tablet health apps rose from 13 percent to 48 percent.

Data from such IoT devices can be analyzed by artificial intelligence for purposes of long-term diagnosis and support, and as patient adoption and healthcare provider 22

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MAY 2019

adoption of such devices continues to grow, the algorithms used to drive such diagnosis and support will likewise become more sophisticated. Advances in artificial intelligence are not limited to analysis of IoT data, of course. Developments in IBM’s Watson AI currently include testing to discover those in need of medical intervention relating to opioid addict issues.

Blockchain technology is likewise developing increased utility in the healthcare industry at a rapid pace. While perhaps best known as a vehicle for cryptocurrency such as Bitcoin, blockchain has numerous applications beyond acting as digital funds. Blockchain, for instance, can act as a secure and immutable ledger of data, a robust database with time-stamped continuously updated and highly encrypted records and information. In the context of a healthcare industry that suffers from security breaches daily, or for healthcare providers who find themselves being accused of altering patients’ records, the possibilities of blockchain are obvious.

Telehealth, IoT integration, artificial intelligence and blockchain all represent ways in which healthcare technology has evolved and will continue to advance in the coming months. With new innovations comes new risks, however.

While telehealth raises the bar on convenience for patients, it likewise raises concerns among governmental agencies

and entities overseeing the safe administration of healthcare such as the Florida Department of Health, and the specifics of the telemedicine system of a practice or practitioner are crucial to analyzing whether or not such a system, and the care and treatment provided remotely to patients via same, is compliant with applicable state and federal law.

While blockchain can securely store a virtually immeasurable amount of data in tamper-proof records, a breach of the blockchain’s security (for instance, through access credentials being compromised due to human error caused by lack of proper education and training by the covered entity of its employees) could allow that virtually immeasurable amount of data to fall into unauthorized hands, creating a “megabreach” scenario and triggering extensive reporting requirements both to all affected patients as well as the U.S. Department of Health and Human Services Office for Civil Rights, and likely causing the breached covered entity to incur hefty penalties and costs to mitigate the damages of the breach.

New developments in healthcare technology are rapidly providing innovative advances in the delivery of care and treatment to patients while enhancing the health care delivery experience for both patients and their treating providers and professionals. These developments are likewise reshaping and facilitating health

information storage and databasing to an extent previously thought untenable.

These developments raise corresponding new challenges that must be met, both in terms of sharing data and access to physicians’ and providers’ data bases by payors and health device/equipment manufacturers, as well as managing care and treatment and being compliant with both HIPAA’s privacy and security regulations and Florida medical record confidentiality, privacy and security laws.

Meeting these challenges and ensuring compliance with applicable statutes, rules, and laws will require careful assessment and analysis by knowledgeable health care counsel, and we are proud to offer such services as health law continues to advance alongside technological innovations in the healthcare industry.

For other healthcare related legal information click here to learn about physician employment agreements.

Michael R. Lowe, Esquire, a boardcertified health law attorney, and Brian C. Evander, Esq., regularly represent providers, physicians and other licensed health care professionals, and facilities in a wide variety of healthcare law matters at the law firm of Lowe & Evander, P.A. For more information regarding healthcare law and such matters please visit our website www.Lowehealthlaw.com or call our office at (407) 332-6353.

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

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

Florida-based Law Practice Representing Physicians & Physician Group Practices

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