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Combating MOC "Professional self-regulation is under attack" By PL JETER
Physicians are outraged about plans by the American Board of Medical Specialties (ABMS) and its 24 specialty boards to overhaul once again the Maintenance of Certification (MOC) requirements they say have already become too time-consuming, expensive and clinically irrelevant. “The MOC controversy is a David v. Goliath story that may be the most significant corruption story ever uncovered in the history of U.S. medical education,” said Westby Fisher, MD, a cardiac electrophysiologist from Illinois and author of the “Dr. Wes” blog. Under ABMS’s MOC requirements, physicians are assessed every other year, and must pass a re-certification exam in their specialty every 10 years. Here’s the rub: MOC is legally considered voluntary
ON ROUNDS
PHYSICIANSPOTLIGHT
Bethany Ballinger,
MBBS
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and not a requirement to practice medicine in the U.S. The ABMS, doctors insist, has an unfair near-monopoly on the MOC recertification process based on long-term partnerships with insurance companies and hospitals, who often mandate MOC recertification, a brewing problem for the swelling number of hospital-employed physicians. Medicare, the standard bearer for coverage in the American healthcare system, does not. “I’ve seen the forensic accounting on this … it would stop your heart,” said Marni J. Carey, executive director of Orlando-based Association of Independent Doctors (AID). But “then you might need a cardiologist, who won’t be available because (of) studying for recertification. MOC is a hoax and needs to stop.” In a grassroots rebellion against unfair
MOC mandates, AID is among many organizations across the country, including the American Association of Physicians and Surgeons (AAPS), Practicing Physicians of America (PPA), and the recently physicianformed National Board of Physicians and Surgeons (NBPAS), that oppose the ABMS initiative launched Sept. 25. A month before the announcement, 33 national medical societies and 41 state medical societies sent the umbrella organization a letter proposing a meeting with certifying medical boards to address their concerns “regard-
ing the usefulness of high-stakes exams, the exorbitant costs of the MOC process, and the lack of transparent communication from certifying boards (that have led to) damaging the MOC brand, and creating state-level attacks on the MOC process.” The societies also want participation in planning a solution. The ABMS initiative, “Continuing Board Certification: Vision for the Future,” was launched anyway. ABMS CEO Lois Nora, MD, insisted the concept had been brewing for months, noting that “concerns … stimulated our thinking about the commission.” “The best step the ABMS can take is to assure us that MOC is voluntary,” said AAPS spokesperson Jane Orient, MD. (CONTINUED ON PAGE 4)
HEALTHCARELEADER
The Gift of Being a Physician Anup Patel, MD, endeavors to provide surgical access to the underserved on an international level Anup Patel, a plastic and reconstructive surgeon who established Orlando Plastic Surgery Institute, completed his MD/MBA degrees at Yale University. He received his plastic surgery training at Yale University followed by a fellowship in hand and microsurgery at the New York University and Mount Sinai. In a lifetime marked by excellence, Patel graduated as the valedictorian of his class at the University of Florida, majoring in economics, biochemistry and molecular genetics and valedictorian of his high-school class at Lake Highland in Orlando, Florida. Dr. Patel maintains a commitment to serv-
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ing society. He co-founded Cents of Relief, a 501(c)3 nonprofit, that seeks to help victims of human trafficking. The foundation has developed a partnership with Operation Smile to deliver burn care to indigent victims and developed a comic book that teaches burn safety to children. He has been on panels with global health leaders such as NBA Global Ambassador Dikembe Mutombo and Partners in Health’s co-founder Dr. Paul Farmer for his work on reducing the global surgical burden of disease. Dr. Patel’s healthcare efforts have been featured in the New York Times best-seller Half (CONTINUED ON PAGE 14)
What resonated in 2017? …
the Future?
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PHYSICIANSPOTLIGHT
Bethany Ballinger, MBBS,
AFRCSEd, FFAEM, FACEP Educating healthcare leaders with an accent on women Bethany Ballinger, MBBS, is the Program Director for the University of Central Florida College of Medicine (UCF COM), Emergency Medicine Residency Program at Osceola Regional Medical Center in Kissimmee, Florida, and Associate Professor of Emergency Medicine at the UCF College of Medicine. She hails from England, where she attended medical school at the University College London School of Medicine, followed by a 3-year emergency medicine residency and then by a fellowship/ specialist registrar posting in Emergency Medicine at Oxford University Teaching Hospital. After several years of practice in England, Dr. Ballinger moved to America and did a second emergency medicine residency at Orlando Regional Medical Center. She was then recruited as an inaugural faculty member for the EM residency at Florida Hospital. Dr. Ballinger's zeal to educate physicians of tomorrow to excel in today's digital world, led to her recruitment at the University of Central Florida College of Medicine (UCF COM). UCF COM's program epitomizes innovation, high-tech learning tools and a pioneering spirit to educate young doctors and scientists in a new and better way for the 21st century. Dr. Ballinger was one of the founding faculty for the medical college, and the college's mission reflects her vision. As a founding faculty member of the UCF COM, she had the vision of developing the new medical school's GME component. Specifically, a residency that would combine excellence in clinical skills with the humanity of the compassionate physician to produce outstanding patient centered care. She was thus naturally chosen to lead the new EM residency for the UCF COM, based at Osceola Regional Medical Center. Dr. Ballinger is renowned for her experience in evidence based medicine (EBM), clinical informatics and patient safety. Her passion for EBM blossomed while she was still at Oxford. Committed to promoting emergency medicine internationally, Dr. Ballinger took this expertise around the world. Notable endeavors include the creation of a "Virtual Health Sciences Library" at the Hue College of Medicine and Pharmacy, in Hue, Vietnam, and launching the "Practising Evidence Based Medicine" course there. One of the American Association of Medical College's (AAMC) current initiatives is "Best Practices for Better Care," a multi3
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year initiative to improve the quality and safety of health care. As an early proponent of patient safety education, Dr. Ballinger implemented the LCT in patient safety at UCF COM, because she is passionate about educating doctors who take the entire patient experience into account. Under her leadership, the UCF COM was one of only 10 schools in the world to participate in the World Health Organization's implementation study of the Patient Safety Curriculum. Integrating technology into medical education, Dr. Ballinger's has successfully taught students to be proactive in looking for possible safety hazards in real time such as dangerous drug interactions using their iPads. Her research and innovations are frequently highlighted at the national AAMC and American Council of Graduate Medical
Education (ACGME) meetings. Dr. Ballinger is active in organized medicine. At the regional level, she is a founding member of the Florida State Committee on Patient Safety Education, and on the academic affairs committee of the Florida College of Emergency Physicians Education. At the national level, she holds the post of American College of Emergency Physicians (ACEP) Ambassador to the United Kingdom. She is a member of the ACEP International section's education committee, and also serves on the communications committee of the International Federation of Emergency Medicine. Dr. Ballinger is a beloved educator and not surprisingly has been recognized by numerous awards, including the Faculty of the Year for the Emergency Medi-
cine Residency Program, and the Florida Hospital Compassion and Excellence in Medical Care Award, for which she was chosen amongst a group of over 2500 qualified physicians. And in September, "National Women in Medicine Month," the American Medical Association honored Dr. Ballinger as one of the nation's most inspirational women in healthcare. This year's AMA celebration carries the theme, "Women in Medicine: Born to Lead," and honors 80 physicians who have offered leadership, mentoring and support to increasing the number of women in medicine. For our forum this month, Dr. Ballinger shares her passion for developing women healthcare leaders and helping them find the balance for success.
IN OTHER WORDS with Bethany Ballinger, MD Growing up in rural England in the 1970s, I told everyone I wanted to be a doctor – just like the kind man who came to our country home whenever I was sick. People just looked at me, patted me on the head and said, “Yes, of course you do, dear.” At that time, all of our community’s physicians were men. That’s changed. Today, half the students in medical schools
are women. Yet females make up only about 15 percent of the leaders in healthcare. The question is why? And just as importantly, what are we doing to change those facts? My specialty – Emergency Medicine – has always been male-dominated. I still have patients who ask, “When is the doctor coming in?” when I enter their exam room. When I joined Osceola Regional Medi-
Physicians, Food, Fellowship and
cal Center in 2014, I was the only female full-time emergency physician. But that’s changing – because many of us worked together to make it so. Today, I lead the ER residency program at the hospital, a partnership between (CONTINUED ON PAGE 13)
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Combating MOC, continued from page 1 “We need options.”
CASH COW
The seismic shift of MOC from lifetime to time-limited board certification has been a major cash influx to non-profit ABMS member boards. For example, the American Board of Internal Medicine (ABIM), the largest of the member boards, reported $27 million in MOC fees on their IRS form 990 three years ago. The MOC re-certification process began innocently enough. The program was originally created when the (ABIM) and the American College of Physicians (ACP) were searching for clever ways to perpetually fund their activities and member salaries. In the late 1970s, the ABIM tried on for size a voluntary ongoing physician recognition program, “Continuous Professional Development,” as an additional board certification. The plan failed because physicians didn’t find the CPD valuable to their practices. Taking a page from the playbook of the American Board of Family Medicine (ABFM) that only offered time-limited board certification, ABIM leaders implemented a similar program, reasoning that physicians “needed to keep up” or face “uncertain circumstances,” noted Fisher. “Before 1990, ABMS’s ‘board certification’ was a well-respected voluntary lifetime physician credential that served as a practical assessment of a physician’s adequacy to practice their specialty following residency training,” Fisher explained. In the 1990s, the ABMS board implemented a MOC program requiring doctors under a certain age to obtain re-certification throughout their careers. The move appeased older physicians, who were grandfathered in via previous lifetime certification guidelines. As the “grandfathers” retire, MOC fees just for ABIM “will certainly top $50 million,” said Paul Teirstein, MD, who formed the physician-led National Board of Physicians and Surgeons (NBPAS) in 2015 to create a competing recertification program.
In a bold move to ensure their place at the table, the ABMS trademarked MOC in 2005. To sell MOC to the public, ABMS promoted the process as showing how doctors are staying abreast of their specialty while also honing their clinical skills. Over the next nine years, while doctors were distracted by ever-increasing federal government mandates, the ABMS quietly increased its coffers. By 2014, MOC costs had increased 244 percent since 1999. MOC fees average $3,000 or more, excluding calculation for time lost caring for patients. An independent study showed that MOC-related fees add nearly $6 billion every decade to the already burdened American healthcare system. That’s not the only fallout. According to ABIM, 13 percent of physicians fail their initial MOC exam, an outcome doctors say is unfair to an unproven system and is “especially inappropriate when doctors are already in short supply and suffering from record levels of burnout and suicide,” noted Fisher. The creation of NBPAS (NBPAS.org), which has gained 6,000 members in less than two years and is on target to hit the 10,000 mark by the end of 2018, was in response to unreasonable MOC mandates. The argument: ABMS lacks significant evidence to support their reasoning of increased public safety to increase MOC mandates. “We’ve been lobbying for change for over two years, but the ABMS member boards still require physicians (to) prepare for tests that have little relevance to their practice and result in well over $100 million in fees to board members,” said Teirstein. In an analysis of 33 MOC studies determining whether re-certification improves patient safety and outcomes, roughly half reported a significant association between certification and positive outcomes while nearly half found no association. Three surveys found a negative association. “There’s no evidence to support their claim to this end,” said Judith Thompson, MD, a general surgeon from Houston.
“Never has a patient outcome been related to the MOC product. Where’s the public outcry for recertification? Show us the data.”
STATE-BY-STATE
So far, 17 states have proposed legislation to ban mandatory MOC requirements, but powerful industry lobbyists quashed Oklahoma’s anti-MOC legislation passed in 2016. The Right-to-Care law, the first of its kind in the nation, intended to eliminate MOC as a stipulation for physicians to receive hospital privileges and licenses. But various loopholes in the language allowed hospitals to mandate MOC as a requirement. In Tennessee, lawmakers were only able to remove MOC requirements for medical licenses. Aggressive anti-MOC bills in Arizona, Kentucky and Michigan legislatures died quietly. In the 2017 session, a Florida antiMOC bill languished in committee. The move was expected, since Gov. Rick Scott made millions as a hospital industry executive and was tied to Columbia/HCA, which eventually became the nation’s largest private for-profit healthcare company. However, on Oct. 25, Sen. Denise Grimsley (R-26th District), a registered nurse, filed Senate Bill 628, “prohibiting the Boards of Medicine and Osteopathic Medicine, respectively, the Department of Health, certain healthcare facilities, and insurers from requiring physicians and osteopathic physicians to maintain certification or obtain recertification as a condition of licensure, reimbursement or admitting privileges.” Other states are making headway on the MOC issue. In an Oct. 11 hearing, Fisher, who has 17,000 Twitter followers, testified to the Ohio Health Committee that “hundreds of Tweets and emails I receive each year speak to the reality of the tremendous negative effect (MOC has) on decent, highly respected colleagues too embarrassed to go public with their failure, many of whom quietly leave medicine.” Georgians embraced the first successful
Physicians are jumping on the bandwagon of the newly formed National Board of Physicians and Surgeons (NBPAS), which offers an alternative MOC certification program. The San Diego, Calif.-based organization has accrued 6,000 members since its inception in 2015, and is on target to reach 10,000 members in 2018. According to the NBPAS.org website, here’s the most common question physicians have about the organization:
Is NBPAS accepted or recognized by hospitals, insurance companies, and state medical boards? It’s important to understand what “accepted” or “recognized” means with respect to these types of organizations. For hospitals, NBPAS acceptance usually means the hospital’s Board of Directors will accept NBPAS certification instead of ABMS member board (or AOA) certification for hospital privileges. The process for gaining acceptance usually starts with an interested physician making a presentation to the hospital’s Medical Executive Committee (MEC), where they vote to recommend the hospital’s Board of Directors accept NBPAS as an alternative. There are currently 4
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over 60 U.S. hospitals that either accept NPBAS certification for privileges or have eliminated MOC requirements from their bylaws. We are fighting to increase hospital acceptance/recognition by: providing advocacy materials on the Advocacy Center tab of our website, engaging our 400-volunteer physician Advocacy Committee, lobbying (within the limits allowed by law) state legislators to pass anti-MOC bills, and meeting with the Federal Trade Commission to consider the anti-competitive aspects of MOC. For payers (insurance companies), NBPAS acceptance means the insurer will
contract with physicians whose ABMS or AOA certification has expired but who have current NBPAS certification. Acceptance by payers is critical for widespread growth of NBPAS, and no insurer that we know of currently accepts NBPAS. It has been very difficult to get the attention of insurance company’s management on this issue. While currently frustrating, we believe our continued growth and political activity will win over the payers. We especially believe passing anti-MOC bills in many states will be very helpful to our goal of gaining acceptance by insurers. For state medical boards, accep-
state-implemented MOC legislation. In May, lawmakers successfully removed MOC mandates at some hospitals for doctor privileges, medical licensure and payer membership. “The battle in state legislatures is an effective first step, but could be sidestepped if ABMS (et al) ‘rebrands’ the MOC program to a new product. As such, the most effective deterrent will be a ruling by the Federal Trade Commission (FTC) that (their MOC program) is a monopoly and violates anti-trust laws,” said Fisher, noting the American Medical Society (AMA) has lobbied since 2015 to keep at bay an anti-trust lawsuit filed in the Northern District of Illinois. “ABMS is now desperate to rebrand the MOC® program that funds as much as 47 percent of some ABMS member-board annual revenues in an attempt to pivot to a new, clever revenue stream that’ll still permit cash to flow to this consortium of unaccountable private non-profit corporations to continue,” said Fisher.
FAIR & BALANCED?
To compile a commission of roughly two dozen members to manage MOC changes, the ABMS has said it will include a diversity of industry representatives. When asked if the commission would include physicians, including representation from unpaid NBPAS members, Nora dodged the question, adding that members appointed to the commission will be determined by the ABMS planning committee. “Physicians should insist their hospital Medical Executive Committee recognize NBPAS as an equal alternative to participation in MOC,” said Fisher. “Both boards require initial board certification, but NBPAS recognizes the Accreditation Council on Continuing Medical Education (ACCME), vetted Continuing Medical Education credits, as valid for documentation of ongoing lifetime certification without having to commit to signing a HIPAA business agreement.”
tance is usually irrelevant. State medical boards do not require board certification or MOC as a requirement for initial licensure or MOL (maintenance of licensure). One important function of NBPAS is to bring awareness of this controversy to the state medical boards, which will help deter any efforts to make MOC a requirement for MOL in the future. However, there is one caveat we are aware of. A few states, including California and Texas, have laws requiring ABMS (or AOA) member board, or equivalent certification if a physician advertises they are a “board-certified specialist.” These laws define “equivalent” very restrictively, so as the laws currently stand, NBPAS would not qualify. As NBPAS gains more widespread growth, we believe these laws will be changed. SOURCE: NBPAS.org.
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It’s Not “Just” GERD Robotic Surgery Plays a Major Role in Successfully Treating Esophageal Disorders, Including Hiatal Hernias that Cause Damaging, Dangerous Esophageal Reflux By FARID GHARAGOZLOO, MD
There has been much discussion around why esophageal cancer has increased by more than 600 percent in the U.S. since 1978. I strongly believe that the increase may be related to esophageal reflux and hiatal hernias. Medical therapy of acid reflux using proton pump inhibitors has not decreased the incidence of esophageal cancer, and in fact may play a role in increasing the numbers. There are hypotheses as to why this is, one being that esophageal cancer may not be caused by acid at all. Yes, we can shut off the acid with medicines, but what if the acid was making things harder on cancer cells all along? Other theories as to risk factors include bile salts and bacterial overgrowth due to backed up food that has liquefied in the esophagus, causing pain and burning. Many doctors, confronted with a patient who presents with “heartburn” pain, will give stronger and stronger medications for acid reflux, not realizing the patient is actually experiencing esophageal (as opposed to gastroesophageal, GERD) reflux caused by a hiatal hernia. In a normally functioning esophageal hiatus, the esophagus goes through the hiatus opening in the diaphragm where it joins the stomach in the abdomen, forming a gastroesophageal valve – not a sphincter, as it is often called. I explain to my patients that if their hiatus gets bigger, even by two centimeters, the valve will no longer work. The wider the opening, the more the stomach can move through the opening, like a napkin pulled through a ring.
HIATAL HERNIAS SHOULD BE TAKEN SERIOUSLY
Hiatal hernias are more than just uncomfortable bulges. A larger hiatal hernia becomes an obstruction of the esophagus, and in addition to concerns around esophageal cancer, a hiatal hernia of that
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size can cause a host of other preventable disorders. When a hiatal hernia patient lies down, digested liquid can flow into airways causing labored breathing. Believing they have chronic sinus problems, they make visits to the ENT, who can discover no real cause for the infection present. When this hernia gets bigger, as the stomach migrates into the chest, it can compresses the vena cava, preventing the heart from filling with blood. Patients begin complaining of low energy. They can’t exercise because they can barely breathe, not due to the hernia compressing the lungs, but due to heart failure. They think it’s all because they’re getting older and gaining more weight, causing poor circulation. When I speak to my patients about this, suggesting that hernia repair can alleviate these symptoms, they often cry with relief. The truth is, our understanding of hiatal hernias has grown. Medicine is like a big ship – it’s hard to turn it fast enough, especially when it comes to the super-specialized area of upper GI. But as an estimated third of our local population has this problem, we must be vigilant in
diagnosing and treating it correctly.
ADVANCED ROBOTIC SURGERY FOR HIATAL HERNIA
Advances in robotic surgery have completely transformed the treatment of hiatal hernia. In the not-so-distant past, patients avoided having the procedure because the methods available made the treatment riskier than the disease. Laparoscopy, though better than open surgery, didn’t allow the visibility or flexibility needed. Things have changed. Robotics allows us to use wrist-like action, with 3D cameras giving the full view necessary to see in the space to reconstruct the hiatus. This technology has changed the game, allowing highly successful results with almost nonexistent hernia recurrence rates.
ROBOTIC SURGERY FOR ACHALASIA
The many benefits of robotic surgery make it an excellent solution to treat many thoracic and esophageal disorders, including achalasia. Patients present with pain on eating and difficulty swallowing. Most achalasia patients we see have been coping with the disorder for many years. Their esophagus have become damaged, causing many problems to occur, including aspiration and choking. Patients who have trouble swallowing should see a specialist who focuses on esophageal medicine for a proper diagnosis. The sooner achalasia can be treated, the better – and not with dilation. Physicians have been searching for ways to treat achalasia since the 1700s, at one point using a whale bone to open the esophageal valve. But dilation, whether it’s done with a whale bone or endoscopy, doesn’t work as a long-term solution. In the past, as with hiatal hernia surgery, patients wanted to avoid open techniques. Laparoscopy, while better, is still not sensitive enough to allow the muscle to be cut and avoid putting a hole in the esophagus.
Laparoscopic myotomy, where the muscle of the lower esophagus is cut in a longitudinal fashion on the front of the esophagus, can be effective, but is associated with an increased incidence of reflux, which necessitates a partial fundoplication, also decreasing long-term benefit. Robotic Lateral Heller Myotomy eliminates the need for fundoplication. Using this technique, the muscle of the esophagus is cut longitudinally on the left side. Cutting the muscle on the left side of the esophagus preserves the normal gastroesophageal valve, which prevents reflux and removes the need for a fundoplication. Robotic Lateral Heller Myotomy procedure without fundoplication is associated with 98 percent benefit, without any reflux. These results have been superior to that of all previous procedures. The robot’s 3D visualization allows the depth of visibility needed. It’s an elegant surgical strike! The patient wakes up and can eat.
LEADING THE NEW WAY
Minimally invasive procedures using medical robotic tools help us operate with more precision and efficiency at the Center for Advanced Thoracic Surgery. Thanks to the assistance of the revolutionary robotic technology, positive patient outcomes are dramatically increased, while blood loss, pain, hospital stay and risk of infection or death are drastically decreased. In most cases the use of the robot allows us to access afflicted areas with minimal incisions and increased visibility for greater success. Farid Gharagozloo, MD, FACS is board certified in general surgery and thoracic surgery, and specializes in providing the latest robotic surgery options to treat thoracic, esophageal, gastrointestinal, and lung diseases and cancers. He is an esteemed physician and is the founding surgeon of the Center for Advanced Thoracic Surgery at Florida Hospital Celebration. His role at Florida Hospital’s acclaimed Global Robotics Institute establishes him as one of a handful of internationally recognized physicians at the leading edge of robotic surgery. To learn more about the Center for Advanced Thoracic Surgery or to refer a patient, contact the practice at (407) 303-4877.
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HEALTH INNOVATORS
New Technology Boosts Cancer Diagnosis and Treatment By JAVIER ROJAS, MedSpeaks
In a world where a growing number of people are diagnosed with some form of cancer each day, the hope for a cure also grows. Recent statistics from the American Cancer Society show that: Every MINUTE three new cases of cancer are diagnosed in the United States.
This is an astonishing number since, in a year’s time, that will equal roughly 1.6 million new cases and there seems to be little we are able to do about it…yet. Though the hope of finding one magi-
cal cure for cancer still seems to be far off, there are a few companies that have decided to take an innovative approach against this deadly disease. Targeting early detection of cancer, DermaSensor is a Miami-based startup. A device resembling the shape of an oversized digital thermometer can quickly and easily detect possible skin cancers by pressing the sensor against suspected cancerous skin tissue, which will display the results on the device’s screen in seconds. The device, which actually started out as desktop device resembling an old school computer, works by using ‘Elastic Scattering Spectroscopy technology’ along with learning algorithms
to effectively differentiate cancerous skin tissue from healthy tissue. Though it is still going through testing in clinical trials, the company aims to first sell their device to physicians and retail clinicians, but ultimately the real goal is to source it to the average consumer at an affordable price. If successful in their mission, DermaSensor could make screening for skin cancer as easy as taking your temperature. Another company taking an innovative approach in oncology is a University of Central Florida sponsored company, SegAna. They are employing a clever
solution to solve the problem of complications that occur during radiation of the lungs or when surgery is necessary. They have developed a unique 3-D printer that can produce an exact structural duplicate of a patient’s lung. This will then allow the surgeon to practice their radiation or surgery on this ‘Phantom’ lung, as SegAna calls it, which greatly reduces the risk of error and generally improves the patient’s outcome. Currently, the prototype is ready, and they are producing a demonstration to show the (CONTINUED ON PAGE 8)
Payer-Tech: Does it Really Exist? FEATURED INNOVATORS: By JOSHUA BOWMAN, Intern, MedSpeaks
Change. It’s the inevitable force that transpires throughout life. Change happens in several ways. We are all familiar with it. When we observe change on a macro scale, such as government policies and regulations, we can see the impact it has on entire industries, and the trickle-down effect it has on businesses. In this case - health insurance. Here are the facts: payers are pouring more money into investing and acquiring businesses than ever before. This is true for all types of companies, especially tech companies. Investing in or acquiring tech companies has a multitude of benefits for payers, but what was the cause of this investment boom? What changed? It’s true that big health insurance companies aren’t only investing in tech companies. Payer/provider relationships are an example of this, focusing instead on evolving care models and cutting costs. Payers have interests in investing in technology for obvious reasons. Whether it’s for data management or information security, it just makes sense. But where things get really interesting is when you consider how tech investments have exploded in recent years. A study done by CB Insights shows that between Q1’12 and Q1’17, 141 transactions (investments and acquisitions) took place. Blue Cross Blue Shield Ventures had the most activity with 42 deals. Sixtythree of the 141 transactions were in digital health. Again, BlueCross Blue Shield led the way with investments in 19 unique digital health companies during this time (CB Insights). Clearly health insurance companies are investing more
than ever before, so let’s examine the catalyst for this change. When the Affordable Care Act passed, specific mandates were put into place to motivate health insurance companies to invest. One of those mandates, which is probably the biggest driver of the investment boom, is known as the medical loss ratio rule. According to Centers for Medicare and Medicaid Services, The Affordable Care Act requires health insurance issuers to submit data on the proportion of premium revenues spent on clinical services and quality improvement, also known as the Medical Loss Ratio (MLR). It also requires them to issue rebates to enrollees if this percentage does not meet minimum standards. The Affordable Care Act requires insurance companies to spend at least 80 percent or 85 percent of premium dollars on medical care, with the rate review provisions imposing tighter limits on health insurance rate increases. If an issuer fails to meet the applicable MLR standard in any given year, as of 2012, the issuer is required to provide a rebate to its customers (CMS). Since health insurance issuers are required to spend premium revenue on quality improvement, they have chosen to spend revenue in a way that offers return on investment. At the same time, they can meet ACA requirements and strategically invest. It’s good business and it makes sense. This trend has payers investing not in technology giants, but instead in smaller startups. According to Fortune, in 2014 Blue Cross Blue Shield of Florida (Florida Blue) started an accelerator for healthcare (CONTINUED ON PAGE 13)
HEALTHCURE is a unique environmental-tech company
with a novel approach to thwart healthcare associated infections (HAIs). The solution, Goldshield, uses a proprietary water-based technology to provide safe, non-toxic prophylactic protection on fabrics and hard surfaces against gram-positive and gram-negative bacteria, as well as mold and mildew for 30 days. The company offers Goldshield - at cost - for healthcare institutions, LTC facilities, schools and other public and private facilities in hurricane crisis areas, such as Florida and Puerto Rico. www.healthcure.biz
AUXADYNE, based in Key Stone Heights, Florida designs and manufactures a patented auxetic polyurethane foam padding. Initially used for sports helmets and padding, the company is expanding its application to innovate prosthetic socks, medical braces, and military and first responder protective equipment. Unlike traditional foams, Auxadyne increases impact absorption by 600x and reduces pressure point stress by 50 percent. Investment Opportunity Available www.auxadyne.com VIOLET DEFENSE TECHNOLOGY, based in Cel-
ebration, Florida recently launched a new anti-microbial product line that combines broad spectrum UV and violet-blue light with artificial intelligence (AI) to kill MRSA, E. coli, Salmonella and Norovirus, from as far as three meters away. The ‘whole room’ unit disinfects a standard size room with various automatic cleaning modes that activate when the room is unoccupied and can be preprogrammed based on a facility’s specific operational needs. www.violetdefense.com Disclosure: Readers, please take note that the companies featured in the Health Innovators section have not paid for or bartered for these acknowledgements. All companies are selected based on merit, intrigue, and their potential to move healthcare forward towards the Quadruple Aim. In a noisy and biased market, we believe this to be a valuable distinction.
GET INVOLVED TECHSTARS STARTUP WEEKEND November 17 from 6:30p until November 19 at 9p http://bit.ly/2z6MunK HEALTH INNOVATORS: NEW MODELS IN MEDICAL TRAINING & SIMULATION NOVEMBER 28 | 6:30PM Orlando, FL | www.meetup.com/FLHealth
IHI’S INSTITUTE FOR HEALTHCARE QUALITY IMPROVEMENT DECEMBER 10-13, 2017 Orlando, FL | www.ihi.org MedSpeaksTM showcases the most exciting experts, events and innovations in Central Florida by bringing together the state’s largest community network of Health Innovators. We have converged over 1,400 healthcare professionals including clinicians, entrepreneurs, and technologists to discuss and promote the problems facing healthcare today and the innovations reshaping the future. www.medspeaks.com
PUT GAMERS TO THE TEST! Sponsorship packages are now available as are mentor registrations. Mentor Roles with Clinical and Executive level experience are needed to rally around teams, discuss and define clinical problems. www.megahealthjam.com.
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Put gamers, geeks, and artists to the ultimate “test” by submitting challenges and/or ideas to engage patients. The best ideas will be pitched at Florida’s first MeGa Jam event which will converge medicine with video gaming technologies to create MEDICAL GAMES! kelli@medspeaks.com
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CPASPEAK
in partnership with
Your Accountant is Your Partner; Choose Wisely By DALIA CANTOR
Our profession has evolved vastly over the years and today we are more than just bean counters and tax preparers. A good CPA can be your company’s financial partner for life and will help you with decisions from day to day operations to strategic planning. So how do you find the right CPA for your business? Like any other partner you choose to be by your side, you need to go through the vetting process. The first step in setting the stage for a successful search is to know what services you need and/or want. Given the level of fees you are prepared to pay, you must decide where your responsibility stops and where the accountant’s begins. You should plan to interview three to five candidates and evaluate each potential candidate based on these criteria – services, personality and fees. You will notice that I am not mentioning professionalism and competence because that should be a given fact amongst the candidates of your choosing. The best place to start your pickings are your referral sources such as business partners in your industry, your attorney, or your banker.
SERVICES
Most accounting firms offer tax and bookkeeping services. But what if you need payroll, management consulting, budgeting and forecasting, estate planning? Will the accountant help you design and implement financial information sys-
ships here so the personality and like mindedness does matter. Is the accountant’s style compatible with yours? Excellent organization skills, high degree of precision, focus on the client, extreme trustworthiness, creativity and collaboration are basic skills that a successful and competent CPA should possess. What about your vision? Can you see this person working side by side with you in achieving your goals? Be sure the people you are meeting with are the same ones who will be handling your business. At many accounting firms, some partners handle sales and new business, then pass the actual account work on to others. tems? Other services a CPA may offer is assistance for loans and financing; mergers and acquisitions related services; managing investments; and representing you before tax authorities. Although smaller accounting firms are generally a better bet for entrepreneurs, they may not offer all these services. Do your homework and find out if the firm has what you need. In addition to services, make sure the firm has experience with your size of business and with your industry.
PERSONALITY
I am talking about long term relation-
FEES
Ask about fees upfront. Most accounting firms charge by the hour; fees can range from $100 to $275 per hour. However, there are some accountants who work on a monthly retainer. Figure out what services you are likely to need and which option will be more cost-effective for you. Try to get an estimate of the total annual charges based on the services you have discussed but don’t base your decision solely on cost. Remember that often you get what you pay for. You should ask your potential CPA candidates questions such as: • Do you deliver timely services? • How soon do you respond to an email
or a phone call? • What other clients do you have in the same industry? • What other services do you offer beyond usual reporting? • Is your firm tech-savvy and how do you use the latest technology for efficiency? • What kind of credentials do you have? • Who in your firm I will be interacting with? • How are your fees calculated? • What can I do to help with your work to keep your fees lower? • Why should I use your firm? You should also pay attention to the questions CPA asks you. You know your finances, but the CPA doesn’t, so are they asking enough questions to understand your entire financial situation? Accounting books provide a basis for business decisions and measure the financial health of your company so naturally you want someone on your team that understands your business, is reliable, precise, and is as passionate about your business as you are! Dalia Cantor, CPA, has been practicing as an accountant and tax advisor since 1997. She is a Certified Public Accountant in the states of Florida and New York, and graduated Dowling College with a Bachelor’s Degree in Accounting. Dalia is a member of the American Institute of Certified Public Accountants and the Florida Institute of Certified Public Accountants. Prior to establishing her own practice, Dalia worked in public accounting managing both domestic and foreign audit and tax clients. In private industry, she was involved in the regulatory environment, specializing in technical accounting, internal controls, and SEC reporting for publicly held companies. She can be reached at Dalia@mycpasolutions.com
HEALTH INNOVATORS New Technology, continued from page 7
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advantage and practicality of the technology for surgeons and oncologists. The definition of an innovator is, “to do something in a new way” and that is exactly what the Tampa-based company, Cverngenx is doing. Cverngenx is focused on radiation therapy, which is anything but new in cancer treatment, except they have taken the current treatment style and revolutionized it by using a patient’s genome to develop personalized radiation treatment. This seems like a pretty simple idea realizing that every person is different and will require a different treatment plan, but currently most cancer patients are being treated with the same radiation treatment across the board. They have developed a ‘Precision Genomic Radiation Therapy platform’ or ‘pGRT™’, which is able to mathematically suggest radiation parameters that would best fit that particular patient. Being able to effectively predict how each patient will react to his or her radiation will not only save time and money but could improve or save that person’s life. Cancer cases are only continuing to grow over the years and until we develop a cure, the best we can do is develop new ways to detect it early on or find more effective ways to treat it once it develops.
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RADIOLOGY INSIGHTS
sponsored by
Patient Radiation in Diagnostic Imaging By DR. WILLIAM F. SENSAKOVIC
Association of Physicists in Medicine. This information can help a practice provide the best care for their patients by ensuring that patient radiation dose is As Low As Reasonably Achievable (ALARA). The radiation delivered during imaging is essential for diagnosis, but brings with is a small risk to the patient. It is important that physicians keep this risk in mind, but also in perspective when ordering imaging studies and performing patient scans. Diagnostic imaging exams, when performed correctly, should not induce non-cancerous effects. The probability of inducing cancerous effects is also quite low to negligible. Qualified Medical Physicists are experts in the application of radiation in healthcare and should be consulted when optimizing protocols, imaging vulnerable populations, and when questions related to dose and image quality arise.
0.01Sv CT scan increases a typical person’s cancer risk from ~40% to ~40.1%. Similarly, a pelvic CT of a pregnant woman increases the fetal risk of childhood cancer from ~0.3% to ~0.5%. Thus, the risk from imaging is very low. However, given the ubiquity of scanning and the possibility of multiple scans on the same patient, it is recommended that radiation is limited to what is diagnostically necessary. Given the small risk of cancer it would be ideal if we could minimize dose; however, this is not possible. Although the exact relationship is complex, image quality generally decreases as dose decreases. Thus, minimizing dose would result in nondiagnostic image quality. Instead, management of patient radiation should follow the principles of justification and optimization. Justification states that an exam should only be performed if it does more good than harm. A good mnemonic is .DAM (dot DAM): Don’t Order Tests that Don’t Affect Management. The physician looking for guidance on appropriate imaging should refer to The American College of Radiology (ACR) Appropriateness Criteria®. These are “evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition.” By ordering the lowest-dose exam that still conveys relevant clinical information the referring physician can play a large
Wilhelm Roentgen serendipitously discovered x-rays in 1895. Scientists and physicians, eager to improve patient care, immediately applied the new technology to imaging the human body. By 1897 reports began to surface of hair loss and skin reddening and in that same year it was confirmed that x-rays induce biological changes when they were used to treat nevi (hairy moles) on the back of a 5 year old girl. Extensive research over the last century using animal models and epidemiological data from events such as the atomic bombings of Hiroshima and Nagasaki and Chernobyl has improved our understandrole in reducing patient radiation dose. ing of radiobiological effects. This research Optimization entails ensuring that has definitively demonstrated that radiamodern technology is utilized and that imtion may cause cancer, epilation, sterility, aging protocols are set such that excess racataracts, erythema, desquamation, tissue diation is not delivered to the patient. New necrosis, and death. Further, radiobiotechnology such as iterative reconstruction logical effects are of particular concern for and automatic exposure control when propchildren and pregnant women. Research erly used create images of sufficient quality has demonstrated that children are more at reduced dose. How that technology is sensitive to radiation induced cataracts, hyimplemented is determined by the scanning pothyroidism, thyroid nodules, and many parameters, which have a tremendous imDr. William F. Sensakovic received his forms of cancer. An irradiated embryo/ pact on image quality and patient dose. The undergraduate degrees and PhD from fetus is at risk for miscarriage, childhood the University of Chicago. His research protocol that describes these parameters focused on image processing, computercancer, growth retardation, organ malforshould be periodically reviewed by a team aided detection, and imaging biomarkers. He is certified by the ABR for Diagnosmation, and intellectual disability. consisting of, at a minimum, a radiologist, tic Medical Physics and by the American These severe radiobiological effects Board of Magnetic Resonance Safety qualified medical physicist, and technolo(ABMRS) as a MR Safety Expert. He is coupled with the ubiquity of medical imaggist. The radiologist reviews image quality, Chair of the AAPM Imaging Physics Curricula Subcommittee ing are often a source of anxiety for both and task group on establishing an image quality registry, edithe physicist reviews the technology and tor for the physics section of both RadExam and Radiology Aspatients and physicians. Add in damning dose, and the technologist reviews workflow sessment and Review (RADAR). He is president-elect for the State of Florida AAPM, the ACR councilor-at-large for Medical exposés in the news, exaggerated journal arintegration and implementation feasibility. Physics, a board member for the ABMRS, and on the board of ticles, and a general lack of education about associate editors for Medical Physics. He is currently a Medical Many resources exist to guide optimization. Physicist at Florida Hospital. radiation and it creates a hysteria that may These include journal articles, ACR practice cause both physicians and patients to avoid parameters, and publications from Image essential imaging. Wisely, Image Gently, and the American To understand the effects of radiation and gauge its danger one needs to understand how we measure radiation. Though RADIOLOGYRADIOLOGY SPECIALISTS SPECIALISTS OF FLORIDA OF FLORIDAUnder the direction and guidance of Florida the field is vast, for our purposes it will suffice Hospital, Radiology Specialists of Florida is to say that tissue radiation absorbed dose is fully dedicated to providing our community measured in Grays (Gy). All radiobiological RADIOLOGY SPECIALISTS OF FLORIDA effects, except cancer, require a minimum with excellent medical imaging services. dose (threshold) before they occur. Under the direction and guidance of Florida Hospital, Radiology Specialists of Florida is fully Computed tomography (CT), nudedicated to providing ourdirection community excellent services. Under the andwith guidance ofmedical Floridaimaging Hospital, Radiology Specialists of Florida is fully clear medicine, and fluoroscopy typically dedicated to providing our community with excellent medical imaging services. give the highest radiation absorbed doses • 24/7 Reads and accessibility (up to 0.1Gy to tissue and Under up tothe0.03Gy direction and guidance of Florida Hospital, Radiology Specialists of Florida is fully • Continuity of care fetal). The lowest dose that produces nondedicated to providing our community with excellent medical imaging services. cancerous biological effects is 0.25Gy in • State of the art technology adults and 0.1Gy in utero. Thus, a typical • High Image quality diagnostic scan will not cause biological • Lowest Levels of Radiation tissue effects in adults or a fetus. It should, • Trusted Florida Hospital Radiology however, be noted that interventional procedures and radiotherapies can that approach a level of concern. Radiation dose measurements are WE PROVIDE modified to account for the varying poten• 24/7 Reads and accessibility tial of cancer induction in different tissues. • Continuity of care This modified dose is called the effective • State of the art technologyWE PROVIDE • High Image quality dose and is measured in Sieverts (Sv). CT • 24/7 Reads and accessibility • Lowest Levels of Radiation• Continuity of care WE PROVIDE typically delivers the highest effective dose • Trusted Florida Hospital Radiology • State of the art technology • 24/7 Reads and accessibility (~0.002-0.01Sv) with radiographs and • High Image quality • Continuity of care 601 East Rollins St. Orlando, FL 32803 fluoroscopy below that. Though there • Lowest Levels of Radiation • State of the art technology is some controversy, currently accepted (407) 303-8178 • Trusted Florida Hospital Radiology • High Image quality models assume any amount of radiation FLORIDAHOSPITALRADIOLOGY.COM • Lowest Levels of Radiation • Trusted Florida Hospital Radiology may induce cancer. That being said a
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Is Your Practice HIPAA Compliant? By MARK LANTON
You know that HIPAA is mandatory, and you know the significance of complying with HIPAA. But, do you really know what all HIPAA commands of you? I use the word “command” because of the heavy hand of the government and the serious consequences, even if due to a simple infraction on the physician’s part. This may surprise you, but according to the government, more than 70 percent of all physician practices are NOT compliant. You have to ask yourself the question, “is my practice in compliance?” And s lie mi Fa & nts Direct Supportt For Patie Families make to ds car if you think you are, how do you know? gas and ses Pas ke ma gle liees Option Bus tox& miRid Sin Fa Lyn car •ds nts ga tie s an r sPa ssepo rtt dFo Not knowing for sure if you are up ier easke to ma cen dsters lthcar gas andhea sesour Pasng reachi iergle Ride Option Bus completely in compliance is like playing Sin rds W almart or Target Gift Ca lix, ier Pubeas • ters for es gam our health cen Russian Roulette with your practice. For and ingrds s, Ca yon cra & ks and Ca tme eos forDVD’s, Coloring boo srds getVid ga dGif or Tar artyon s, •an instance, a three-physician dermatolW alm x, ks & cra oo er for esvid pro gam andthe it tos,see wayon wh&ocra boonks ngldre s vice Colorichi , ser D’s al DV dic ogy practice in Massachusetts was fined me and os and ts visi t der ovi port patien utio ersertrib con vid ial pro anc theme es ns to sup Fin vic • d see to it al wa dic o $150,000 because an office employee wh ren an ts s visi t ser vice ort patien t patient visits and medical backed up patient records on an unenncial contributions to suppor r Managers nte Ce h alt He r Support of Ou ect Dir crypted thumb drive that was stolen. This rs er Towels gePap Center Managers na old Ma lti-F nterMu h Ce x and altene was not an intentional HIPAA violation, upport of Our •HeKle Towels itizer Sanels ndTow Haer but not paying attention to details are the nex and Multi-Fold• Pap • Disinfectant Wipes cause of a significant number of HIPAA d Sanitizer esr Patients & Families t Fo orteri A Bat AApp andSu AAect violations nationwide. ke ma nfectant Wipes • Dir to s Bus Passes and gas cards Bagtion e Op Ridge glerba SinGa Kitcxhen Another example of a HIPAA blun• Lyn and AAA Batteries • Tall ves Glo centers easier dicalhea lth Meour s n-L der was an employee at the University chixng • No reaate Kitchen Garbage Bag mpors Target Gift Cards g Sta ilinalm MaW art of Iowa Student Health Center who had For •ves Pubr lix, n-Latex Medical Glo • eve s for oks & crayons, and gaxme bo er ing Pap lor py s Co noticeably displayed her surprise when Co , mp ite D’s Sta g Wh DV ) ilin d • an Ma 13” r eve • Videos 0,er9” x 12” and 10” e #1 (Sizpro pesthe elosee Env g vid ilin Ma she learned the results of a high-profile ite Wh er in to it Pla Pap • wa py o wh te Co children#1 x 13”) and 12” xssu ffs10” 0,”)9” Cuto ts and medical ser vices athlete’s pregnancy test. Even though the rens visi e”Blo t (Siz 13 Pre tien x pes pa od rt 10 elo d po Env an atic g sup ” om ilin 12 x Ma Aut 9” • ite utio Whe #10, sn (Siz ancial contrib er Trainings eer • Fin nte unt olu ffsMount Flat Screen Television for Vol employee had compliance training, this all• reWCu omatic Blood Pressu ffs gs er Trainin eer nte unt olu Vol for rs on ge visi na employee made a supposedly virtuous Tele Ma r een Scr nte t Ce gs Fla t h inin Healt ll-Mnoun er Tra eer nte unt olu for Vol isio Direct Support of Our remark in wishing the young couple well. els Paper Tow • Kleenex and Multi-Fold The employee was “thinking out loud,” • Hand Sanitizer but was overheard by other employees who reported her statement. The em• Disinfectant Wipes ployee was then fired. • AA and AAA Batteries gs I can go on-and-on with examples • Tall Kitchen Garbage Ba ves Glo al of HIPAA violations that were easily predic Me x ate n-L • No s ventable. It is reported that there have mp Sta g ilin Ma r • Foreve been more than 27,000,000 medical reer Pap • White Copy 9” x 12” and 10” x 13”) cords disclosed in the past three years. 0, #1 e (Siz pes elo Env g • Plain White Mailin That number is more than the populaCuffs Volunteer your time at a er Trainings • Automatic Blood Pressure of manyVisit nations around the globe. eer nte unt olu Vol for n sio Every $ Makes tion a Difference: and double your donation. Televi Hope Health Center. t Scr Shepherd’s Volunteer yourFla time at aeen all-Mount • W Doctors, nurses, Every $ Makes a Difference: Visit e your donation. Selected items ShepherdsHope.org/DonateNow office managers and are shipped For more information, visit Shepherd’s Hope Health Center. healthcare professionals all share in the ShepherdsHope.org/DonateNow ms are shipped ShepherdsHope.org/Volunteers Volunteer yourdirectly time to at Shepherd’s a For moreHope. Call 407-876-6699 Ext. 230. information, visit Every $ Makes a Difference: confusion that is linked to HIPAA. epherd’s Hope. Hope Health Center. ShepherdsHope.org/Volunteers CallVisit 407-876-6699 Ext. 230. hepherd’s
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Who is responsible for following HIPAA? Every covered entity (CE), physician practice must appoint a Compliance Officer within the practice. A Compliance Officer can be the Office Manager or physician. The Compliance Officer carries a heavy load on their shoulders because the fate of the practice can depend Everyon $ the Makes a Difference: Visit quality and thoroughness in mainShepherdsHope.org/DonateNow taining compliance. If you are responsible maintaining the in your Callfor407-876-6699 Ext.compliance 230. practice, your employment, finances and freedom can be all at risk. Fines can range in the neighborhood of $50,000 or more. Recent legislation has increased the government’s ability to audit and penalize
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to the fullest extent. If your Officer Manager or in-house biller is undercoding or unbundling codes, the possibility of being audited is greatly increased. It has been shown that outsourcing to billing/coding companies have proven to dramatically decrease government audits, and increase a practice revenue. What happens to a practice that is not found in compliance? Several things can happen, depending on the violations. In the case of a data breach, in addition to the hefty fines by HHS, the HITECH Act also gives the State Attorney General authority to impose civil penalties for violations. A practice can also run the risk of receiving negative publicity. Here’s how. If there is a breach in protected health information (PHI) of more than 500 patients, the covered entity (CE) is required to notify each affected patient, and also report the data breach to the media. There will be various additional sanctions on this practice as a result of the data breach. A scenario like this can certainly cause significant problems to a practice, and patient trust in this practice will be minimal.
What can you do to secure a compliant practice? You have to follow the rules. How do you know what rules to follow? By having security and privacy procedures in place that will protect PHI. Although you can do it yourself, it is proven that using a purchased product, such as an independent medical revenue management company to identify the compliance and security “pain points” of a practice has been highly effective. Solutions can then be formulated, which will result in increased practice efficiency and compliance. The HHS has clearly communicated their goal in strict enforcement of HIPAA. Don’t let your practice become a bad example. You can be publicly censured by the government for unintentional infractions. You can be subject to enormous fines, loss of patients and possible imprisonment. The reality of being forced to do the figurative “perp walk” of shame because of something that was preventable, is easy as accidentally forgetting to lock your computer when you leave the office for lunch. We want your practice to thrive and focus on giving great patient care instead of dealing with insurance companies, complicated paperwork and the over-bearing government. Take an inventory of your practice and ask yourself this question. When was the last time your practice had a checkup? Mark A. Lanton, CMRM, is founder/ CEO of Lanton Consulting, LLC., Specializing in increasing physician practice efficiency, compliance and cashflow via Practice Management, Revenue Cycle Optimization and Private Practice Business Support. Visit www.LantonConsulting.com or email Mark@LantonConsulting.com
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Why Companies Should Use Staffing Services By KATIE BLAYLOCK & PATRICK DUDLEY
By working with a staffing agency, the hiring manager can ensure temp employees possess the necessary skills, education, and experience to meet their needs. Here are a few reasons a staffing agency can help.
Medical professionals are looking to staffing agencies to help staff their offices and hospitals with high quality temporary employees more and more. Utilization of staffing agencies used to be an option of last resort, but now staffing agencies provide a strategic advantage and financial benefits. While there are many advantages of working with a staffing agency, how do you find the right one? You start by clearly outlining your specific needs and then identifying the staffing agency that can work with you as a partner to meet your objectives. By working with a staffing agency, the hiring manager can ensure temp employees possess the necessary skills, education, and experience to meet their needs. Here are a few reasons a staffing agency can help.
LOWER COSTS
By employing temporary staff through staffing agencies, the employer eliminates many tasks and cost associates with generating payroll. There are no employee tax or benefit costs. No liability insurance covering employee actions. No paid time off for holidays or vacation. No payroll withholdings or deductions to pay or report.
Part of being a strong industry specific staffing agency is understanding the real job needs, as well as the hiring manager needs. While corporate recruiters could certainly do this, they rarely get the chance. As a result, too many corporate recruiters over-rely on skills, experience and compensation to filter candidates, eliminating high potential and diverse candidates from consideration.
NEED TO KEEP PERMANENT HEADCOUNT DOWN
STAFFING FLEXIBILITY
become permanent employees when the hiring freeze is over. • Medical office managers know there are many advantages to using temporary staff, but how do you take the risk out of outsourcing those positions? Many managers are shifting their perspective from simply locating staffing agencies to developing relationships with strategic partners. • The difference is more than semantics. The thought of using temp labor for critical services may be unnerving because you feel you could lose control and connectivity. By working with a strategic partner, those services should have a
There are three major types of jobs During hiring freezes, managers are that staffing agencies help companies fill: not allowed to hire permanent employ• temporary – the employer can work ees. At this time, temporary employees with a candidate for a set time become a valuable resource. They can • temp to hire – the employer can work with a candidate for a time to ensure they are a fit before offering a permanent position • direct hire – the employer uses the staffing agency as a recruiter for For more a permanent the information about When you’re sick or hurt,position within company policy benefits, limitations, Aflac pays cash benefits directly Byunless working with the agency, you andcan exclusions, please call to you, otherwise assigned, determine the job and the best way to your fill Aflac insurance agent: to help you and your family Bonus… Improved Employee that position which offers you staffing with unexpected expenses. flexibility.
Aflac is an extra measure of financial protection.
different feel and result. Although a contract is involved, a strategic partnership is relationship based. Working with an agency as a strategic partner, the focus is placements not activity
Some external recruiters might submit as many candidates as they can and hope one sticks. By working with an agency as a strategic partner, you work together to identify the job and candidate needed to fill that position. The best agency will present fewer high-quality candidates and will help manage the process from beginning to end. (CONTINUED ON PAGE 14)
Independent Physician’s RX for “Extra” Financial Protection Recruiting & Reduced Employee “Churn”
Juan Lopez-Cortes (407) 802-8715
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Wouldn’t it be nice to actually work on things that will benefit your company rather than always dealing with turnover? With the improving job market, the hiring process is longer and more difficult for many companies. The staffing agency can assist in the process. An experienced staffing agency has access to a greater talent pool including both active and passive candidates. Convincing a person who is not considering an opportunity takes more time than recruiting someone who is anxious to leave. Most corporate recruiters spend their time with active candidates because they know the position needs to be filled. They simply don’t have the time to invest in passive candidates.
Policy – Benefits - Limitations - Exclusions Juan Lopez-Cortes; Principal DOC Office Support, LLC An Independent Aflac Provider 407-802-8715 Juan-lopezcortes@us.aflac.com
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PRACTICEMANAGEMENT
Overwhelmed Yet? By SONDA EUNUS, MHA, CMPE, CPB Orlando Medical News continues this series of answers to questions from readers dealing with issues faced by practice managers in our healthcare community. We encourage readers to send questions they face in everyday practice. Use the subject Practice Management Challenges to editor@orlandomedicalnews.com Questions selected for inclusion in the next edition will receive a complimentary 300 x 600 pixel ad with animated gif on our website.
1. WHAT ADDITIONAL SERVICES CAN PRIMARY PRACTICES OFFER TO GENERATE MORE REVENUE?
There are various ways that a practice can generate additional revenue from ancillary services and products. For example, a primary care practice may choose to offer allergy testing and immunotherapy services by partnering with an allergy testing lab (ex. BioTek Labs). This is an easy partnership in which the practice physicians refer patients for the testing, which is then done onsite. Many other types of lab testing can also be implemented. Another way to generate additional revenue would be to have an onsite pharmacy, so that patients are able to fill their prescriptions immediately. All of these options are
convenient for the patients, and profitable for the practice. Some practices have also greatly profited from offering new services by leasing medical equipment that they did not have the capital to purchase. These are only a few examples of ways to implement additional revenue sources, it is up to each practice to determine which services would be the most appealing to their patient base.
2. WHAT CAN OUR PRACTICE DO TO RECRUIT MORE PHYSICIANS?
Physicians, as most employees, are motivated by much more than just financial compensation when considering a job offer. They want to join a team with a vision that they can buy into, with leadership that is honest, fair, ambitious, and passionate about the success of the practice. Physicians want to work with nurses and other ancillary staff who enjoy their jobs and anticipate their physicians’ needs. Aside from creating a great work culture, there are several other ways that a practice can become more appealing to a physician candidate. Tuition reimbursement is greatly appreciated by physicians, as they frequently have large sums of outstanding
student loans. Some medical practices can qualify to become a loan forgiveness site, and be able to offer tuition reimbursement at no cost to the practice (https://nhsc. hrsa.gov/loanrepayment/). Health insurance is usually desired by candidates, and smaller practices may find that the costs of offering group health insurance are very steep. Additionally, the plans offered usually come with a high share of cost for the employee as well. One way to bypass this challenge is to offer health insurance reimbursement, in which an employee obtains their own health insurance plan, and the practice then reimburses an agreedupon percentage of the premium. Finally, compensation packages are usually most effective when a base salary is combined
with a productivity and quality incentive system, which motivates physicians to see more patients, while still maintaining the practice’s standard of quality. Sonda Eunus, Founder & CEO of Leading Management Solutions has a background in managing a multilocation pediatric primary care practice, and truly enjoys medical practice management. She holds a Master of Healthcare Management, and a BA in Psychology. She enjoys sharing her work experience and knowledge of the healthcare field through her consulting work and her writing. She founded Leading Management Solutions, a healthcare management consulting firm, out of her desire to assist medical practice managers and physician owners in the successful management of their practices, by providing services that she herself needed while managing her practice. Along with a team of experienced and knowledgeable consultants, Sonda aims to make Leading Management Solutions a one-stop shop for medical practices by offering a variety of needed services that add great value to any healthcare organization. She can be reached at sonda@lmshealthpro.com
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HEALTH INNOVATORS
PHYSICIANSPOTLIGHT
Payer-Tech: Does it Really Exist? continued from page 7
Bethany Ballinger, continued from page 3
startups. As stated earlier, Blue Cross Blue Shield is among the most active investors. The accelerator, which is run by Healthbox, has invested in 47 healthcare startups. Why tech startups? Prevention is a major emphasis of Affordable Care Act. A healthier person means less spent overall on healthcare and can drive costs and spending down. Prior to the Affordable Care Act, the focus on prevention wasn’t what it needed to be. So now we have the focus on prevention. A wonderful example of the added focus on prevention is no cost preventive care. Add in the medical loss ratio rule to this equation and you get the answer. With so much thought being put into health and wellness, the number of startups with this focus is astounding. Payers have taken notice and jumped at the many opportunities to invest. For example, Florida Blue has invested in a company by the name of ROSTR. ROSTR offers scouting and talent evaluation services to high school athletes who seek college scholarships for their potential sport. Through mobile technology, student athletes can track and view performance statistics and vital statistics. Potential scouts can view the data on what is known as a Rostrcard. This investment by Florida Blue is interesting because it is a good example of how
the UCF College of Medicine and Osceola Regional. And half of the core physician faculty in our graduate medical education program are women. Dr. Jennifer Waxler serves as the emergency department’s regional medical director and Dr. Larissa Dub is the department’s assistant medical director. Osceola Regional has made it a priority to diversify its leadership. That’s something we all can and must do. The lack of women healthcare leaders is a nationwide problem. Recent studies show that women make up only about one-third of the nation’s full-time medical school faculty positions. Only 15 percent are department chairs. Only 16 percent are medical school deans. The most common leadership position for women across the nation is medical director. There are very few women leaders at the top of the healthcare arena. As physicians caring for an increasingly diverse community, we must look at why more women are not in leadership positions. Half of the country’s newly graduated MDs are women. That means half of the residents in our hospitals are female. So what happens to women physicians along the way? Why don’t they become leaders after they finish their training? What are their concerns and decision points? Where do we lose them? Work-
payers are investing in tech startups that are outside the realm of direct healthcare, but is still a medium for people to focus on health and wellness through technology. Ultimately, since the implementation of the Affordable Care Act, there has been a huge emphasis on cutting healthcare costs. Through mandates such as the medical loss ratio rule, payers have started investing in tech companies that can at the same time help keep their members healthy and offer a return on investment. As technology advances and payers put a higher emphasis on health and wellness, investments in tech companies will continue to rise. Healthcare is early in its ever-changing journey and with the potential repeal of Obamacare, new trends and forces may arise. If repealed, many of the mandates currently in effect could no longer exist, which would lead payers to re-think business strategy. It remains to be seen what effect this could have on the current investment trend.
family balance may be one of the concerns. Can our workplaces – hospitals, clinics, out-patient surgery centers – work to help accommodate those concerns? Have we, as leaders, done everything we could to mentor young female physicians on work-life balance? I am the mother of a 14-year-old son. I hope my journey can be an example to other physicians – both female and male – of being a healthcare leader while raising a family. Each of us is a role model for others. We need to start acting that way and sharing our experiences. I have a responsibility to highlight women physicians who are leaders and to encourage qualified women to take on leadership positions. I have the responsibility to work within my hospital to develop and promote women leaders. And I have the responsibility to show women doctors they have every opportunity available to them. We are only limited by our imaginations. We have come a long way since my childhood in England. But we must do more. As women, we have unique traits that serve us well as care-givers. Those same characteristics make us strong leaders. We just have to work together to make more of those opportunities happen.
It’s time to go social,
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Reach out to more than 1 million Orlando residents on Facebook! Thank you to Florida Hospital Fish Memorial and RS&H Architects for including Pennington & Associates, Inc. in the recently completed Fish Memorial Executive Office Project
Social Media Strategy, Facebook Advertising, Online Marketing Materials, Web Development
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Optimizing Your Billing Workflow By ROSE M. ROMERO
In an effort to navigate through the many complex aspects of running a private practice, you have likely measured your documentation practices, workflows, and staff productivity. However, you may be surprised to learn that those fundamental measures of practice operations are not the only factors that directly impact your bottom line. The reality of healthcare today is that the effort you apply on the front end of patient care is only as good as the attentiveness and accuracy that goes into your billing practices on the back end. After all, if the claims you send to insurance companies are inaccurate, there is a hundred percent chance that you will experience a delay in your reimbursement. In fact, according to an article in Healthcare Finance, claims errors can double the amount of time it takes for your claim to be processed. Think of it this way, how likely is a piece of mail going to get to its intended recipient without the correct address? That mail will continue to be returned until it contains everything the post office needs to process it appropriately. With that said, your practice’s cashflow depends entirely on the optimization of your billing workflow; sending out clean claims – the first time, every time. But before you can optimize your billing workflow, you have to understand the entire process of revenue cycle. So where does the work start? Believe it or not, your front office staff have the most impactful role in your revenue cycle. Their ability to collect and enter your patient’s demographic data with accuracy and completeness is just as important as the physician’s responsibility
to assign the appropriate ICD-10 and level of service to an office visit. Even the smallest of errors like a misspelled name, wrong date of birth, or a transposed insurance ID number can lead to a claim denial and ultimately slow your practice’s cash flow - not to mention, it could also lead to inaccurate patient records. What if I told you that it costs your practice $15-$25 per claim error- and that almost 80% of those errors were due to registration mistakes? The first step to optimizing your billing workflow is collecting information over the phone when a patient calls to schedule an appointment, known as preregistration. This will help to identify if your practice accepts the patient’s insurance plan and also inform the patient if they should expect to pay a copay at the time of service. In addition to point of service collections, gathering identification and insurance cards, and validating the information entered establishes your revenue cycle process. As healthcare continues to evolve and become more complex, establishing a comprehensive revenue cycle processing will certainly help you continue to navigate through those changes. The truth is, everyone in your practice has some skin in the game and spending time to ensure the accuracy of your claims is a step toward improving efficiency and optimizing your billing workflow. Rose M. Romero is the founder/ CEO of Accredited Medical Billing Associates, a leading revenue cycle management company based in Altamonte Springs, Florida. For over 30 years, she has helped medical practices create customizable business solutions to optimize practice revenue, enhance cash flow and profitability, and increase efficiency. Visit www.AccreditedMedical.com or email Rose at rromero@asordoc.com
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Staffing Services, continued from page 11 Good strategic partners are more consultative than transactional which means their candidates take the job for the right reasons
These external recruiters build relationships with candidates. By understanding the needs of both the hiring company and candidate, the recruiter can find the right fit for your company. Understanding it takes more time to build these relationships, the recuiter can hire a person who will be more successful in the long run because they understand what both parties are wanting. Where do you start looking for a strategic partner? It begins with trust. Trust is built through proven integrity, capability, and commitment.
INTEGRITY Choose a partner with a long history of integrity; not just in appearance, but built into its value system and exemplified in its
leadership. CAPABILLITY Partners who consistently perform well have the experience to provide quality hires to your organization. COMMITMENT Having a desire to excel and determination to overcome all odds are characteristics that all winning teams share. There are open lines of communications of what is needed and what is supplied. Is the provider you currently use willing to learn your culture and embrace those characteristics in the candidates they present? Identify that provider, and you may have revealed your strategic partner. Katie Blaylock, Manager of Marketing and Communications, and Patrick Dudley, Managing Director, of SourceMaster Search | Staffing | MatchabilityTM. Patrick has over 20 years’ experience in the staffing industry including owning his own agency since 2001. Patrick can be reached at Patrick.dudley@source-master.com. Learn more about SourceMaster Search | Staffing | MatchabilityTM on their website, www. source-master.com.
HEALTHCARELEADER Dr. Anup Patel, continued from page 1 the Sky: Turning Oppression into Opportunity and on the NBC Tonight Show Starring Jimmy Fallon. For our “In other words…” forum, Dr. Patel talks about Cents of Relief and his efforts to sustain the benefits to those it serves.
IN OTHER WORDS from Dr. Anup Patel
Dressed in a gaudy, orange sari to go with her fiery-red lipstick and cheap jewelry, a terrified woman whose facial disfigurement and burn contractures reveal the violence she endured as a sextrafficked victim in the notorious red-light area of Sonagachi. That summer of 2003 volunteering in India’s red-light area as an undergraduate, I witnessed a plethora of medical conditions these victims sustained from the abusive sex-trade without access to healthcare. The time in Mumbai and Kolkata proved to be the catalyst for co-founding Cents of Relief (CoR) that endeavors to empower victims of human trafficking through healthcare and education. The experience engendered my passion to become a physician, and, ultimately, a plastic surgeon with the armamentarium necessary to tackle the overwhelming craniofacial and hand pathology found in these areas. The unique ability of plastic surgery to restore both form and function, as well as the specialty’s capability to provide healthcare on the international level attracted me to the field when I was a medical student. Today, I find myself spending my time working to treat patients in the greater Orlando area, while working to expand and raise awareness about human trafficking via CoR. The former means working with medical stu-
dents and residents to treat cosmetic, oncologic, and traumatic issues from head to toe for patients of any age. For example, in one day, our clinic may have patients needing carpal tunnel surgery, reconstruction of a facial skin cancer, or aesthetic rejuvenation. Many patients during their visit inquire what led me to the path of medicine which inevitably brings up the CoR story and a discussion about human trafficking. Moreover, in the fall, Rina, my wife and co-founder of CoR, and I spend the evenings working on the logistics for our annual charity’s golf tournament in Orlando. This golf tournament brings the journey from volunteering in India to becoming a plastic surgeon to returning back to Orlando full circle. The funds directly proceed the victims of human trafficking supported by CoR’s projects with many teams formed by friends in the area, including many of whom have been those inquisitive patients asking me what was the impetus for becoming a doctor. Many Lake Highland, University of Florida, and Yale alums and current students as well as medical professionals not only play, but also volunteer during the weekend tournament. At the end, the tournament serves as a professional networking event with altruistic-minded members of the community getting to know each other better. The surgical training obtained at first to provide an underserved area of India now pays dividends to treat the plastic and reconstructive needs of Central Florida with many of those patients joining the CoR crusade of giving back to the underserved areas of our globe. Dr. Patel practices at the Orlando Plastic Surgery Institute and at Orlando Hand Surgery Associates. He can be reached at dranupprsATgmail.com
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Anti-Virus Protection and The Truth About Thanksgiving By: RON FRECHETTE
Thanksgiving is the time of year when we gather around the dinner table with our family, friends and loved ones to reflect on the past year’s events and share the things we are thankful for in our lives. This is when family traditions we have established and practiced for years come to life. The savory smell of stuffed turkey and the sweet smell of pumpkin pie in the oven tickles our senses creating a continuous flow of water in our mouths as we wait in anticipation for all the family to arrive. It is truly a favorite time of the year for many of us here in America! So what does Anti-Virus Protection and The Truth about Thanksgiving have in common? I’m sure if we dig deep we could find many parallels. My objective for this month, however, is to arm you with some facts about each of these topics that will be sure to enlighten and impress everyone around the Thanksgiving Day dinner table. There are two main types of anti-virus protection in the market today. Let’s examine both…
Blacklist Anti-Virus Protection Blacklisting software works by comparing files against a list of known threats. If a file is on the list, then it won’t be allowed to execute, thus keeping our computer devices from being infected. You may know them as McAfee and Norton by Symantec. The challenge we face with blacklisting is that it can only protect against “known threats”. In recent years, cyber criminals have developed and deployed more sophisticated forms of malware that have been able to outsmart blacklisting software and wreak havoc on millions of people and businesses who con-
duct most of their communication and business on the World Wide Web (WWW). It is estimated that there are about 500,000 new malware variants being launched onto the WWW EVERY DAY. They now come in the form of browser hijackers, ransomware, keyloggers, backdoors, rootkits, trojan horses, worms, malicious LSPs, dialers, fraudtools, adware, spyware… and the list keeps growing. Recently we are discovering other forms of cyber threats such as infected and malicious URLs, spam, phishing attacks, online banking attacks, social engineering techniques, advanced persistent threats (APT) and botnet DDoS attacks which we talked about in last month’s article. How can we protect ourselves with half a million new malware variants being launched into cyberspace on a daily basis? By adding a whitelist solution to our cybersecurity defense-in-depth strategy…
Whitelist Anti-Virus Protection Whitelisting works the opposite of blacklisting by approving a list of trusted files and applications that can run on your network. If a file tries to execute that is not on the list, then it is rejected. Whitelisting has been around for quite some time. The challenge with this technology until recently has been limited functionality of business operations. Today’s whitelisting solutions have been able to overcome these challenges and allow a business to function both efficiently and much more secure. Whitelisting also decreases the risk of human error and unplanned security issues. Any malware falsely clicked will not run. This new technology is providing more peace of mind to those in charge of maintaining the security of a business in addi-
tion to private users. Fact is most security breaches are due to impulsive clicking or lack of cybersecurity knowledge. Whitelisting reduces the fear and danger that users with a low level of security knowledge can be protected. I highly recommend learning more about this new technology. A full list and overview of whitelist solutions can be found at: https://www.gartner. com/doc/1582715/application-controlwhitelisting-endpoints
The Truth About Thanksgiving English explorers began coming to the shores of Massachusetts in the early 1600s. The earliest explorers would capture the Indians and ship them back to England to work as slaves. Once word got out about the paradise they discovered in The New World, the Pilgrims began showing up… literally in boatloads. The early Pilgrims who first arrived in America did not do very well. Many died during the winter due to sickness and lack of food and proper shelter. The following Spring, the Pilgrims were confronted by a tribe of Indians called the Wampanoags. Among them was an Indian named Squanto who had been sold into slavery and eventually escaped by way of a friendly English explorer, Captain John Weymouth. Captain Weymouth taught Squanto how to speak English so he could communicate with the newcomers. Squanto and his fellow tribesmen saw that the Pilgrims were in rough shape. They began to teach them how to survive. They brought them meat, furs for clothing, and taught them how to farm the land and build proper shelter. When the Fall season came, thanks to the help of Squanto and the Wampanoags, the Pilgrims were in much better health,
had plenty of food, and had built houses that would keep them warm and protected through the winter. The Pilgrim’s leader, Captain Miles Standish invited the Wampanoags to celebrate and give thanks. They were overwhelmed by the number of Indians that showed up and quickly realized they did not have enough food. Squanto and the Wampanoag leader ordered their men to go back to their village and bring more food. The Indians ended up supplying most of the food and they celebrated the First Thanksgiving in peace for three days. Soon after, the Puritans began migrating to the New World to avoid persecution from the English. The white man eventually outnumbered the Indians and no longer needed their help to survive. The Puritans began to condemn the Wampanoag’s religious beliefs and customs which were based on giving charity to the helpless and hospitality to anyone who came to them with empty hands. A generation later, the children of that first Thanksgiving Day celebration began killing each other which became known as King Philip’s War. At the end of that conflict most New England Indians were either annihilated, fled north among the French in Canada, or they were sold into slavery in the Carolinas by the Puritans. The trade of Indian slaves became so successful that several Puritan ship owners in Boston began invading the Ivory Coast of Africa for black slaves to sell to the colonies of the South, which marked the beginning of the African Americanbased slave trade. In closing, combining both a blacklist and whitelist anti-virus strategy will dramatically mitigate your risk of becoming a victim of a cyber-attack. As for the truth about Thanksgiving and how it relates to AntiVirus Protection, I welcome your feedback. Wishing you all a Secure and Happy Thanksgiving!!
Sources: top10bestantivirus.com/free-antivirus-software gartner.com/doc/1582715/application-controlwhitelisting-endpoints en.wikipedia.org/wiki/Antivirus_software webcache.googleusercontent.com/search?q=cache:http:// www.manataka.org/page269.html
Ron Frechette, Co-Founder & Managing Partner of GoldSky Security is a cybersecurity and healthcare entrepreneur who over the last several years dedicated his career to helping enterprise companies reduce the risks of cyber-attacks. Ron left the enterprise security world in 2015 and cofounded GoldSky Security, LLC. Ron’s vision is to build cybersecurity firms across the US that exist to help smallmidsize businesses implement affordable cybersecurity solutions. Ron can be reached at (321) 296-3527 or ron. frechette@goldskysecurity.com
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It’s Not Too Late!
Five Best Practices to Meet MACRA Requirements by the End of the Year By KIM HATHAWAY, MSN, CPHRM
The last 90-day reporting period for the Medicare Access and CHIP Reauthorization Act (MACRA) in 2017 began on October 2. Physicians and practices who are still interested in avoiding the negative penalty must act promptly. Practices that have not yet developed their MACRA plan face great urgency to complete it— and those who have started may be feeling overwhelmed. Regardless of the reporting stage, these steps can help guide practices to succeed: 1. Review past performance in quality measures such as the Physician Quality Reporting System (PQRS) or specialty measures that your practice has reported. These are strong indicators of how your practice will do in the future. Align activities and quality measures with what you are already doing in your practice and determine how to make capturing the needed data part of your team’s workflow. Educate and engage the entire workforce about what you are trying to accomplish and why. Ask for input from the frontline of your practice about the most efficient ways to collect the necessary data elements. Even if you participated in PQRS in the past, there are differences that will require a team effort to be successful. Don’t try to do it alone. Consider making quality measurement part of the annual review for employees. 2. Study the specifications for measures you are reporting to better understand its value. For claims or registry reporting, go to Quality Payment Program website and choose the appropriate file under “Documents and Downloads.” If you are reporting through your electronic health record (EHR), the vendor can be very helpful in choosing your measures. In fact, not all EHRs will report all measures and there are some that collect data but don’t report to the Centers for Medicare and Medicaid Services (CMS). Clarify with the EHR vendor when and how the documentation is captured and counted toward the measure. The same applies to the various registries. Be sure to do your homework and know about pricing and any requirements related to system compatibility. 3. Monitor your data on a weekly or bi-weekly basis. Compare the reports that you run in your office to those generated by your EHR or registry. Investigate any discrepancy so that it can be corrected now by coaching the team on documentation or timeliness of reporting. Don’t wait until the end of the reporting period to look at your performance data. There may not be time nor the ability to correct it later. 4. Understand that the scoring 17
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process for the quality measures is very different than it was in PQRS. Under PQRS, if you reported the measure enough times, you received credit. And if you reported on one patient, you would get a pass. Under the PQRS scoring process (based on 100 patients): • Provider 1: 95 patients’ performance met, 5 patients’ performance not met = PASS • Provider 2: 5 patients’ performance met, 95 patients’ performance not met = PASS Under the quality measure, your rate will determine your score (based on 100 patients): • Provider 1: 95 patients’ performance measure met, 5 patients’ performance not met = 95% Performance Rate • Provider 2: 5 patients’ performance met, 95 patients’ performance not met = 5% Performance Rate On top of the change in how much you report versus the performance rate, the scores will be determined based on national benchmarks, with the highest performing deciles receiving a greater point value. 5. Review the Quality Resource Utilization Report (QRUR) to fully understand how the practice performs in quality and cost. Use the 2015 or 2016 QRUR (publishing fall 2017) to identify potential weaknesses and address them before cost returns as a scored category in 2019—because cost will carry a weight of 30 percent toward the Merit-based Incentive Payment System (MIPS) composite score. This is a complex report that requires familiarity to truly understand its content. The biannual report
outlines the quality and cost data from PQRS and compares it to a national benchmark. Costs are determined by claims data. There are no reporting requirements for the cost category in 2017. CMS will provide feedback on cost for the 2017 performance period, but it will not be counted in the final composite score for 2017 or 2018. Groups and solo practitioners may access their QRUR through the CMS Enterprise Portal. The person who accesses this report for the group will need to create a login at CMS’ Enterprise Identity Management (EIDM) system. This is a very secure site. It contains questions to verify and confirm the identity of the person registering, as well as information about specific providers in the group. Security is very strict around these reports because they include patient health information so that groups may identify which patients may be attributed to them. For help with interpreting the information on your QRUR, consult the CMS website regarding QRUR analysis and payment.
You will find additional resources and links to the EIDM System and what to do if you believe your QRUR is not accurate. If you would like to know how to participate in MIPS and avoid a penalty, consult with the Quality Payment Program CMS website. For additional information, visit The Doctors Company’s MACRA Resource page. The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered. Kim Hathaway is a Patient Safety Healthcare Quality and Risk Consultant at The Doctors Company. She has more than 25 years of experience in healthcare administration, nursing, and progressive leadership experience. Her extensive experience also includes the areas of quality performance improvement and healthcare regulation. Her e-mail address is khathaway@thedoctors.com.
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GrandRounds Parrish Healthcare Names Andrew Waterman VP Ambulatory Services Andrew (Drew) Waterman, an experienced healthcare executive, is Parrish Healthcare’s new vice president of ambulatory services. Waterman comes to Parrish from Providence Health Northeast in Colombia, S.C., one of the Providence Hospitals group, where he served for 12 years, most recently as vice president and chief administrative officer of the hospital’s orthopedics program. “Andrew’s multi-faceted healthcare background fits perfectly with our nationally certified integrated care approach and our mission of providing healing experiences for everyone all the time,” said George Mikitarian, president and CEO Parrish Medical Center | Parrish Healthcare. “Integrated care means that everyone throughout our healthcare system is communicating and coordinating care with the patient and one another to eliminate unnecessary duplication of services, improve clinical quality and patient safety, and reduce healthcare costs,” Mikitarian added. “Drew’s experience is a plus and we’re delighted to have him join us.” Waterman’s roles since 2005 at Providence Hospitals included managing or directing departments that include laboratory; radiology; respiratory therapy; physical and occupational therapy; imaging; inpatient services; and orthopedics. “Parrish has an amazing national reputation for the high quality of care, safety, and patients’ experiences,” Waterman said. “It’s an honor to be part of the Parrish Healthcare team of care partners who are making such a tremendous difference in lives of the people and communities served, and I look forward to contributing to the system’s continued success.” As Ambulatory Services vice president Waterman will lead: • Parrish Health & Fitness Center, • Parrish Healthcare Centers (Port Canaveral, Titusville, Port St. John, Suntree/ Melbourne), • Parrish Medical Group, north Brevard’s largest network of primary care physicians and specialists, and • The Children’s Center, a childhood development resource center. Waterman will also oversee Ambulatory (outpatient) Services for Parrish Healthcare, a regional network formed by PMC to improve patient care service integration. Parrish Healthcare is made up of hundreds of patient and family-centered healthcare providers and in 2016 earned America’s first certification as an integrated care network from The Joint Commission, the nation’s premier healthcare accrediting organization. The Joint Commission annually surveys and accredits more than 21,000 healthcare providers and programs. Waterman attended Ashford University, based in San Diego, Calif., where he earned his bachelor’s and master’s degrees
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in healthcare administration and management. He is a retired U.S. Army veteran.
St. Cloud Regional Medical Center Recognized for Excellence with ACC Chest Pain Center Accreditation The American College of Cardiology has recognized St. Cloud Regional Medical Center for its demonstrated expertise and commitment in treating patients with chest pain. St. Cloud Regional Medical Center was awarded Chest Pain Center Accreditation in August based on rigorous onsite evaluation of the staff’s ability to evaluate, diagnose and treat patients who may be experiencing a heart attack. Hospitals that have earned ACC Chest Pain Center Accreditation have proven exceptional competency in treating patients with heart attack symptoms. They have streamlined their systems from admission to evaluation to diagnosis and treatment all the way through to appropriate postdischarge care and recommendations and assistance in patient lifestyle changes. “ACC Accreditation Services is proud to bestow Chest Pain Center Accreditation on St. Cloud Regional Medical Center,” said Abraham Joseph, vice president of ACC Accreditation Services. “We commend St. Cloud Regional Medical Center for its demonstrated commitment to providing St. Cloud and its surrounding communities with excellent cardiac care.” Hospitals receiving Chest Pain Center Accreditation from the ACC must take part in a multi-faceted clinical process that involves: completing a gap analysis; examining variances of care, developing an action plan; a rigorous onsite review; and monitoring for sustained success. Improved methods and strategies of caring for patients include streamlining processes, implementing of guidelines and standards, and adopting best practices in the care of patients experiencing the signs and symptoms of a heart attack. Facilities that achieve accreditation meet or exceed an array of stringent criteria and have organized a team of doctors, nurses, clinicians, and other administrative staff that earnestly support the efforts leading to better patient education and improved patient outcomes. “I’m so proud to be a part of the team that works together every day to maintain St. Cloud Regional Medical Center’s accreditation for chest pain patients,” said Rodolfo Aldir, M.D., FACC, FCCP, board-certified cardiologist with St. Cloud Medical Group Cardiovascular Clinic. “The integration of evidence-based science, quality initiatives, clinical best-practices and the latest medical guidelines into our cardiovascular care processes will ensure our patients consistently receive state-of-the-art care. “ St. Cloud Regional Medical Center provides comprehensive heart care, offering advanced diagnostic equipment in the Cardiac Catheterization Lab. The experienced clinical cardiologists use a wide range of cardiac procedures to diagnose heart disease and
Heart of Florida Regional Medical Center Breaks Ground on New Freestanding ER for Four Corners Community
Heart of Florida Regional Medical Center broke ground on the newest addition to the Four Corners area: Four Corners ER. With shovels in hand, dignitaries, EMS, and local leaders from Osceola, Orange, Polk and Lake Counties joined Heart of Florida to “turn the dirt” on the northwest corner of US 192 and Avalon Road for the new freestanding emergency department. Four Corners ER will be equipped to treat patients with illnesses and injuries that require a higher level of care than urgent care facilities offer. It will function as a department of Heart of Florida, meaning it will be a fully-operational emergency room with the immediate support of a hospital setting for any patient, 24 hours a day if needed. Many emergency services can be effectively managed at freestanding emergency departments without the need for transfer to a traditional hospital setting. The features of Four Corners ER will include: • Over 12,000 square feet • Separate ambulance entrance • On-site laboratory • On-site radiology, including CT, x-ray and ultrasound • Around-the-clock emergency services
• Pediatric emergency care • Boarded emergency physicians • 13 private exam rooms Four Corners ER is being built from the ground up and designed to support future development. “This investment into Four Corners demonstrates Heart of Florida Regional Medical Center’s commitment to offering expanded services to the area,” said Ann Barnhart, Chief Executive Officer at Heart of Florida Regional Medical Center. Michael McHale, MD, Medical Director of Heart of Florida’s Emergency Department said, “For years, residents and visitors have had to choose which direction to travel to get emergency services – which county to travel into for care. Now, with Four Corners ER, there is no more need to travel. People in the Four Corners area will have a local place to receive quality healthcare – because emergencies can’t wait.” Construction on the multi-million dollar facility is expected to be completed in spring 2018. More than 40 new jobs will be created to serve patients at the emergency room, including registered nurses and lab, imaging, admitting and environmental services staff. As the opening approaches, jobs will be posted at www.HeartOfFlorida.com.
Pictured are, from left, Representative Sam Killebrew, Florida House of Representatives; John Newstreet of Kissimmee-Osceola Chamber of Commerce; Betsy Cleveland of Haines City-NE Polk Chamber of Commerce; Michael McHale, MD, Medical Director of Emergency Services at Heart of Florida; Randy Spivey, Director of Emergency Services at Heart of Florida; Michael Willis of Gresham, Smith and Partners; Ann Barnhart, CEO at Heart of Florida; Matt Valentine of Wehr Constructors; Nicole Hendricks, COO at Heart of Florida; Gloria Ceballos, CNO at Heart of Florida; Deputy Chief Keith Cartwright of Reedy Creek Fire Department; Asst Chief James Bates of Orange County Fire Rescue
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GrandRounds recognize heart failure in patients. The ACC and American Heart Association are collaborating to offer U.S. hospitals like St. Cloud Regional Medical Center access to a comprehensive suite of co-branded cardiac accreditation services designed to optimize patient outcomes and improve hospital financial performance. These services are focused on all aspects of cardiac care, including emergency treatment of heart attacks.
Florida Hospital Opens Newest Sports Medicine and Rehabilitation Location Florida Hospital is pleased to announce the relocation of its Sports Medicine and Rehabilitation office location in Kissimmee. Located at 2400 N. Orange Blossom Trail, Florida Hospital Sports Medicine and Rehabilitation offers a unique care option for patients with common muscle sprains, strains, neck and back pain, and recurring injuries. Patients can utilize the “Direct Access” program, which allows physical therapists to administer treatment without a physician referral for certain conditions and injuries. By going straight to physical therapy, the overall cost of care to the patients is reduced. The center is now open for patients. Florida Hospital Sports Medicine and Rehabilitation has 18 locations across Central Florida. To learn more, visit FHSportsMed.com.
New Drug Enables Infants with Genetic Disorder to Live Longer, Gain Motor Function Infants with the most severe form of spinal muscular atrophy (SMA) were more likely to show gains in motor function and were 47 percent more likely to survive without permanent assisted ventilation support when treated with a new medication, according to a study published today in the New England Journal of Medicine. The drug, nusinersen, performed so well that the study was stopped early and the treatment was approved shortly thereafter by the U.S. Food and Drug Administration (FDA) for all patients with this progressive neuromuscular disorder. "This is transformative for children with SMA," said Richard S. Finkel, M.D., the chief of neurology at Nemours Children's Hospital in Orlando and lead author of the study. "Babies with this debilitating and deadly disease were destined to have a short lifespan and limited motor function. This study shows nusinersen is life-altering for families touched by this genetic disorder." SMA Type 1 occurs in infants who have mutations in a gene responsible for production of a protein required for muscle development. Infants with this form of the disease, which usually presents between birth and 6 months of age, have progressive muscle weakness, and are never able to sit without help. Trouble breathing and swallowing leads to frequent lung infections, and a majority of babies fail to survive to 2 years of age without a feeding tube and artificial ventilation support. Other, less severe, types appear in older children and in adults. SMA affects 1 in 11,000 newborns, with approximately 60% having the most
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severe type 1 form, and an estimated one in 40 adults is a carrier of the genetic defect. Before nusinersen, no targeted drug treatments were available for SMA. This treatment modifies the SMN2 gene with an antisense oligonucleotide (ASO), a tiny fragment of synthetic DNA, injected directly into the spinal fluid. The DNA gets absorbed into nerve cells of the spinal cord to increase production of the protein required for neuromotor development. The study included 121 infants with SMA Type 1 from 31 centers in 13 countries. Patients were randomly assigned to receive injections of the drug into the spinal fluid, or a control group known as "sham" treatment. Physicians and family members were unaware of which patients received which treatment. This double-blind, randomized study design is considered the gold standard in medical research, although often difficult to achieve with rare diseases like SMA. Researchers overcame many obstacles to achieve this standard through a global research protocol that allowed broader patient recruitment. In addition, special procedures were developed to ensure researchers evaluating patient progress remained "blinded" and did not learn which patients received medication through a spinal injection. Over the 13-month study period, 41 percent of the nusinersen-treated infants showed improvement on a scale of motor function, and several infants began developing motor skills such as kicking, head control, rolling over, sitting, and standing, while none of the untreated infants in the control group made progress. The risk of death was 63 percent lower for those treated with nusinersen, and treated patients were less likely to require permanent assisted ventilation. The injections were also generally well tolerated by patients, with no serious safety concerns following administration of the drug. In December 2016, after reviewing an analysis of interim data from the study, the FDA quickly approved nusinersen, now available under the brand name Spinraza, for use in patients of all ages and with all types of SMA. This new therapy is the first FDAapproval for use of an ASO in infants, and demonstrates the life-saving possibilities of "precision medicine" for patients with devastating chronic or even fatal, diseases. Following the conclusion of the study, all participants were enrolled in another trial evaluating the longterm impact of the treatment. The drug is also being tested in other trials. One study is evaluating nusinersen in older children with SMA Type 2, which also demonstrated a benefit in motor function, while another is testing it in pre-symptomatic infants who were found to have SMA through a genetic test at birth. Dr. Finkel and colleagues are also spearheading an effort to have SMA included in the Health Resources and Services Administration's Recommended Uniform Screening Panel, a newborn screening panel of conditions that warrant immediate identification. If included, infants with SMA could be diagnosed routinely and treated before symptoms appear. The study was funded by Biogen and Io-
nis Pharmaceuticals, which markets Spinraza
All Orlando Health Hospitals Receive Top Grades for Patient Safety Orlando Health’s Dr. P. Phillips Hospital, Health Central Hospital, Lakeland Regional Health Medical Center, Orlando Regional Medical Center (ORMC), South Seminole Hospital, and South Lake Hospital in affiliation with Orlando Health have all received “A” hospital safety grades by The Leapfrog Group, an independent national nonprofit organization operated by employers and other large purchasers of health benefits. Grades are based on a point system that assigns – then calculates – numerical scores of nearly 30 healthcare measures including communication between clinicians and patients, implementation of processes and protocols to promote safe patient care that have been established by the National Quality Forum, and a hospital’s culture. “In today’s rapidly changing healthcare climate, hospitals must decide where to prioritize their energy and resources,” said Thomas Kelley, MD, chief of quality and clinical transformation, Orlando Health. “Some organizations have elected to focus on strengthening their economic position at the cost of lower quality outcomes. An "A" rating for every hospital in Orlando Health is a clear indication that we have invested heavily in the assurance of high quality care and that we value the safety of our patients.” Orlando Health has developed a robust system-wide structure to attain and maintain the safe delivery of care to patients. Major initiatives include the implementation of infection prevention bundle protocols, clinical standardization to assure best practices are followed, and custom education modules called “Testing with a Purpose” that encourage teamwork between nursing assistants, nurses and physicians. “Our entire team has worked very hard to reach this goal and we are extremely proud,” said David Strong, president and CEO, Orlando Health. “But the ultimate winner today is the patient, who can use this information to help them decide where they want to go to receive safe, high quality care.” To view Orlando Health’s Leapfrog scores, visit the Hospital Safety Score website at www.hospitalsafetyscore.org.
Parrish Medical Group Welcomes Homi S. Cooper, MD, FACOEM Parrish Medical Group, with offices in Titusville, Port St. John, Suntree/Melbourne and now Port Canaveral, welcomes Homi Cooper, MD, FACOEM, as its newest board-certified physician in Occupational/Environmental Medicine. He received his medical degree from Grant Medical College at the University of Bombay in India, and completed residencies in neurology and internal medicine in India and the U.S. He completed a fellowship in Occupational/Environmental Medi-
cine in 1997. He is a Fellow of the American Association of Disability Evaluating Physicians and American Board of Quality Assurance and Utilization Review Physician Fellow of the Institute of Health Care Quality as well as a Diplomate of the American Board of Preventive Medicine in Occupational/Environmental medicine. He holds certification in workers’ compensation, managed care, risk management and case management by the American Board of Quality Assurance and Utilization Review Physician. Dr. Cooper joins Parrish Medical Group from Space Coast Orthopedics in Merritt Island. In addition to practicing in Florida, Dr. Cooper has practiced medicine in Louisiana and Pennsylvania. Dr. Cooper is conveniently located in the Parrish Healthcare Center at 390 Challenger Rd., Cape Canaveral and is currently accepting Medicare, Medicaid, and most insurances.
Florida Hospital for Children Partners with Children’s Hospital of Pittsburgh of UPMC to Develop Pediatric Liver Transplant Program In order to make lifesaving liver transplants available throughout central and north Florida, Florida Hospital for Children is partnering with Children’s Hospital of Pittsburgh of UPMC to develop a comprehensive pediatric liver transplant program. This will be the first program of its kind in Orlando, the second in Florida, and is expected to start accepting patients in January. Florida Hospital is one of the largest not-for-profit hospitals in the country. The organization’s range of nationally and internationally recognized services includes transplant, pediatrics, cardiology and advanced surgical programs. Florida Hospital for Children’s flagship hospital in Orlando is the heart of a children’s network that includes primary care pediatricians, specialty clinics, emergency departments and Kids Urgent Care. “There is a critical need for children across our state to have access to a liver transplant program that is close to home,” said Regino Gonzalez-Peralta, M.D., director of pediatric gastroenterology, hepatology and liver transplantation with Florida Hospital for Children. “This partnership brings the experience of one the nation’s best pediatric liver transplant programs to central Florida. The Florida Hospital and Children’s Hospital of Pittsburgh of UPMC’s partnership is not only a win for our patients, but all of Florida.” The teams will work in partnership with Florida Hospital’s Transplant Institute, which offers kidney, liver, kidney/pancreas, lung and heart transplants. “Florida Hospital has been committed to saving lives through our transplant programs for more than 40 years, and it is our goal to provide the same level of advanced and compassionate care to infants and children in our community in need of liver transplants,” said Thomas Chin, M.D., director (CONTINUED ON PAGE 21)
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BEST PRACTICES
Surgeon Specializes in Robotic-Arm Assisted Joint Surgery Robotic-arm assisted hip and knee replacement has the ability to offer those suffering from osteoarthritis in their knees and hips almost immediate relief. It is estimated that 15 million Americans suffer from osteoarthritis (OA) in their knees. The U.S. Census Bureau estimates that the 55 and older age group, who are peak knee replacement candidates, will reach 96 million by 2020. That age group is also the most susceptible to suffer from Degenerative Joint Disease (DJD) of the hip as well. Abhijit Manaswi, MD, a specialist in joint replacement surgery, knows his robotic-arm assisted hip and knee replacement offers a solution to OA and DJD sufferers. Heart of Florida Regional Medical Center, where Dr. Manaswi is the director of the Joint Replacement Center, is the only hospital in Polk County where the robotic arm joint replacement surgery is performed. Dr. Manaswi uses a robotic arm interactive orthopedic system to map the area that will be operated on. Using a computer guided robotic arm, Dr. Manaswi can easily and quickly remove the osteoarthritis from the healthy bone and replace the knee or hip joint with the new joint. “There is a smaller, less invasive incision than traditional surgery, and only the arthritic portion of the joint is removed, preserving the healthy bone and tissue,’’ Dr. Manaswi said. “There is less scarring, minimal hospitalization time and a more rapid recovery time.’’ When patients start having symptoms of DJD in the hip, for example, they notice they start limping to avoid putting weight on the affected hip, and that pain radiates down to the lower back, or thigh to knee. They also notice that pain medication is also no longer helping. That is when the robotic arm joint replacement surgery provides the most relief. “By using the robotic arm system to remove the damaged bone, I can reduce the risk of leg length discrepancy and improve the post-operative range of motion. There is also a rapid relief of pain and a quicker return to daily activities,’’ Dr. Manaswi said.
How It Works It all starts with a personalized plan. After a CT scan of the joint is taken a 3-D virtual model of area is generated. That model is loaded into the robotic arm system software and a personalized pre-operative plan is created. During surgery, Dr. Manaswi uses that plan to
Robotic-arm joint replacement.
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Original knee.
3-D map of hip for robotic-arm hip replacement surgery.
3-D map of knee for robotic-arm joint replacement surgery.
prepare the bone for the implant and the system guides him within the pre-defined arthritic area and keeps the machine from moving outside of the defined area for treatment. This helps provide a more accurate placement and alignment of the implant. After surgery, the goal is to get the patient back up and moving around as soon as possible. At the Joint Replacement Center at Heart of Florida, the patients will be up and doing physical therapy within a few hours of the surgery. They also participate in group therapy with others who have had the surgery as well. Patients also return home sooner than after traditional knee and hip replacement surgery.
Potential Benefits Improved surgical outcomes Optimal implant positioning Smaller incision, less invasive Minimal hospitalization Less scarring More rapid recovery Ligaments remain intact for a more natural feeling knee and hip • Ability to return to an active lifestyle quickly Dr. Manaswi offers several procedures including: robotic arm assisted total hip replacement, computer assisted total knee replacement, robotic arm assisted partial knee replacement, revision knee replacement, and revi-
sion hip replacement. To find out more about the robotic arm joint replacement surgery, call Dr. Manaswi’s office today to make an appointment and come see how the robotic-arm assisted joint surgery can help your patients get their active lives back. For patients who would like to learn more about the surgery, please call Dr. Manaswi’s office at 863-419-8922. Disclaimer: Before you decide on surgery, discuss treatment options with your doctor. Understanding the risks and benefits of each treatment can help you make the best decision for your individual situation. Member of the medical staff at Heart of Florida Regional Medical Center. Heart of Florida Regional Medical Center is owned in part by physicians.
• • • • • • •
Hip presentation
Abhijit Manaswi, MD, MS, FCPS, DNB, MNAMS, FRCS Board Certified | Fellowship Trained Total joint Surgeon Director, Joint Replacement Center
Robotic-Arm Hip Replacement
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GrandRounds of the Florida Hospital Transplant Institute’s liver transplant program. “We are honored to partner with Children’s Hospital of Pittsburgh of UPMC and bring our world-class programs together.” In order to offer these transplants to families in the Florida area, the hospital will work with the Hillman Center for Pediatric Transplantation at Children’s Hospital of Pittsburgh of UPMC, which has performed more than 1,800 pediatric liver transplants – more than any other center in the United States, according to the United Network for Organ Sharing, with patient survival rates consistently higher than national averages. “We are grateful for this opportunity to now expand our services and expertise in pediatric liver transplantation to families in the Florida area,” said George V. Mazariegos, M.D., chief of pediatric transplantation at Children’s. “Our extension of expertise will provide the best possible care and make transplant a life-saving treatment for local families and help them to achieve a better quality of life.” In 1981, Children’s Hospital of Pittsburgh of UPMC opened the country’s first comprehensive pediatric transplant center under the guidance of transplant pioneer Thomas E. Starzl, M.D., Ph.D. According to the 2017 data released by the Scientific Registry of Transplant Recipients, the pediatric liver transplant program at Children's ranks number 1 out of 62 pediatric liver transplant centers in the United States for one-year overall patient and graft survival when comparing hazard ratio estimates. The program remains at the leading edge of expertise, innovation, and patient- and family centered care for transplant patients from all over the world. Members of the transplant team from Children’s Hospital of Pittsburgh of UPMC will participate in the management of patients in Florida. Transplant surgeons, medical specialists and nurses from Florida and Children’s Hospital of Pittsburgh of UPMC will perform pediatric liver transplant surger-
ies together at Florida Hospital for Children. The pediatric liver transplant partnership with Florida Hospital is the second program of its kind for Children’s Hospital of Pittsburgh of UPMC. In 2016, Children’s Hospital became the first and only pediatric liver transplant program to expand the geographic reach of its expertise through a partnership with the University of Virginia Children’s Hospital in Charlottesville. Today, Children’s pediatric liver transplant network extends from Pittsburgh to Virginia, and now Florida.
Federation of State Medical Boards Launches Blockchain Pilot Program The Federation of State Medical Boards (FSMB) has become the first professional membership organization to issue official documents to the blockchain. The FSMB issued sample verifications of undergraduate and graduate medical education credentials as part of a pilot of the Learning Machine blockchain records issuing system. “The FSMB is dedicated to supporting the work of its member state medical boards in their efforts to ensure that only qualified and capable physicians practice medicine,” said Michael Dugan, Chief Information Officer at the FSMB. “Verification of medical education and related credentials is a critically important endeavor, and we are hopeful that the continued success of this pilot may provide the level of certainty needed to implement blockchain technologies in the medical licensing and credentialing process.” Traditionally, verification of medical education has relied upon the maintenance of physician profiles by credential verification organizations such as the FSMB. These profiles are then shared with third parties, such as hospitals and state medical boards upon request, and are often maintained in a redundant manner. Anchoring official records such as degrees, transcripts, and verification
forms to the blockchain allows physicians and other practitioners to maintain their own private profiles of medical competency, which they can share as they see fit. In short, blockchains combine fraud protection with individual custodianship of official records. Physician ownership of their official qualifications is possible through the blockchain certificates open standard ("Blockcerts"). As a result of this standard, professionals can hold and share their records using a credential wallet, a free mobile app. The Blockcerts Wallet serves as a user-owned portfolio to which no vendor or issuing institution has access. Behind the scenes, it seamlessly manages the user’s public and private blockchain addresses so that the process of owning one’s digital assets is radically simplified. Any vendor or institution can build a Blockcerts-compatible wallet using the open standard. The open source Blockcerts Wallet is also available in the iOS and Android app stores. “Blockcerts was built to serve as a foundation for recipient ownership of digital assets,” said Natalie Smolenski, VP of Business Development for Learning Machine. “That is the great promise of blockchain technology: now individuals can own their digital property without reliance upon trusted intermediaries to serve as custodians of that property. However, many blockchain-based applications still put vendors at the center, diluting that promise. Learning Machine is building a social infrastructure that will outlast any company or issuing institution. We are building for the long-term future.” The Blockcerts standard provides vendor and issuer independence. Should any issuing institution or platform vendor issuing Blockcerts cease to operate, the recipient still owns their records and can share and verify them in perpetuity.
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