Orlando Medical News November 2021 by Orlando Medical News

NOVEMBER 2021

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Taking a Closer Look at Trauma-informed Care

Myriad effects on future outcomes

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CONTENTS || FEATURES PHYSICIAN SPOTLIGHT

Three Young Surgeons with Their Eyes on the Skies

PUBLISHER John Kelly

FEATURES 4

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COVER STORY Taking a Closer Look at Trauma-informed Care

John Kelly 407-701-7424

PHYSICIAN SPOTLIGHT Three Young Surgeons with Their Eyes on the Skies

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EOCC Paying it Forward November: Benefits all the way around What’s Next for Florida Nurse Staffing in the Wake of Delta Earn Passive Income Through Real Estate Investing

——————————————————— EDITOR editor@orlandomedicalnews.com ——————————————————— CREATIVE DIRECTOR Katy Barrett-Alley ——————————————————— CONTRIBUTING WRITERS Pranam Ben, Joy Chuba, LCSW, Dorothy Hardee, Jackie Jackson, Sergio Larach, MD, Marianna Midkiff, Anne Packham, Jennifer Pomietlo, Grant Wojdyla ——————————————————— UCF INTERN Brianna Kirby ———————————————————

PCAN sets Three Times the Number of Certified Navigators to Help Guide Healthcare.gov Clients Five Things to Know about Medical Billing

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Newer Treatment Options for Hemorrhoids Offer an Easy Recovery for the Bleeding Patient

How A Digital- and Data-First Approach to Healthcare Better Serves Patients

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Taking a Closer Look at Traumainformed Care Myriad effects on future outcomes BY JOY CHUBA, LCSW

health outcomes have been found to have a dose-response relationship with trauma. For each additional ACE a person has experienced, they are at a higher risk for heart disease, diabetes, stroke, broken bones, depression, COPD, obesity, depression, suicide, several types of STIs, cancers – and many, many more. That’s a serious issue, not least because childhood trauma is far more common than you might expect: 67 percent of adults in the United States have experienced at least one ACE, and 12 percent – about one in every eight people – have an ACE score of 4 or more. Despite how prevalent trauma is, the tendency to treat it as a social problem – rather than a physiological fact – is hard to shake. After all, if adults with high ACE scores are at a higher risk for behaviors like smoking and drug abuse, how do we know that those behaviors aren’t the true cause of illness? Isn’t this an issue of unhealthy coping mechanisms rather than physical health? But the data doesn’t bear that out. Even when a patient exhibits zero behavioral risk factors, their childhood trauma may still have a direct and life-threatening impact on long-term health. To explain why, researchers have taken a closer look at the biological and chemical pathways behind trauma.

The first time we meet with a healthcare provider, we’re likely to be asked a series of questions. What is your age, sex, height, weight, race, ethnicity? What illnesses are common in your family? How often do you exercise? Do you smoke? One question that may not come up is “Were you abused as a child?” It’s routine to screen for risk factors that can predispose a patient to serious illnesses. By conducting an initial interview with a patient to determine biological risk factors – age, sex, race, ethnicity, age, family history and so on – as well as lifestyle risk factors, like smoking or physical inactivity, doctors can more effectively tailor care to their patients. But these screenings often overlook a critical risk factor for lifelong illness … and one that affects more than half of all adults in the United States: childhood trauma. In the late 1990s, researchers from Kaiser and the CDC partnered to survey more than 17,000 adults about their exposure to childhood trauma. A traumatic event goes beyond academic stress or fears about fitting in. In this study, trauma was measured through 10 specific, serious adverse childhood experiences (referred to as ACEs). These included emotional, physical, and sexual abuse; emotional and physical neglect; exposure to domestic violence; mental illness; parental separation; household substance abuse; or the incarceration of a family member. Someone who didn’t experience any of these would have an ACE score of zero; a person who experienced all of them would have an ACE score of 10. What the study found was groundbreaking: The more adverse experiences a child has, the higher their risk of poor health outcomes later in life. In the subsequent years of research, more than 40

What research found In highly stressful situations, the sympathetic nervous system kicks in to create a fight-or-flight response. This cascading series of split-second changes – muscle tension, racing heart, stress hormones, dilated pupils – works to keep the body awake, alert and energized until the danger has passed. However, when this stress response is repeatedly triggered, it becomes harder to relax and rest – even when the danger has passed. In essence, an individual can be in the physiological state of flight-or-fight constantly and is referred to as toxic stress. Toxic stress during childhood can harm the developing body at its most basic levels. It measurably changes the nervous, endocrine, and immune systems, and even the physical structure of DNA. Over a lifetime, those changes

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make it harder to focus, solve problems, plan ahead, and balance risks and rewards. Because of these neurological changes, survivors of adverse experiences often struggle in school, have a lower rate of graduation, and have lower lifelong earning potential. They may struggle to manage their emotions and relationships, respond more negatively to stress, and engage in higher-risk behaviors than those individuals who have an ACE score of zero. For those who have already survived dangerous and stressful experiences, that may seem like a dishearteningly bleak prognosis. But there’s good news, too: Those outcomes aren’t predestined. It’s true that trauma is a predictor of poor health, but it’s not a guarantee. Like any other condition, it can be effectively treated and also prevented … and the best way to do that is through specific, trauma-informed care. Instead of starting the conversation with, “What’s wrong with you?” a practitioner trained in trauma-informed care asks: “What happened to you?” By recognizing that behaviors and symptoms may be caused by adverse experiences, we can treat them more effectively. An approach rooted in safety, trust and empowerment is essential.

Consider two patients served by the same healthcare provider A woman with a close family member diagnosed with breast cancer is twice as likely to develop breast cancer as well. To provide effective care, a doctor should take note of that patient’s family history and recommend earlier or more frequent screenings. Another woman has an ACE score of 4, meaning she has more than double the risk of developing chronic obstructive pulmonary disease (COPD). But unless her doctor is taking a trauma-informed approach, they may not identify that risk factor at all. In the worst-case scenario, dismissing or disregarding a patient’s experiences can also

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PHYSICIAN || SPOTLIGHT SPONSORED BY

Three Young Surgeons with Their Eyes on the Skies They are three friends and colleagues from different places.

experience. He specializes in total joint replacement and direct anterior hip replacement. He also loves research. They are all passionate about their specialties, their patients, and the community they are now all a part of.

They have different sets of experiences and are motivated by different things. And while they each are unique, they share a unifying and intense interest in how some of the most complex bones and joints in the human body work and how to repair those bones and joints when they are broken or failing. Each physician has distinguished himself early in his career. Each has completed a fellowship at a top orthopedic program in San Diego, Houston, or Charlotte. And now they are on the same team at the fast-growing Orlando Health Jewett Orthopedic Institute. There’s Bryan Brown, MD, from Cocoa Beach, Florida, just a few miles from where rockets still lift off from Earth for space. He likes the challenges of dealing with the complexities of the hand, arm, and shoulder. From the other side of the Florida peninsula comes Pierce Ebaugh, DO, who was influenced by his respected grandfather and who likes to solve puzzles. He specializes in disorders of the lower leg, foot, and ankle. Finally, there’s Cody Green, MD, who as a rough-and-tumble kid growing up in St. Louis, learned to love orthopedic surgeons from his own personal

The Engineer Cocoa Beach is one of those near-legendary places in Florida where soft sand and hard science exist together. Look to the east and you’ll see the Atlantic surf breaking on the shore. Look up and a rocket might be accelerating into orbit from the nearby Kennedy Space Center. When he was a kid, Bryan Brown, thought he wanted to be an engineer; he liked studying how mechanical parts worked together. As he got older, he became fascinated by the mechanical systems inside people: their bones and joints. And as he narrowed his focus while studying medicine at the University of Vermont, it was the joints in the hand and shoulder that he found most fascinating.

“The anatomy for the hand and shoulder is very complex,” he said. “I like the challenge.” The pain or loss of motion that comes from an injury or chronic condition can be devastating. “I take the ability for someone to use their upper extremities very seriously. If I can get somebody back to functional use of their hand or arm, I know it will have a huge impact on their ability to live a normal life.” Brown described a recent case in which a patient had fallen off a ladder and severely injured his shoulder. The solution ended up being replacement of the entire shoulder joint, a very complicated procedure. But, within a few months, the patient was back to full function of the joint. After earning his medical degree, Brown returned to familiar territory: Central Florida, for his residency in orthopedic surgery at Orlando Health, where the Central Florida Association of Physicians presented him with the Best Resident Award. After that he completed a fellowship at the University of California San Diego for hand and upper extremity.

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EAST ORLANDO CHAMBER OF COMMERCE

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CALENDAR:

Paying it Forward November: Benefits all the way around

Misters & Sisters Great “COFFEE” Adventure

Celebrating National Cappuccino Day!

BY DOROTHY HARDEE, EAST ORLANDO CHAMBER DIRECTOR OF OPERATIONS

NOVEMBER 8 | 8:30 – 9:30 AM Rosso Specialty Coffee Avalon Market Place Food & Beverage is responsibility of attendee

“Community service is important to me for so many reasons! First and foremost, I take pride in knowing that I am helping to positively affect someone’s life.” – Gilliam Rappaport

Testimonial Tuesday LIVE on Facebook NOVEMBER 9 | 9:00 AM – 12:30 PM Live on Facebook. Member Exclusive Participation

Misters & Sisters Great “Lunch” Adventure

As a young girl, I often gravitated to activities that helped others. A perfect example was watching the Jerry Lewis MDA Labor Day Telethon, then volunteering to go door-to-door collecting donations and begging my dad to drive me to the local TV station to deliver the money to be counted in the grand total. Later, I worked with a local Little League, walked for the Heart Association with co-workers and eventually on to the American Cancer Society, March of Dimes & Alzheimer’s Association. Not only did I feel my small contribution would make a difference, but it made me feel good about myself. Tony Robbins concurs, reminding us that giving back cannot be understated. It not only helps those around us, but also benefits everyone giving back by:

Celebrating National Fried Chicken Sandwich!

NOVEMBER 9 | 1:00 – 2:00 PM PDQ Waterford Lakes – East Colonial Drive Food & Beverage is responsibility of attendee

Local Charities Luncheon “Lights, Camera, Action” featuring Barbara Poma, onePULSE Foundation Sponsored by Orlando Health

NOVEMBER 10 | 11:00 AM – 1:00 PM Holiday Inn East UCF Area. Celebrating & supporting five local charities during this season of giving. $40 for EOCC members | $50 Nonmembers

• Improving mental health

Healthcare Collaborative Meet & Greet at The Bridge Orlando

• Improving physical health • Expanding your network

NOVEMBER 11 | 7:30 AM – 9:00 AM

• Developing new skills

The Bridge Orlando. Register to participate at eocc.org

• Transforming your perspective

Ribbon Cutting & Grand Opening Iron Bodyfit Waterford Lakes

• Fulfilling your deepest human needs AARP adds that it also makes an impact; strengthens our community; allows you to connect with others and take the lead; share your expertise; up your resume ante; find new opportunities and (as I mentioned earlier) just plain feel good. So, are YOU ready to take the next step leading by example? Now is the perfect time to start. We are launching our Nonprofit theme for November with our W.I.S.E. (Women in Successful Endeavors) featuring Women in Nonprofit: Focus on Foundations, sponsored by Orlando Health, November 3rd at The Celeste Hotel Orlando. Graciela NoriegaJacoby, COO with Heart of Florida United Way will lead the discussion with a dynamic group of women leading nonprofit foundations. Joining her will be Lainie Fox-Ackerman (Orlando Health); Linda Landman Gonzalez (Orlando Magic Youth Foundation); Meghan Curren (AdventHealth); Jodie Hardman (Bank of America Foundation) and Min Sun Kim (Edyth Bush Institute). The East Orlando Chamber’s Local Charities Luncheon sponsored by Orlando Health is proud to feature Barbara Poma, Founder of onePLUSE Foundation, November 10th at the Holiday Inn East UCF Area. Seats are still available until November 8. Register to attend at EOCC.org. During our Local Charities Luncheon “Lights, Camera, Action” event, we will feature five local charities doing good work in our community. Each will be featured during the event, making a passionate plea for support through our “Giving Tree” Our charities and their five simple “ask” include:

NOVEMBER 11 | 5:00 – 7:00 PM RSVP to participate in this Free After-Hours event

Misters & Sisters Great “Happy Hour” Adventure

Celebrating National Happy Hour Day!

NOVEMBER 12 | 4:00 – 6:00 PM Bonefish Grill Waterford Lakes. Food & Beverage is responsibility of attendee

#Buzz4Biz Meet & Greet for Chamber Curiosity Seekers NOVEMBER 16 | 8:30 – 9:30 AM The 5th Floor Orlando, Avalon Park. Register to attend – for non-members interested in exploring the EOCC

EOCC Real Estate Advisory Council presents: Residential Real Estate Sponsored by milliCare by Cubix, Inc.

NOVEMBER 17 | 8:00 – 9:30 AM The Pavilion at Avalon Park $35 for EOCC members | $40 Nonmembers

Coffee Club Nona NOVEMBER 18 | 8:30 – 9:30 AM Sam’s Club Lake Nona. Open Networking. Free for members | $10 Nonmembers | Discount for College Students

International Diamond Center After-Hours NOVEMBER 18 | 5:00 – 7:00 PM International Diamond Center Waterford Lakes RSVP to EOCC.org

Visit EOCC.org for a complete listing of November events

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NOVEMBER 2021

• Friends of Fisher House Orlando: 3-$25 Gift Cards & 2-$50 Gift cards to either Publix, Walmart or Amazon for food, cleaning supplies or person hygiene items for Fisher House Guests. • Junior Achievement Central Florida: 5-$5 Gift Cards to Jeremiah’s Ice; 4-Flash Drives; Portable Laminator; 2 -Wireless Mouse • One Heart for Women & Children: 1- $25 Publix Card; 1 - $25 Walmart Card; 10 x 10 Pop-up tent(s); Large Size Children’s Diapers & Pull ups; New throw blankets (Target or Walmart) • Pathway Homes of Florida: $25 for Toilet Paper; $25 for Laundry & Dish detergent; $50 for hygiene items; $50 for Lynx bus passes for clients; $75 for cleaning supplies • Volunteers for Community Impact: 1-$75 Amazon card; $25 for “My Brother’s Keeper books; $50 for the OTTER program; $75 for RSVP craft supplies ; $35 for GOAL program How can you help? Fulfill one or more of their needs, dropping your gift by the East Orlando Chamber office between now and December 2. Believe me, you can never have too many gift cards, supplies or donations especially during the end of the year. Do you want other ways to give back? You can join me for The ALS Association Florida Chapter Run 90 Miles this November. Every 90 minutes someone is diagnosed & every 90 minutes someone passes away from ALS. It will not only allow me to give back to a worthwhile cause, but also keep me accountable for changing my habits to incorporate intentional activity into my day. Who knows, I may even take a stab at periodic fasting and vegetarian days. How about you? Here is more good news. Did you also know the East Orlando Chamber Foundation, a 501(c)(3) nonprofit organization has launched? Its mission is to provide financial support, mentorship, development, and guidance for small and medium sized businesses starting their business or taking the next step to growth. We are looking for supporters and potential Board Members. Interested? Call the Chamber at (407)277-5951 or contact Jennifer Englert. Looking for more ways to highlight your business? The East Orlando Chamber has a plethora of opportunities to get you noticed, connecting you with your next clients and partners, keeping your business healthy. For the health of your business reach out to the East Orlando Chamber for a menu of unique offerings elevating your businesses visibility and connect you with others helping your business thrive. We are the first in the state offering traditional Health Insurance plans, as well as supplemental products including dental, vision, critical illness, accidental and more. For more information or to register call (407) 277-5951 or visit our website at eocc.org. The East Orlando Chamber of Commerce everywhere East of I-4.

What’s Next for Florida Nurse Staffing in the Wake of Delta ta-driven surge, some hospitals in Florida offered were offering up to $9,600 per week. Now, the average weekly gross pay for a travel nurse is $3,770. We expect pay packages will come down somewhat, though we think they will remain elevated above 2019 levels. With the decline in hospitalizations, the number of open jobs listed through our platform has also dropped to levels more closely reflecting pre-pandemic levels. In October 2021, this number averaged between 475 and 500. As crisis rates decrease, we expect the normal industry flow to resume. There will be increased demand with the approaching “snowbird season,” specifically for PCU, ICU and respiratory therapists in areas like Orlando and South Florida. January pre-books will happen on schedule, and there will be a spike in demand for holiday and New Year coverage. When both the number of travel nurse job openings and the average pay packages decrease, travel nursing will become less lucrative. Some nurses who left their permanent staffing positions for travel nursing during the pandemic will return to permanent positions, equipped with added skills from having worked under pressure in new environments and “floating” roles. In one key change to keep an eye on, nurses who tried travel nursing for the first time during the pandemic have been hesitant to return to permanent jobs. Many have gotten used to higher-than-average pay packages, and they may expect this elevated pay level to continue. This is a concern for hospitals and healthcare networks that are already stretched thin financially after 18 months of filling urgent positions using top dollar rates and purchasing PPE

BY JENNIFER POMIETLO

The tide of coronavirus cases once again is receding in Florida, and with it, the demand for traveling healthcare professionals. However, the Delta variant, which hit hard and fast here, will likely have lasting effects in the healthcare system. Already faced with a pre-existing nursing shortage, hospitals were not prepared for Delta with an adequate workforce. As a staffing expert who connects nurses and allied healthcare professionals with travel and permanent positions, I watched as open jobs in Florida hospitals soared to record numbers that tracked alongside daily Covid-19 cases and hospitalization numbers. In October 2019, roughly 400 travel healthcare job openings in Florida were active in our system on any given day. In August 2021 alone, there were about 1,600 Florida travel jobs open daily on our StaffDNA platform. Florida healthcare systems were not only competing against each other for nurses, but they were also fighting other states facing a similar surge in coronavirus infections. Finding nurses to meet the increased demand was a challenge for healthcare facilities and staffing companies across the country. Hospitals were forced to offer sky-high pay packages to travel nurses in order to attract talent. Throughout the pandemic, the average pay for travel nurses in the Sunshine State has more than doubled. Before Covid-19 a typical travel nurse pay package was $1,570 for weekly gross pay. At the peak of the Del-

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and increased sanitation materials. While high pay packages will continue to be a driving factor for nurses, hospitals should be exploring other forms of benefits to attract top talent. It’s clear in the long term that we all need to do more to address the nursing pipeline. According to a recent report commissioned by the Florida Hospital Association and the Safety Net Hospital Alliance of Florida, the state will face a shortfall of more than 59,000 nurses by 2035. Whether we are finally seeing Covid-19 recede for good in Florida or there’s yet another surge in cases, we believe the state’s healthcare systems are now better prepared to summon necessary resources should the need arise. Hospital administrators have a much better idea now of the havoc that Covid-19 can wreak and the speed at which it can do so, and a better plan in place should that happen again. Jennifer Pomietlo is the vice president of strategic development at StaffDNA, a digital marketplace for permanent and travel healthcare careers. StaffDNA, which launched its app in June 2020, helps solve staffing needs in more than 3,000 healthcare systems in 31 states. You can find out more about StaffDNA at www.staffdna.com.

Earn Passive Income Through Real Estate Investing BY JACKIE JACKSON

2020 and beyond has been a hurdle for medical professionals. You’ve worked through this pandemic and continue to save lives and help the fight against COVID-19. As an Officer in the U.S Army Reserves, I know firsthand what it’s like to work in rigid and high stress environments. You’ve been on the “front lines” of the pandemic for the past year and a half. With that, I thank you for your service and all you’ve done to combat this pandemic.

Financial Stress on Medical and Healthcare Professionals Healthcare workers today are faced with looming issues – the pandemic, burnout, and lack of support. An emerging issue with medical professionals and healthcare workers is financial stress, which takes a massive toll on mental health and wellness. In addition to the emotional and physical toll of the pandemic, a third of frontline workers have been faced with destabilized financial security. Many have been dealing with reduced income. Medical Professionals have been dealing with financial stressors long before the pandemic. Studies have found that medical professionals were lacking in education on financial literacy. Medical Professionals deal with a lot of stressors that impact their finances – student debt and reduced salaries from contract work. (https://www. orlandomedicalnews.com/article/4923/how-addressing-

financial-health-will-help-florida-healthcare-workers-getthrough-pandemic)

Building Wealth with Multiple Sources of Income One of the best strategies that medical professionals can do to help combat financial stress is to create extra sources of income. Multiple streams of income are among the fastest growing ways to build wealth. Now is the time to plan for the future – retirement, a savings account, or even setting aside something for your descendants. Real estate is one of the best types of investments you can make. It has withheld the test of time, especially compared to stocks. Real estate has been proven to be one of the best

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Jackie Jackson is a Real Estate Coach & Mentor based in Central Florida. After working over a decade in corporate America and climbing the success ladder to vice president, she walked away from it all. As a result, she pursued her calling as a mentor, motivator, and business coach. She does one-on-one coaching, offers boot camps and speaks at seminars and teach courses. Visit www.TheJackieJackson.com

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It’s no secret that real estate is lucrative. However, many people don’t really know the details or intricacies that are involved with growing wealth through real estate. The reason why I became a real estate investor was because it was a unique way for me to create wealth that I set out in my goals and implement some really creative strategies that did not require a lot of money out of my pocket in order to get started. Some people purchase their real estate in different ways. They might be borrowing money from their local bank or local credit union. That is one way to do it. However, when I started out investing, that was the first route I took. However, since then, I did not borrow money from a bank. I found all of the other creative real estate investing strategies and I wanted to make sure that I was well-versed in them, so I did not have to use my personal credit or borrow money against any of my properties if I didn’t have to. Even in 2021, you can still purchase properties in creative ways without having to risk your personal credit or borrow money. The real estate industry appears precarious, but there are still opportunities for purchasing properties and creating cash flow from them.

Tax Deeds and Tax Liens are hidden gems for real estate investors who are looking for lucrative investing opportunities. Tax liens and tax deeds are one of the best kept secrets of real estate investing. Tax liens occur when a property owner doesn’t pay taxes on a property. As a result, the city or municipality places a lien against the property. In the event that a delinquent property tax remains unpaid, the tax lien will be sold at a public auction. Tax deeds function in similar ways to a tax lien. The difference is that at a public auction, ownership and interest by deed is transferred to the winning bidder. When you win the bid, you get to gain the title to the property itself. The tricky part about tax deeds is that there may be a redemption period depending on the state, and not every state will have a redemption period.

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investments that you can make. Diversification is essential for the health of a financial portfolio. Real estate makes a great edition to your portfolio. There are numerous benefits to real estate investing – predictable cash flow, tax breaks and deductions, appreciation, risk-adjusted returns, and building equity and wealth. If cash flow is a goal of yours, real estate will offer that to you.

NOVEMBER 2021

PCAN sets Three Times the Number of Certified Navigators to Help Guide Healthcare.gov Clients BY ANNE PACKHAM

Appointments are virtual (through Zoom) or in-person, and are confidential. There is no charge for the service. The Marketplace offers multiple insurance plans to give people solid choices in a one-stop shop approach. The COVID-19 pandemic and ensuing Great Resignation – people leaving their jobs in droves for self-employment or to seek jobs with more work/life balance – has sharpened the need for Marketplace insurance to cover a broader population. Whether a short or long-term solution, Navigators are equipped to assist in selecting a great plan. Regardless of whether you have enrolled for insurance through the Marketplace in the past or this is your first time, tapping into the expertise of a licensed Navigator is highly recommended. They will walk you through the complex level of plans, help you pick the right one with your needs and income in mind, work with you to understand the tax subsidies and guide you through the paperwork. Countless clients from across Florida have felt the relief of knowing they were in the hands of licensed, caring experts.

Central Florida residents who are planning to enroll for insurance through the Health Care Marketplace will have access to three times the number of licensed Navigators this year and more plan options than ever. Covering Central Florida, navigators work for the Primary Care Access Network (PCAN), a 501c3 non-profit organization located in Orlando Florida. PCAN is a dynamic collaborative among Orange County Government, primary health care centers, community agencies, hospitals and other social services. PCAN’s mission is to improve the access, quality and coordination of health care services to the underinsured and uninsured populations of Orange County. PCAN represents our community’s “safety net” providers and other community organizations dedicated to improving access to care. Navigators are certified by the Centers for Medicare and Medicaid Services (CMS), licensed by the State of Florida, and must pass a Federal Background Check. Also new for this open enrollment period: the range of people qualified for financial assistance has been expanded to higher income levels. The first recommended step in the process is contacting a Navigator at www.coveringcfl.net or 877-564-5031 to set up a free appointment. Open Enrollment is November 1, 2021, through January 15, 2022, and Navigators are available now to assist those seeking guidance on finding the right, most cost-effective plans. Making an appointment early in the enrollment period ensures quicker peace of mind. Clients use words like prepared, personable and professional in describing their experience with Navigators. Without the help of her Navigator, “my husband would never be able to receive the medical treatment that he will now be able to get,” wrote one woman of her experience. Writes another: “She takes the stress and confusion right out of the system.”

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Anne Packham works for Primary Care Access Network (PCAN) and is the Project Director for health insurance Marketplace navigators in Central Florida. She and her team have worked tirelessly since 2013 to educate Central Floridians about health insurance options in order to increase access to care. In addition to her work at PCAN, Ms. Packham has provided consulting services to the Health Council of East Central Florida, the Florida Alliance for Healthcare Value (formerly the Florida Healthcare Coalition) and taught at the University of Phoenix. Visit www.coveringcfl.net

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PHYSICIAN || SPOTLIGHT | Three Young Surgeons with Their Eyes on the Skies

Brown said the ability to reengage with the networks of friends and colleagues he had established during his residency that made the opportunity to return to Orlando Healthy especially attractive. And he’s extended those networks to the broader community by volunteering his services at Orlando’s Shepherd’s Hope, a group of free clinics for uninsured people. “It’s a way to give back and to address a very serious need in our community.”

trained to take a whole-person approach to his patients. “An orthopedic surgeon can rebuild something and make it look perfect, but the person still has to heal it,” he said. “What goes on with a patient outside the operating room is sometimes more important than what’s going on in the operating room.” Eager to expand his ability to work collaboratively with other physicians, Ebaugh says he hopes Orlando Health Jewett Orthopedic Institute is seen as a place for all physicians to turn for collaborative help in caring for their patients. “You know, sometimes it seems like we just push a button and send people on their way. That’s not how my grandfather would have me practice medicine.”

The Puzzle Solver Pierce Ebaugh, DO, grew up in Florida’s bustling Tampa Bay area. But it was in the comparatively slow town of Roanoke, Virginia, where his grandfather lived that he would learn how important a doctor can be to a community. “My grandfather was a pediatrician. And he would take me along with him on errands around town. We would go to the grocery store, and it would take three hours because everybody had to stop and talk to him,” Ebaugh said. “He was just awesome, very old school. Even in the mid-to-late 1990s, he would make house calls.” His grandfather is retired now but he consults with Ebaugh on his greatgrandchildren from time to time. As influential as his grandfather was and continues to be, it was the riddle of medicine that attracted Ebaugh. It’s also what drew him toward specializing in injuries and disorders of the foot and ankle. “I like puzzles,” he said. “And a lot of foot and ankle issues are puzzles. Something has failed and there is usually a reason for that. I like to solve things. I don’t want to just make it better; I want to solve it.” Before completing his fellowship in orthopedic foot and ankle surgery at the University of Texas McGovern College of Medicine, Ebaugh earned his Doctor of Osteopathic Medicine degree from Lake Erie College of Osteopathic Medicine in Bradenton, Florida. There he was

The Researcher The image you might have of someone driven by medical research is of someone with his head buried in a book. With Cody Green, you have someone who as a kid was liable to be buried underneath a bunch of other boys who were trying to tackle him. While growing up and playing on the football fields, basketball courts, and baseball diamonds of St. Louis, Green managed to break 14 bones. “I think my parents thought something was wrong with me,” he laughed, “but I was just an aggressive sports player.” In fact, it was while being treated for a broken ankle from a basketball game in the sixth grade that he decided to become an orthopedic surgeon. Now, after graduating with degrees and honors from Wright State University’s Boonshoft School of Medicine and Miami University in Oxford, Ohio, completing a residency in orthopedic surgery at Orlando Health (where he met Dr. Brown) and then completing a fellowship in adult hip and knee replacement at the prestigious OrthoCarolina in Charlotte, Green specializes in total joint replacement and direct anterior hip replacement. He uses robotic assistance for the most minimally invasive

procedures. People who remember long recovery periods with strict rules for how they sat or admonitions against crossing their legs would be astonished by how quickly patients today can resume normal activities. Green is eager to discuss how he can help care for patients utilizing these technics, but he gets even more excited discussing research and the new fellowship program he is helping design. “One of my passions is research,” he said. “I am going to be the research chair for the hip and knee department. I am putting together a registry for Orlando Health where we can follow the outcomes for hip and knee patients, so we can use technology and statistics to see what works and what doesn’t work. And we’ll be able to publish and share these findings.” Green will also be one of the co-directors for a new Orlando Health Jewett Orthopedic Institute fellowship, which will have its first fellow in 2022. Green said he hopes to model it on the OrthoCarolina program he completed. The fellowship programs that Drs. Brown, Ebaugh and Green completed after their hospital residencies placed them at the sides of expert surgeons for a year of intensive additional training. Besides the practical experience in the operating room, the best of these fellowships help the fellows and their surgical mentors establish a culture of collegiality and professional friendship they cherish today. “That’s what I want this program to become,” Green said.

The Orlando Health-Jewett Orthopedic Institute Busy as they already are, Brown, Ebaugh and Green are eagerly anticipating the new Orlando Health Jewett Orthopedic Institute which is scheduled to open in 2023. The new 370,000-square-foot institute is designed to become a center of excellence, among the best in the nation. It will be a collaborative center in which patients have access to orthopedic specialists, imaging services, radiologists, and physical therapists, who are all within steps of each other. Ebaugh may have summed up the hopes and expectations of his colleagues the best: “This will be a place where it’s easy to take care of hard problems.”

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Five Things to Know about Third Party Billing you from having to adjust off work for free. By the time your patient is checked in with the receptionist, they should know what their copay and deductible amount is. That way there are no surprises on the back end. If you let a patient through without advising them of this information ahead of time, 70 percent of the time you will not be able to collect this amount from them later. Just another instance where you could be working for free because you have staff not efficiently verifying ahead of time. Your receptionist as well should appropriately be trained on how to enter insurance data correctly to the system. This information will affect ALL departments.

BY MARIANNA MIDKIFF

There are many reasons to seek the services of a third-party medical billing company. Reducing staff, reducing the time you spend overseeing billing operations, having to deal with insurance companies, lost revenue from time spent away from practicing medicine, continuing education demands on code changes, regulations, etc., more efficient reimbursement, protecting your practice from employee turnover, converting fixed costs for billing into variable costs, more time with family and most important of all, maintaining focus on patient care. These are items to know about third party billing.

• Coding and Data entry: Compliance is on the very top of the list of importance. Having a certified coder on your staff is extremely important for compliant billing. Audits from the government payers are done periodically through the year. Is your staff billing the appropriate code and making sure the documentation supports the procedure billed? Are these questions you are asking your staff and is your certified coder educating you on any updates that are happening in the industry? If the answer is no, then you should be concerned that you can be non-compliant causing the insurance companies to take back the money that was already paid to you, or even worse having the OIG come into your practice and place your business under investigation. When your certified coder educates you on being non-compliant, listen to them. Greed never wins and trying to overbill or perform procedures on patients that are not medically necessary will not get past the government.

• How important is set up? When a doctor starts working or setting up his practice, the appropriate credentialing needs to be done with the carriers. Several of the government and commercial insurances require an application to be set up in their system. This also includes application to set you up electronically to bill and receive explanation of benefits and receive electronic funds transfer. On top of being credentialed with the insurance carriers, you also need to be credentialed with a clearinghouse to transmit claims. Are you confident that your staff has set you up appropriately? You could be currently working for nothing. • Insurance Verification: When a patient has an appointment, it is very important that your staff verifies the insurance 24 hours ahead of time. Patients’ insurance companies change often, and they could have updated to an insurance that is not on your contract list. If you are not contracted there are several insurance companies that DO not have out of network benefits, therefore you should be collecting the self-pay rate on these patients. Some insurance policies require a referral from the PCP or an authorization before the patient can be seen. Having your staff verify beforehand will save

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• Accounts Receivable: Having staff work your accounts receivable is very important for successful billing. Insurance companies are not your friend. They will do anything to not pay your claims. If you do not have motivated and aggressive employees working your A/R, you could possibly be working for nothing. Having to adjust claims, because your staff is not checking claim status within 30 days of

Taking a Closer Look at Trauma-informed Care

re-traumatize a patient and aggravate the problem. Effective treatment starts with respect and compassion: recognizing a person’s experiences and helping them choose their path to recovery. This intentionally positive approach to overcoming past adversity is sometimes called the “PACEs” model, to symbolize a step-by-step path toward healing. At the Children’s Advocacy Center Osceola, we provide one-on-one advocacy to underage victims of sexual abuse and their non-offending caregivers. Offering support to the whole family is critical. In cases of child sexual abuse, non-offending caregivers and relatives are often deeply shaken. They have their own crisis to recover from before they can effectively advocate for and support their child. We serve hundreds of children and their families each year, usually referred to us through law enforcement or child protective services following the initiation of a formal investigation. Many of those cases are called in by community members including healthcare providers, physicians and nurses who notice the signs of neglect or hear a report of abuse from a child. Not only is this required by law, but it’s also a critical safeguard for our community’s children. Accurate and timely reports can prevent abuse from continuing,

empower the family to seek support and treatment, and minimize the long-term effects of trauma through prompt and informed care. While the science behind childhood trauma and health outcomes has been well-documented since the initial 1997 ACEs study, the trauma-informed approach is often seen as a niche development in the field of mental health and recovery. What is commonplace in organizations that serve survivors of abuse and neglect is still not widely understood by many physicians and care providers. But a single-pronged approach isn’t enough. As with any health issue, a long-term solution will require advances in both prevention and treatment across a multitude of disciplines. That starts with social and economic policies that build stronger families, academic programs for mentorship and counseling, routine screening for signs of abuse and neglect, and a trauma-informed approach to medical care. As we gain a better understanding of the ways we can prevent, identify, and treat the impact of trauma, we can more effectively intervene to help patients of all ages find a path to safety and recovery. Joy Chuba, LCSW, is executive director of the Children’s Advocacy Center (CAC) Osceola and a current officer of the local Child Abuse Prevention Task Force. CAC Osceola is a program of Embrace Families.

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NOVEMBER 2021

submission, or appealing denials within the time frame, will force you to adjust off balances because legally you cannot bill the patient for your staff dropping the ball. There are several providers that do not have the time or resources to run reports and analyze data to see if their Staff is working their A/R to its full potential. • Contracting and Payment analysis: Each insurance company that you contract with gives you a contracted rate that they pay you per procedure. Your staff should be reviewing these contracts annually and contacting the insurance carriers inquiring if your contract is up for negotiation. Every time you receive a payment from an insurance company you should have a member of your staff analyzing if that claim is paid according to what it states in your contract. A lot of insurance companies will underpay, and your staff should be sending an appeal for additional reimbursement. Marianna Midkiff is CEO of MK Medical Consulting, offering professional billing services dedicated to meeting all of the insurance and patient billing needs of your practice or doctors just out of residency. We specialize in offering new physicians out of residency credentialing services. Our company will handle every aspect of obtaining billing numbers required to bill most major government carriers such as Medicare, Medicaid, Blue Cross and Blue Shield. Our services are specifically designed to meet the needs of individual and small group practices. Contact her at mariannakuchma@yahoo.com

Newer Treatment Options for Hemorrhoids Offer an Easy Recovery for the Bleeding Patient BY SERGIO LARACH, MD, GRANT WOJDYLA, MD CANDIDATE AT UCF

in the U.S., annually (approximately 40 percent of those being asymptomatic), with half of all U.S. adults over the age of 50 having, at some time in their life, experienced the ill-effects of hemorrhoids. There are many therapeutic modalities available of hemorrhoids depending on the type, grade, and associated symptoms. For most, the initial treatment is conservative local management (creams, suppositories) and correcting underlying issues such as constipation or diarrhea by increasing dietary fiber. If these efforts are ineffective or are not indicated, common office-based surgical procedures such as rubber band ligation may be performed, with the main treatment for symptomatic hemorrhoids being one of the many variations of hemorrhoidectomy. However, some of these procedures can be quite painful to the patient with protracted recovery periods, lasting several weeks to months in duration. The new and innovative procedure of Transanal Hemorrhoidal Dearterialization (THD) is an alternative method for internal hemorrhoids grades II or III (hemorrhoids that bleed and prolapse, either reducing spontaneously or manually, respectively) that have been refractory and unresponsive to conservative or topical treatment options. THD is a minimally invasive modality that preserves the anorectal anatomy, whose outcomes attenuate the pain and discomfort experienced, and curtail the recovery period. Able to be performed under either general or locoregional anesthesia, THD is known as an incision-less or excision-less procedure that uses highly sensitive ultrasound doppler imaging to identify and target the problematic hemorrhoidal vessels where blood flow

Bleeding can occur anywhere in the gastrointestinal (GI) tract and may result from a myriad of issues – ulcers, fissures, diverticula, ischemia, inflammation, infections, and neoplasia (to name a few). To further broaden the non-specificity of this issue, loss of blood can be thought of as being on a spectrum: occurring once and occultly to being chronic and frankly conspicuous. A final characteristic that patients will describe is the color, as this blood may be anywhere from pink to black – with darker colors being more suggestive of lesions higher up in the GI tract. Medical attention is often sought out by those who notice blood in their stool, on their toilet paper, in the toilet bowl, or who find evidence of blood in their undergarments. Common causes of this bleeding are secondary to anorectal conditions such as fissures with the most common being hemorrhoids. Though these disorders are the most frequent, other issues and cancers of the GI tract must always be considered and ruled out. Any bleeding that lacks a clear explanation of cause in the first exam needs a colonoscopy, regardless of age. Hemorrhoids affect an estimated 10 million individuals

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is at its greatest – a relatively uncomplicated and effective method as branches of the hemorrhoidal arteries become more superficial, approaching the level of the submucosa, in the distal rectum. Once this area is located, the colorectal surgeon ligates the vessel via suturing techniques – thereby precisely restricting blood flow, reducing the hemorrhoid – while also simultaneously performing a mucopexy to restore any prolapsed mucosa to its original position. Because THD is a minimally invasive procedure, with tissue disruption restricted only to the anorectal mucosa and submucosa, postoperative complications are limited in both number and severity – the primary complications being tenesmus, along with minor pain and discomfort. Typically lasting anywhere from a few hours to days, these symptoms are caused by inflammation and ischemia associated with the plication or repositioning of the tissue at the site of dearterialization and are not related the ligated hemorrhoidal cushion. In most cases, these symptoms are resolved within 10-14 postoperative days. If symptom relief for pain is requested, non-steroidal anti-inflammatories and/or analgesics will typically suffice. Another common symptom experienced by the patients that undergo THD with mucopexy may be discharge from the surgical site, which can be bloody or have mucous but will also typically dissipate after a few days. As stated before, the real benefit to this procedure over

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How A Digital- and Data-First Approach to Healthcare Better Serves Patients BY PRANAM BEN

Since the mid-1900's, the world has been consistently undergoing a digital revolution that has transformed every aspect of the human experience. As of 2020, the total amount of data created, captured, copied and consumed globally has reached 64.2 zettabytes and is projected to grow to more than 180 zettabytes by 2025. To contextualize this, if each terabyte in a zettabyte were a kilometer, it would be equivalent to 1,300 trips to the moon and back. With so much data at our fingertips, it could be hard to believe how much the COVID-19 pandemic uncovered so many digital gaps in the world, especially as it relates to healthcare. It provided an immediate awakening to the industry and ushered in a digital transformation that wasn’t predicted to happen until several years later. In early 2020, only seven percent of people had a virtual consultation with a provider compared with a staggering 32 percent this year. With the healthcare industry on the fast-track to digital, providers were faced with a decision to pivot to virtual care or get left behind. Whether we choose to accept it or not, digital automation is here to stay. We can’t shy away from it. With technology consistently evolving, it’s best to get ahead of the curve and prioritize the adoption of tech. The increased digitalization of healthcare means less misinformation will be spread and providers, as well as patients, will have the necessary tools to better manage health and medical records. In a recent report by Dr. Joe Corkery, Google Cloud’s Director of Product Management, Healthcare & Life Sciences, of the 300 physicians surveyed across the United States, 96 percent agreed that easier access to critical information may help to save someone’s life and 86 percent believe it will significantly cut time to diagnosis. Improving access to patient data allows for better interactions with patients, leading to improved outcomes. Although many providers have the will to interact more closely with their patients and communities, a broken healthcare system and the lack of efficient technology use continues to be a perpetual source of physician burnout. Half of all doctors report troubling symptoms like depression, exhaustion, dissatisfaction, and a sense of failure. With burnout on the rise, physicians are twice as likely to commit a serious medical error. Lives are at stake and the adoption of population health management platforms is no longer an option, but an urgent necessity. It could mean the difference between living or dying for the 100,000 to 200,000 people who die each year from

medical errors. Implementing health technologies to help bear the load of medical documentation could reduce costs while improving the quality of care. Proper population health management allows for a “patient-centric” view with real-time access to data and closed gaps in medical histories; key factors that assist with the Nation’s imminent transition to value-based care. With the pandemic forcing a digital emergence in healthcare, inclusivity is a requirement and technology must now account for the various demographics of people that make up our world. Equal opportunity of access is not synonymous with equal use and the time for a “cookie-cutter” approach has expired; today, it’s imperative to keep accessibility top of mind. Apart from the traditional accessibility concerns, age and generational differences play a huge role. The Silent Generation and Baby Boomers are among the highest users of healthcare and a survey found that overall use of telemedicine services among seniors increased by 300 percent during the COVID-19 pandemic. When adopting technology, educating this demographic must be at the helm for a smoother transition. Rather than solely catering to the younger Millennials and Gen Z who are inherently tech savvy, having an intuitive design and easy-to-use navigation allows for greater usage among healthcare’s largest demographic - meeting them right where they are. The ability to leverage technology in healthcare spaces has been a game changer for the industry. However, advancements in health tech are only as efficient as the data and analytics used to power it. From increasing efficiency to gaining actionable insights from large amounts of data, it’s important to invest in the right technology that's equipped for such a large undertaking. The proper solu-

tion intuitively connects the dots on all aspects of health management through data aggregation and functionality and can be integrated into workflows to solve real-world challenges. Improvement in workflow is directly tied to an improvement in care outcomes because it streamlines information gathering and reporting allowing care managers to identify gaps in care at-a-glance and be more informed with accurate risk scores. It took a global pandemic for providers to begin fully embracing digital healthcare as a viable alternative to in-person care and with 47 percent of millennials saying they will prefer telehealth to in-person visits once the pandemic passes, now is the time to prepare for the future. Digitalizing healthcare is essential, but at the crux of the movement lies data. On its own, digital isn’t equipped to provide an individualized or unique experience. A data-first approach is what actuates the goals of value-based care. For example, The Garage’s population health management platform, Bridge, is a nexus between providers and patient data, connecting all the dots on value-based care. With a data-driven platform at the forefront of care management, informed guesswork is replaced with concrete and fact-based evidence. Applying intelligence to rich patient data is what drives the right digital experience - better engaging patients in their own care and empowering physicians to make a real impact in the communities they serve. Pranam Ben has always been an innovator. Over his 20+ year career, Ben has found much success in the Healthcare Informatics world and The Garage has been no different. Pranam has been behind the vision, design and architecture of award-winning software products while being directly responsible for running businesses for large corporations. A problem solver by nature, The Garage has allowed Pranam to resolve some of healthcare’s biggest challenges. For more information, email pben@thegaragein.com or visit www.TheGarage.health.

CONTINUED ... Newer Treatment Options for Hemorrhoids Offer an Easy Recovery for the Bleeding Patient THD on patients who are concurrently on oral anticoagulation therapy, without the need of preoperative cessation. Because this procedure is minimally invasive and does not require any incisions, the risk of considerable bleeding is reduced. This is a benefit to the patients because removing a patient off their anticoagulation therapy increases the risk of thromboembolic or cardiac events. The fact that THD is a surgical option while being able to maintain a patient’s oral anticoagulation, avoiding these increased risks, is a preference for the patients and surgeons, alike.

the alternative methods described is the drastic reduction of postoperative pain. Patients report a significant decrease in bleeding and pain, which is a relief for those who sought out surgical therapy primarily due to these symptoms. Though this modality has an increased rate of recurrence when compared to standard hemorrhoidectomy (15-20% versus 14%, respectively), Transanal Hemorrhoidal Dearterialization can be performed repeatedly for recurrent hemorrhoids. Another advantage to performing a THD over the other surgical options is that there is evidence supporting

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Transanal Hemorrhoidal Dearterialization is a safe and effective technique for many suffering patients, bringing an easier alternative to correct this common condition. Sergio Larach, MD, FASCRS, FACS is a colorectal surgeon at the Digestive and Liver Center of Florida. He is devoted to his work allowing him to become a pioneer in performing laparoscopic surgical procedures and co-creator of the TAMIS procedure. Besides taking in patients at DLCFL, he also dedicates his time to educating colorectal surgeons, and future doctors as a Clinical Assistant Professor at University of Central Florida and Florida State University.

NOVEMBER 2021

2022-Model Central Florida International Auto Show Roars Into Orange County with New Vehicles, Exotics, Test Drives, Muscle Cars Featuring hundreds of new vehicles, test drives, exotics, classics and more, the 2022-model Central Florida International Auto Show will fill the North Concourse of the Orange County Convention Center (OCCC), Friday, December 3 through Sunday, December 5, 2021. The show will operate with appropriate health and safety protocols in place as directed by the Florida Department of Health in Orange County. Everyone is invited to check out hundreds of the latest vehicles in a non-selling environment, inspect engines and experience the latest automotive technology. Take the show floor experience to the next level and test-drive a lineup of all-new vehicles, right at the show. From electric vehicles to heavy duty trucks, licensed drivers are invited to get a feel for the performance and handling of dozens of new vehicles from several manufacturers including BMW, Ford, Jeep, Ram, Stellantis, Subaru and more. Professional 4x4 drivers will take passengers on a thrilling interactive adventure along an off-road test track at Camp Jeep® featuring the iconic Jeep Mountain, an 18-foot, 35-degree hill

climb; three-wheeling over Camp Jeep’s Trail Rated Pass; and a stretch of terrain that simulates fallen logs. A collection of allnew Jeep models will be available to test on the track. Admission to the event is $14 for adults, $10 for seniors (62 and older) and military and first responders (w/any DOD or municipal ID) and students (under 21 w/school ID) when purchased online in advance. Children 12 and under are FREE. Purchase advance tickets at www.orlandoautoshow.com.

Learn2Engage Offering Free e-Learning and Instructional Consultations

ORLANDO || GRAND ROUNDS Orlando Heart & Vascular Center Announces the Addition of Aalok Patel, MD Aalok Patel, MD, has joined the team at Orlando Heart & Vascular Center. Patel is board-certified in internal medicine, cardiovascular diseases, and interventional cardiology. He earned his undergraduate and medical degrees in a combined 6-year BS/MD program at the University of Missouri-Kansas City before going on to complete the J. Willis Hurst Internal Medicine Residency at the Emory University School of Medicine in Atlanta, Georgia. Dr. Patel subsequently completed a cardiovascular diseases fellowship at the prestigious Mayo Clinic in Rochester, Minnesota. Thereafter, he completed an advanced fellowship specializing in coronary, peripheral, and structural heart disease interventions at the Scripps Clinic in La Jolla, California. Dr. Patel specializes in treatments for structural heart disease, including transcatheter aortic valve replacements (TAVR), mitral valve repairs (MitraClip), PFO/ASD closures, and left atrial appendage closures (Watchman). Before joining Orlando Heart & Vascular Center, he practiced with various cardiology groups across Florida. Additionally, Dr. Patel has published many articles in peer-reviewed journals and has participated in numerous clinical trials. Patel speaks English but is also proficient in Spanish, Hindi, and Gujarati.

went on complete a residency in internal medicine at the Icahn School of Medicine at Mount Sinai in New York City. Following this, Dr. Balouch completed a fellowship in cardiology at the University of Illinois College of Medicine in Chicago and an additional one in interventional cardiology at the University of Alabama at Birmingham.

Cheryl Powell, CEO of Learn2Engage, is proud to be in her 25th year as an Instructional Design and e-Learning Specialist, with clients all over the US and overseas. She is based out of Orlando and a member of the East Orlando Chamber of Commerce. Her industry specialty entails developing both online and virtual employee training for healthcare providers, pharmaceutical companies, and private medical and dental practices. Clients such as Bristol Myers Squibb, Biopharm, Precision Health, and Wellpath, have used Learn2Engage for their SCORM compliant training needs. She holds a Bachelor’s in Business Management, Master’s degree in Project Management, K-6 Teaching Certificate, and a Level 1 Gamification Certification, and studies the Adult Learning principles of experts and theorists such as Gagne (Gagne’s nine events), Maslow (Maslow’s hierarchy of needs), and Dr. Ruth Clark, to ensure her courses engage learners of all ages and get organizations RESULTS. Learn2Engage is truly a one-stop shop B2B business, able to work any training project from start to finish. Let us take your PowerPoint, white papers, and content documents, and turn them into eye-catching, interactive, engaging modules with high Learner Retention rates. Schedule a free one-hour consultation today by calling 407-881-4487 or emailing info@learn2engage.info.

Orlando Health Heart & Vascular Institute Adds Nationally Recognized Cardiothoracic Surgeons Orlando Health Heart & Vascular Institute recently added two new cardiothoracic surgeons to its multidisciplinary team of cardiologists, heart surgeons, vascular surgeons and other clinical staff and health care professionals. Paul Massimiano, MD, and Anthony Rongione, MD, are both nationally renowned cardiothoracic surgeons, highly trained experts in minimally invasive heart surgery. Dr. Massimiano specializes in minimally invasive mitral valve surgery, which he helped develop. Dr. Rongione specializes in minimally invasive aortic valve surgery and left ventricular assist device implantation. The addition of the two surgeons builds upon the specialized level of surgical care currently provided to patients at Orlando Health Orlando Regional Medical Center. “Dr. Massimiano and Dr. Rongione bring unique specialties and surgical options for our patients,” said Farhan Khawaja, MD, president, Orlando Health Heart & Vascular Institute. “We are excited to offer these new options in minimally invasive surgery and innovative heart therapies to improve the quality of life for our cardiac patients.” Board certified in surgery and thoracic surgery, Dr. Massimiano earned a medical degree from Georgetown University School of Medicine in Washington, DC. He completed internships in general surgery at the National Naval Medical Center in Bethesda, Maryland, and Navy Regional Medical Center in the Philippines. He also completed residences in general and vascular surgery at National Navy Medical Center. In addition, Dr. Massimiano completed a cardiothoracic surgery fellowship at Yale University School of Medicine, and an advanced valve fellowship with Albert Starr, MD, at St. Vincent Heart Institute in Portland, Oregon. Dr. Starr co-invented and implanted the world’s first successful artificial heart valve.

Dr. Muhammad Adnan Balouch Joins Orlando Heart & Vascular Center Orlando Heart & Vascular Center announces the addition of Dr. Muhammad Adnan Balouch. Balouch is a Board-Certified Interventional Cardiologist. He earned his medical degree at Khyber Medical College in Peshawar, Pakistan, and

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Paul Massimiano, MD, Left and Anthony Rongione, MD Right

Dr. Massimiano’s scope of research topics includes transcatheter valve replacement, minimally invasive surgical ablation, and minimally invasive mitral valve repair. Dr. Massimiano has been published in several medical journals such as the American Journal of Medical Quality, The Annals of Thoracic Surgery, the European Journal of Cardio-Thoracic Surgery, and the Journal of Thoracic and Cardiovascular Surgery. Dr. Massimiano’s professional affiliations include membership in the American Medical Association, the International Society for Minimally Invasive Cardiothoracic Surgery, and the Society of Thoracic Surgeons. Prior to joining the heart and vascular institute, Dr. Massimiano served communities in Bethesda and Silver Spring, Maryland. Board certified in surgery and thoracic surgery, Dr. Rongione earned his medical degree from Rush Medical College in Chicago. He completed a general surgery residency and fellowship at UCLA Medical School in Los Angeles, California, and a cardiothoracic surgery residency at University of Washington School of Medicine in Seattle, Washington. Dr. Rongione’s scope of research includes several clinical trials to evaluate left ventricular assist devices. Other research topics include cardiac surgery and blood conservation. Dr. Rongione has been published in several medical journals such as Circulation, Journal of the American College of Cardiology, and Journal of Cardiac Failure. Dr. Rongione’s professional affiliations include membership in the American College of Surgeons.

NORTH CENTRAL FLORIDA || GRAND ROUNDS section of State Road 50 and Citrus Tower Boulevard. “We are committed to providing convenient care close to home, wherever consumers live in Central Florida,” said Kari Vargas, market CEO for West Orange and South Lake counties. “With a fast-growing population and lack of providers, we look forward to offering the residents of South Lake a whole range of exceptional, compassionate care.” The parcel is surrounded by a vibrant mix of residential and commercial construction. “My fellow City Council members and I are excited to welcome AdventHealth to Minneola,” said Mayor Pat Kelley. “We expect their presence will further accelerate development of our economic development zone, and bring both health and business benefits to our city.” A timeline for the project remains under development, and AdventHealth will provide additional details as the project is finalized.

Orlando Health National Training Center

MK Medical Consulting Brings 25 Years’ Experience to Ocala Providing Medical Practice Billing Services

The road to healthy living begins at South Lake Hospital’s National Training Center (NTC), where fitness goals are met with inspiration, guidance and the tools you’ll need to achieve them. Membership grants you access to our high-tech strength and cardiovascular equipment, private personal training and group classes and much more. South Lake Hospital’s Outpatient Rehabilitation is located in the NTC as well as community education classes and support groups. The NTC also offers youth programming such as swimming, soccer and track and field to keep your whole family healthy and active. In addition, the NTC is home to dozens of Olympic athletes and serves as a warm-weather training ground for individual athletes and teams from across the nation and the globe. For more information about membership and all the NTC has to offer, please visit www.usantc.com.

Offering professional billing services dedicated to meeting all of the insurance and patient billing needs for established medical practices and physicians just exiting residency to provide credentialing services. Our company will handle every aspect of obtaining billing numbers required for billing most major government carriers such as Medicare, Medicaid, Blue Cross and Blue Shield. Additionally, MK Medical Consulting has expert experience helping new physicians establish Tax ID numbers and setting up systems for conducting electronic funds transfers ensuring direct deposits of insurance payments. Our services are specifically designed to meet the needs of the individual and small group practices that are currently flourishing in the United States. Ensuring each client receives our complete and INDIVIDUAL attention sets us apart from most nationwide billing companies. Contact Marianna Midkiff at mariannakuchma@yahoo. com or 352-815-7081.

Chair of Surgery at UF College of Medicine Named to the National Academy of Medicine GAINESVILLE, Fla. — Gilbert Rivers Upchurch Jr., M.D., the Edward M. Copeland III and Ann and Ira Horowitz Chair in the University of Florida College of Medicine’s department of surgery, has been named to the National Academy of Medicine for his seminal contributions to the understanding of the development of vascular disease and contributing greatly to the advancement of all aspects of vascular and surgical care. Upchurch was recruited in 2017 for his international reputation as an acclaimed clinician, researcher and educator in the study and treatment of aortic and vascular disease. Since then, he has continued advancing the specialty — even taking the time to consider its future. In his 2019 presidential address to the Society for Clinical Vascular Surgery, Upchurch cited data predicting a shortage of between 20,000 and 30,000 surgeons by 2030. This, in conjunction with widespread burnout and a lack of diversity in the specialty, he said, illustrated the problems endemic to becoming a vascular surgeon. His suggestions about how that could be addressed — changing the way surgeons learn, deliver care and lead, have

AdventHealth Purchases Minneola Land for Future Hospital AdventHealth has purchased a 30-acre parcel in the city of Minneola, with plans to expand its care network and better serve the residents of South Lake County. The parcel is located at Florida’s Turnpike and Hancock Road, off the Minneola interchange in an economic development zone. Plans for the site include a full-service hospital. With the Minneola purchase, AdventHealth is further expanding its footprint in the fast-growing area. In nearby Clermont, a 24-bed emergency department is scheduled to open later this month, followed by comprehensive outpatient services coming in January with the opening of the Clermont health park. These new services will meet a significant need in Clermont, which suffers from a shortage of physicians in nearly every specialty, including primary care, cardiology, pediatrics, gastroenterology, oncology, obstetrics and gynecology. The Minneola parcel is approximately 4 miles from the Clermont ER and health park, which are near the inter-

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mirrored his own career arc at UF. During Upchurch’s time as chair, the department of surgery has seen several milestones — many set against the backdrop of the COVID-19 pandemic. Faculty have performed some of the first COVID-19-related lung transplants in the nation, leveraged artificial intelligence to supplement clinical decision-making and published meaningful research on the subject of diversity in clinical trials and the surgery workforce itself. Prior to joining UF, Upchurch served as the chief of vascular and endovascular surgery in the department of surgery and as the medical director of the Heart and Vascular Center at the University of Virginia Medical Center in Charlottesville, Virginia. He was also the William H. Muller Jr. professor of surgery as well as a professor in the department of molecular physiology and biological physics. Earning his medical degree at the University of North Carolina Chapel Hill and training at Harvard University, Boston University and the Cleveland Clinic, Upchurch serves on the editorial boards of several prestigious publications, including the Annals of Surgery, Surgery, the Journal of the American College of Surgeons, JAMA Surgery, and the Journal of Vascular Surgery. He has also served as editor or associate editor for 13 books. Upchurch is a fellow of the American College of Surgeons, the American Heart Association and the Society of Vascular Surgery. He also serves as the chair of the Vascular Surgery Board and is a member of the American Board of Surgery. He also serves on the UF Health Shands Hospital board. Election to the Academy is considered one of the highest honors in the fields of health and medicine and recognizes those who have demonstrated outstanding professional achievement and commitment to service. New members are elected by current members through a process that recognizes individuals who have made major contributions to the advancement of the medical sciences, health care and public health. A diversity of talent among NAM’s membership is assured by its Articles of Organization, which stipulate that at least one-quarter of the membership is selected from fields outside the health professions — for example, from fields such as law, engineering, social sciences, and the humanities. “It is my privilege to welcome this extraordinary class of new members. Their contributions to health and medicine are unmatched – they’ve made groundbreaking discoveries, taken bold action against social inequities, and led the response to some of the greatest public health challenges of our time,” said National Academy of Medicine President Victor J. Dzau, M.D. “This is also the NAM’s most diverse class of new members to date, composed of approximately 50 percent women and 50 percent racial and ethnic minorities. This class represents many identities and experiences – all of which are absolutely necessary to address the existential threats facing humanity. I look forward to working with all of our new members in the years ahead.” Established originally as the Institute of Medicine in 1970 by the National Academy of Sciences, the National Academy of Medicine addresses critical issues in health, science, medicine and related policy. NAM works alongside the National Academy of Sciences and National Academy of Engineering to provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions.

Ocala - Leaders with AdventHealth and community leaders celebrated the groundbreaking of AdventHealth Care Pavilion Heathbrook, located at 3949 SW College Road, Ocala. AdventHealth Care Pavilion locations are a new type of concierge focused, personalized primary, specialty, laboratory, and imaging care tailored to the community. AdventHealth Care Pavilion Heathbrook will be the third in the hospital system’s West Florida Division. Two others are currently located in the Greater Tampa Bay area. The 24,904 SqFt center is opening Fall 2022. Services may include: primary care, specialty care, full imaging, lab, pharmacy and café.

VOLUSIA/BREVARD || GRAND ROUNDS

St. Francis Reflections Lifestage Care Announces Partnership with Partners in Care: Together for Kids TITUSVILLE — St. Francis Reflections Lifestage Care announces their recent selection as the state’s only provider of choice for Partnership with Partners in Care: Together for Kids in Brevard County. PIC:TFK is offered by the Agency for Health Care Administration, the Florida Department of Health, and the Florida Hospice and Palliative Care Association. The program relies on partnerships between state-employed care coordinators who identify children for possible enrollment and palliative care staff who provide home and community-based services. “At the heart of our mission is a commitment to uplifting lives in our community. As Brevard’s only dedicated pediatric palliative care team, we are privileged to provide specialized care and services for the seriously ill children of Brevard County,” said Lauren Loftis, Chief Medical Officer for St. Francis Reflections. The Pediatric Palliative Care Team at St. Francis Reflections provides care for pediatric patients with life-limiting conditions and adds an extra layer of support for the children and their families. The program is supported by expert physicians, child life specialists and registered nurse case managers. Together, their goal is to create a better quality of life for pediatric patients, their families, and the community-at-large. The multidisciplinary team delivers complex care to help kids feel better and live more fully. “It is my greatest honor to enhance quality of life by providing comfort, coping skills, and education using play and support through a developmentally appropriate lens for children living with serious illness (and their families). To allow ‘kids to be kids’ and to be a ‘kid helper’ is a treasured privilege,” said Kathryn Sparger, Certified Child Life Specialist for St. Francis Reflections. “I am so proud to work alongside our specialized pediatric palliative team to uplift lives and provide sincere patient and family centered care.” The St. Francis Reflections pediatric scope of services also includes a child grief program called NorthStar. Child grief specialists provide a safe and welcoming space for children to express their grief through peer support groups. Providing support to children, along with their families, the team encourages children to express their grief and emotions. The specially trained staff utilizes a variety of techniques and skills through play, stories, and peer interactions to help children. Child Grief Specialists provide support both on-site and online. Specialists can also be available to provide support in the school setting through coordination with school personnel. The St. Francis Reflections NorthStar program is exclusively dedicated to grieving children and is open to any child in Brevard County. St. Francis Reflections Lifestage Care was founded in 1977 and licensed in 1990. St. Francis is Brevard’s longest-serving, not-for-profit, independent, interfaith provider of hospice, palliative care, pediatric palliative care and grief support services. For more information about St. Francis Reflections Lifestage Care, please visit ReflectionsLSC.org, call (866) 269-4240, or on Facebook @StFrancisReflections.

Six new doctors join Halifax Health ER. From L to R: Dr. Morgan Dufresne, Dr. Michael Gleimer, Dr. Dallas Joiner, Dr. Brenton Kinker, Dr. Mikhail Merchenko, Dr. Malav Patel will focus on functional recovery, mental wellbeing, and the ability to return to work or to pre-COVID daily activities. “The respiratory system is central to a number of the lingering symptoms of long COVID,” explained Mark A. Carbone, CEO of PN Medical. “Implementing respiratory muscle training can positively impact the pathways involved in breathing and provide a gradual, progressive method to improve respiratory muscle function.” The four-week study is completely virtual, allowing anyone in the U.S. who has been affected by COVID-19 to apply. Participants will receive PN Medical’s respiratory muscle training device (THE BREATHER or BREATHER FIT) and follow a training plan on the BREATHER COACH connected app that requires using the device up to two times a day on a specific number of days per week to test its effectiveness in reducing long COVID symptoms. Interested persons can determine their eligibility and enroll in the COVID Virtual Recovery Study by visiting https://www.pnmedical.com/covid-virtual-recovery-study-cvrs-2/ “PN Medical shares Mayo Clinic’s dedication to evidence-based science and cutting-edge research; in this case to develop drug-free solutions to help people improve their respiratory health,” said Carbone. “My hope is that this research study with Mayo Clinic will result in new protocols that lead to COVID resilience before, during and after positive exposure to the virus.” PN Medical helps people worldwide improve their respiratory health and performance with a dedication to evidence-based science, cutting-edge research and innovative product and software development. Since 1980, the company has enabled more than 1.5 million people to breathe better, including people who want to decrease the burden of chronic illness or achieve a higher level of human performance without drugs. Respiratory therapist and founder Peggy Nicholson broke new ground with her invention of THE BREATHER, the first respiratory muscle training device of its kind. Endorsed by clinicians worldwide who provide Respiratory Muscle Training (RMT), it is an effective way to treat respiratory, cardiac and neuromuscular impairments. To learn more, visit www.PNMedical.com.

OMNI Healthcare Now Offering Pfizer and Moderna Vaccine Booster and Initial Vaccination at All OMNI Offices

Mayo Clinic Collaborates with PN Medical on a Research Study of Long COVID Patients

MELBOURNE - OMNI Healthcare has received a substantial supply of the Pfizer-BioNTech Covid-19 vaccine and is now administering the vaccine at its Melbourne vaccination clinic and all OMNI offices on a walk-in basis. The Moderna and Johnson & Johnson Covid-19 vaccines are also available. The Pfizer-BioNTech vaccine is the first and only Covid-19 vaccine to receive full approval by the US Food and Drug Administration (FDA). The Pfizer vaccine is now marketed as Cominarty, for the prevention of Covid-19 disease in individuals 16 years of age and older. The vaccine also continues to be available under emergency use authorization (EUA), including for individuals 12 through 15 years of age and for the administration of a third dose anyone over the age of 18 with a medical condition and anyone over the age of 65. On September 22, the FDA amended the EUA for the Pfizer-BioNTech Covid-19 vaccine to allow for use of a single booster dose, to be administered at least six months after completion of of the primary series in: • individuals 65 years of age and older; • individuals 18 through 64 years of age with a medical condition; and • individuals 18 through 64 years of age whose

COCOA BEACH – PN Medical, a leading developer of cardiopulmonary training devices, is supporting Mayo Clinic in a clinical trial to identify new approaches to treat the symptoms of post-acute COVID syndrome (PACS). The COVID Virtual Recovery Study will focus on people who have tested positive for the SARS-CoV2 infection and have completed a 14-30 day quarantine. A new study from the University of Oxford reports that more than one-third of COVID-19 patients may experience lingering symptoms for months following infection. Commonly referred to as Long COVID, some of the more common symptoms of post-acute COVID syndrome (PACS) include shortness of breath, fatigue, brain fog, loss of taste and smell, joint pain and depression. Health experts say the condition is clearly of public health concern, given the substantial impact it has on society, ranging from increased health care costs to economic and productivity losses. The goal of Mayo Clinic’s COVID Virtual Recovery Study is to investigate the benefits of respiratory muscle training (RMT) on strengthening the respiratory system and accelerating recovery from COVID-19. The findings

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frequent institutional or occupational exposure to SARSCoV-2 puts them at high risk of serious complications of Covid-19 including severe Covid-19. The clinic is located on the 2nd floor of 1344 South Apollo Blvd in Melbourne and is open from 8 a.m. to 5 p.m. Monday through Friday. Appointments are not required but can be made by calling (321) 802-5515, or by emailing the request and including their name and phone number to COVID@OMNIhealthcare.com. Anyone interested in receiving the vaccine should bring a state-issued ID and their insurance card. Without insurance, a social security number is required. Vaccination record card is also required to receive the booster shot. Boosters and second shots can be administered at OMNI even if a person’s initial shot(s) was received elsewhere.

New Emergency Department Doctors Join Halifax Health DAYTONA BEACH - Halifax Health Medical Center employs compassionate professionals to provide expert level care to our community in our Emergency Department. Morgan DuFresne, MD, Michael Gleimer, MD, Dallas Joiner, MD, Brenton Kinker, MD, Mikhail Marchenko, MD, and Malav Patel, MD, are joining the Halifax Health Emergency Medicine team to aid in the relief of emergent patient conditions. Board-certified physician, Morgan DuFresne, MD, attended Ross University School of Medicine before completing his emergency medicine residency at the University of South Florida. Michael Gleimer, MD, is a board-certified physician with a specialization in emergency medicine. After finishing medical school at the University of Michigan, Dr. Gleimer completed his emergency medicine residency at the University of Cincinnati. Emergency medicine specialist, Dallas Joiner, MD, is a board-certified physician with expertise in critical care. Dr. Joiner earned her doctorate at the University of Florida, completed her residency in emergency medicine at Orlando Health, and went on to complete her fellowship in anesthesia critical care at Jackson Memorial Hospital. Brenton Kinker, MD, is a board-certified emergency medicine physician. After attending Wayne State University for medical school, Dr. Kinker completed his residency in emergency medicine at Western Michigan University Homer Stryker M.D. School of Medicine. Board-certified physician, Mikhail Marchenko, MD, attended medical at the University of Central Florida before pursuing a residency in emergency medicine at the University of South Florida. Malav Patel, MD, is a board-certified physician specializing in emergency medicine. Dr. Patel earned his doctoral degree from the Florida State University College of Medicine prior to attending the University of Virginia for his emergency medicine residency. “Our highly skilled, emergency medicine team continues to grow bigger and better,” said Stephen Viel, MD, Medical Director of Emergency Services at Halifax Health. “We hire passionate individuals that demonstrate their commitment to making a positive impact on our community by treating each patient with skilled care and consideration.” Halifax Health Medical Center Emergency Department continues to offer the most comprehensive emergency services in Volusia and Flagler counties. Dr. DuFresne, Dr. Gleimer, Dr. Joiner, Dr. Kinker, Dr. Marchenko, and Dr. Patel will make great additions to an already outstanding emergency medicine team. To learn more about the Halifax Health Medical Center Emergency Department, visit us online: halifaxhealth.org/emergency