October 2017 Orlando Medical News by Orlando Medical News

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Florida Continues to Lag Behind Nation on Telemedicine Policy Veteran’s affairs to increase telemed service in muted criticism of state laws that hinder development By PL JETER

As the federal government gives its blessing to telemedicine with the September 29th announcement that the Department of Veterans Affairs is advancing its plan to allow VA physicians to treat patients regardless of either’s location, overriding all state laws, begs the question – where does the advancement of telemedicine stand in Florida? With a Halloween deadline fast approaching for recommendations on the state’s telemedicine practices, members of

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PHYSICIANSPOTLIGHT

Esteban Varela, MD, FACS, FASMBS

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the Florida Telehealth Advisory Council are working overtime to dissect the extraordinarily complex issue. Their work could lead to meaningful legislation in 2018. “It’s not as simple as I first thought,” said Michael P. Smith, MA, MPA, telemedicine program development director at the Florida State University College of Michael Smith Medicine, and an advisory council member. “I’ve been a proponent of telemedicine for many years, but I’ve (CONTINUED ON PAGE 4)

HEALTHCARELEADER

Thibaut van Marcke President, Dr. P. Phillips Hospital Thibaut van Marcke joined Orlando Health as a senior vice president and president, Dr. P. Phillips Hospital in April 2016. Thibaut comes to Orlando Health from HCA - North Florida Regional Medical Center in Gainesville, a 432-bed tertiary hospital, where he was vice president and chief operating officer, responsible for all hospital operations including executive oversight of surgical services, cardiovascular services and all ancillary and support departments. Prior to that role, he was chief operating officer of Medical Center of Trinity in New Port Richey, Florida, and associate administrator at HCA/HealthONE in Aurora, Colorado. Thibaut has worked closely with the American Heart Association and has served

as an advisory board member for the YMCA of the Suncoast. He holds a bachelor’s degree from the University of Richmond and a Master of Health Administration from Virginia Commonwealth University. “Since I was a kid, I have been drawn to healthcare. I volunteered in the rehab department of my local hospital in high school and went to college with the intent of being a physical therapist. While my interests changed in college, I learned more about the field of health administration from my sister-in-law who was just starting a career in the field. While I wasn’t cut out to be a direct care giver, I found that I could make an impact through leadership. That led me to pursue a graduate education in health administration,” he said.

We talked with van Marcke about what he has learned in his year at his new post, and what goals he has for the hospital. • OMN: What would you describe as your guiding principle in providing healthcare for patients in your care? • TvM: I have a couple of thoughts: 1) Our primary responsibility is to make sure that our patients are better when they leave than when they arrived. I realize that this sounds basic but it’s very important that we always remember our fundamental purpose. 2) I believe that our primary responsibility as leaders is to create an environment where our team members and physicians can do their best every day. I am not a clinician and am probably the last (CONTINUED ON PAGE 8)

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PHYSICIANSPOTLIGHT

Esteban Varela, MD, FACS, FASMBS Sharing a novel hypothesis

By PL JETER

This month our physician spotlight is on Dr. Esteban Varela, Chairman of the Department of Surgery at Oviedo Medical Center and a professor at the University of Central Florida. He is board-certified in General Surgery with fellowship training in advanced minimally invasive and bariatric surgery from the University of Illinois at Chicago and the University of California Irvine. Dr. Varela is recipient of the “Golden Laparoscope” Award by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and has received research funding by the National Institutes of Health. In his “In other words” platform he wants to share with readers a recent interview he and Dr. Carlos Felipe Chaux gave Bariatric Times on a novel hypothesis of utilizing metabolic surgery in combination with adult stem cell therapy to promote β-cell regeneration, which might result in insulin independence in type 1 diabetes mellitus. They discuss how intestinal reconstructions in metabolic surgery, which have proven effective in the treatment of patients with type 2 diabetes mellitus, could be extrapolated to type 1 diabetes mellitus. They concluded that metabolic surgery and stem cells should be considered as part of a multimodal treatment algorithm for type 1 diabetes mellitus treatments, and propose a protocol requiring a multidisciplinary team approach and infrastructure including metabolic surgeons, endocrinologists, immunologists, and regenerative medicine specialists.

In other words…. Please explain the pathophysiology of both types 1 and 2 diabetes mellitus. How do they differ? Drs. Varela & Chaux: Diabetes varies on its pathophysiology and age of presentation. In general, type 1 diabetes mellitus (T1DM) presents in childhood as an autoimmune process that destroys beta cells, resulting in life-long insulindependence. On the other hand, type 2 diabetes mellitus (T2DM) is of adult onset and mostly related to obesity, lipotoxicity, pancreas burnout, hyperinsulinemia, peripheral insulin resistance, and eventually insulin dependence. In addition, there is an uncommon presentation in the adulthood that is also autoimmune mediated, so called latent autoimmune diabetes in adults (LADA).

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In the article you state the following, “It is also possible that a small percentage of obese patients are mislabeled as T2DM when in reality they belong to the T1DM spectrum, with associated severe obesity and may present with clinical manifestations of both diabetes types (i.e., autoantibodies, insulin resistance, and insulin dependence).” How would “mislabeling” affect their treatment? Drs. Varela & Chaux: It is possible that a very small percentage of patients with LADA are being labeled and treated as insulin dependent type 2 diabetics without knowing their immune status (i.e., autoantibodies titers). This small subset of patients might not be good responders to bariatric surgery. Nevertheless, surgical treatment should be the same for both groups. As it has been previously shown, subject with obesity with T1DM show minimal improvements of their glycemic profile and insulin requirements up to 50 percent. When and why did you and your colleagues begin to hypothesize that metabolic surgery in combination with adult stem cell therapy to promote β-cell regeneration may result in insulin independence in T1DM? Drs. Varela & Chaux: We as bariatric and metabolic surgeons already offer the best treatment for T2DM, which provides effective and long-term remission of this condition when compared to medical therapy alone.2 However, we are running short treating T1DM with bariatric surgery. Although there are some positive metabolic responses after surgery, a complete remission has not been achieved. The answer might seem intuitive as there are different pathophysiologic entities, and there is completely destruction of pancreatic islet cells (Figure 1). However, there is evidence that even individuals with T1DM have dormant beta cells that might be reactivated when appropriately stimulated. Stem cell therapy may provide and promote pancreatic cell regeneration.

What are the mechanisms of action in utilizing this therapy in treating T1DM? Drs. Varela & Chaux: Explanations from the paper: An elongated biliopancreatic (BP) limb reconstruction may be able to further augment this incretin activity and β-cell trophic factors, mainly by glucagonlike peptide 1 (GLP-1), gastric inhibitory polypeptide (GIP), and peptide (PYY) effects. Prior rodent studies by Kamvissi et al showed the importance of the BP limb in diabetes remission and its positive incretin effects.4 Typical teaching during Roux-enY gastric bypass (RYGB) reconstruction (Figure 2) has been to perform BP limbs between 30 and 50cm in length. We have advocated longer BP limbs up to 150cm for patients with diabetes to maximize incretin activity with no observed adverse absorptive effects (i.e., a 150/150cm Roux/BP limb reconstruction).5 This elongated BP limb practice during RYGB is being popularized in Europe and Brazil. What procedure of stem cell regeneration therapy would be used in this hypothesis? Drs. Varela & Chaux: We are utilizing adult stem cells as compared to embryonic stem cells. Adults carry a large number of stem cells that are easily accessible in the fat tissue and bone marrow. These stem cells are harvested, processed, and implanted at specific sites and times after RYGB. We have yet to determine the proper cell donor sites and cell preparation procedures. The Metabolic Surgery plus Stem Cell (METASTEM) protocol will include patients with and without obesity. Six months following

metabolic surgery, patients will undergo bone marrow harvesting for stem cell procurement and processing. How might the sixmonth outcomes of the metabolic surgery affect the stem cell regeneration? Drs. Varela & Chaux: The majority of patients with T1DM are either normal weight or overweight. Very seldom do they have obesity. We plan to study both diabetic groups. Bariatric surgery provides the best possible metabolic environment (by decreasing lipotoxicity, increasing incretins, and insulin sensitivity) for stem cell implantation and long-term survival. We believe that six months may be the right time for those metabolic changes to take place prior to stem cell implantation. After that time, prepped cells will be laparoscopically implanted at specific organ sites. In addition, adult stem cells, as compared to islet cell transplants, are readily available and less costly, without the need for life-long immunosuppression. What stage is the METASTEM protocol in currently? Drs. Varela & Chaux: We are currently conducting pilot studies and searching for additional funding. We envision stem cells being part of the bariatric surgeons’ armamentarium along with lifestyle, pharmacologic, endoscopic microbiology and surgical interventions and as part of a simultaneous multimodal approach. Dr. Varela can be reached at Esteban.Varela@ucf.edu. Reprinted with permission from Bariatric Times (www.bariatrictimes.com) 2017:14 (7)22-23. Copyright © 2017 Matrix Medical Communications. All rights reserved.

Has the utilization of metabolic surgery in conjunction with implantation of adult stem cells been studied previously? Drs. Varela & Chaux: Stem cells from various sources have been previously studied by Shapiro et al3 for the treatment for T1DM. However, the utilization of stem cells after bariatric surgery is a new hypothesis that, to date, has not been tested.

OCTOBER 2017

Florida Continues to Lag Behind Nation on Telemedicine Policy, continued from page 1 yet to be able to show what the revenue stream would look like because it’s complicated.” For example, proponents of telehealth say it will save money. But it could increase costs. “Let’s say I do a telehealth consultation with a direct-to-consumer doctor,” explained Smith, speaking about his experiences with telemedicine advancement and not as an advisory council spokesperson. “At the conclusion, the doctor directs me to my primary care physician. That’s another charge.” Another issue is provider reimbursement. Let’s say a primary care physician needs to consult with a hand surgeon. “How does the hand surgeon get paid for his time? Telemedicine might pay for the doctor consult, or it might pay for the hand surgeon consult, but probably not both. These are the kinds of issues that insurance companies are going to raise with legislators,” said Smith. There’s also a minefield of unintended consequences “that, frankly, some of us can never anticipate until they happen,” noted Smith. “For example, an unintended consequence concerning the opioid epidemic occurred when the work of providers of behavioral health support via telemedicine suddenly came to a screeching halt because of a rule the Board of Medicine promulgated concerning controlled substances,” he explained. “The Board had to rewrite

the rule to enable psychiatrists to prescribe controlled substances that had to do with psychoactive agents. That took time.” The advisory board has sought input from national experts, including Mario Gutierrez, the late executive director of the Center for Connected Health Policy and board member for the California Telehealth Network. “California was one of the leaders 30 to 40 years ago, and they’ve recently changed their rules,” said Smith. “We’re late to the table and definitely paying attention to lessons learned in other states.” For example, Delaware recently passed telemedicine legislation that could link Nemours Children’s Hospital in Orlando with providers at Nemours corporate headquarters in Wilmington. But, “as it is today, a specialist in Delaware couldn’t be available for telehealth services in Florida unless that specialist is licensed in Florida. That doesn’t make sense. How can we do this smartly?” Also, even though Mayo Clinic has a major satellite operation in Florida, residents cannot access telehealth services from world-renowned medical experts in Minnesota because of licensure barriers. “We’re working to identify those barriers and offer suggestions for bringing them down,” said Smith. Federal repeal-and-replace of the Affordable Care Act efforts haven’t impacted the advisory council’s direction, primarily because it’s tied to Medicare and Social

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Justin Senior, Chair, Secretary of the Agency for Health Care Administration Celeste Philip, MD, Florida Department of Health, Florida Surgeon General and Secretary of Health Ernest Bertha, MD, Sunshine Health, representing health insurers Anne Burdick, MD, University of Miami Miller School of Medicine, representing healthcare practitioner organizations Leslee Gross, Baptist Health South Florida, representing long-term care providers Darren Hay, Care Angel, representing telehealth product developers Kim Landry, MD, Leon County EMS and Lifeguard Ambulance Service Inc., representing healthcare practitioners William Manzie, Memorial Healthcare, representing hospitals Elizabeth Miller, CRNP, WellCare Health Plans, representing health insurers Steven Selznick, DO, Selznick Consulting CFP Physicians Group, representing telehealth product vendors

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October Managing Your Clinical Supply Chain

Second only to personnel costs, the healthcare supply chain Moderator consumes a large portion of a health system operating expense. Patrick Roth Supply chain Thursday strategies can be leveraged to improve Senior Supply Chain Manager 5:30 PM – 8:15organizational PM financial performance, physician, nurse and staff Telehealth Summit Florida Hospital satisfaction and patient safety. Understanding key elementsFlorida of Second only to personnel costs, the healthcare supply chain Thursday Moderator November 7-9 purchase and inventory models, from traditional to vertically consumes a large portion of a health system operating expense. Patrick Roth Supply chain strategies can be leveraged to improve integrated approaches, the supply chain can be better managed SafetyVenue Harbor Resort & Spa Senior Supply Chain Manager organizational financial performance, physician, nurse and staff Welcome The communities for which healthcare organizationsSenior operate leaders can Florida and key developed a Hospital key business initiative. satisfaction and patient safety. Understanding elements of into are only rapidlyto diversifying. Not only do they care for a supply diBayshore Drive Ken Bradley personnel costs, theprovide healthcare chain 105 North purchase and inventory models, from traditional to Second vertically greatly influence the strategic and verse community of patientsfactors and families, but decisions their workforcethat serve as Moderator integrated approaches, the supply chain can be better consumes managed aVenue large portion of a health system operating expense. SafetySenior Welcome Executive South West Market FL Officer, 34695 isimprovement also growing more diverse. This diversity is exhibited in a and developed into a key business initiative. Senior leaders catalysts forcan of supply chain management value PatrickHarbor, Roth Supply chain strategies can be leveraged to improve Ken Bradley of ways, including nationality, race, religion, language, greatly influence the strategic factors and decisions that serve number as Florida Hospital Senior Supply Chain Manager Senior Executive Officer, South West Market principles. Creating aorientation culture supply chain valueandprinciples organizational performance, physician, nurse staff Sponsored by the Southeastern catalysts for improvement of supply chain management value age, sexualfinancial andof physical ability. The business Florida Hospital Florida Hospital principles. Creating a culture of supply enables chain value broader principles implications imperatives healthcare organizations face satisfaction and and patient safety. Understanding key elementsreduce of management options, enhance efficiency, Resource Center (SETRC), enables broader management options, enhance efficiency, reduce concerning diversitymodels, and inclusion are traditional immense. to vertically Telehealth purchase and inventory from Panelists Panelists waste, control cost and improve patient outcomes. waste, control cost and improve patient outcomes. organizer of the Florida Telehealth integrated approaches, supply chain can be better managed Celeste West the AGENDA Venue Welcome Celeste Westalso the Florida Register now at: CentralFL.ache.org and developed into a key business initiative. Senior leaders can Vice President Supply Chain Group in 2014, and Register now at: CentralFL.ache.org 5:30Adventist PM NETWORKING & DINNER Ken Bradley Health System Vice President Supply Chain greatly influence the strategic factors and decisions that serve as State University College ofWest Medicine 6:15 PM PROGRAM BEGINS Senior Executive Officer, South Market catalysts for improvement of supply chain management value Randy Hayas Adventist Health for System APPROVED FOR 1.5 FACE-TO-FACE CREDITS and Florida Partnership Telehealth, 404 Celebration Pl, Celebration, FL 34747

TELEHEALTH ADVISORY COUNCIL

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Security legislation. “Medicaid is much more flexible, and in our state, it’s been commended for its adoption of reimbursement for certain telemedicine activities, particularly around behavioral health,” he said. In the meantime, some innovative Florida employers are finding success providing this trending form of healthcare. By contracting with direct-to-consumer companies, such as Teladoc, American Well, and MDLive, employees have access to telemedicine. “For example, a credit union with 120 employees may contract with Teladoc to provide employees 24/7 access to consultation,” he explained. “In return, Teladoc might send a monthly report that goes something like this: Of your 120 employees, 18 accessed Teladoc’s services. Eight would’ve gone to the emergency room. Six would’ve gone to urgent care. But all 18 were treated via telemedicine, and the savings to the company totaled $4,000 for the month. That gets people’s attention.” Despite hectic professional schedules dotted with public hearings and frequent brainstorming sessions, the 14-member council, established by state lawmakers in 2016 after promising telehealth legislation languished, has worked in lockstep to achieve its goal. “I’ve been impressed with the leadership of Justin Senior and Celeste Philip,” emphasized Smith. “They’re very busy people with huge portfolios, and they haven’t missed a meeting. They’ve been

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When Pain is Untreatable with Drugs Sometimes imaginative solutions are in order By DR. JEN GOLDIN

It is in our very nature as physicians, to try to have answers for all our patients’ ailments. What happens when you have a patient in chronic pain and you really have nothing more to offer him? Sometimes that is just not possible. Sometimes what a patient really needs is validation that his symptoms are really awful and then be made to understand what comes next is up to them. Often, it seems there are unrealistic expectations on the part of the physician and the patient for us to provide the diagnosis and to be the solution. In 2011, I become this patient. After being rear-ended in a motor vehicle accident, I underwent a cervical fusion and was eventually diagnosed with Complex Regional Pain Syndrome. Suddenly instead of being on equal footing with my colleagues, I was trying to explain how the smell of pineapple and strong perfume made my pain worse. My children couldn’t walk across the floor too loudly for fear of causing me pain, and the feeling of raindrops hitting my arm would make me scream. Despite receiving what I knew to be the best possible medical care, I was declining so rapidly I could no longer provide for my family’s basic needs or mine. Gone was the woman whose pas-

sion it was to care for families and solve the puzzles their symptoms, labs and diagnostic tests presented. I was lying on the floor between each patient I saw. Lost was the ability to exercise, dance, garden, cook and watch my kids sporting events. It was then that I discovered The Martial Arts Center for Health in Altamonte Springs. I was simply searching for a place where I could become more mobile and active and lessen my pain. What I found far exceeded my expectations. I was introduced to restorative exercise. Most importantly, it was not my skill level, my fitness level, nor my physical limitations that mattered. I mattered. At MACH I was being empowered to harness my body’s natural ability to heal itself. Each time I would go to class I would leave with a little more energy than when I came in. Slowly, I regained use of my arm. I stopped resisting and fearing the pain and learned how to incorporate it into my life. My pain improved and I no longer spent the majority of my day lying down. I was slowly getting my life back. What I did not expect to gain from my training was improved confidence, making important changes in my life became much easier, and I was stronger as a person overall. The Center has been in business for over 25 years and utilizes a combination of

Kung Fu, Bagua, Tai Chi and Qigong. The instructors have a minimum of 14 years experience and have all been personally trained by the owner Thomas Curtin. Students are taught to do the movements in a way that is safe for their body at the time. SelfDefense, which is also a portion of the curriculum, is practiced in a safe environment and is always optional. If self-defense is of no interest to the student alternative movements are offered at that time. This is a fantastic opportunity for empowerment, growth, and recovery for patients who may have suffered from a traumatic past. The training can be tailored to students in a wheelchair or who use a walker. Because their style and teaching methods are so unique prospective students are offered a free private lesson to avoid any intimidation affiliated with trying martial arts. Continued private lessons are available to those not interested in a group setting. A free Qigong class, open to the public, is also offered on Friday evenings. Not everyone training at MACH has a specific diagnosis or ailment. Everyone can benefit from their curriculum. The instructors treat each member with respect, care and dignity to help them develop physically, mentally, and spiritually. Not only have I

heard stories of tremendous personal growth, I have witnessed students, who are already training at the center, recover from surgery much quicker than expected, recover deficits after a stroke far beyond what is typically expected. Improved focus, stress reduction and increased flexibility are just a few of the additional benefits I haven’t mentioned. While it may seem counterintuitive to suggest martial arts to someone in severe pain the Martial Arts Center for Health is a much-needed resource in the medical community and one I wish I had when I was practicing. For more information please visit martialartscenterforhealth.com.

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Dr. Goldin graduated medical school at the Wright State University School of Medicine in Dayton, Ohio.  She completed her Family Medicine Residency at Dayton Community Family Medicine Residency.  She is board certified in Family Medicine. For more information please contact Dr. Goldin at jlgoldin@comcast.net.

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HEALTH INNOVATORS

Breakthrough Medicine for All of Us FEATURED INNOVATORS: SYNDAVER LABS: Founded by Dr. Christopher Sakezles, these

award-winning synthetic cadavers replicate real human and animal tissue and bodily functions like breathing, bleeding, blinking, and moving limbs. The products replace the need for human cadavers and live animal testing. Practical applications include medical device studies, surgical simulation and clinical training, as well as for developing military weapons and armor systems. The level of detail is so specific that it can emulate validated pathologies such as scar tissue, tumors, and vascular plaques. www.syndaver.com

DISPATCHHEALTH - 2017 Winner of Florida Hospital’s InnovationX Competi-

tion- Denver-based Co-founder and CEO Mark Prather MD, MBA, pitched his team’s on-demand triage and urgent care solution that provides advanced medical care in the home and workplace, as well as care navigation via phone and telemedicine consultations. DispatchHealth partners with employers, SNFs, ACOs, and hospital systems to provide the appropriate level of care for a given disease process to reduce costs for emergency departments. The platform is not yet available in Orlando but given the new relationship with Adventist Health System, it may not be long before it arrives. www.dispatchhealth.com/ By KELLI MURRAY, MedSpeaks

The National Institute of Health (NIH) recently launched a pilot-project called All Of Us that will collect and study the genetic, lifestyle, and environmental data of 1 Million people. The objective is to answer the question, “Why me?” when it comes to disease. Scientists of the study will be looking for patterns and combinations of factors that increase risks for certain diseases (beyond cancer) with the ultimate goal of providing personalized forecasting and care treatment. Eric Dishman, a former Intel executive and survivor of a rare kidney cancer, is leading this project with what is expected to be the largest database of its kind. His personal aim is to widen a patient’s access to the types of precision medicine that saved his life. As reported by the Associate Press, according to Dr. Francis Collins, director of the NIH, “The DNA is almost the easiest part.” However, he adds that the greatest challenge is, “figuring out how to put all that (DNA information) together to allow somebody to have a more precise sense of future risk of illness and what they might do about it.” This invitation-only study will follow participants over 10 years and involves the capture of standard health and medical record data, DNA profiles, and intends to include wearable sensors to track vital signs and environmental exposure, such as air quality. The observational research study is not just unique in size and scope. Its goal is to enroll people across ethnicities, socioeconomic status, and geographies; particularly for those who have been historically underrepresented in research. Additionally, unlike traditional study models, the data and various testing results will be made available to participants who can then share their information with their providers. Data sharing is a key element to NIH’s mission to speed up health research breakthroughs for all of us and gives new meaning to being called “one in a million.” To learn more visit: www.joinallofus.org. orlandomedicalnews

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GET INVOLVED

SENSCIO SYSTEMS - Physicist and CEO, Dr. Piali De, cofounded this AI-Driven home-to-clinic population health system to personalize care for chronically ill and at-risk populations. The robust digital platform allows patients to actively engage in self-management while artificial intelligence (AI) processes data and monitors changes in behaviors and vitals that call for care team intervention. In 2016, the company participated in a HealthBox accelerator program at GuideWell Innovation in Lake Nona, Florida. Since then, Senscio was named one of the “10 Most Promising Population Health Management Solution Providers – 2017” by “Healthcare Tech Outlook” magazine.

ORLANDO TECH WEEK OCTOBER 6-14 Theme: Smart Cities, Health & Wellness www.orlandotechweek.com

HEALTH+ACCEL NOVEMBER 3, 2017

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.

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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

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

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Financial Success – Sweating the Big Stuff … Literally By DALIA CANTOR, CPA

I am a CPA and naturally my work is all about finances and helping my clients grow their businesses to their highest potential. I am also an Ironman finisher, which is a triathlon competition that includes 2.4-mile open water swim, 112 mile bike ride and 26.2 mile run – all must be completed within 17 hour timeline. You might ask ‘what does an Ironman has to do with financial success?’ My answer is – everything. Competition in sports is no different than a competition in business – it requires determination, preparation, endurance, discipline and consistency. Many of you will think that this is absolutely insane, but you might be surprised that many of the Ironman competitors are doctors, lawyers, CEO’s and other professionals that have very demanding work lives. Naturally these people have A type personalities that drives them to compete, not only in their business world, but also outside of it. I want to share with you things that I’ve learned from preparing for and competing in an Ironman triathlon: • Focus – once I made a decision to do an Ironman, all my actions were designed around it - I changed my sleeping regime and made my day

as efficient as possible fitting in my client meetings and workouts. It’s no different when you are focused on growing your business – you create a plan of action and you change your routine to execute it. • Discipline – this is probably the biggest take away for me personally, even to this day. It takes enormous discipline to train for an Ironman and I am talking about 15 to 20 hours of training per week, which is of course in addition to your day job. No other event in my life has brought me as much discipline as training for an Ironman. I would get up at 4:30 am, run 17 miles and be in the office by 9:30am. I knew I had to do that if I wanted to succeed in the race. • Determination & commitment – I really wanted to succeed and complete in this race and therefore I was very much determined. It’s like anything else in life – if you are determined, you will commit to the necessary actions and therefore succeed. Determination will translate into a commitment which will help you stay disciplined in a long run. • Sacrifice – again, real life kicks in – something has to give. Success

in sports or business does not come without a sacrifice. While training for the ironman I had to give up a lot of social and other activities but this is what I wanted and therefore the sacrifice was worth it to me. Nothing great in life comes easy but if you want it bad enough you can achieve it! • Desire – everything is meaningless without a passion and desire. Desire is what drives people to make certain commitments and sacrifices; desire will push you to do better than mediocre and will give you courage and strength. The finish line is so rewarding and I relive it in my mind quite often, especially when things get tough or I lose my mojo for a moment. So, dream big, get serious about your desired achievement and choose growth! 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

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HEALTHCARELEADER Thibaut van Marcke, continued from page 1

person you’d want in a medical emergency but we have a tremendous group of doctors, nurses, technicians and therapists. My job is to help identify barriers and to remove them. If we can do that effectively, I can go home at night knowing that our patients are receiving the best care possible. • OMN: You’ve been at your present post about a year and a half now…what have you learned about working with the staff, the board and employees at the hospital? Are there some unique/interesting qualities you’ve discovered and want to encourage, improve on or change? • TvM: I’ve learned that the abilities of our staff and physicians is virtually limitless. I am fortunate to work with a talented and creative team who is dedicated to achieving excellence. In my role, I intend to continue to support that innovation so that we can continue on our journey toward excellence in everything we do. • OMN: Of all the things you would especially like to bring to the hospital what’s most important? • TvM: I hope to continue to create an environment that supports innovation and achievement. The healthcare industry faces many challenges in the coming years and the greater our ability to solve problems and redesign processes, the better prepared we will be to thrive. • OMN: What projects do you have going online in the next 5 years and what long-term projects do you want to get started with? • TvM: Dr. P. Phillips Hospital is in the midst of a tremendous growth period. As a result, we have a number of projects planned that will expand our capabilities as well as make our services available to a broader population. In 2018, we plan on opening an outpatient cancer center on the hospital campus as well as a free-standing emergency department located in Kissimmee. We are also in the beginning stages of planning for additional operating rooms as well as new patient rooms that will be designed with comfort and patient convenience in mind. • OMN: There’s been a noticeable trend in cost difference for services performed in a hospital setting and services at stand-alone centers. What are the moves being made to address the issue? • TvM: Orlando Health and Dr. P. Phillips Hospital have been very focused on expanding our ambulatory capabilities to address that very issue. Just last year, we opened the Orlando Health Medical Pavilion at Spring Lake (Located next to Dr. Phillips Library) that houses physicians in numerous specialties as well as an outpatient lab, pharmacy and imaging center. The intent is to make services that don’t need to be in the hospital more convenient and cost-effective for our patients. We have also recently partnered with CareSpot who is an urgent care provider in the community and is now affiliated with Orlando Health. We have additional outpatient centers planned in the community that will make access to care more convenient and affordable. (CONTINUED ON PAGE 23)

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Why Doctors Say Outsourcing is the Way to Go By MARK A. LANTON

Long gone are the days when doctors were strictly focused on giving great patient care and maintaining the optimum health of their patients. In this present day, physicians wear the dual hat as the medical doctor and businessman. We have said, “so long” to those times when your doctor gave your school immunizations, then broke off the needle and gave you the syringe to fill with water to squirt people (that was my flashback when I was six years old). It would be unheard of to hear that we have only one doctor for the entire town we live in who still makes house calls. In addition, those days of billing the insurance company on paper forms is past-history. Fast forwarding to 2017, the demand for perfection in medical billing is predominant. It is common that doctors use in-house billing/coding personnel. Insurance companies will try to find a way to deny/reject any medical claim. A simple “typo” or wrong date of birth is cause for rejection. This means extra work for the physician and/or staff to make corrections and re-submit the claim. The time taken to do these preventable tasks costs money and does not add value to the practice. If a doctor sees 400 patients per month and their rejection rate is 20%, that’s revenue from 80 claims at risk of being thrown down the drain every month. Instead of re-submitting the claim, doctors are taking the loss and “write off” that lost revenue. Another concern that can accompany inhouse billing personnel is compliance, or lack there-of. These kinds of practices have possible increased risk of liabilities due to the inattention of un-appealed claim denials and ignored encounter forms. In-house billers come with higher costs. The burden of paying salaries, benefits, training and purchasing the necessary systems, requires some hefty cash. On top of that, the worry of maintaining computer servers, occasional system upgrades and limited IT support can drain finances. Another issue with in-house billing personnel is when that employee calls in sick, goes on vacation or takes a leave of absence, there is a void that can cause unbelievable strain. Doctors have found a way to minimize or eliminate the struggles that accompany the usage of in-house practice management staff. As an alternative to closing their doors and working as an employee at a hospital or a medical group, doctors are outsourcing their practice management activities at an alarming rate. The primary factor for the demand of outsourcing is less cost, a higher quality product and increased revenue. Outsourcing focuses on increasing a practice net yield while decreasing expenses. Outsourced billing companies are known to orlandomedicalnews

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Once a doctor chooses to outsource, the benefits are superior. There are no more computer software upgrades or buying expensive computers. No more days of being short staffed and over worked ... use ultra-secure cloud-based billing systems that upgrade automatically. Their services can provide periodic reports so doctors can keep control, see trends and prevent claim discrepancies. Plus, they are HIPAA, HL7 and Meaningful Use Certified. Outsourcing your billing services can ensure your practice will maintain compliance and remain current on all CMS directives. With the feature of a clearinghouse, medical claims are scrubbed to detect errors. These errors are automatically corrected and the claim is then submitted. It is not unusual for a physician practice with in-house billers to have a claim rejection rate above 30%. Outsourced billing companies are known to utilize the clearinghouse technology, which can dramatically reduce the claims rejection rate to under 5%. Once a doctor outsources, they immediately increase their cash flow and their expenses will decrease. It is very likely that when a physician practice outsources their billing, the doctor will see a quantity of under-paid claims and notice the lack of follow-up for unpaid claims, as a result of their previous billing operation. Outsourced billing companies like to pride themselves in being dedicated to regular follow-up on unpaid claims because that is a major area of lost revenue due to not filing in a “timely” manner. To sum it up, the contrast between in-house and outsourced billing operations are very clear. The “out of pocket” difference is indisputable, and the quality of the outsourced product is undeniable. Once a doctor chooses to outsource, the benefits are superior. There are no more computer software upgrades or buying expensive computers. No more days of being short staffed and over worked. Outsourcing can free up those in-house employees so they can focus on giving quality health care. The outsourcing solution can increase practice efficiency, boost compliance, and most importantly increase revenue. The outsourcing company insures to have the best interest of a medical practice at hand because the more money the practice generates, the more money they make. Mark A. Lanton, (CMRM) is founder/CEO of Lanton Consulting, LLC., and specializes in medical revenue management, practice management, revenue cycle optimization and private practice business support. Visit the website at www.LantonConsulting.com or email Mark@LantonConsulting.com

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

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The Deep Dark Web By RON FRECHETTE

In last month’s article, Healthcare Practices Hammered by Data Breaches and Ransomware in 2017, we discussed the importance of protecting PHI and why it is so valuable to cybercriminals. We mentioned the Dark Web which sparked lots of questions. So, for this month, we thought it would be good for physician offices and their staffs to begin learning more about the differences between the Surface Web, Deep Web and Dark Web. It is important for us to understand these components of the web to better protect our practice and patients from becoming victims of cybercrimes.

The Internet and World Wide Web Let’s take a step back and start with a basic understanding of the Internet and World Wide Web interact together. The Internet was built in the sixties by the Defense Advanced Research Projects Agency (DARPA ). It is basically a massive group of computer networks interconnected across the world that link everyone together. The World Wide Web was invented in 1991 in, of all places, a nuclear particle physics research lab near Geneva, Switzerland. The WWW consists of protocols used by web browsers that talk to servers that allow us share content and files over the internet. Think of your voice or other forms of data transferred via a phone line. The world wide web works very similar on the internet. Now, let’s take a look at the different areas of the World Wide Web.

of what is visible to the public on the web.

The Deep Web The Deep Web consists of about 7.5 petabytes of space and makes up about 96% of the internet, about 500 times larger than the Surface Web. It encompasses all sites that are not indexed by standard search engines. We are on the Deep Web more often than we realize. For instance, logging on to any website that requires certain credentials to access your account would be considered, “on the Deep Web.” Basically, the Deep Web is invisible to everyone at the Surface Web level which is why we hardly hear about it. One of the biggest draws of the Deep Web is the ability to access an endless list of various (legal and illegal) on-line marketplaces anonymously. In order to access the Deep Web, you must download a dedicated browser from a specific website. The Onion Router (TOR) is most com-

The Surface Web The Surface Web consists of any web pages a search engine like Yahoo, Google or Bing can find and index. The Surface Web represents about four percent (4%)

monly used although there are alternative solutions. This action may send a red flag and prompt the FBI and/or a few other law enforcement agencies to begin keeping an eye on you… especially if you decide to venture into The Dark Web!

The Dark Web The Dark Web consists of servers that cannot be accessed by search engines. Not much of anything positive happens on the Dark Web. On the contrary, you have access to sites that promote illegal drug sales, child pornography, prostitution, human trafficking, weapons trading, buying counterfeit money, watching live murders, and hiring a hitman. You name it… you can most likely find it on the Dark Web. And let’s not forget our global terrorist friends. Yes, they too have a place in the Dark Web that allows them to communicate, recruit and transfer assets anonymously. The Dark Web is also the place

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where cyber criminals come to buy and sell all the Protected Health Information (PHI) they steal from us. In closing, we cannot emphasize enough how dangerous it is for anyone to be on the Dark Web. Everyone is masked in anonymity with the intention of causing people massive harm in their lives. It’s about as close to hell as you can get on-line. And rest assured, if you attempt to access the Dark Web, you will most likely be receiving a visit from the FBI, your local friendly law enforcement agency and quite possibly a cybercriminal or two who may have uncovered your true identity.

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Hurricane Preparedness for Hospitals, How Much is Too Much? By SUSAN BITAR, RN, MSN

The 2017, hurricane season has been an eye opener and has prompted hospitals to adapt a costly and convoluted action plan to prepare for the impending natural disasters with the potential for mass casualties. In 1980, the natural disaster preparation plan for a hospital, consisted of making sure the hospital staff, administrators and doctors are on standby at their residences and have a viable mean of communication, merely, a phone line and a pager. The local sheriff was also alerted in case help was needed to assist doctors and staff to get into the hospital if access was limited due to the disaster itself. Back then, there was no need for extra personnel to stay in house (camp out at the hospital) unless a medical staff member knew ahead of time that he or she would be cut off during or after the disaster. The cost of disaster preparedness was due to lack of new patient admission and cancellation of elective procedure when the local community is hunkered down during the natural disaster. In 2017, the natural disaster preparedness is a complex process and has many disciplines: • The maintenance crew and engineers have to be deployed on site to help maintain and implement backup plans for power loss, water damage, flooding, contamination of water supply, alternative shelter if upper floors are damaged or lower floors are flooded. • The administrative team has to be on site to assess disaster related problems and to make decisions as problems arise. • Additional staff and certain specialty physicians have to be in house in case access to and from the hospital is impeded by the disaster itself. • The patients who could not be discharged from the hospital prior to the disaster and their families that wished to sleep in a cot next to them and the family members of anyone on the hospital ancillary personnel or medical staff along with their loved ones who could not be left home alone ( a vulnerable family members at home during the disaster, single parent with children, elderly parent, family members with special needs etc). It is no surprise that a hospital facility that ordinarily has 150 patients and 250 support staff finds itself housing a patient load of 50 but with 250 support staff and additional 200 family members (patient families and staff families). This demands additional security staff, additional food services and housekeeping personnel to deal with this hospital population over-

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load. The hospital is now saturated to maximum capacity and turns into a large: part shelter part hospital. One can only imagine the financial and manpower burden on the hospital during the natural disaster – couple that with halted elective procedures during and after the disaster due to community recovery efforts. Normally, the local authorities and federal government agencies have various search and rescue plans that have manpower resource limitation and budget restraints attached to it. The national guard search and rescue policies factor in the risk to first responders, the available manpower and the cost of the mission. Sometimes,

judgment is made by the local officials in charge, to abandon a search and rescue mission based on various factors, some of which may be exhausted manpower resources, low yield of a successful mission and exhausted financial resources. In case of a flood of injuries during a disaster, the fact that the hospital is already saturated with staff, ancillary staff, families and pre-disaster inpatients, is a detriment. The overpopulation of the hospital will impede the work flow and limit the hospital’s ability to accept and care for a large number of disaster related injuries. All local and federal agencies including FEMA, operate within a limited budget and, therefore, hospitals too, may need

to revisit the disaster preparedness process and consider the financial ramification. The preparedness execution plan should not have an open account expense and should have reasonable fiscal restraints. The hospitals taking on the role of a part shelter, as a way to accommodate extra ancillary staff and family, put the facility at greater risk if the physical building itself is affected by the disaster, for example, fire, flood, partial building destruction. The added number of people in the building puts more stress on the resources to help a hospital population in need of dire help. One idea to consider, is to designate a nearby shelter for the ancillary staff families, so the staff can feel that their families are close by and yet protected. Another idea is to classify the necessary added ancillary staff into group A that has to be on the premise during the impending natural disaster and group B, that can stay with their family in the nearby shelter and can be quickly transported into the hospital if the need arises. The medical facility should incorporate an expense account to fund the disaster related financial burden and attempt to stay within an allocated annual fiscal budget. Susan Bitar, RN, MSN, is a professor in the Department of Nursing at Seminole State College in Altamonte Springs, Florida. She can be reached at Suebitar@gmail.com

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Top Three Reasons Medical Practices Fail to Reach Their Goal By JAY A. SHORR and MARA L. SHORR

As medical practice consultants, we have clients throughout the United States and Canada whom we assist with their operational, administrative and financial health and goals. When we first begin working with a client, we have an onboarding conversation and many times an extensive questionnaire to determine the current status of their practice. Regardless of why, where and who our clients treat as patients, there is one mandatory commonality, and that is the ultimate safety, treatment and care of the patient. Upon performing best medical practices, you can never lose sight of the fact that your medical practice is indeed a business and must be treated as such. Several common factors lead to a practice’s demise or stagnated growth, and your mission is to reduce or eliminate what’s keeping you from being at the top of your “business” game. How many years did you spend in medical school? How many courses did you take to teach you how to run a business when you decided to go out on your own? For the majority of the providers we speak with, the answer is shockingly low, if not zero. What are the top three reasons medical practices fail to reach their goals?

1. Failure to Properly Plan. You have heard this many times before, but it’s true. The failure to properly

plan and forecast your business is like going to an unknown destination without a map or set of directions. Failure to plan is most certainly planning to fail. This should include a proper and executable plan, illustrating a financial, administrative, and marketing component. Your financial plan should incorporate pro forma revenue and expense generation. If you can’t increase your revenue, at least curtail your expenses. Every dollar you save in expenses is a true net profit dollar, while a revenue dollar possibly generates 15%-35% of net profit. Once you complete this portion, it must be reviewed, reviewed, and reviewed again. Your administrative plan should include your policies, procedures, and protocols, similar to a head coach of a sports team. They call it a playbook, and that’s exactly what it is in your practice. Each facet of your practice must have protocols that everyone must follow with NO EXCEPTIONS. Administrative plans also include human resources and an employee handbook, which is probably your most important asset. Marketing plans allow you to sell yourself to the public, outside of insurance company referrals. Most importantly though is how you capitalize on your marketing efforts. Don’t spend time or money on marketing if you can’t measure its effectiveness. Another cliché is you can’t manage what you can’t measure. Determine your ROI (return on investment) to quickly modify your plan if you find that you do not have a sig-

nificant return. Realign your marketing budget on the things that bring in the most margin, making sure to review options that include, but are not limited to, print, digital media, social media, on-air media, community outreach, public relations and more. Again, this doesn’t mean you have to include each aspect of those items into your marketing mix, but it does mean you need to make an educated choice about what you will and won’t be including.

2. Failure to Hire Properly. Human resources are one of your top assets, yet medical practices do not invest enough in their staff. Consequently, there is always an excessively high turnover which can cost the practice approximately 25% of a new hire’s annual salary. Why are you willing to pay a higher starting salary to a new employee who has experience instead of a paying your existing staff member a higher wage? When you pay peanuts… you get monkeys. Your recruitment, consideration of employment, official hiring, orientation, ongoing training and incentives must be clear, concise and consistent. Hire from appropriate resources, always call references and check applicant’s social media sites. Many of our clients have us perform background checks (state laws dictate criteria) but you must have the person’s written permission.

3 . Failure to Properly Know Your Fixed and Variable Expenses

When was the last time you really looked at what you were paying for everything in your practice? Remember, every dollar in expenses is a true profit dollar, so every opportunity you miss to save money, is an actual lost dollar. Many expenses that can be reduced are your cost for supplies. Are you enrolled in a buyers group or club? Do you actually take the early pay discounts? Do you purchase in bulk for a discount or is bulk tying up needed capital? Many of your long-term agreements can be re-negotiated. These include, but aren’t limited to, maintenance (A/C, electric, plumbing, cleaning services, capital equipment maintenance agreements, etc.). When was the last time you checked your biomedical hazardous waste disposal cost? Have you compared it to other licensed companies? You may not even need the level of service you are being billed for. Review your additional patient financing options. If you ever need to utilize these type of services, there are multiple resources that can save you up to 10% of your procedure cost in FREE patient financing. Make sure you’re evaluating the costs associated with potential or current programs in use for your practice. Did you know that there are hundreds of merchant processor fees credit card merchants can charge you? Credit card processing is charged to you by a fee on top of what the credit card company actually charges, per transaction fees, possible statement fees, compliance fees, chargeback fees, cancellation fees, etc. It can be complicated if you don’t know how to properly review your statement. They are meant to be confusing so transparency is difficult, so be sure to closely evaluate your statements or, if needed, request the assistance of someone who can help you do so. Remember, as Benjamin Franklin said, “A penny saved, is a penny earned.” Jay A. Shorr, B.A., MBM-C, CAC I-X, is the founder and managing partner of Shorr Solutions, assisting medical practices with the operational, financial, and administrative health of their business. He is also a professional motivational speaker, an advisor to the Certified Aesthetic Consultant Program, and a certified medical business manager from Florida Atlantic University. Mara Shorr, B.S., CAC II-X, serves as the vice president of marketing and business development for Shorr Solutions. She is level II-X certified aesthetic consultant, utilizing her knowledge and experience to help clients achieve their potential. She is also a national speaker and writer. Visit http://www.ShorrSolutions.com

OCTOBER 2017

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HEALTHYWEALTH

Wealth, Taxes & Health – A Value Proposition By DEBRA L SEPHTON

My favorite quote by Isaac Newton, “What we know is a drop, what we don’t, is an ocean,” comes into play a great deal in my practice when it comes to clients getting ready to retire and or turning 65. My best clients will educate themselves by researching or allowing someone else to provide their expertise, which is why they seek my advice. When I was looking to reallocate a portion of my retirement funds several years ago, I decided to look at my options and what I discovered, changed my financial picture. I’ve learned there is a threat that most of us don’t consider when we approach the subject of planning for our financial future. This discovery changed how I structure my practice and it has proven to be extremely beneficial for my clients. The traditional “retirement account” also known as the 401(k) is a wonderful plan, enables an employee to contribute pre-tax dollars which an employer may match a portion of and the account grows tax deferred. Reducing taxes on earnings and on growth, plus the employer matching contributions are a winning strategy, right? So, now that you have accumulation and growth covered, what about distribution? Here is where taxes show off its fancy foot work, (but not before age 59 ½ or you’ll pay a 10% penalty). Here is the most overlooked problem; during our working years, we have the greatest opportunity for applying tax deductions, such as business expenses, child care, mortgage interest, college, etc... but as we near retirement and we’ve sold the business, grown children, paid mortgage, what’s left to offset this income which is now going to be 100% taxable? How do we protect this wealth from tax erosion? The threat of taxes is real, dissolving a significant portion of a portfolio, reducing generational growth… how do we combat this inevitable event? Possibly by limiting 401(k) pre-tax contributions. By contributing pre-tax salary only as much as the employer matched percentage of your income. The remainder could be placed in an age-old idea implemented by millionaires for centuries, a cash value life insurance policy. I know, life insurance? That’s exactly what I thought when I first heard of this concept. But the more I learned and discovered the value of this powerful tool I was on-board and made a step forward to own one. Cash value life insurance is not only used for a death benefit but also as a hedge against taxes, here’s how. After-tax dollars placed in a cash value life insurance policy grows tax deferred, may be orlandomedicalnews

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taken from the policy pre-59 ½ without the 10% penalty, and may be used for any purpose. When structured properly and distributed properly these funds are generally tax-free. Riders may also be available with some carrier’s which offer lifetime income protection, critical and terminal illness. Cash value of these polices build without market risk, never decreasing due to market volatility, providing peace-ofmind and enabling retirement planning at a time you choose, not the market. Another tidbit most people wish they you knew before they retired and one most every financial planner is either unaware of or does not pay attention to, is the Medicare Income Related Monthly Adjustment Amount (IRMAA). I can’t tell you how many of my clients consult with me regarding Medicare Supplements, they are totally unaware of the amount of money their Part B (medical) and Part D (pharmaceutical) monthly premiums will cost them. In 2017, a married couple with a 2015 tax return (yes, they look back 2 years) modified adjusted gross income (MAGI)

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above $170,000, will pay more for their Part B which is currently $134.00 each per month for most individuals. A couple with a MAGI above $428,000 will pay $428.60 each per month. Part D may cost more as well, depending on MAGI but minimal in comparison. Another reason why a pre-tax retirement account, such as a 401(k) or IRA, combined with after-tax/tax-free accounts, such as cash value life insurance, may be the answer to an overlooked surprise when retirement is realized, taxes and Medicare planning. The dollars received properly from a cash value life insurance policy generally will not create a taxable event, generally will not trigger a 1099 form, and generally will not increase Medicare premium costs or additional Social Security taxation when structured properly. Overall, there are specialty products and consultants available when seeking alternative and complete advice when it

comes to hedging life’s unforeseen obstacles. Planning for retirement is not just growing the allimportant portfolio, but also reviewing the impact of Social Security benefits, Medicare, Long Term Care and Life Insurance. There comes a time when the distribution and wealth preservation need to be addressed and after retirement is too late for most people. Consulting with a Life and Health Insurance agent who specializes in specialty designed cash value splans, Medicare and Long-Term Care Insurance planning will complete the total retirement picture. This article is not intended to provide legal or tax advice and cannot be used to avoid tax penalties or to promote, market, or recommend any tax plan or arrangement. Atlantic Benefit Consultants, LLC and Debra L Sephton do not give legal or tax advice and do not work for Medicare. You are encouraged to consult your tax advisor, attorney or Medicare directly. For more information, please email Deb@AtlanticBenefitConsultants.com

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OCTOBER 2017

The Einstein Method There are 3 methods to treat obstructive sleep apnea non-invasively. Two methods have been traditional. The earliest method was CPAP which continues to be effective especially for the treatment of severe sleep apnea. Many patients, however, cannot tolerate CPAP for many different reasons. The second traditional method has been a custom-made, intra-oral sleep apnea appliance. Recently, a third method for the treatment of sleep apnea has been developed. It is called the Einstein Method. The beauty of the Einstein Method is that it can be used as a stand-alone technique, or used with either CPAP, the intra-oral appliance, or when CPAP, and he intra-oral appliance are used together. It is important that you understand how the Einstein Method works. This understanding can motivate you to easily incorporate the Einstein Method into your daily schedule. Doing so will improve your sleep and give you more daytime energy. The most common cause of obstructive sleep apnea is when the base of your tongue falls posteriorly to the back of your throat, thus blocking the airway. Figure 1 shows the back of the tongue obstructing the airway in the area of the throat between the soft palate and the epiglottis. Keeping your tongue forward will be helpful to prevent this posterior collapse. There is only one muscle that can keep your tongue forward. It is called the genioglossus muscle. Forward tongue position is accomplished by strengthening the genioglossus

muscle. The Einstein method is designed to strength the genioglossus muscle. The stronger the muscle, the more forward will the tongue rest, thus keeping your airway open. Figure 1 shows the genioglossus muscle. This muscle is the only muscle that connects your tongue to the lower jaw. It is the only muscle that moves your tongue forward. By virtue of the anatomical connection of the genioglossus muscle to your lower jaw, the tip of your tongue can move forward, completely out of your mouth. The genioglossus muscle is fully contracted only when the tip of your tongue is sticking completely out of your mouth. In order to strengthen the genioglossus muscle to its full potential, full contraction of the muscle is necessary. However, we as human beings seldom stick the tongue out of the mouth. The common activities of the tongue – talking, singing, eating, swallowing – keep the tongue inside the mouth. Thus, the genioglossus muscle is almost never fully contracted, and so, it is never fully strengthened. Moreover, with age, muscles get weaker including the genioglossus muscle. As the genioglossus muscle gets weaker, the more apt it is to fall posteriorly to the back of your throat and block your airway. Brian D. Fuselier, DDS and Barry A. Loughner, DDS, MS, PhD, are members of the American Dental Association. Dr. Fuselier and Dr. Loughner are in private practice at Central Florida Oral and Maxillofacial Surgery in Orlando. For contact information visit their website: Dr. Fuselier and Dr. Loughner are at www.cforalsurgery.com.

Figure 1: Strengthening the genioglossus muscle will tend to hold your tongue in a more forward position in your mouth while sleeping. When you are sleeping on your back, gravity tends to force your tongue back and narrow the airway or temporarily completely block the airway as shown in Figure 2. Note that in Figure 1 the airway is open and airflow is normalized. When the genioglossus muscle is strengthened and toned to a maximum degree, the tongue works against the force of gravity to keep the airway open.

THE EINSTEIN METHOD

A daily Method for people with sleep disordered breathing. It is important to gradually protrude (stick out) your tongue keeping your upper and lower lips around your tongue. Do not open your mouth wide. Protrude only ½ inch for the first month, and for each successive month another ½ inch reaching its greatest protrusion in 3 months. 1. Protrude your tongue for 30 seconds, then relax your tongue for 30 seconds. 2. Repeat 5 times 3. Perform this method 3 times per day This Method may appear unusual,

and for some patients embarrassing even when performed alone. Therefore, perform this Method during non-social occasions, such as driving alone in your car or in the shower. As a beginner, do not perform this Method when lying on your back. Strengthening the genioglossus muscle is extremely important to help hold your tongue forward during sleep. As adults, we rarely fully use this muscle. Thus, make this Method a part of your daily routine.

Figure 3 shows the tongue position for each successive month.

First Month 16

Second Month

OCTOBER 2017

Third Month

Fully Extended

Figure 2: The single page instruction sheet for the Einstein Method is attached. Follow the step-by-step instructions. It is important to remember to begin the Einstein Method gradually. Your genioglossus muscle is, at present, very weak. It has been weak for a long time. If when you start the Method and begin by fully contracting the genioglossus muscle by sticking the tongue out to its maximum extent, you can injure the muscle. For the first 3 months of performing the Einstein Method, you must gradually protrude the tongue. Figure 3 shows the tongue position for each successive month. orlandomedicalnews

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OCTOBER 2017

GrandRounds Shepherd’s Hope Breaks Ground on New Healthcare Facility City and health care leaders gathered to break ground on construction of Shepherd’s Hope’s new West Orange Medical Clinic & Administrative Center (WOMC&AC) in Winter Garden. The facility will provide greater access to free health care services for the growing West Orange County community, including essential primary and secondary medical services, health management and education, and wellness programs. The WOMC&AC is a collaborative partnership among Shepherd’s Hope, the West Orange Healthcare District and the City of Winter Garden: • The 10,200-square-foot facility marks a significant milestone for Shepherd’s Hope, representing the first permanent location for the 20-year-old organization that also operates five other free and charitable clinics in Central Florida. Since opening its doors in 1997, Shepherd’s Hope has provided free medical services to more than 237,000 patients. • The West Orange Healthcare District has pledged a $1 million matching grant to be used for capital facility construction. “In addition to offering free medical care, this facility will also provide greater access to healthy food, creating a holistic approach to caring for the most vulnerable members of our community,” said Tracy Swanson, executive director of the West Orange Healthcare District, whose focus is on enhancing health and wellness in west Orange County. “It’s in perfect alignment with our mission and we’re proud to have provided the seed capital for this project.” • The City of Winter Garden is leasing Shepherd’s Hope two acres of land at 455 Ninth Street. Notably, the location is just blocks away from the first Shepherd’s Hope’s clinic that opened in 1997 at the Westside Vocational Technical School. “Shepherd’s Hope has been an effective healthcare resource for two decades in our community, reaching those in need by providing much needed medical visits to the uninsured,” said City Manager Mike Bollhoefer. “We are pleased to work with them in bringing a permanent medical clinic and their administrative center to Winter Garden.” Other “Founding Legacy Donors” include: • The West Orange Health Alliance has contributed $500,000 toward the West Orange Healthcare District’s $1 million matching gift. • Dr. Phillips Charities has committed a $250,000 matching pledge toward the project. • St. Luke’s United Methodist Church has committed $100,000 to build out as a tenant in the new facility with a two-fold purpose. The first is to serve as a teaching kitchen to help Shepherd’s Hope patients and local residents learn how to prepare nutritious meals. Second, it will support a small farmers’ market planned for the adjacent city site by allowing vendors to use the space to prepare food products for

OCTOBER 2017

sale. St. Luke’s church is the founding organization for Shepherd’s Hope, based on a desire of its former lead pastor, Dr. William S. Barnes, to deliver health care to the community’s most vulnerable citizens by raising critical dollars while volunteer doctors and nurses treated patients in donated spaces. The WOMC&AC will include a 3,500-square-foot administration center, a 5,600-square-foot health center and St. Luke’s 1,100-square-foot nonprofit community kitchen. Shepherd’s Hope provides free primary and secondary medical services to the 1-in4 Central Floridians who are uninsured or underinsured, including children. An estimated 850,000 Floridians remain in a gray area - in the coverage “gap” in regards to insurance availability - earning too much to qualify for some programs, but not enough to afford products offered on the Healthcare.gov exchange, even with federal subsidies, because of out-of-reach deductibles and co-payments. “It is significant in our 20th anniversary year that our new health care facility will return Shepherd’s Hope back to its roots in East Winter Garden where our first patient was treated,” said Marni Stahlman, president/ CEO of Shepherd’s Hope. “Joined again in our mission, as we were then, by longtime health care partners, Florida Hospital and Orlando Health, we now welcome the West Orange Healthcare District, West Orange Health Alliance, Dr. Phillips Charities and the City of Winter Garden into our family of ‘caring people, caring for people’. United, along with our amazing volunteers, we will bring access to essential health care services that will transform the lives of those in need.”

Cutting-edge Blood Analysis Service to Realize Use in Healthcare Finnish biotech Nightingale Health, which provides a comprehensive blood analysis service world-wide to universities and medical research institutions, has announced a pilot of its technology in the healthcare sector. The goal of the pilot, in partnership with Finnish health service provider Coronaria, is to verify that Nightingale’s service can be successfully applied within a healthcare setting. Nightingale's blood test can replace many routine blood tests currently used in healthcare (e.g. glucose tests). Additionally, Nightingale’s service provides other blood biomarkers that can enhance disease risk prediction. In the long-term, Nightingale plans to provide better tools for clinicians, enabling preventive healthcare for chronic diseases, such as diabetes and cardiovascular disease. "The only sustainable way to reduce the burden of chronic diseases is to invest in their prevention. The goal of this cooperative pilot with Coronaria is to prove Nightingale's technology's suitability for routine clinical use," said Nightingale Health's CEO Teemu Suna. The pilot's cooperative partner Coronaria is one of Finland's largest providers

Flamingos Flock to Lake Eola Park for the First Time to Kick Off Pink Out Initiative

Orlando Mayor Buddy Dyer, District 3 City Commissioner Robert F. Stuart, restaurateur John Rivers, and leaders with Florida Hospital for Women gathered at Lake Eola Park to kick off the annual Pink Out initiative, which provides access to care for under-served and uninsured women battling breast cancer. Florida’s iconic pink yard flamingos are a signature element of Pink Out, which coincides with Breast Cancer Awareness month. This year, flamingos are gathered in a flock at Lake Eola Park, representing the 1,890 women who will be newly diagnosed with breast cancer across Central Florida by the end of this year. “The City of Orlando is pleased to partner with Florida Hospital and 4 Rivers Restaurant Group on this important initiative,” said Orlando Mayor Buddy Dyer. “Each year, we enjoy seeing these flamingo flocks pop up around town, and they serve as an effective visual reminder of the importance of mammograms.” Florida Hospital’s Pink Out campaign began in Winter Park in 2011, and has since expanded throughout Central Florida. Proceeds from the sales of the yard flamingos and community donations have funded breast cancer screenings for more than 6,500 women who otherwise could not afford a mammogram. Several dozen of those women were diagnosed and treated for breast cancer. 4 Rivers Restaurant Group is joining this year’s efforts and encouraging Central Floridians to help spread awareness

through social media. To join and help raise funds, people are invited to post a picture of themselves person standing on one leg — like a flamingo — with the hashtag #jointheflock. The restaurants will donate $1 to the Florida Hospital Breast Cancer Care Fund for each post made throughout October depicting the flamingo stand and hashtag. “Breast cancer is a serious health concern for women of all ages,” Rivers said. “We are happy to support the Pink Out initiative and look forward to people across Central Florida ‘joining the flock.’” Throughout October, Florida Hospital is offering mammograms for $30. The screenings are offered at more than a dozen Central Florida locations. To learn more, visit 30minutemammo.com. “Breast cancer is very treatable when detected early, and we want women to know that getting a mammogram is not only extremely important, it can also be convenient and affordable,” said Dr. Lisa Minton, surgeon and breast cancer specialist at Florida Hospital. Also helping kick off Pink Out was Tarralyn Jones, who was first diagnosed with breast cancer in 2002 at the age of 35. She was diagnosed again in 2008. After treatment, she is now cancer-free. “For me getting a mammogram was a lifesaver,” Jones said. “I want to do all I can to let other women know the importance of screening and early detection.” Florida Hospital is spreading the flamingo flocks to 12 cities across Central Florida this month.

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GrandRounds of healthcare services. "Coronaria aims to build a novel healthcare system in Finland that will benefit all of us, with patients receiving better care, personnel achieving more and society saving money. The emphasis in healthcare must be shifted to preventive and personalized care, especially for chronic disease treatments. We see Nightingale's blood analysis as an important tool to achieve this goal. As a result, we wanted to be the first to pilot the service in Finland", said Olli Karhi, member of the board of Cor Group.

Lakeland Regional Health Joins Orlando Health Lakeland Regional Health (LRH) and Orlando Health (OH) completed an affiliation to create an integrated regional health care system on October 1, 2017. This regional system better positions both organizations to advance clinical programs, improve access, and enhance the clinical quality of services provided. "We are very excited to advance the future of health care for those we serve through our affiliation with Orlando Health. We see great promise in the opportunity for our exceptional doctors, nurses and team members to collaborate with our peers at Orlando Health," said Elaine C. Thompson, PhD, FACHE, president and CEO of LRH. "Bringing together two health systems that share complementary people-centered, clinically advanced cultures will be an amazing catalyst to strengthen the health of our community." "This is an exciting time for Orlando Health and for the entire Central Florida community," said David Strong, president and CEO, Orlando Health. "Having Lakeland Regional Health join Orlando Health will not only expand our network of hospitals, but will create a unified health care system with common objectives and fully aligned interests. We look forward to sharing knowledge and expertise to advance the quality, delivery, and access to health services across the region." The affiliation, effective October 1, 2017, was formed following a period of due diligence and the execution of a definitive agreement detailing the relationship between the two systems. LRH will continue to have a local Board of Directors made up of leaders living in the Lakeland community with the addition of one director representing Orlando Health. Two directors from the LRH Board will be appointed to Orlando Health's Board of Directors. Lakeland Regional Health Medical Center will remain a City of Lakeland asset. The position of LRH President and Chief Executive Officer will continue to be held by Elaine C. Thompson, PhD, FACHE, who now dually reports to the LRH Board of Directors and the CEO of Orlando Health. Dr. Thompson will continue to focus her efforts on providing strategic leadership of Lakeland Regional Health's efforts to expand access to high quality health care for Lakeland and the surrounding communities. In addition, she will assume regional system responsibilities benefitting the Ororlandomedicalnews

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lando Health system as a whole. Other affiliations currently in place with both organizations will continue. Both Foundations will remain under the control of their respective health care systems, performing community specific philanthropic activities. Funds raised by each Foundation will be used exclusively to benefit and support the system's projects and the communities served. Orlando Health is a private, not-for-profit health care system that has been caring for the Central Florida community since 1918. Orlando Health consists of eight acute care hospitals (2,295 beds) and was recently granted a certificate of need to build a 9th hospital in the Horizon West community in west Orange County. The organization has more than 2,000 affiliated physicians, 500 employed physicians, and 18,000 employees. In addition, Orlando Health is a teaching hospital that trains over 250 physician residents in 7 different clinical programs and 17 fellowship programs. LRH is a private, not-for-profit health care system that has been caring for its community since 1916. LRH consists of Lakeland Regional Health Medical Center, which is Florida's fifth largest hospital with 849 beds, including the 32-bed Bannasch Institute for Advanced Rehabilitation Medicine, as well as the Hollis Cancer Center and other care locations providing outpatient healthcare services. LRH has over 500 physician members of its medical staff, employs 135 physicians, and has over 5,200 employees. About Orlando Health: Orlando Health is a not-for-profit health care organization and a community-based $2.6 billion network of physician practices, hospitals, and outpatient care centers throughout Central Florida. The organization is home to the area's only Level One Trauma Centers for adults and pediatrics and is a statutory teaching hospital system that offers both specialty and community hospitals. More than 2,000 physicians have privileges at Orlando Health, which is also one of the area's largest employers with more than 18,000 employees who serve nearly 2 million Central Florida residents and more than 4,500 international patients annually. Additionally, Orlando Health provides more than $204 million in support of community health needs. More information can be found at www.orlandohealth.com. About Lakeland Regional Health As a catalyst for community health, not-for-profit Lakeland Regional Health is reaching beyond its hospital walls to promote wellness, education and discovery in new places and new ways, providing a wide range of inpatient and outpatient healthcare services at its Medical Center, Hollis Cancer Center and ambulatory care locations. LRH holds Most Wired status from American Hospital Association's Health Forum and the College of Healthcare Information Management Executives and has earned workplace awards from Forbes, Gallup and Becker's Hospital Review. Its 849-bed comprehensive tertiary referral hospital, Lakeland Regional Health

Medical Center, operates a Level II Trauma Center, a Level II Neonatal Intensive Care Unit, Bannasch Institute for Advanced Rehabilitation Medicine and the nation's busiest single site Emergency Department. For more information about Lakeland Regional Health, visit http://myLRH.org.

Access Health Care Physicians Launches New IT Platform - Claims Lite Access Health Care Physicians, LLC, is pleased to announce the launching of its new IT Platform – Claims Lite. Claims Lite is an organizational pro-

gram built on technology that has been designed to effectively work as an IT Solution in the Health Care industry for managing paper claims. It allows for professional healthcare offices to submit and track claims easier than ever before. , “With the launching of this platform we expect to increase quality of care and produce a positive experience for healthcare providers and patients along with better compliance systems and Revenue Cycle management “said Carlos Arias, Chief Operating Officer of Access Health Care Physicians. Claims Lite offers an online submission of professional, institutional & dental & tracking of claims. Thus it acts as a gateway to

Florida Hospital Celebrates Milestone of 4,000 Kidney Transplants Dr. Robert Metzger, who helped launch the transplant program, with Terri Miller, Florida Hospital’s longest surviving kidney transplant patient. Miller was Metzger’s patient 42 years ago when she had her transplant. They reunited today as physicians and patients celebrated the 4,000th kidney transplant. Florida Hospital is proud to announce its kidney transplant team performed its 4,000th procedure, marking a major milestone for the clinical teams and program. Florida Hospital has one of the nation’s oldest and largest transplant programs, with more than 160 adult and pediatric kidney transplants performed annually. From its first kidney transplant in 1973 to today, the Transplant Institute transforms the lives of patients in Central Florida and beyond who are in need of a life-saving organ transplant. “We are honored that our community has entrusted us for more than 40 years to provide high-quality, advanced and compassionate care,” said Dr. Robert Metzger, who helped launch the kidney transplant program and continues to serve as its medical director. “This milestone would not be possible were it not for our physician partners, including Nephrology Associates of Central Florida, who share in our commitment of providing life-changing and life-saving care.” Terri Miller underwent her transplant 42 years ago, making her Florida Hospital’s oldest surviving kidney transplant patient. She was diagnosed with kidney failure when she was 21 years old and six months

pregnant. Now 64, Miller is a happiness coach who encourages people to value life, but most importantly quality of life. “Living donors are angels that hold on to their faith to make a sacrifice and give someone the gift of life,” Miller said. “I wouldn’t be here today if it wasn’t for that. I have a huge respect for anyone who donates.” More than four decades after Miller received her new kidney, Florida Hospital’s kidney transplant team has performed just over 4,000 procedures. “This milestone would not be possible were it not for the thousands of organ donors and their families. Because of their generosity, generations of lives have been impacted,” said Dr. Michael Angelis, surgical director of the kidney transplant program. “We are so proud of our physicians and clinical teams for reaching this remarkable milestone. Transplants require immense coordination, time and skill, and we applaud their untiring efforts to build this program and provide the highest quality and compassionate care to their patients,” said Florida Hospital Vice President Kari Vargas.

OCTOBER 2017

GrandRounds various forms of healthcare reimbursement. The technology has been designed by professionals in the IT health industry. It has been reviewed and tested by physicians in the field. This has resulted in constant improvements. Claims Lite brings forth advancement in Healthcare Technology that has till now been lacking in this category. Some of the Key Features Include: • Converts paper Claims to Electronic Claims: Converts paper claims to electronic claims for professional, institutional and dental claims. • Attaches Paper Claims: Attaches one or multiple paper claims while creating or updating claims. • Tracks Claims: Tracks the status of claims from creation to dispatch. • Manages Queues: Managing different queues based on the status of the claim. • Generates Electronic Data Interchange (EDI’s): Generation of professional, institutional & dental EDI file. • Manages Paper Claims: System automatically places uploaded paper claims into different queues based on the type of claim. • Live Dashboard: Provides the statistics of claims based on their statuses & type of claim. • Configurable System: Configurable system to support multiple payers and receivers. “We believe we will be able to improve Care Management and stratify high risk patients so that they may receive intense and directed Disease Management services. The platform will also improve outcomes and patient engagement along with enhanced population medicine metrics and improved continuity of care of our sickest and most needy,” said Pariksith Singh, CEO of Access.

iRemedy Healthcare Introduces “iRemedy MSO” Solution For Large Group Medical Practices, Hospitals And Health Systems The iRemedy Healthcare Companies, Inc. parent of iRemedySupply.com and the industry transformative iRemedy ecommerce platform, today announced its introduction of “iRemedy MSO,” a turnkey, technology-enabled medical supply chain management solution designed specifically to reduce cost for – and speed delivery of – medical supplies used by large group medical practices, hospitals and health systems operating multiple remote provider locations. According to a study released by the Physicians Advocacy Institute (PAI) in September 2016, hospital ownership of physician practices is on the rise, noting that hospitals and health systems acquired 31,000 physician practices, a 50% increase, from 2012 to 2015. Moreover, study results revealed that acquisitions of practices occurred in every region of the U.S., demonstrating that the trend towards investing in building and buying out clinical locations that are closer to the patient is not concentrated in key geographic regions, but pervasive across the country. Consequently, hospitals and health systems are now having to redefine their procurement and supply chain processes that meet the needs of

OCTOBER 2017

HCA To Open Seven Healthcare Access Points In Seminole And Orange Counties not only the institutional hospital environment, but also remote ambulatory, clinical and homecare settings. In Gartner’s 2016 Healthcare Provider Supply Chain Outlook report, researchers note that healthcare organizations are especially focused on supply chain management, product selection/utilization and standardization. Gartner researcher Eric O’Daffer told Inbound Logistics magazine, “They’re having to develop relationships with suppliers in order to fully understand the logistics and total delivery costs to measure right price, right time and service cost collections, and then they are having to design a supply chain network that supports adherence.” Offered as a Software-as-a-Service (SaaS) solution, iRemedy MSO is an innovative B2B medical supply order and fulfillment managed services program created by iRemedy that will allow large institutional providers and group practices to leverage iRemedy’s robust end-to-end ecommerce platform to fully standardize and control procurement costs and delivery of medical products to remote clinical locations within their respective provider networks. By deploying customized formularies of products selected and pre-approved by the parent care organization, physicians and other remote care specialists can order needed medical supplies and other care products directly from iRemedy through a customized ecommerce system, custom-branded to the parent organization. In turn, iRemedy will manage the fulfillment of those orders through direct or drop shipments, as required. Tony Paquin, founder and CEO of iRemedy, stated, “Solving supply chain management challenges for large provider organizations with far-flung remote operations can only be achieved with technology, coupled with proven supply chain expertise and capabilities. IRemedy fills that bill. We expect that our new Software-as-a-Service (SaaS) iRemedy MSO solution will quickly prove to be the answer for our many hospital and large group practice clients who have been actively seeking better, more efficient approaches to managing medical supply logistics for their growing network of remote clinics, ambulatory surgery centers and home health agencies.”

DOH-Orange Welcomes Vivian Capo as Executive Community Health Nursing Director

The Florida Department of Health in Orange County (DOH-Orange) welcomes Vivian Capo as the new Executive Community Health Nursing Director. Ms. Capo comes to DOH-Orange from the private sector with over 17 years of acute

HCA Healthcare’s North Florida Division will open three freestanding emergency rooms and four CareNow® Urgent Care centers across Central Florida in 2017 and 2018 – expanding community access to healthcare and HCA’s presence in the region. Two freestanding emergency rooms will be located in Orange County near Baldwin Park and in the Millenia area, with another freestanding emergency room located in Seminole County on International Parkway. Each will operate as a full-service emergency department providing 24/7 emergency care for adults and children. The locations will be about 10,000 square feet and contain approximately 11 beds. CareNow® Urgent Care will open two more Seminole County locations in Sanford and Lake Mary and for the first time have a presence in Orange County with two locations in East Orlando on Alafaya Trail and in Winter Park. CareNow® opened its first Orlando-area clinic this past February, in Winter Springs. CareNow® Urgent Care is part of HCA and affiliated with HCA North Florida Division. “As the leading hospital network in the nation and largest healthcare provider in Florida, HCA is uniquely positioned to meet Orlando’s growing need for healthcare services,” said Michael P. Joyce, FACHE, President of HCA North Florida Division. “Our comprehensive system increases continuity of care and provides patients with more options and resources for their health care needs.” “CareNow® is a growing part of the HCA family in Orlando and 12 other major markets,” said Tim Miller, President of CareNow® Urgent Care. “With our extended hours and neighborhood locations, we are committed to meeting patients’ needs for convenient quality care in non-emergency situations.” “CareNow® urgent care Physicians and

other healthcare professionals provide urgent care – quick care for non-life-threatening illnesses and injuries, such as sprains and strains, minor burns, coughs, sore throats and flu-like symptoms – as well as physicals, vaccinations, and general diagnostic and wellness check-ups. The clinics have X-ray and lab services onsite. CareNow® urgent Care clinics also provide occupational medicine services to local employers, including examinations and treatment of injured workers in worker’s compensation cases, pre-employment screenings and drug tests.” “More and more, consumers are looking for new options for healthcare and treatment. They want quality care, but they also want greater convenience. CareNow® urgent care delivers both and we are proud to be affiliated with HCA’s North Florida Hospitals so that our patients needing a higher level of care may be connected to the broader resources of the HCA North Florida healthcare system,” said Konrad Holt, Central Florida Market Manager, CareNow Urgent Care. HCA has grown its Orlando footprint substantially in recent years with freestanding emergency rooms in Hunter’s Creek and Oviedo. The Oviedo ER recently expanded into a full-service hospital, Oviedo Medical Center. Additionally, HCA launched a consortium with the University of Central Florida’s College of Medicine to train up to 600 medical residents and fellows by 2020. HCA is now partnering with UCF to build a community-based teaching hospital in Lake Nona. Freestanding ERs are on the rise nationwide as health providers seek more efficient ways to treat patients. In addition to freestanding ERs, HCA operates four hospitals in Central Florida: Central Florida Regional Hospital, Oviedo Medical Center, Osceola Regional Medical Center and Poinciana Medical Center.

HCA’s three new freestanding ERs will look similar to the existing Hunter’s Creek ER in south Orange County.

HCA’s existing CareNow facility in Winter Springs

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GrandRounds

Orlando Magic and Florida Hospital Expand Health and Sports Performance Field

(left to right): Jeff Weltman, President of Basketball Operations, Orlando Magic; Alex Martins, CEO Orlando Magic; Daryl Tol, president and CEO of Florida Hospital and Central Florida Division – Adventist Health System; gather Thursday as the renewed partnership is announced in Orlando. The Orlando Magic and Florida Hospital have announced a renewed and expanded partnership with a large focus on innovation in the sports medicine realm. As a Magic partner for the past 28 years, Florida Hospital will continue its “Champions of the Community” (COTC) status with the team. “The Magic and Florida Hospital have been great partners for more than a quarter century,” said Orlando Magic CEO Alex Martins. “As the leaders in sports medicine and health innovation, we are so honored to have Florida Hospital continue with us as one of our Champions of the Community partners. Together we share in the vision of building healthier, more active and engaged communities all across Central Florida.” This distinctive partnership will include a collaborative and specialized body of research. Through this partnership Florida Hospital and the Magic will work together to develop a world-class sports performance and medical model with the focus on reducing athlete injury, creating the best course of action, optimizing performance and translating those learnings to the broader community. The expanded partnership brings Florida Hospital’s focus on caring for the whole athlete — mind, body and spirit — by incorporating elements such as nutrition, sleep, and injury prevention and recovery. The Florida Hospital team will work closely with the Magic’s high-performance director to extend the life of its athletes on and off the court. “Our partnership is a unique opportunity to bring together medicine, research, and our philosophy of whole-person health to the Orlando Magic,” said Daryl Tol, president and CEO of Florida Hospital and Central Florida Division - Adventist Health System. “It is our hope that in the future, learnings from these elite athletes will shape medicine and how we care for all patients — from the little league pitcher to the senior water-aerobic enthusiast.” Florida Hospital Chief Medical Officer Dr. Jeff Kuhlman will serve as an advisor to the Orlando Magic as part of the new partnership. Prior to joining Florida Hospital, Kuhlman was in the U.S. Navy

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for 30 years and served as White House Physician from 1997-2013 for President Bill Clinton, President George W. Bush and President Barack Obama. Kuhlman began medical school at Loma Linda University at the age of 19. He went on to become a designated naval flight surgeon at the Naval Aerospace Medical Institute before eventually completing a master’s degree in public health and post-doctoral fellowships at John Hopkins University. Kuhlman is quadruple-board certified in aerospace, family, occupational medicine and medical management. Florida Hospital is a leader in medical research, with 500 clinical trials in progress at any given time in areas such as cancer, cardiac, neuroscience and diabetes. Through its Translational Research Institute (TRI) for Metabolism and Diabetes, Florida Hospital is bridging the gap between the research bench and the patient's bedside in an effort to tackle obesity, diabetes and cardiovascular disease. More than a dozen research studies are underway at TRI, focusing on topics such as: body shape and metabolism; age-related muscle loss; and rare, genetic causes of obesity. With the partnership extension, Florida Hospital becomes the naming rights entitlement partner of the Magic training facility at Amway Center, gaining stronger visibility in the training facility and the Magic’s practice court to showcase its innovation in medical services. In addition, Florida Hospital is the Magic’s season tip-off partner which encompassed training camp, open practice and is the presenting partner of all preseason games and opening night. As one of the Magic’s six COTC sponsors, the Magic and Florida Hospital will continue to work together to positively impact and make a difference in the Central Florida community through support of the Orlando Magic Youth Foundation, the Magic’s charitable arm. Florida Hospital will also remain the official hospital of the Orlando Magic and Orlando Solar Bears (partners since 2011) and extending to the team’s other entity, the Lakeland Magic. Florida Hospital will be one of the four inaugural cornerstone partners of the Lakeland Magic.

care experience in hospital and outpatient settings. Along with her clinical experience, Ms. Capo brings direct health administration oversight leadership resulting in high performing medical centers with exceptional quality and service standards. “We are proud to welcome Vivian Capo to the DOH-Orange family. She has great nursing leadership experience and a business acumen that will lead the nursing staff into the next decade,” said Dr. Kevin Sherin, Health Officer and Director of DOH-Orange. Ms. Capo’s background includes developing and executing programs to improve productivity, profitability, and effectiveness with a focus on patient outcome and patient satisfaction. She has in-depth operational, administrative, and financial skills in multi-disciplinary healthcare organizations. In addition, Ms. Capo has demonstrated success in large corporate and start-up ventures, and is skilled on managed care/ health maintenance organizations and accountable care organizations. Ms. Capo holds a Master's degree in Health Services Administration from the University of Central Florida and a Bachelor's degree in Nursing from the University of Puerto Rico. She will supervise a nursing and support staff of 59 at four clinical sites.

Parrish Medical Center Welcomes New Emergency Department Medical Director

Gregory P. Cuculino, MD, FACEP, an Emergency Room physician leader who was twice recognized as a “top doctor” while with a Philadelphia, Pennsylvania hospital system, is Parrish Medical Center’s new Emergency Department Medical Director. Dr. Cuculino comes to PMC from Crozer-Keystone Health System in Delaware County, Pennsylvania. Dr. Cuculino chaired the Emergency Departments of the system’s four hospitals, which are staffed by 50 emergency medicine physicians and 20 advanced care practitioners who see more than 120,000 emergency room patient visits annually. Dr. Cuculino, board-certified in emergency medicine, is a Fellow of the American College of Emergency Room Physicians (FACEP). He was twice recognized as a “Top Doc” in Main Line Today magazine, a regional magazine serving the Philadelphia area. In 2013, he was named a Main Line Today “Health Care Hero” for his work in stroke awareness. Under his chairmanship, the Emergency Room of Taylor Hospital in Ridley Park, Penn., earned National Research Corp.’s Innovative Best Practice Award for commitment to improving patients’ experiences. Dr. Cuculino said PMC’s “atmosphere of

genuine caring for patients” was his reason for accepting this position after he and his wife decided to relocate after spending the last 18 years in Pennsylvania. “I was very impressed with PMC’s people and their emphasis on a healing environment,” he said. “A hospital building can be made to look impressive, but what matters goes beyond what you can see. The friendliness of the PMC care partners and the way the Care Partners genuinely care for their patients, and for each other, were the deciding factors for me. “That atmosphere of caring is where I want to be,” he added. “I look forward to being a part of accomplishing great things for the people served by PMC.” Dr. Cuculino earned his medical degree in 1996 from the Medical College of Pennsylvania in Philadelphia and completed his residency in Emergency Medicine in 1999 at Christiana Care Health System Medical Center of Delaware.

UCF Health Welcomes New Physician

Dr. Michael K. Seifert is board certified in internal medicine and sports medicine. After graduating from the University of Florida and before attending medical school, he worked as a computer engineer in healthcare information systems. His interest in the breadth of the medical field led to his initial specialization in internal medicine. He sub-specialized in sports medicine so that he could provide excellent musculoskeletal care. Dr. Seifert received his M.D. at the University of South Florida Morsani College of Medicine in Tampa, FL. He completed his residency in internal medicine at Virginia Commonwealth University in Richmond, VA. His fellowship training in primary care sports medicine was completed at Maine Medical Center in Portland, ME. Dr. Seifert provides medical care for patients with acute and chronic conditions who wish to live healthier lives and achieve their health goals. He has advanced musculoskeletal ultrasound training and experience with regenerative medicine techniques including PRP injections. He also received additional training in outpatient internal medicine as part of his residency’s primary care track. He is passionate about helping athletes (and aspiring athletes) to achieve and maintain fitness, health, and success. He has experience as a team physician for high school, college, and NBA Development League teams. He has provided sideline care to athletes at sporting events including marathon, triathlon, and trail running events. He is a life-long soccer fan, and stays active by playing with local teams.

OCTOBER 2017

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