October 2018 Orlando Medical News

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Burnout Rates Continue to Rise

By PL JETER Three of four doctors have suffered burnout, a much higher rate than a few years ago when a perfect storm of changes rocked the healthcare industry. Compared nationwide, Florida physicians experience burnout more frequently than their counterparts.

“It’s sobering,” said Gary Price, MD, president of The Physicians Foundation, a nonprofit group that published the 2018 Survey of U.S. Physicians, with nearly 9,000 physicians weighing in. “The career plans and practice pattern trends revealed in this survey will likely have a significant effect on our physician workforce, and ultimately everyone’s access to care.”

According to the sixth biennial survey by national physician search firm Merritt Hawkins, the problem is so severe that 31

Physicians in Florida are more pessimistic about the future of their profession

percent of Florida doctors say if they had a do-over, they wouldn’t choose the same profession, and more than half say they would not recommend medicine as a career to their children. Even more disturbing: 46 percent of respondents plan to change career paths.

Much is to blame. The most frustrating problem, a vast majority of doctors say, is the inefficiency of a system created for efficiency: electronic health records (EHRs). They’re unhappy about the inefficient EHR design and interoperability; nearly half the respondents said EHRs have reduced or detracted from their interaction with patients.

Other least satisfying career factors: insurance and regulatory burdens, professional liability concerns, and erosion of clinical autonomy. These problems may contribute to doctors being slow to adopt telemedicine, with only 17 percent practicing some form of it.

“The evidence points to the need for a major effort on the part of all the partners in the healthcare industry to re-examine the electronic health record as a tool for improving physician’s abilities to provide care, and reinventing it for that purpose,” said Price.

Doctors also point to third party authorizations, treatment protocols, EHR design and pesky administrative tasks as adversely impacting their practice to “a great degree.”

Clinical-wise, social problems – addiction, poverty, unemployment, homelessness - that make it difficult to treat patients also frustrate physicians. In fact, 81 percent of Florida doctors say their patients are impacted by a social situation that poses a serious impediment to their treatment of care.

“It’s distressing that such a high number of patients are dealing with one or more social situations that are detrimental to their health,”

said Walker Ray, MD, who chairs the foundation’s research committee. “These challenges directly impact a physician’s ability to deliver effective care, and the cost implication of these issues is enormous.”

Perhaps because of those circumstances, a vast majority of patients consistently don’t adhere to their treatment plans; 31 percent don’t follow plans at all.

“More patients with complex and chronic diseases cannot follow through on care recommendations due to limited finances and unpredictable living situations,” said Dr. Russell Libby, board member of the Physician’s Foundation. “Physicians like to see their patients get better. When it’s diminished by social determinants, they may experience a sense of futility, failure and be more susceptible to burnout.

“It’s one of the many heavy feathers accumulating on the backs of physicians and (CONTINUED ON PAGE 6)

HEALTHCARELEADER

ON ROUNDS

PHYSICIAN SPOTLIGHT

Pooling Talent with Eyes on the Future

Kenneth A. Krumins, MD ... 3 Keeping the Dream Alive – Fertility Preservation ... 4

INDEPENDENT PHYSICIAN Jason Pirozzolo, DO ... 5

It’s Time for Business Continuity and Data Protection ... 7 CBD: Miracle Cure or Snake Oil? ... 8

HEALTH INNOVATORS

Where Does Your Innovation Live? ... 9

RADIOLOGY INSIGHTS Wear It Pink! ... 24

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No complacency at Radiology Specialists of Florida

By PL JETER

Ten years, a trio of radiologists moved to Orlando and pooled their talents to form Radiology Specialists of Florida (RSF) at Florida Hospital Central Division and Central North Division.

Today, the group represents one of the nation’s largest diagnostic and interventional sub-specialized radiology groups.

RSF employs over 115 radiologists in various subspecialties to perform more than 2 million imaging studies annually, including those in bone density scan

(DXA), computed tomography (CT) scan, interventional radiology (IR), MRI, mammography, nuclear medicine/PET-CT, ultrasound, women’s imaging, emergency radiology, pediatric radiology, and body imaging. RSF recently recruited twelve radiologists including a cardiac imaging radiologist from Johns Hopkins Hospital.

With round the clock reads and accessibility, the group focuses on continuity of care, advanced technology, and high-image quality following Image Wisely® and Image Gently® guidelines for lowering the levels of radiation used

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in medically necessary studies. Coming soon: Prisma, a new unique and highly powerful 3T MRI platform with innovative applications. Its benefits include significantly increased signal-to-noise ratio (SNR), unprecedented long-term stability and minimized acoustic noise. It will be utilized specifically for neuroimaging.

In 2012, RSF added much-needed residency spots by establishing an ACGME-accredited diagnostic radiology residency program, which includes Early Specialization in Interventional Radiol-

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(CONTINUED ON PAGE 7)

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PHYSICIANSPOTLIGHT

Jewett Orthopaedic Surgeon and Community Volunteer Dreams of Catching the Big Fish Kenneth A. Krumins, MD, grew up outside Philadelphia, one of three sons of a Latvian immigrant who owned a construction company. Krumins spent his summers during medical school working alongside his family, shingling roofs and tacking up siding.

While his brothers followed in their father’s footsteps. Those summer construction jobs motivated Krumins to seek an indoor career path that required hands-on work. After rotating with doctors of various practices, he chose orthopaedic surgery, and it’s turned out to be a perfect fit.

Dr. Krumins graduated magna cum laude from DePauw University, received his medical degree from the Medical College of Pennsylvania in Philadelphia, and completed his orthopaedic residency at the State University of New York in Syracuse. He also received specialized training in sports medicine and knee surgery under Dr. James Barnett through the J. Allen Lacey, M.D. Fellowship at the Jewett Orthopaedic Clinic, where he now practices. Krumins specializes in arthroscopic and reconstructive knee surgery, sports medicine, minimally invasive knee joint replacement, and lower extremity trauma.

Krumins credits Barnett with teaching him how to have a surgeon’s hand and a servant’s heart. “Jimmy was an important mentor to me. He taught me a lot about life, a lot about orthopaedics, and how to give back to the community.”

Krumins has been volunteering in the community since 1997, including 17 years with the University of Central Florida’s athletics department, where he currently serves as the medical director for all sports and travels with the Knights’ football team. He has found his volunteer work with the student-athletes to be most gratifying, with several patients making valiant returns from injuries before transitioning to careers as professional athletes.

Earlier, this year, Krumins also began giving his time and talents to Shepherd’s Hope, a faith-based nonprofit organization that provides free primary care and specialty care medical services to uninsured patients from five free-standing health centers in Orange and Seminole counties. The organization also operates the Community Referral Provider Program (CRPP), designed to give sovereign immunity to volunteer physicians and other community health care partners who provide free specialty care services to Shepherd’s Hope patients.

Krumins shares his thoughts and experiences as one of Shepherd’s Hope’s newest medical volunteers: 3

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patients who would not otherwise have access to medical care reaffirms the feeling that you’re doing something amazing for them and the community.”

When you’re not working or volunteering in the community, what do you enjoy doing?

Why did you choose to volunteer at Shepherd’s Hope?

“Three reasons. First, I believe you need to do more than just live and work in the community – you need to give something back to it. Second, I knew that a few of my partners at Jewett Orthopaedic had volunteered at Shepherd’s Hope over the years and had positive experiences, including Dr. Brian Barnard and Dr. John Papa.

Finally, my son had a friend in law school who was working at Shepherd’s Hope over the summer and she mentioned to him their great need for orthopaedic care. It was serendipity.”

Is there a memorable patient encounter that is especially meaningful to you?

“Yes. In fact, it was the very first patient I saw on my first night volunteering at the downtown clinic. A young woman who had just relocated from Jamaica came in with an unstable ankle fracture that needed urgent surgery. She was two weeks out from her injury when she showed up at the clinic and I was able to provide her with the urgent care she needed.”

“Working with Shepherd’s Hope’s CRPP, we received sovereign immunity authorization and cleared this patient for surgery within 24 hours. It was unbelievable. Two days after she presented at the clinic, we performed the surgery. Today, she’s three months post-op, walking and doing amazingly well.”

“Beyond this patient, the entire experience of volunteering at Shepherd’s Hope is really quite special. The staff is extremely helpful, and they even provide a scribe to assist me with the patients. I’ve been struck by the huge need for orthopaedic care. One night, I saw four patients who needed an operation. Helping these

“My two favorite hobbies are snow skiing and offshore sports fishing. I especially love downhill skiing and friendly competitions with the Orlando Ski Club. My personal best event was skiing 57,510 vertical feet in a single day in Mount Bachelor, Oregon and winning first place in a vertical distance competition.”

“When it comes to fishing, I love competing in sailfish, marlin and yellowfin tuna tournaments. I’ve traveled to many tropical places and won six tournaments over the years. On the top of my bucket list is catching a grander blue marlin (1,000 pounds) in Australia – something that’s very hard to do. My biggest catch to date is a 468-pound blue marlin.”

The specialties represented in Shepherd’s Hope’s Community Referral Provider Program range from gastroenterology and neurosurgery to ophthalmology and obstetrics/gynecology. The volunteer providers determine the number of patient cases they are willing to see and the types of services they will provide. Currently, there is a need for neurology, otolaryngology (ENT), and general surgery practices.

To learn more about joining Shepherd’s Hope’s CRPP network, please contact Community Care Manager Ella Romano at (407) 876-6699, ext. 241 or ella.romano@shepherdshope.org.

Fo information about volunteering at a Shepherd’s Hope clinic, contact Volunteer Program Manager Abby Seelinger at (407) 876-6699, ext. 233 or abby.seelinger@shepherdshope.org, or visit www.shepherdshope.org/volunteers.

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Keeping the Dream Alive – Fertility Preservation

By COREY BURKE

Fertility preservation is a term used for protecting or preserving eggs, sperm, embryos, or reproductive tissue so that they may be used in the future to have biological children. Most commonly fertility preservation is associated with cancer treatment, but many other conditions and lifestyles can threaten one’s fertility. Endometriosis, uterine fibroids, autoimmune diseases, genetic diseases, toxic exposure, gender reassignment, and hazardous duty (Military) are all reasons to consider fertility preservation.

Cancer survival is at an all-time high for many forms of cancer. The American Cancer Society reports 5-year relative survival rates of 70% for women with Stage 0-III breast cancer with a five-year relative survival rate of close to 100% in women with stage 0 or stage I breast cancer. Far more people are surviving cancer and for many that means the opportunity to start a family and live the life they dreamed of before their diagnosis.

In 2013 the American Society of Clinical Oncology updated their guideline on fertility preservation. The guidance states that caregivers including oncologist, gynecologist, radiational oncologist, urologist, hematologist, pediatric oncologist, surgeons, and others should offer information about fertility preservation to all adult and pediatric patients. It further recommends that if the patient is interested in fertility preservation they should be referred to fertility specialists and that such referrals take place early in the treatment plan. Since this guidance began the number of patients seeking fertility preservation has increased somewhat, particularly in the male population, however it is relatively infrequent that women seek this option.

Several issues may explain the low numbers of women seeking fertility preservation. The procedure in men is far simpler, affordable, requires little time to complete, and usually requires no medications. All the options available to women require significantly more time to complete than men, and costs significantly more. In years past, fertility cycles were initiated based on the women’s menstrual cycle which often added weeks to the process. An additional concern was that the process of ovarian

stimulation lead to increases in estradiol levels which can drive some tumors. All are valid concerns but can be overcome and should not be a reason for not offering it to a patient. Financial concerns are valid, but options exist including financing. The time to complete treatment and stimulation concerns can be greatly reduced by using mid cycle starts and stimulation protocols to reduce the effects of increased estrogen levels.

What options are available?

Semen cryopreservation is the most effective means of male fertility preservation and is the choice of treatment for most patients. The process is simple, the patient provides a specimen by masturbation and cryoprotectant is added. The specimen is then packaged in straws or vials, slowly chilled to a temperature of -196°C , and stored. Once frozen semen seems to last indefinitely, the oldest specimen used successfully to date being 24 years old. While this option is fast and affordable, physicians should be reminded that one ejaculate is not enough to allow multiple attempts at pregnancy, and patients should be encouraged to provide multiple specimens prior to beginning treatment. To provide optimal results ejaculates should be between 48-72 hours

apart. Usually enough semen can be collected in a two-week period to meet the patient’s future reproductive goals.

Cryopreservation of testicular tissue is an option for prepubescent boys as well as men who are incapable of ejaculating sperm. Testicular tissue cryopreservation in prepubescent boys is considered experimental and should only be done as part of IRB approved research or a clinical trial.

Gonadal shielding is an option for men undergoing radiation treatment, however cryopreservation is recommended with this option as well.

Women have several options available to them. In the early 2000s a process of “freezing” eggs called vitrification became available to embryologists. Prior to this breakthrough cryopreservation of eggs was difficult and survival rates of eggs post thaw were very poor (30% or less).

Freezing a cell involves the formation of ice crystals that can damage and/or kill the cell. Vitrification overcomes this problem by rapidly cooling eggs to -196° C in a fraction of a second. The temperature change approaches – 20,000°C/min and is so rapid it does not allow ice crystals time to form. Survival rates of vitrified

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Jason Pirozzolo, DO When Dr. Jason Pirozzolo, conceived the IP Network, his peers paid attention.

After all, this is the guy who used the remainder of his student loan money to enroll in flight school on his first day of medical school, and now, as an instrument-rated single and multi-engine pilot who flies airplanes and helicopters and is type-rated to fly jets, travels to Tallahassee during legislative sessions to keep Florida lawmakers healthy.

He’s also the guy who, when financial adversity struck hard while completing an externship program at Harvard Medical School, lived in his car.

The strategic acquisition of a Cambridge Racquet and Fitness Club membership early on allowed him to shower at the gym and continue his education undetected. “No one knew the position I was in,” he said.

That experience led Pirozzolo to become a Certified Strength and Conditioning Specialist while completing his internship and residency at Duke University.

It makes sense that overcoming adversity is why Pirozzolo pursued medicine. While competing in the New York State Free-Style Wrestling Champion-

ships, he landed in the hospital for the first time after fracturing his radial head.

“I remember sitting in a wheelchair waiting to get that initial X-ray, and I was taken aback by everything that was going on,” he marveled. “From that point, I was hooked on medicine.”

Creating the IP Network – an integrated network of independent physicians using proprietary technology to lower costs and improve patient quality -- was

a natural next step for the industry advocate, who created a model that challenges the nation’s flawed healthcare system.

Over 1000 physicians have paid $150 each to join the corporate structured LLC, which prioritizes transparency and equality.

“I don’t think there’s any better way than to have every doctor own an equal share,” he explained, adding that working with Florida Hospital and Orlando Health is an integral component to the program.

“We can develop strategies and coordinate our systems in a way to share data.”

Pirozzolo helped to devise the plan while working with orthopedic surgeon George White, MD, at Orlando Hand Surgery Associates, where Pirozzolo has specialized in non-surgical orthopedic sports medicine and trauma since 2011.

The best part of the IP Network, Pirozzolo pointed out, is that “patients see the continued affiliation with their independent doctors.”

The successful business model has been well accepted by his colleagues, who elected him to the Board of Governors of the Florida Medical Association, vice president of the Integrated Independent

Physicians Network, and a Florida delegate to the American Medical Association.

Former Florida Gov. Charlie Crist appointed him vice chairman of the Greater Orlando Aviation Authority. While serving in that position, he became the only board member in the nation to become certified in airport management, the same certification required by CEOs running airports such as LAX, JFK and ATL. In 2016, Pirozzolo completed the Florida Hospital Physician Leader Development Course under his mentor General Mark Hertling.

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Burnout Rates Continue to Rise, continued from page 1

“It’s prudent to keep in mind that the first reaction to seeing canaries perish in a coal mine wouldn’t usually be to send out for tougher canaries.” Gary Price, MD, president of The Physicians Foundation. may be the one that breaks some of them.”

Long hours – typically 50 to 60 weekly – also turn off physicians, with 65 percent seeing up to 30 patients daily. Eighty percent report being at full capacity or overextended. Thirty percent don’t see Medicaid patients, while 15 percent don’t accept Medicare patients.

These factors contribute to an overall 40 percent of doctors planning to retire or cut back on hours within the next three years. The largest group of respondents? Aged 56 to 65.

“The frustration and diminished sense of accomplishment associated with burnout almost certainly contributes to the large numbers of physicians reporting plans to diminish work hours or retire earlier than anticipated,” said Price.

The accelerated growth of hospitals ac-

quiring physicians has also taken a toll. Only 12 percent of respondents agree it’s a “positive trend likely to enhance quality of care and decrease costs.” To that end, 35 percent describe hospitals employing physicians in a “somewhat negative and adversarial” light.

“In our survey, 52 percent of employed physicians reported very or somewhat positive feelings about their morale in general, compared to only 37 percent of independent physicians,” said Price, noting that only 31 percent of respondents are in private practice, down from 48 percent in 2014.

Libby pointed out it’s important to find ways to engage physicians in the discussion about burnout.

“We need to have ways to screen, and vehicles to offer once an individual has

been identified, and especially when they’re reaching out for help,” he said. “We need to build systems that address the myriad causes … and build evidence-based solutions to sustain the careers and productivity of our medical professionals.”

Price expressed concern about symptoms of burnout being directly related to medical errors, lower quality measurements, and lower patient satisfaction, adding that medical organizations have developed programs to provide tools for physicians to identify burnout symptoms, identify pathways to treatment, and strategies to attempt to avoid it.

“Practicing physicians are the leaders of our healthcare system, yet their voices are often not heard,” noted Tim Norbeck, CEO of The Physicians Foundation.

Dr. Russell Libby But only partial solutions can be offered.

“If the root causes aren’t addressed, the problem will not go away,” said Price. “It’s prudent to keep in mind that the first reaction to seeing canaries perish in a coalmine wouldn’t usually be to send out for tougher canaries.”

WHICH FACTORS ARE MOST SATISFYING ABOUT PRACTICING MEDICINE? Relationships with patients and intellectual stimulation. Perhaps surprisingly, the profession’s financial rewards ranked a distant third, while the prestige of medicine landed last on a list that includes interaction with colleagues and social impact on the local community.

THE PHYSICIANS FOUNDATION A SURVEY OF AMERICA’S PHYSICIANS" PRACTICE PATTERNS & PERSPECTIVES RESPONSES FROM THE STATE OF FLORIDA Following are responses from the state of Florida to a national survey of physicians commissioned by The Physicians Foundation and conducted by Merritt Hawkins. Of 8,774 survey responses, 461 were from physicians in Florida. Responses of Florida physicians are compared to all survey responses.

1. Which best describes your professional morale and your feelings about the current state of the medical profession?

11. What TWO factors do you find LEAST satisfying about medical practice?

Erosion of clinical autonomy Professional liability concerns Regulatory/paperwork burdens Lack of time with patients Inefficient EHR design/interoperability Income/Compensation

FLORIDA ALL

Very positive Somewhat positive Somewhat negative Very negative

6.4% 7.1% 34.4% 37.7% 40.3% 37.4% 18.9% 17.9%

2. Which best describes how you feel about the future of the medical profession?

Very positive/optimistic Somewhat positive/optimistic Somewhat negative/pessimistic Very negative/pessimistic

3. What is Your Medical Specialty?

Primary Care Specialty

4. What is Your Current Professional Status?

Practice owner/partner/associate Employed by a hospital Employed by a hospital-owned medical group Employed by a physician-owned medical group Other

5.2% 6.2% 28.0% 32.2% 45.7% 42.4% 21.1% 19.2% 28.8% 32.1% 71.2% 67.9% 35.0% 31.4% 12.0% 19.1% 13.4% 17.4% 15.5% 12.6% 24.1% 19.6%

5. If you had your career to do over, would you choose to be a physician?

Yes, medicine is still rewarding No, the negatives outweigh the positives

68.6% 72.6% 31.4% 27.4%

6. Would you recommend medicine as a career to your children or other young people?

Yes No

46.7% 51.3% 53.3% 48.7%

7. Do you now practice some form of telemedicine?

Yes No

17.3% 18.5% 82.7% 81.5%

8. What percent of your patient encounters occur through telemedicine?

0-10% 11-25% 26-40% 41-60% 61% or more

8. What is your age?

35 or under 36-45 46-55 56-65 66 or older

9. What is your gender?

Male Female

67.9% 73.8% 16.7% 15.9% 8.9% 4.8% 2.6% 1.3% 3.9% 4.3% 9.4% 11.2% 20.9% 19.8% 21.8% 22.9% 31.6% 29.0% 16.3% 17.0% 64.3% 66.1% 35.7% 33.9%

10. How many of your patients are affected by a social situation that poses a serious impediment to their health?

All Many Some Few None

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3.4% 4.7% 45.7% 51.7% 35.9% 31.4% 14.6% 11.1% 0.5% 1.1%

35.6% 37.0% 37.5% 30.2% 65.4% 67.7% 11.9% 12.4% 31.6% 39.2% 14.4% 13.3%

12. In the next one to three years, do you plan to (check all that apply): Continue as I am Cut back on hours Retire Switch to a cash/concierge practice Work locum tenens Sell practice to hospital/health system Merge with another physician group Seek a non-clinical job within healthcare Seek employment with a hospital Work part-time

53.6% 54.2% 23.4% 22.3% 15.9% 17.4% 5.3% 4.5% 8.5% 8.4% 3.1% 2.2% 3.1% 2.8% 11.6% 12.4% 4.2% 4.3% 10.1% 8.5%

13. Hospital employment of physicians is a positive trend likely to enhance quality of care and decrease costs.

Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree

2.8% 2.7% 9.2% 10.6% 23.5% 29.2% 32.9% 29.6% 31.6% 27.9%

14. Value-based compensation is likely to improve quality of care and reduce costs.

Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree

2.9% 2.9% 12.9% 15.1% 24.5% 25.2% 32.1% 33.1% 27.6% 23.7%

15. What do you think is the best direction for the U.S. healthcare system?

Maintain the current system Move to a single payer insurance Move to a two-tiered system Move to a market-driven system Other

2.7% 4.5% 18.2% 26.2% 36.8% 35.5% 35.2% 27.2% 7.2% 6.6%

18. On average, how many hours do you work per week (include all clinical and non-clinical duties)?

0-20 21-30 31-40 41-50 51-60 61-70 71-80 81 or more

3.9% 4.9% 5.9% 5.0% 11.6% 11.6% 23.9% 24.1% 24.2% 26.1% 16.8% 15.7% 9.6% 7.8% 4.1% 4.7%

19. What TWO factors do you find MOST satisfying about medical practice?

Patient relationships Prestige of medicine Intellectual stimulation Interaction with colleagues Financial rewards Social/community impact

72.9% 78.7% 8.9% 9.8% 60.9% 55.1% 10.9% 14.3% 22.5% 18.9% 20.5% 20.9%

20. Of these, how many hours do you work each week on NON-CLINICAL (paperwork) duties only?

0-5 6-10 11-15 16-20 21-25 26 or more

29.0% 25.0% 26.6% 28.6% 15.7% 18.8% 13.5% 12.3% 5.7% 6.1% 9.4% 9.2%

21. On average, how many patients do you see per day (include both office and hospital encounters)?

0-10 11-20 21-30 31-40 41-50 51-60 61 or more

18.2% 18.1% 35.0% 40.0% 29.8% 27.7% 8.3% 8.6% 4.8% 2.6% 1.5% 1.3% 2.4% 1.8%

22. Which of the following best describes your current practice?

I am overextended and overworked I am at full capacity I have time to see more patients and assume more duties

25.6% 23.9% 51.3% 55.6% 23.1% 20.5%

23. On the whole, how would you describe the current state of relations between physicians and hospitals, many of which now would employ physicians?

Mostly positive and cooperative Somewhat positive and cooperative Neither positive nor negative Somewhat negative and adversarial Mostly negative and adversarial

6.3% 6.1% 20.8% 25.6% 23.9% 21.8% 34.7% 34.4% 14.3% 12.0%

24. How has EHR affected your quality of care?

Increased/Improved Little to no impact Reduced/Detracted from

25. How has EHR affected your efficiency?

Increased/Improved Little to no impact Reduced/Detracted from

23.2% 28.6% 34.1% 18.9% 42.7% 35.8% 22.9% 25.2% 19.8% 18.9% 57.3% 55.9%

26. Approximately what percent of your patients DO NOT consistently adhere to your treatment plans?

0-10% 11-20% 21-30% 31-40% 41-50% 51-60% 61-70% 71-80% 81-90% 91-100%

13.8% 12.7% 21.4% 21.3% 25.1% 24.3% 14.8% 15.1% 10.1% 9.9% 5.7% 7.1% 3.9% 4.7% 3.5% 3.3% 1.2% 1.2% 0.5% 0.4%

27. How has EHR affected your interaction with patients?

Increased/Improved Little to no impact Reduced/Detracted from

9.1% 7.9% 43.8% 26.4% 47.1% 66.7%

28. Are you a member of your: County medical society State medical society National specialty society American Medical Association American Osteopathic Association

36.6% 40.6% 56.9% 63.2% 77.7% 79.4% 22.1% 26.3% 7.9% 6.6%

29. What is your position on concierge/direct pay medicine?

I now practice some form of concierge/direct pay medicine 8.9% 6.6% I am planning to transition fully to this model 3.3% 2.4% I am planning to transition in part to this model 12.8% 9.9% I have no plans to transition to this model 75.0% 81.1%

30. To what extent do you have feelings of professional burnout in your medical career?

No such feelings Rarely have these feelings Sometimes have these feelings Often have these feelings Always have these feelings (significant burnout)

5.7% 5.7% 13.5% 16.6% 39.4% 37.7% 30.7% 31.0% 10.7% 9.1%

31. How much ability do physicians have to significantly influence the healthcare system?

34.1% 32.0% 33.9% 30.5% 21.9% 26.9% 7.6% 8.1% 2.4% 2.5%

Very little Little Somewhat A good deal A great deal

32. To what degree is patient care in your practice adversely impacted by external factors such as third party authorizations, treatment protocols, EHR design, etc.?

Not at all Little Somewhat A good deal A great degree

2.4% 2.6% 8.4% 8.8% 20.4% 26.6% 30.8% 33.0% 37.9% 29.0%

33. Is any of your compensation tied to quality metrics such as patient satisfaction, following treatment guidelines, compliance, “citizenship”, error rates, etc.?

Yes No Unsure

43.6% 47.1% 39.7% 39.5% 16.8% 13.4%

34. What percent of your TOTAL compensation is tied to such 36.2% 41.9% 21.9% 22.4% 10.7% 8.4% 3.1% 2.5% 2.6% 1.8% 6.1% 4.2%

0-10 11-20 21-30 31-40 41-50 51 or more

35. Maintenance of Certification (MOC), as required by my specialty board, accurately assesses my clinical abilities.

Completely disagree Disagree Neither agree nor disagree Agree Completely agree

38.7% 35.7% 28.1% 32.6% 18.8% 18.0% 11.9% 11.8% 2.4% 1.9%

Courtesy of The Physicians Foundation and Merritt-Hawkins

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.com

It’s Time for Business Continuity and Data Protection

HEALTHCARELEADER

Pooling Talent, continued from page 1 ogy (ESIR) accreditation. The group has a high faculty-to-resident ratio under the tutelage of education and research officer Laura W. Bancroft, MD, FACR and program director Kurt Scherer, MD. In 2016, Florida Hospital’s diagnostic radiology residency program graduated its first class, with all four residents earning a 100 percent first-time boards pass rate.

“I enjoy the success the residents in our program have had here and I’m thrilled with the fellowships they’ve acquired through hard work and research,” said L. Bancroft.

CONNECTING THE DOTS

By CURTIS PARTRIDGE

When we think of business continuity or disaster recovery disasters such as hurricanes or a structure fire come to mind.

Though these do live top of mind due to the scale of the impact, businesses everyday are struck by more mundane, but just as destructive, disasters.

Recently a Central Florida surgery center had just such a disaster. Just after one o’clock in the afternoon one of the employees opened what appeared to be a harmless attachment in their email. No one noticed any issues with the network or files through the remainder of the afternoon. The office was closed for the next 3 days due to a long weekend. Upon returning to work the users noticed software operating correctly and files couldn’t be opened. A scary message displayed on everyone’s computer screen demanding payment to decipher their data.

A quick check by a remote IT tech confirmed the practice had been hit by ransomware. This fast-moving software had spread through the desktop computers and servers through the weekend. All their data was reduced to a jumbled mess of encrypted data.

Ransomware has been outpacing natural disaster for business data the past few years. Cybersecurity Ventures predicts that damage cost for just ransomware will exceed $5 billion in 2017. According to the Cisco 2017 Annual Cybersecurity Report, attacks are growing at a yearly rate of 350 percent. Business and organizations large and small are being hit by ransomware every day. Only the larger organizations such as the City of Atlanta or Hollywood Presbyterian Medical Center make the headlines, but businesses of all size are being attacked.

Criminals are targeting healthcare more than any other industry. According to Cylance in 2017 the industry suffered 34 percent of the attacks compared to the next sector which was manufacturing in 17 percent. Healthcare practices are data7

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driven enterprises and data protection is critical. Attackers are crafting specific attacks directed at this industry because they know they are more likely to pay. Reasons are to keep the practice operational as well as avoiding the embarrassment and liability of admitting to a data breach.

There are steps that a practice can take to protect themselves from ransomware.

The least expensive and most effective to date is a good business continuity or data recovery system. These low-cost systems can take a snapshot of all your data, servers, and desktops as frequently as every few minutes. They can also detect ransomware and stop backup activity while alerting a technician to investigate. Importantly these systems can keep versions of data ranging from minutes to years to allow a roll-back to a time before the attack.

On the horizon information technology providers are beginning to test and implement cybersecurity systems that detect the ransomware attack and almost instantly begin an automated recovery of data. This eliminates the data recovery time of older systems that can take up to a few hours to a day or two to complete.

These preventive solutions are just a piece of the complete protection puzzle.

Other items to consider are keeping systems up to date with current software patches, employee education regarding safe computer practices, anti-virus software, and network protection appliances such as firewalls with current software implementations. These systems must be proactively monitored and maintained on a near daily basis.

RSF’s founders– R. Scott Shill, MD, Bancroft, and Josiah W. Bancroft, III, MD –met during residency training at the University of Miami School of Medicine at Jackson Memorial Medical Center in Miami. All three doctors teach medical students at the University of Central Florida (UCF) and Florida State University (FSU) – Laura Bancroft’s a full professor. All are board-certified in diagnostic radiology.

“I chose radiology because it could answer the clinical questions that percussing could not,” said L. Bancroft, whose mom was a nurse at Barnes Jewish Hospital at Washington University in her hometown, St. Louis, Mo. She completed medical school at the University of Missouri and trained with world-famous fellowship director Thomas Berquist, MD at the Mayo Clinic Florida in Jacksonville,

(CONTINUED ON PAGE 9)

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

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

FOR MORE INFORMATION https://cybersecurityventures.com/ ransomware-damage-report-2017-5-billion/ https://healthitsecurity.com/news/healthcareindustry-takes-brunt-of-ransomware-attacks Curtis Partridge is a Senior Systems Engineer with Lotus Management Services, Inc., a provider of better solutions for small business IT in Florida. Chat: lotusmserv.com/chat

specializing in musculoskeletal radiology. She spent a dozen years serving in multiple roles, including director of its Musculoskeletal Fellowship Program and associate dean of the Mayo School of Allied Health. She is highly involved with the local Radiology Specialists Volunteer Program, a charitable group comprised of radiologists, spouses and support staff.

Joe Bancroft, husband of Laura Bancroft, is the acting president of RSF. A University of Florida College of Medicine grad and interventional radiologist, serves as a UCF clinical assistant professor and FSU adjunct professor.

Shill is RSF’s vice president and interventional radiology section chief. The University of Health Sciences’ Chicago Medical School grad remained in Miami to complete a fellowship in vascular/interventional radiology. Dr. Shill serves as the Radiation Safety Chairman for Florida Hospital Orlando, Florida Hospital Flagler and Florida Hospital New Smyrna.

While the men are managing the business, Laura Bancroft holds rotating leadership roles representing their specialty.

In 2014, she was elected president of the Florida Radiological Society, which was honored with the Overall Excellence State Chapter Award at the annual American College of Radiology meeting in 2015. That year, she became the UCF Chair of Radiology. In 2017, she was named a fellow of the American College of Radiology, and teaches as a clinical professor of radiology at FSU.

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

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

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CBD: Miracle Cure or Snake Oil The truth lies somewhere in between

By MICHAEL C. PATTERSON

It seems everywhere you look these days, CBD is being talked about as a miracle cure for everything such as cancer, colitis, IBS, chronic pain, seizures, MS, diabetes, psychosis, and dozens of other ailments. The big question is does it really work?

The short answer is “yes, most people show some relief of symptoms.” The long answer is “yes, but it must be lab tested free of contaminants, properly dosed in a useable form, and legal to purchase and use.”

What is CBD? Is it Cannabis (Marijuana)?

CBD, or cannabidiol, is a chemical compound found in cannabis and hemp.

The chemical compounds in cannabis and hemp are called cannabinoids. There are over 100 cannabinoids found in cannabis and hemp. CBD is a cannabinoid that does not have a euphoric effect or “high.” That effect comes from the cannabinoid THC (tetrahydrocannabinol). So, CBD can come from a hemp plant or a cannabis plant.

Why does it work?

CBD works based off a system in our body called the endocannabinoid system. The endocannabinoid system is a group of receptors throughout our bodies which accept cannabinoids. This system works like a “lock and key” system accepting cannabinoids, like CBD, without rejection or harmful side effects.

This is the main reason that so many people who use CBD have little or no side effects. It has been proven that CBD decreases inflammation throughout the body, as well has a homeostatic effect on the body keeping it at a point of wellness. This could be why it works on so many different ailments.

Is it legal?

It depends on which Department of the US Government and State Government you ask. California and Ohio have deemed CBD illegal unless it is purchased at a licensed Cannabis Dispensary. Colorado and Kentucky have embraced CBD extracted via hemp and look to continue to capitalize on the surge of CBD use. The FDA has recently given approval to a drug from GW Pharmaceuticals called Epidiolex, which is used for seizures and contains CBD (It will cost $32,000 per year).

In Florida, it is legal to purchase CBD through a licensed Medical Marijuana Treatment Center (MMTC) Dispensary, at many retail stores, and online. However, manufacturing CBD from hemp or cannabis for purchase is still considered illegal at the federal level. The DEA goes back and forth on the legality of CBD depending on which legal opinion you read. However, the “grey” area of legality could be soon coming to an end. At the time of publication, the US Congress is in the final stretch of passing the 2018 Farm Bill which would fully legalize hemp, which would require CBD to be 100 percent legal in the United States.

Wait…what does making hemp legal have to do with CBD being legal? And, what is Hemp?

Hemp, or more commonly called Industrial Hemp is what I like to call a “cousin” of the cannabis (marijuana) plant.

Hemp is typically grown outdoors and grows very tall (up to 15 ft tall) similar to corn or wheat. Hemp is used in over 25,000 different products such as clothing, plastics, building materials, food, gasoline, and many

others. Even though hemp looks like Cannabis, by law it has less than .03 percent THC (the cannabinoid that makes you feel “high”), but still has CBD. So, if Congress legalizes hemp, which it looks as if they will, then CBD will be made fully legal.

What are some problems with CBD? Dosing, quality, and consistency. As of now, CBD production is not regulated by any US government agency. However, in Florida it is regulated by the Department of Health Office of Medical Marijuana Use for sale in licensed MMTC Dispensaries. CBD purchased anywhere other than a MMTC dispensary is typically not regulated whatsoever.

Also, cheap CBD products typically have little milligrams of CBD in them. So, the product will do little if anything for you.

Dosing Dosing has been a challenge with CBD because everyone reacts differently

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to CBD. One patient could show benefits with 10mg of CBD and another could take 400mg of CBD or more to feel the same benefit. Most training that has been provided to physicians through CME classes recommend to dose CBD using the approach of “start low and go slow.” Start with a low recommended mg dose of CBD and keep increasing dosage until the patient feels the benefit of the medicine. Due to CBD having little or no side effects, there is little or no risk on increasing the mg dose of CBD to achieve the desired effect.

If your office is looking to suggest the use of CBD for certain diagnoses and ailments, I would encourage you to research recommended dosing to ensure that you have the most updated data possible.

How can CBD help my patients and my medical practice?

I would bet that a lot of your patients are already taking CBD, or thinking about taking it, and just not telling you. The reason I know that is because everywhere I go in Florida that’s all patients tell me. They know I am receptive to the use of Cannabis and CBD for medicinal purposes and they will not be “shamed” or treated like a criminal discussing its use. Patients will feel more comfortable talking to medical staff about CBD products and benefits if their physician is willing to talk about it. Medical practices recommend over the counter medications to their patients all the time (Tylenol, vitamins, natural remedies, etc.).

A discussion about the use or non-use of CBD by a patient’s physician when appropriate can go a long way in keeping the lines of communication open with patients.

The future for medical offices for revenue generation on CBD is private label sales or direct CBD sales via the Medical Office. (just like medical practices sell other non-covered insurance items or services like Botox, B12 IVs, certain private label vitamins or skin creams). Patients will pay more for CBD if they purchase from a medical practice because they trust it is safe and effective. If you or your practice decides to sell or market CBD, ensure that the CBD is lab tested for contaminants and consistency of product. Your patients trust your judgement and professional opinion.

Make sure your products are safe and effective to use.

The use of CBD and CBD related products is only going to increase. The more knowledgeable you and your medical practice are regarding CBD and its uses, the better you can educate and service your patient population.

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

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FLORIDA’S INNOVATION HEADLINES (Plantation, FL) MagicLeap, has raised $2.3B (yes, billion) to create a head-mounted virtual retinal display.

The company has a dedicated mixed reality team specifically developing digital health programs and in the process is creating Florida jobs: https:// www.magicleap.com/careers (Orlando, FL) Speaking of mixed reality technology in healthcare, according to Dr. David Metcalf, Director, METIL at University of Central Florida Institute for Simulation & Training, “VR has gotten traction in healthcare mainly as a training and education device, but industry-wide it’s a green field for innovation.” David Metcalf, based here in Orlando, presented for HIMSS on the topic. You can find his talk here: https://www.himsslearn.org/virtual-realitygets-real-healthcare (Orlando, FL) This startup is using tech funded by NASA to diagnose diseases.

The company has raised $4M with an additional $4M in process. The company, Aviana Molecular Technologies, is developing a smartphone device to detect infectious diseases with a single drop of blood. https://www.bizjournals. com/orlando/news/2018/06/27/howthis-ucf-incubator-startup-is-using-tech.html (FL) A possible replacement for the Epi-pen?

Nova Southeastern University scientists have created a tablet that dissolves under the tongue to potentially replace expensive autoinjectors: https://www.popsci.com/forgetepipen-its-time-for-an-epi-pill 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.

FEATURED EVENTS: 10/06/18 Medical AllStars Expo

HEALTH INNOVATORS

Where Does Your Innovation Live?

By JOHN NOSTA, NostaLabs

What is the zip code of your innovation lab?

Or, should I ask for the genetic sequencing of your innovation connective tissue?

My concern is that too many innovation labs, accelerators and incubators are being built without real and tangible connections to those people they intend to serve. Yes, they are all branded around the same thing: Customers first! But in this case, the customers (who should be served first) must be the rank-and-file employees who actually bring the magic to market.

The real innovation lab doesn’t live down the road or in some dramatic urban setting with a powerful industrial design. It lives as a neural network that connects and inspires all. Innovation must connect with the heart and soul of a company—the employees.

It’s really a “culture lab” that connects innovation to individuals and helps transform from within. And conversely, it’s culture that squashes innovation at its earliest stages. Yet, many companies still build their funky silos in an attempt to attract innovators and innovations only to find that “the big idea stops here.”

It’s time to add a few ideas into those wordy mission statements:

HEALTHCARELEADER NUTS & BOLTS

Among high priority research projects, the RSF team is evaluating the treatment possibilities of molecular imaging for patients with somatostatin tumors. Lutathera (Lu-177 dotatate) is a new FDA-approved peptide receptor radionuclide therapy for the treatment of gastroenteropancreatic neuroendocrine tumors. Targeted therapy reduces the risk of cancer spreading by 79 percent when compared to a larger-thannormal dose of long-acting octreotide therapy. The treating agent is injected through an IV and the radioactive drug attaches to the tumor to essentially melt away the tumors, said Joe Bancroft.

RSF is working on radioembolization of liver cancer via a procedure using glass- or resin-encased radioactive isotope

• Innovation is a shared engagement.

• Staff must share in the process, from insight to execution.

• Innovation must be expressed and fostered across staff levels and functions.

• Innovation is not outside in; it’s from the inside out.

• A company where the staff is not aligned on innovation will fail.

Of course, much of innovation comes from outside corporate’s brick walls. But the friction and resistance to change from within can be insurmountable. And the heat of this resistance can be felt outside those walls. Obstructionism, ignorance, apathy and a host of other issues are seen and

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sensed by those external innovators who bring the lightning to the lightning rod.

The dirty little word in innovation that many often miss is receptivity. We live in a world where ideas flourish. Innovators abound and eclectic ideas traverse the globe, looking for a place to land. Today’s corporations must embrace this dynamic and understand that they are the runways upon which many ideas come to ground.

However, it’s sad to see how many brilliant ideas have crashed and been lost because of those rigid bumps and treacherous cross winds of opinion that make landing the big idea almost impossible.

You can find more articles from John Nosta on PsychologyToday.com (reprinted with author’s permission)

Pooling Talent, continued from page 7 Yttrium (Y-90) to place directly in blood vessels that feed a tumor. This directed therapy blocks the supply of blood to the cancer cells and delivers a high dose of radiation to the tumor without damaging normal tissue.

“Using prostate MRI data, we're able to guide the surgeons to tumor areas for therapy,” said Joe Bancroft.

RSF is studying prostate embolization, a procedure to treat benign prostatic hyperplasia, where microscopic beads are placed in the blood vessels to block the blood flow to the prostate. This oxygen deprivation to the cells causes the prostate gland to shrink.

Having many subspecialties allows RSF to provide specific solutions for patients and consultation opportunities for

physicians.

The benefit to the referring physician and the patient is they know there’s a team of multidisciplinary doctors that can handle their specific area of concern.

That’s the challenge and the enjoyment of what the physicians do at Radiology Specialists of Florida.

“It covers all aspects of medicine. So it's challenging in regards you have to be up on every aspect of medicine, because every type of physician or practice comes to you for questions, and you're also the doctor's doctor because they send a patient to you when they're trying to figure something out, and hopefully you can lead them down a more targeted diagnostic trail to help them take care of patients,” said Shill.

10/16/18 3D Printing at GuideWell Innovation Core

10/22/18 Opioids Event 11/09/18 Lung Force 11/14/18 Digital Orlando at the Orlando Science Center

11/29/18 1st Annual Women in

Healthcare Leadership Symposium

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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Keeping the Dream Alive – Fertility Preservation, continued from page 4 eggs are close to 100% and overall IVF success rates are similar to IVF with fresh eggs. The process involves controlled ovarian stimulation, surgical retrieval of the oocytes, vitrification, and storage. Using mid cycle starts the process can be carried out in 3-6 weeks’ time.

Embryo creation is an option for women who are married or have a partner. Oocytes are fertilized using the sperm of the patients’ partner. Embryos are then cultured in the embryology lab and vitrified using a similar procedure to that of oocytes.

The advantage of embryo cryopreservation is that vitrified embryos are easier to warm than eggs because they are multicellular and if a few cells are damaged during warming the embryo will still survive and is usually unaffected by the loss of a few cells.

Ovarian tissue cryopreservation is an experimental procedure with limited results to date. Samples of tissue containing thousands of primordial oocytes are removed from the ovary and cryopreserved. The tissue can later be implanted and hopefully begins to produce mature

oocytes that can be harvested and used in IVF to create embryos and ultimately produce a child. So far over 70 pregnancies have been achieved worldwide, but the outlook is encouraging, especially for preadolescent women.

Corey Burke is the Tissue Bank Director of Cryos International – USA. He has 20 years of reproductive laboratory experience and is an industry leader in the field of oocyte and sperm cryopreservation, running one of world’s largest donor egg and sperm banks. Working as an andrologist and embryologist, he has helped thousands of people achieve their dreams of becoming parents. Contact at usa@cryosinternational.com orlandomedicalnews

.com

GrandRounds

Community Health Centers Announces Roshni Patel, Md As Chief Of Pediatrics

CMS to Strengthen Oversight of Medicare’s Accreditation Organizations Today, the Centers for Medicare & Medicaid Services (CMS) took action to improve quality and safety in healthcare facilities and empower patients with information to make decisions about where to receive care.

“Today we are taking action to improve our oversight of Accrediting Organizations, including by increasing transparency for patients on the organizations’ performance,” said CMS Administrator Seema Verma. “The public trusts CMS to ensure the quality and safety of patient care, and we take this responsibility very seriously. Today’s changes will bolster the processes for overseeing how effective Accrediting Organizations, who work on CMS’ behalf, are in evaluating healthcare facilities.”

Currently, Medicare-participating healthcare providers and suppliers are surveyed either by State survey agencies or by Accrediting Organizations (AOs) to ensure that they meet CMS’ quality and safety standards. AOs receive deeming authority from CMS, which affirms that AOs’ health and safety standards meet or exceed those of Medicare. Only facilities and suppliers that have been deemed by state or AO surveyors to meet CMS’ standards may receive payments from Medicare. There are currently 10 CMSapproved AOs, each of which surveys one or more different types of facilities.

CMS will enhance and strengthen its oversight and quality transparency of AOs in three ways: 1) the public posting of AO performance data; 2) a redesigned process for AO validation surveys and 3) the release of the Annual Report to Congress. Taken together, these efforts will provide important insights to the public and assist AOs, providers, and suppliers in ensuring patient health and safety.

Posting AO Performance Data Online To increase transparency for consumers, CMS will post new information on the CMS.Gov website, including: The latest quality-of-care deficiency findings following complaint surveys at facilities accredited by AOs; a list of providers determined by CMS to be out of compliance, with information included on the provider’s AO; and overall performance data for AOs themselves. To view AO performance data, visit: https://qcor.cms. gov/hosp_cop/HospitalCOPs.html Today, the public relies on accreditation status as a way to gauge providers’ and suppliers’ quality of care. By posting more detail—accredited hospitals’ complaint surveys, out-of-compliance information, and performance data for AOs themselves—CMS will offer the public more nuanced information than accreditation status alone provides. The agency is currently prohibited by law from disclosing the actual surveys done by AOs, except for surveys of home health agen-

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cies and surveys related to an enforcement action.

Pilot Testing Direct Observation for AO Validation Surveys CMS is testing a more streamlined, efficient way to assess AOs’ ability to ensure that facilities and suppliers comply with CMS requirements.

CMS evaluates the ability of AOs to accurately assess providers’ and suppliers’ compliance with health and safety standards through a validation survey process. Historically, CMS has measured the effectiveness of AOs by choosing a sample of facilities, performing stateconducted assessment surveys within 60 days following AO surveys, and comparing results of the state surveys with the AO surveys. In a pilot test, CMS will eliminate the second state-conducted validation survey and instead use direct observation during the original AO-run survey to evaluate AOs’ ability to assess compliance with CMS’s Conditions of Participation.

Direct observation will enable CMS not only to evaluate AO performance more effectively, but also to suggest improvements and address concerns with AOs immediately. This approach will relieve providers from having to undergo the burden of a state’s follow up assessment. The approach is another example of the wide-ranging effort at CMS to eliminate duplication and relieve burden, reducing the amount of time that healthcare facilities must spend on compliance activities.

CMS will also analyze and incorporate State complaint investigations of accredited facilities as part of the agency’s strengthened validation program. This work will focus on identifying and monitoring accredited facilities that are out of compliance with Medicare health and safety requirements. CMS will use this information as an additional indicator of AO performance.

Posting the Most Recent Annual Report to Congress Regarding AO Performance CMS has also posted the most recent annual Report to Congress, the “Review of Medicare’s Program for Oversight of Accrediting Organizations and the Clinical Laboratory Improvement Validation Program Fiscal Year 2017,” on the CMS website. As the changes announced today inform and bolster our oversight of AOs, CMS will continue to publish this report online annually to demonstrate the impact of these changes on the oversight of AOs and to provide greater transparency for the public. The FY 2017 Report to Congress is posted online:https://www.cms.gov/Medicare/ Provider-Enrollment-and-Certification/ SurveyCertificationGenInfo/Policy-andMemos-to-States-and-Regions.html

Community Health Centers (CHC) is pleased to announce the promotion of Pediatrician Roshni Patel, MD to Chief of Pediatrics. Dr. Patel, a graduate of Rosalind Franklin University of Medicine and Science, completed her residency in 2012. She relocated to Florida where she became a Resident Physician at Orlando Health’s Arnold Palmer and Winnie Palmer Hospitals before joining CHC in 2015.

Dr. Patel has been instrumental in the growth of our Pine Hills center and has contributed to numerous quality initiatives, procedure developments and accreditation readiness to reach our goal in continuing to provide quality and compassionate care to our patients. As the Chief of Pediatrics, Dr. Patel shared, “I am honored to be able to continue the work I love and be a part of an organization that is dedicated to improving the lives of children and the communities we serve”.

“I look forward to Dr. Patel serving in her new role as Chief of Pediatrics.

Dr. Patel’s focus on excellent pediatric health care and child advocacy for improved child health outcomes aligns perfectly with CHC’s mission to provide quality and compassionate primary healthcare services to Central Florida’s diverse communities”, states Debra Andree, MD, Chief Medical Officer.

Community Health Centers, Inc. (CHC), a Federally Qualified Health Center (FQHC), provides quality and compassionate primary healthcare services to insured, uninsured, underinsured, and underserved children and adults within Central Florida. CHC is the medical and dental home to more than 66,000 patients in the Apopka, Bithlo, Clermont, Forest City, Groveland, Lake Ellenor, Leesburg, Meadow Woods, Pine Hills, Tavares and Winter Garden communities. CHC has been recognized as an Orlando Sentinel Top 100 Company for Working Families for the past years. www.chcfl.org

PMC announces October Food Truck Frenzy Cutline: Poinciana Medical Center recently kicked off the third month of its Food Truck Frenzy. Community members and hospital staff are invited to eat from three different food trucks which will make stops in the hospital parking lot. The following food trucks are

scheduled for the month of October: Master Chef, Ruben Place Asia, Burger Lab. October food truck visits are as follows: Ruben Place Asia: 11 a.m. – 1:30 p.m. October 9, 16, 30; Burger Lab: 11 a.m. – 1:30 p.m. October 10 and 24.

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.com

GrandRounds Major Gift to Expand Cardiovascular Services Florida Hospital Orlando plans to expand its Cardiovascular Institute with a new Center for Living, which will offer a comprehensive program to identify, prevent and treat cardiovascular diseases — the leading cause of death in the nation.

The Center for Living has been made possible thanks to a generous $3 million gift by the Ginsburg Family Foundation.

The Ginsburg family’s support of Florida Hospital’s Cardiovascular Institute started more than 10 years ago with a $20 million gift, which funded the hospital’s Ginsburg Tower.

Aligning with the hospital’s new initiative to use genomics to diagnose, treat and prevent diseases, the 13,200-square-foot Center for Living will feature a genomics clinic focused on cardiovascular diseases.

The center will also incorporate the cardiac and pulmonary rehabilitation unit, where patients will have access to a prevention and wellness program.

The Center for Living is expected to care for more than 8,000 cardiovascular patients during its first three years of operation.

“Florida Hospital continues to provide lifesaving, cutting-edge health care in the field of cardiology to all of us in Central Florida and beyond,” said real-estate developer and philanthropist Alan Ginsburg.

“The Ginsburg family is pleased to benefit the community through this much needed addition to the Ginsburg Tower.”

The Florida Hospital Cardiovascular Institute is one of the largest programs of its kind in the country, by patient volume.

“We appreciate the Ginsburg family for their generosity and continued commitment to advancing health care in Central Florida. The Center for Living will create an environment that combines our diverse cardiovascular services with genomics and wellness programs, elevating our care and strengthening our wholistic approach to healing,” said Dr. Duane Davis, chief medical officer of Florida Hospital’s institutes, including cardiovascular. “As we look to the future of health care, this program is key to keeping our patients and greater community healthier.”

Construction of the Cardiovascular Center for Living is scheduled to begin during the first quarter of 2019 with completion expected by the end of 2020.

suring the stiffness of the liver. FibroScan® detects any thickening or scarring of the liver tissue (fibrosis). There is no pain or discomfort involved in this procedure and it is performed at the office and on average, it takes about 15-20 minutes to complete.

FibroScan® works by emitting a small pulse of energy, which may feel as a slight vibration on the skin. FibroScan® calculates the speed of this energy to give the healthcare provider an immediate measure of the stiffness of the liver. This measure is an important part of understanding the overall liver health.

During a FibroScan®, an ultrasound probe is placed at the surface of the skin to measure the condition of the liver via sound waves. The data created is then sent to a computer for analysis. An image of the liver is displayed on the screen and it shows the physician the level of fibrosis or hardening of liver tissue in real-time.

Indications for a FibroScan® include: Fatty Liver Diseases, Chronic Viral Hepatitis C, Chronic Viral Hepatitis B, Alcoholic Liver Disease, Cystic Fibrosis, Autoimmune Liver Diseases, Portal Hypertension, and HIV/ HCV C-Infection.

Annual VA Report Shows Orlando VA Medical Center Improvement in Quality of Services Using an annual web-based report scorecard that measures, evaluates and benchmarks quality and efficiency at its medical centers, the U.S. Department of Veterans Affairs (VA) recently released data that showed significant improvements at the majority of its health care facilities.

The Orlando VA Medical Center was among VA facilities that made improvement in the SAIL Score and is working to

PMC recognizes employees Cutline: Poinciana Medical Center recently recognized employees around the hospital for outstanding performance and exceptional work. Wound Care Nurse Debra Medina was honored as employee of the month and Nurses Marlene Ferguson and Carol Schollard-Palka were presented with Patient Safety Awards.

Digestive Liver Center of Florida Offering Fibroscan® Non-Invasive Liver Testing The Digestive and Liver Center of Florida is the first independent Healthcare Practice in Central Florida to offer FibroScan®. This a quick, pain-free, and non- invasive liver scan and also the latest innovation in mea-

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GrandRounds continue progress. For example, since the opening of the medical center’s inpatient unit the facility has seen positive quality metrics and high levels of satisfaction with inpatient care.

“We are committed to providing the best quality healthcare for our Veterans.” said Orlando VA Medical Center Director Timothy W. Liezert. “Our metrics have improved because our employees are dedicated to serving Veterans. By focusing attention on specific outcomes, we are able to meet the unique needs of combat Veterans and continue to sustain life-long relationships with our Veterans.”

Compared with data from the same period a year ago, the July 2018 release of VA’s Strategic Analytics for Improvement and Learning (SAIL) report showed 103 (71 percent) VA Medical Centers (VAMCs) have improved in overall quality — with the largest gains seen in areas where there were VA-wide improvement initiatives, such as mortality, length of stay and avoidable adverse events. Seven (5 percent) VAMCs had a small decrease in quality.

“This is a major step in the right direction to improving our quality of services for our Veterans,” said VA Secretary Robert Wilkie. “Over the past year, we were able to identify our problems and implement solutions to fixing the issues at 71 percent of our facilities. I’m extremely proud of our employees and the progress they have made to raise VA’s performance for our nation’s heroes.”

Additionally, of the 15 medical centers placed under the Strategic Action for Transformation program (StAT), an initiative that monitors high-risk medical centers and mobilizes resources to assist the facilities, 33 percent (five medical centers) are no longer considered high-risk and 73 percent (11 medical centers) show meaningful improvements since being placed under StAT in January 2018.

The quarterly SAIL report, which has been released publicly since 2015, assesses 25 quality metrics and two efficiency and productivity metrics in areas such as death rate, complications and patient satisfaction, as well as overall efficiency and physician capacity at 146 VAMCs. It is used as an internal learning tool for VA leaders and personnel to pinpoint and study VAMCs with high quality and efficiency scores, both within specific measured areas and overall. The data is also used to identify best practices and develop strategies to help troubled facilities improve.

Nemours Recognized for Offering One of the Nation’s Best Workforce Health and Well-being Programs The National Business Group on Health, a nonprofit association of more than 420 large U.S. employers, today honored Nemours Children’s Health System for providing one of the best workforce health and employee well-being programs in the

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Nemours Children’s Hospital Wins Florida Hospital Association Award for Innovation in Patient Care A 3D modeling program being used in preoperative interventional radiology, cancer surgery and cardiac surgery cases at Nemours Children’s Hospital (NCH) in Lake Nona was honored Thursday night by the Florida Hospital Association (FHA) with The Innovation of the Year in Patient Care award during The Celebration of Service Awards Ceremony in Orlando. Click here to see a short video highlighting the technology.

“It is an honor to receive this distinction from the Florida Hospital Association recognizing our hospital’s innovative approach to how we care for our patients,” said Dr. Daniel Podberesky, Radiologistin-Chief of Nemours Children’s Health System. “We are constantly looking for ways to stay cutting-edge, all the while doing a better job clinically and helping families better understand what’s happening to their child.”

This is the fifth time the FHA has honored Nemours Children’s Hospital with an Innovation of the Year award and the sixth year the FHA honored the hospital.

The hospital opened its doors less than six years ago on October 22, 2012.

nation.

Nemours is among 49 U.S. employers that received the 2018 Best Employers for Healthy Lifestyles® award presented at the National Business Group on Health’s Workforce Strategy 2018 Conference.

Nemours received a Platinum Award for its YOURHealth and WellBeing program.

This marks the first time that Nemours has received the Best Employers for Healthy Lifestyles® award.

Comprised of three areas – employee health, wellness and fitness – the Nemours YOURHealth and WellBeing program offers a holistic approach to support a variety of needs that associates may have on their journey to achieving optimal health,

Utilizing cutting-edge 3D modeling technology, Nemours surgeons, radiologists and proceduralists are using the only FDA-approved segmentation software to plan complex multidisciplinary cases in interventional radiology, cancer surgery, and cardiac surgery.

The models serve as a blueprint and roadmap, allowing specialists to deliver the safest, most efficient care. By using 3D models, it is reducing procedure times and minimizing unexpected finds in the operating room. This pre-planning translates into less time for a patient in the operating room, which is a relief to families.

In addition, using modified models, doctors can run simulations of the surgery and can more accurately determine the surgical supplies they will need beforehand, cutting down on waste.

“The simulation aspect of 3D modeling is a game changer. To be able to look at a model of a tumor from all angles, without the restrictions of an image on a computer screen, is completely changing how we are planning complex surgery,” said Craig Johnson, Enterprise Director, Interventional Radiology, Nemours Chil-

including physical, emotional and social well-being. Programming and support for YOURHealth includes a comprehensive wellness portal, activity challenges, health coaching, weight and stress management programs, CBT-I sleep therapy and free biometric screenings. The organization has focused on building a culture of health and wellness by utilizing internal communications, monthly management meetings and leadership forums to promote employee well-being.

“Nemours is a uniquely special place, and associate engagement is key to our Nemours True North goals. As a team, we strive to communicate to associates that it’s not all about earning points, but about

dren’s Health System and Chair of the Department of Radiology at Nemours Children’s Hospital.

Currently, the service is not reimbursable by insurance companies, yet Nemours undertakes this step on behalf of the families. Since making this offering available to patients and their families, Nemours has received great feedback.

The true-to-size visualization offered by 3D models also helps educate families on procedures.

“At Nemours, we know patient-families are an integral part of the care teams, so it’s important that they feel empowered by understanding exactly what is happening to their child,” said Dana Bledsoe, President of Nemours Children’s Hospital in Orlando. “With this offering, it is our hope that physicians – across the health system – can continue to deliver the safest care possible.”

The awards ceremony was held during the FHA’s annual meeting on October 4 at the Hyatt Regency Grand Cypress in Orlando.

health, prevention and early detection,” said Terri Young, Nemours’ Senior Vice President of Human Resources. “We know our efforts are working. Over the last few years, our data shows health risk improvement in several categories.

Brian Marcotte, President and CEO of the National Business Group on Health, commented: “We congratulate Nemours and their leaders for their unique and innovative approaches to employee, family and community health and well-being.

Nemours is among a growing number of companies who are on a path to integrate employee well-being into their workforce strategy to deploy the most engaged, competitive and productive workforce orlandomedicalnews

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GrandRounds Florida Hospital Winter Garden Adding New Inpatient Pavilion Florida Hospital Winter Garden, which has provided emergency care to the residents of Winter Garden and surrounding communities since opening in early 2016, will soon add a new 100-bed inpatient pavilion.

The seven-story, approximately 300,000-square-foot building will complement the existing 24-bed emergency department and medical office building on the site at 2000 Fowler Grove Blvd.

“Florida Hospital will soon be AdventHealth, and our goal is to bring wholeness to the communities we serve by providing care close to home,” said Tim Clark, CEO of Florida Hospital Winter Garden. “Adding inpatient beds allows us to provide comprehensive services to the residents of Winter Garden and continue to make a positive impact in West Orange County.”

Since opening in February 2016, the emergency department has seen 71,228 patients — illustrating the strong and growing demand for health-care services in fast-growing region. The adjacent medical office building contains primary care provid-

ers and a variety of specialty practices.

“Florida Hospital Winter Garden has proven to be a good neighbor, providing skilled and compassionate care,” said Winter Garden Mayor John Rees. “It has made a strong impact on our community and we look forward to many years of the innovative, whole-person care Florida Hospital delivers.”

The expansion is expected to create

possible.”

Winners of the 2018 Best Employers for Healthy Lifestyles® awards were honored in one of three categories: Platinum, for implementing a workforce well-being strategy with demonstrated results; Gold, for organizations with a strong commitment to holistic wellbeing and related metrics; Silver, for organizations with emerging well-being strategies, often with a focus on physical health.

for children. Improving the lives and wellbeing of our children has been the basis of my entire professional life.”

Dr. Moss is a renowned pediatric surgeon, biomedical researcher, educator, and health system executive. He is internationally recognized for leadership in healthcare quality and safety, including service as a founding director for developing quality standards for pediatric surgery nationally.

He is also known for tremendous achieve-

Dr. R. Lawrence Moss Begins Tenure As President, CEO Of Nemours Children’s Health System October 1, marks the first day at work for Nemours Children’s Health System’s new President and CEO, Dr. R. Lawrence Moss.

Succeeding previous leader Dr. David Bailey, Dr. Moss joins Nemours after serving seven years as Surgeon-in-Chief at Nationwide Children’s Hospital in Columbus, Ohio.

“I am both excited and humbled by the privilege,” said Dr. Moss. “It is a challenge to lead any pediatric health system, but at Nemours where I will be trying to fill the shoes of my predecessor, Dr. David Bailey, it will be an especially herculean task.

Nemours’ mission of putting the child first in every interaction and every decision is not only familiar to me, it is aligned with my most deeply held beliefs about health care

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700 hospital jobs with an annual average wage of $64,480, well above the Central Florida average. Total employment is projected at 5,509 people (including direct, indirect and induced jobs), leading to a total personal income of $249 million annually.

“Florida Hospital has served the Central Florida region for many decades. It is exciting, and gratifying, to see this leg-

ments in academic health centers, national hospital associations, and government organizations accountable to the public.

While at Nationwide Children’s Hospital, Dr. Moss was also the E. Thomas Boles, Jr., Professor of Surgery at The Ohio State University College of Medicine.

“We are delighted to have Dr. Moss join the Nemours team in delivering on our mission to provide the leadership, institutions and services to restore and improve

acy of care and service focused locally in Winter Garden,” said Hal Bekemeyer, a longtime pastor and member of the hospital’s Community Advisory Council.

“I am personally satisfied to witness this next step in the healing ministry of Florida Hospital.”

A construction timeline is being finalized.

the health of children through care and programs not readily available,” said Brian Anderson, Chairman of the Board of Directors of the Nemours Foundation. “His commitment to whole child health makes him a wonderful fit for the children, families, and the communities we serve.”

Dr. Moss was an integral part of the Nationwide team that transformed its surgery program into an academic powerhouse influencing children’s surgery worldwide

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GrandRounds and consistently ranked as one of the elite programs in the world. Under his leadership, the program developed the first FDA approved studies in Tissue Engineering for congenital heart disease, internationally renowned centers in colorectal and craniofacial care, and more than a dozen federally funded surgical research programs.

Prior to his time at Nationwide Children’s Hospital Dr. Moss served as the inaugural Chief of Surgery atYale New Haven Children’s Hospital and Robert Pritzker Professor of Surgery at Yale University School of Medicine, and in leadership roles at Stanford University School of Medicine. He has also advised theNational Institutes of Health (NIH), the National Quality Forum (NQF), the Food and Drug Administration(FDA), and the Agency for Healthcare Research and Quality (AHRQ). Dr. Moss is a past Chairperson of the Surgical Section of the American Academy Pediatrics and is currently President of the Children’s Hospital Association Surgeons-in-Chief Forum.

“The President and CEO role at Nemours represents a wonderful opportunity to lead an institution that embodies the values I hold as most important. I believe the future of American healthcare begins with our children,” said Dr. Moss. “With a focus on creating health over treating disease, efficient care delivery and an alignment of the success of the health system with the health of the population it serves, I believe that Nemours is on the verge of breaking into elite status in children’s healthcare.”

AMA Announces Next Phase of National Effort to Create the Medical Schools of the Future As part of its ongoing efforts to ensure physicians are trained to meet the needs of patients in both modern and future health systems, the American Medical Association (AMA) today announced the next phase of the AMA Accelerating Change in Medical Education Consortium. Each of the consortium’s 32 medical school members have committed to continuing their work together to reimagine medical education and develop new—and expand upon existing—education innovations that can be shared among medical schools nationwide. The projects being announced today include curricular innovations focused on improving student well-being, addressing social determinants of health, improving quality of patient care and enhancing patient safety.

“Our consortium of medical schools has been an invigorating and productive community of innovation over the past five years. Knowing that our work to transform medical education is far from finished, the AMA is excited to continue to foster this environment where individuals and institutions can learn from each other and innovate,” said AMA CEO and Executive Vice

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UCF Welcomes New Physicians President James L. Madara, M.D. “This next phase of work will allow consortium schools to continue to explore new concepts and create new solutions for medical education—impacting the national direction of medical education and better preparing all of our future physicians for practice in the continually changing health care environment.”

As part of a new three-year commitment, all 32 medical schools will continue the work that began in 2013 to create the medical schools of the future—with some schools building on existing curricular innovations developed through the consortium and others generating new concepts and curricula altogether. The AMA’s goal for the work of the consortium remains focused on fostering collaboration across institutions and disseminating meaningful innovations to medical schools across the country. The AMA will continue to convene regular meetings of the consortium, providing funding for representatives of member schools to attend.

To further cultivate the innovation ecosystem needed to significantly transform medical education, the AMA also plans to expand the consortium and invite other medical schools to collaborate with the consortium in the future.

Some of the newly proposed consortium projects announced today include curricular innovations focused on improving student well-being and addressing social determinants of health. Other projects will build upon the innovations and concepts developed and implemented over the past five years by the consortium. These projects include implementing competency-based programs, a teaching electronic health record (EHR), curricula that allow medical students to be totally immersed within the health care system from day one of medical school, training in physician leadership, education in team care skills, and curricula aimed at achieving health equity and increasing diversity in the physician workforce.

Additionally, many of the new projects aim to incorporate the teaching of Health Systems Science—the third pillar of medical education identified by the consortium—to help students learn how to navigate the changing landscape of modern health systems when they enter practice, especially as the nation’s health care system moves toward value-based care.

EnableSoft & PMG Announce Partnership to Deliver Faster Integration ORLANDO -- EnableSoft Inc., a provider of Robotic Process Automation (RPA) software for banks, healthcare and other organizations, today announced that it has partnered with PMG, the provider of a leading low-code BPM platform. Together the companies will leverage their technologies to accelerate integration capabilities in process automation for PMG customers.

UCF Health announces the addition of two new physicians.

Dr. Charles Giangarra is a board-certified orthopaedic surgeon specializing in arthroscopic surgery of the shoulder, elbow, knee, and ankle.

He earned his medical degree from the State University of New York, Downstate College of Medicine. He then completed his residency in orthopaedic surgery at Albert Einstein College of Medicine’s hospital, Montefiore Medical Center. His fellowship in highly advanced Sports Medicine training was completed at the renowned KerlanJobe Orthopedic Clinic in Los Angeles.

Dr. Giangarra has served as an orthopaedic consultant and physician to Stanford University, The San Francisco Giants, New Orleans Saints summer campus and the U.S. Olympic team.

He then went on to practice at Marshall Orthopaedics in 2004 and now UCF Health. He specializes in the diagnosis, treatment and prevention of musculoskeletal injuries and is dedicated to keeping patients active and healthy.

He has earned a certification from the American Board of Orthopaedic Surgery and is a Fellow in the American Academy of Orthopaedic Surgery. He is also a member of the American Society for Sports Medicine, American College of Sports Medicine, and U.S. Olympic Team Physicians Society.

Dr. Vishwas Vanar is a gastroenterology and hepatology specialist. Before joining UCF Health, he had academic and clinical appointments at University of Illinois College of Medicine, and Indiana University School of Medicine.

In addition to routine endoscopies, Dr. Vanar offers advanced GI screening and treatment procedures, including video capsule endoscopy, esophageal manometry, impedance pH monitoring, single balloon enteroscopy, radiofrequency ablation for Barett’s esophagus, and fecal microbiota transplant.

Dr. Vanar earned his medical degree from Smt. NHL Municipal Medical College in India. He completed his internal medicine residency training at University of Illinois College of Medicine in Urbana-Champaign, and Gastroenterology fellowship training at the University of Illinois College of Medicine in Peoria

PMG’s low-code application development platform makes solving hard business process problems easy. Using a robust set of automation tools, PMG leverages the APIs from different systems to create comprehensive workflow automation solutions that eliminate time-consuming manual processes. With the help of Foxtrot robotic process automation (RPA) software from EnableSoft, PMG is able to offer faster integration for customers who rely on data from legacy systems and websites that have no available API.

where he also served as chief fellow.

Dr. Vanar has published in the field of gastroesophageal reflux and healthcare utilization. He has a special interest in acid reflux, inflammatory bowel disease (IBD) and chronic liver disease (cirrhosis, non-alcoholic fatty liver disease, hepatitis). He also focuses on innovative endoscopic procedures throughout the GI tract.

Dr. Vanar is board certified in internal medicine and a fellow with American College of Physicians. He is also a member of the American Society for Gastrointestinal Endoscopy, American Gastroenterological Association and American College of Gastroenterology.

“With Foxtrot, the absence of an API no longer slows down our integration process,” said Ben Alexander, Vice President of Product for PMG.” He added that in some instances, using Foxtrot to automate processes is more efficient than leveraging existing APIs. “We’re all about speed and efficiency,” said Alexander. “If Foxtrot can get the job done faster and more efficiently, that’s the route we’ll take.”

“We’re very excited to be able to help PMG offer a more complete solution than ever before,” said EnableSoft CEO Richard orlandomedicalnews

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GrandRounds Milam. “As companies rely more and more on automation to solve business needs, RPA software will play an increasingly important role across all industries.”

As an early innovator in the RPA space, Orlando-based EnableSoft Inc. has helped organizations save time, save money, and improve productivity. Serving over 500 corporate clients worldwide, EnableSoft develops and markets Foxtrot®, software that eliminates the burden of manual data processes by behaving, deciding and working just like a person. Additional information is available atwww.enablesoft.com.

Unity Health Selects PatientMatters to Improve Patient-Centered Registration Process Orlando — PatientMatters, a patient access and advocacy solutions provider helping hospitals and health systems offer their patients highly-personalized financial solutions, today announced that Unity Health, a leading, multi-county Arkansas health system, has chosen the PatientMatters flagship solution, IntelliPass+®, to enable a more patient-friendly, efficient, and productive registration process across its three hospital locations.

To provide a better financial experience for its patients, improve point-of-service (POS) collections, and enhance registration quality and speed, Unity Health sought a system with a holistic approach – combining both cutting- edge technology to work across business functions, and hands-on training strategies, for guaranteed results.

With a patient-centered, data-driven approach, delivered by hospital staff trained to engage in personalized conversations at pre-registration, PatientMatters’ IntelliPass+ stood out as a perfect solution for Unity Health.

“Our strategic partnership with PatientMatters is consistent with our patient-centric approach to healthcare,” said Kevin Burton, Director, Patient Financial Services at Unity Health. “With PatientMatters by our side, we will be able to provide our patients with the streamlined, ‘no surprises’ financial experience that they deserve so they can focus on what matters most – their health.”

IntelliPass+ is an integrated platform that streamlines the patient financial experience and improves performance. The robust technology platform provides accurate bill estimations, broader payment plans and options and personalized financial guidance that’s unique for every patient, all handled prior to care. Leveraging this technology with training, onsite expertise, and a “playbook” of proven best practices, along with advanced analytics and reporting, will ensure Unity Health to facilitate a comprehensive patient onboarding and trusted financial engagement process.

This fast and accurate pre-registration

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Orlando Area Physician Summits Mt. Kilimanjaro, To Raise Colon Cancer Awareness Orlando area Gastroenterologist Dr. Sri Pothamsetty took his mission to raise colon cancer awareness to new heights when he summited Mt. Kilimanjaro on July 21.

In conjunction with the Colon Cancer Coalition, he travelled to Tanzania to take on the highest mountain in Africa, an elevation of 19,341 feet. The one week long climb culminated in his unfurling a ban-

ner promoting colon cancer awareness at the summit.

“The climb was difficult, at times, brutal” Dr. Pothamsetty said. “But if it means even one colon cancer is prevented because of my effort, it would have been worth it. My mother was diagnosed with colon cancer 3 years ago. Since then, this crusade to raise the awareness of the need to get everyone screened for colon

cancer has become very, very personal for me”.

According to official summit success rate figures published by the Kilimanjaro National Park, only 45% of climbers succeed in reaching the summit. Obstacles faced by climbers include Acute Mountain Sickness including High Altitude Cerebral Edema, High Altitude Pulmonary Edema, falls and hypothermia.

“Get a Mammogram, Give a Mammogram” Provides Free Screenings to Women in Need Breast cancer is the most commonly diagnosed cancer in women. Each year, more than 250,000 women in the U.S. will be diagnosed; an average of one woman every two minutes. Unfortunately, many women in Central Florida will forgo this important annual screening because they lack health insurance.

Shepherd’s Hope and Sand Lake Imaging are partnering to provide free mammograms to women in need. For each new patient who gets a mammogram at Sand Lake Imaging during the month of October, the facility will donate a free mammogram screening to an uninsured Shepherd’s Hope patient. It is the sixth consecutive year for the “Get a Mammogram, Give a Mammogram” initiative held in conjunction with national Breast Cancer Awareness Month.

“One in eight women will be diagnosed with breast cancer in her lifetime, but for those who are uninsured, this life-saving procedure is far from reach,” said Marni Stahlman, president and CEO of Shepherd’s Hope. “We are grateful

for our longstanding partnership with Sand Lake Imaging that allows Shepherd’s Hope to provide local uninsured women with this essential medical exam at no charge.” Shepherd’s Hope provides free primary and secondary medical services to the one in four Central Floridians who are uninsured or underinsured at five health center locations in Central Florida. Annual mammogram screenings can detect breast cancer early and help reduce breast cancer mortality. “Breast cancer is the second leading cause of death among American women of all ages, with 21 percent of all cases occurring before the age of 50,” said Dr. Robert Posniak, women’s specialty radiologist and president of Sand Lake Imaging.

“Routine annual screening mammog-

raphy for an average risk woman beginning at the age of 40 has been proven to save lives and gives more treatment options, if diagnosed early. Our mammography provides better, earlier breast cancer detection for patients with results that are significantly more accurate that 2D exams alone, detecting 20-60% more invasive breast cancers than its 2D counterparts. We also reduce callbacks by up to 40%, compared to 2D alone.”

To schedule a screening mammogram appointment at any of Sand Lake Imaging’s three facilities, located in Orlando, Maitland and Lady Lake, call 407-363-2772

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GrandRounds Move Over Flamingos, This Orlando Swan is Turning Pink Flamingos are taking up residence at Lake Eola, and one of the lake’s iconic swan boats is taking on a new pink look to match its colorful relatives.

To kick off Florida Hospital’s annual Pink Out initiative, Orlando Mayor Buddy Dyer, District 3 City Commissioner Robert F. Stuart and leaders from Florida Hospital for Women gathered Tuesday to debut a newly painted swan. The swan boat, one out of eight on the lake, will remain pink during October to represent the one in eight women who will be diagnosed with breast cancer over their lifetime.

During the event, Mayor Dyer and Commissioner Stuart also officially proclaimed October 2018 “Pink Out Month.”

The Pink Out initiative raises funds — through sales of paper flamingos and donations — that provides access to breast cancer screenings and care to Central Florida’s underserved and uninsured.

Pink Out has funded screening mammograms and additional diagnostic testing for close to 9,000 uninsured and underserved women since 2010. Several dozen of those women were diagnosed and treated for breast cancer as a result of the mammo-

eliminates redundancy and improves POS patient collections, resulting in fewer data errors, reduced bad debt, improved staff productivity and revenue performance.

“At PatientMatters, we believe the patient financial experience of care is important and should support the positive clinical experience. We are looking forward to working alongside Unity Health, who shares this belief,” said David Shelton, CEO of PatientMatters. “Employing a personalized approach to patient financial services increases collections and improves patient experience and loyalty, so it is a win-win for both the patient and hospital by making the financial aspects of healthcare easier for all parties involved.”

The PatientMatters IntelliPass System enables hospitals to guide patients through the maze of healthcare finance with accurate bill estimates and personalized financial plans. The IntelliPass System consists of four core modules: IntelliReg®, IntelliPass®, IntelliPass+®, and IntelliGuide®; now offered either as standalone products and services or as part of an integrated suite of solutions.

Winnie Palmer Hospital Earns International BabyFriendly Designation Orlando Health Winnie Palmer Hospital

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Dave Kilwein Joins MedXSurg as Director Of Sales grams they received.

“The City of Orlando is pleased to partner with Florida Hospital on this important initiative,” said Mayor Dyer. “We know that mammograms are a key element in detecting breast cancer early, when it’s most treatable — and the more widely we can spread this message to women in our community, the better.”

Since Pink Out’s inception, flamingo flocks have sprung up in city parks, businesses and residential lawns. In keeping with tradition, 10 locations throughout Central Florida, including Lake Eola Park, will turn pink with flamingo flocks in October.

“Pink Out is a cause that is close to my heart and it’s a wonderful way for residents to come together to raise awareness about a disease that has personally affected so many women and families in our city,” said Commissioner Stuart. “I am grateful to Florida Hospital for recognizing the impor-

tance of making health care accessible to everyone in our community.”

More than 265,000 women nationwide are expected to be diagnosed with breast cancer this year, according to the American Cancer Society.

“Women often put the health care needs of others before their own, so we need to make it easy for women across our community to have access to the tools they need to stay healthy,” said Dr. Olga Ivanov, a breast surgeon at Florida Hospital.

“Breast cancer is treatable when detected early. Getting a mammogram is not only extremely important, it can also be convenient and affordable.”

Throughout October, Florida Hospital is offering mammograms for $30 in 30 minutes without a physician’s referral at 13 Central Florida locations. To learn more, visit PinkOut.com.

for Women and Babies, a part of Arnold Palmer Medical Center, has received international recognition as a designated BabyFriendly birth facility, making it the highest volume delivery hospital in the country to be given this honor.

The recognition is part of an initiative sponsored by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) to distinguish hospitals and birthing centers that provide an optimal level of care for breastfeeding mothers and their babies. To receive BabyFriendly designation, hospitals must adhere to ten evidence-based practices, such as “rooming in” or keeping the mother and baby together 24 hours a day to help new mothers recognize feeding cues.

For more than three years, Winnie Palmer Hospital has implemented these practices, in addition to facilitating nearly 13,000 hours of breastfeeding training for more than 800 physicians and nurses at Orlando Health.

“We are extremely proud to be recognized for the hard work of our team members throughout the Baby-Friendly process,” said pediatrician and chief quality officer of newborn care, Rachel Prete, DO. “Winnie Palmer Hospital is committed to providing the support, education and resources moms need to successfully breastfeed when they leave our care.”

At 23.9 percent, Florida has the fifth highest rate of infants who receive formula at less than two days of age. Since implementing Baby-Friendly practices, over 50

percent of new mothers are exclusively breastfeeding when discharged from Winnie Palmer Hospital. The Baby-Friendly designation must be renewed every five years for the hospital to retain its status.

Florida Hospital Breaks Ground on New Emergency Department Florida Hospital broke ground in September on an emergency department that will expand the health care system’s network to better serve residents of Waterford Lakes and surrounding communities in east Orange County.

The emergency department will have 24 patient rooms (including two pediatricfriendly rooms to make ER visits less stressful for young patients); respiratory therapy; diagnostic imaging, including CT scans, X-ray and ultrasound; and a full-service laboratory.

The facility will be staffed by a comprehensive clinical team including board-certified emergency physicians and emergency nurses.

“We are pleased to add this ER to our expanding network of care across Central Florida,” said Jeff Villanueva, CEO of Florida Hospital East Orlando. “The UCF area is growing fast, and we are growing along with the community. Our mission is to make our patients feel whole — by

MedXSurg, an independent Group Purchasing Organization, welcomes Dave Kilwein as Director of Sales.

“I’ve been fortunate to always represent products that I believe in.

MedXSurg is a program that truly deserves a serious thought for independent practices who are looking to save 25-40% on their medical supply cost,” says Dave.

Along with a successful 13-year sales career, Dave is also a devoted husband, father, and musician who is known for his passion for music, work ethic, and positive attitude.

You can reach Dave at dave@medxsurg.com to see how MedXSurg can save you money on your medical supply needs.

treating the mind, body and spirit — in a setting that’s close to home.”

The approximately 19,000-square-foot facility, which is slated to open in summer 2019, will be known as AdventHealth Waterford Lakes ER. The emergency department will be located at the intersection of Colonial Drive and Lake Pickett Road.

St. Cloud Regional Medical Center’s New Emergency Department Opens for Operation Nearly ten months after breaking ground, St. Cloud Regional Medical Center’s expanded emergency department and new main entrance are open to serve patients. The multi-million dollar project, which added more than 14,000-square feet to the hospital, increases capacity to 20 private exam rooms and enhances privacy, comfort, and technology in an emergency department that served more than 26,000 patients last year.

“This expansion will enhance our number one priority- delivering quality care to our patients safely and efficiently,” said Brent Burish, CEO of St. Cloud Regional Medical Center.

Private patient rooms are larger and incorporate new technology. The Department also includes space for a new CT orlandomedicalnews

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GrandRounds Machine directly within the ED space. The ED continues to be prepared to respond to a wide variety of emergencies with decontamination, isolation rooms and major exam rooms.

“These changes will support our physicians, nurses and other healthcare professionals as they care for our growing community,” shared Dr. Marcy Rosenberg, Medical Director for the Emergency Department at St. Cloud Regional Medical Center. “The new design will support a more efficient work environment with new technology and improved workflow, and minimize the time it takes to serve patients.”

St. Cloud Regional Medical Center is dedicated to providing quality care in an efficient manner to its emergency department patients. In 2016, the hospital implemented a 30-minute ER service pledge through which it pledgees that a medical professional – a physician, physician assistant or nurse practitioner – will work diligently to see patients within 30 minutes of their arrival. The hospital has been recognized as an accredited Chest Pain Center by the American College of Cardiology for its commitment to following best practices for emergency cardiac care.

“I’m proud of this milestone for St. Cloud Regional Medical Center,” said Mr. Burish, “St. Cloud Regional Medical Center has a long standing presence in the community, and this expansion is a great accomplishment to improve access to care for our patients that could not have been achieved without the support of the physicians, employees, volunteers and community members.”

A ribbon-cutting ceremony for the new space is one of the activities planned during the Community Health Fair on Friday, October 26 from 4-7 pm. The ceremony will occur at 5:30pm and the public is invited to attend. Other activities include safe trick-or-treating, music and food. For more information on the event or the services provided by St. Cloud Regional Medical Center, visit StCloudRegional.com

help they need.”

Florida Hospital’s Community Health Impact Council, commonly known as CHIC, announced this year’s recipient projects: Intensive Psychosocial Rehabilitation Initiative: Aspire Health Partners aims to help those diagnosed with severe and persistent mental health disorders regain the ability to live independently through an intensive rehabilitation program. The initiative will target adults with a readmission history to Florida Hospital’s emergency departments and Aspire’s crisis units. ($645,000) The Central Florida Healthy Pantry: Second Harvest Food Bank aims to improve the health of low-income Florida Hospital patients who have been diagnosed with diabetes or high blood pressure by making it easier for them to access nutritious food from pantries throughout Central Florida. ($480,000) Food Voucher Program: The CHIC grant extends funding to this United Against Poverty program, which aims to provide subsidized access to healthy and nutritious food to low-income Central Floridians diagnosed with malnutrition. ($75,000) “Our partnership with Florida Hospital will deeply impact the health and wellbeing of our most vulnerable, low-income neighbors,” said Dave Krepcho, president and CEO of Second Harvest Food Bank of Central Florida. “Through an innovative approach, we will provide healthy meals and nutritional education for those who struggle to afford the right kinds of food.”

Oviedo Medical Center Earns MRI ACR Accreditation Oviedo Medical Center has been awarded a three-year term of accreditation in magnetic resonance imaging (MRI) as the result of a recent review by theAmerican College of Radiology (ACR). MRI is a noninvasive medical test that utilizes magnetic

From The Ashes: Medical Village at Lake Nona Prospering Despite the rumors to the contrary, the project known as Medical Village at Lake Nona is a true “phoenix rising from the ashes” story within the medical real estate world. The project faced a variety of challenges from losing tenants for various business reasons to construction funds being exhausted in the summer of 2017. To all involved, the future of Medical Village at Lake Nona seemed bleak.

While under contract, one of the original partners found an investor to help the property and the holding com-

fields to produce anatomical images of internal body parts to help physicians diagnose and treat medical conditions.

The ACR gold seal of accreditation represents the highest level of image quality and patient safety. It is awarded only to facilities meeting ACR Practice Parameters and Technical Standards after a peer-review evaluation by board-certified physicians and medical physicists who are experts in the field. Image quality, personnel qualifications, adequacy of facility equipment, quality control procedures and quality assurance programs are assessed. The findings are reported to the ACR Committee on Accreditation, which subsequently provides the practice with a comprehen-

pany for Medical Village at Lake Nona changed hands. This much needed change breathed new life into the project including $2,000,000 in new capital to complete it. With a new energy surrounding Medical Village at Lake Nona, it wasn’t long before the building was fully leased.

In 2018, the fully operational Medical Village at Lake Nona was purchased by an investment group out of South Florida that specializes in managing medical properties across the United States.

sive report that can be used for continuous practice improvement.

The ACR, founded in 1924, is a professional medical society dedicated to serving patients and society by empowering radiology professionals to advance the practice, science and professions of radiological care. The College serves more than 37,000 diagnostic/interventional radiologists, radiation oncologists, nuclear medicine physicians, and medical physicists with programs focusing on the practice of medical imaging and radiation oncology and the delivery of comprehensive health care services.

Florida Hospital Awards More Than $1 Million to Local Nonprofits Florida Hospital is pleased to announce it has awarded more than $1.2 million to area nonprofits that provide important services to the underserved and address health disparities in Central Florida.

“We are committed to addressing the needs of the whole person — mind, body and spirit — and by partnering with local organizations and supporting innovative projects, we are improving the health and well-being of our neighbors,” said Daryl Tol, president and CEO of Florida Hospital and Central Florida Division – Adventist Health System. “From addressing mental health needs to fighting food insecurity, these programs will help the most vulnerable members of our communities get the

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The Right Population Health Analytics to Transform the Patient Experience

By ABHINAV SHASHANK

Consider a situation where healthcare is not just an industry term- a situation where EHRs are not an integral part of physicians’ schedule but just a support to providing care. All considered, imagine a situation where patient-centric care actually involves the patient, and patient engagement is not just a buzzword but a reality. Unfortunately, all these imaginations were supposed to be a reality, but still, healthcare managers and organizations are struggling with the problems such as the lack of patients’ adherence to medication, varying trends in the population health, and a lot more. Patient population, nowadays, expect the same on-demand delivery convenience from the healthcare organizations as they get from the other companies like Netflix.

Why is Patient Engagement the Core of Providing Patientcentric Care?

To understand the value of the patient in the entire care continuum, let us take an example. Consider a patient, Marcus, who works at an IT firm and is affiliated to a Commercial ACO in his county.

Marcus is a 65-year-old male suffering from comorbidities like Type 1 Diabetes, and diabetic retinopathy. He is at constant risk of sporadic elevated blood pressure.

In the year 2016, Marcus visited the ED approximately five times. Considering the situation, the primary care physician of Marcus referred him to a specialist and prepared a schedule comprising at least two monthly visits.

The year 2017 started with a lot of workload for him at his firm, and he was unable to keep up with the prescribed schedule. Due to improper communication between his PCP and him, his physician was not able to keep track of Marcus’s health. As a result, the ED utilization rate of Marcus increased from five times to nine times. Due to enhanced stress and improper quality of care, the sporadic episodes of elevated blood pressure turned into a constant problem of hypertension.

Also, the overall cost of care for Marcus increased drastically.

Challenges in Achieving True Patient Engagement Patient Engagement, in itself, is not as simple as ABC. It is not just bringing patients in the cycle of care continuum but enhancing the patient’s skills, ability, knowledge, and most importantly, willingness to participate in the task of managing his own care. The concept of providing care with ‘engaged patients’ sounds great theoretically, but it is not that smooth sailing. According to a survey, nearly 87 percent of the patient population believes that communication with their doctor apart from their scheduled appointments 19

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is really important.

The major flaw is the lack of awareness among the patients regarding their care procedures. Many patients are ignorant of the clinical processes which a physician follows, and they might miss out on major health details. With no actual knowledge of the disease symptoms, patients might not report to their physicians which might lead to reduced patient engagement, not to mention the increased risk of developing a chronic disease.

Care teams play a vital role in engaging the patients through regular followups. Irregular and fragmented workflows of care managers and lack of personalization might lead to the generation of ineffective care plans for the patients. Reduction in patient engagement could also be the result of underutilization of technologies to analyze the massive amount of patient data that care managers have at their disposal. Through building more personalized care plans, patients can be engaged at a more grass-roots level.

Driving Effective Engagements through Value-based Care Predictive population health analytics is the answer to nearly every problem linked with patient engagement. Advanced predictive analytics tools will help in dealing with the problems of disparate data systems and can pinpoint the exact area on which healthcare organizations can focus. Leveraging the insights obtained by data analytics, care teams can prepare the statistical models to prioritize each patient and can take necessary measures to engage patients in the process of decision-making.

Understanding the patients’ habits by the care teams increases the chances of preparing personalized care plans for them and enhancing the level of patient satisfaction.

With enhanced technologies, advanced tools, and constant patient engagement, individual care management can pave the path for systematic populationlevel solutions. Whether it may be population-level or individual-level intervention, it is essential to identify the root cause of the problem. With interactive analytics, the physicians can identify the episodic outcomes variations. Systematic analysis of patient population can not only help in stratifying population based on factors such as risk-scores but can also lead the way for holistic diagnosis and personalized care being delivered based on key health trends.

When it comes to realizing smart healthcare choices, we always eliminate a major factor- social and behavioral determinants of health. This data helps in identifying individual struggle with daily routine activities and can turn out to be a strong tool in eliminating the barriers which are outside the limits of healthcare.

Care organizations can classify the area’s population based on various parameters like language, accessibility to vehicles, and

others to manage their outreach programs.

Including social determinants of health data for advancing patient engagement can be highly beneficial for healthcare. For instance, if the physician knows her patient to be someone who follows an unhealthy lifestyle, she can take preemptive steps to avoid the occurrence of any illness that the patient might have become prone to. Moreover, the patients can be made aware beforehand about any health risk they might be contracting due to their lifestyle, environment, neighbourhood, eating habits etc.

Advanced Approach to Bridge the Physician-Patient Gap Healthcare organizations are constantly trying to improve the patient experience of care and deliver quality at every step. And the immense amount of healthcare can serve as a significant avenue for innovation to enhance patient engagement. A patient can receive care from multiple facilities- even within a network. A comprehensive, accurate picture can be obtained only when the patient health data is obtained from all these facilities and brought together on a unified healthcare data platform.

Such a healthcare data platform can integrate disparate sources into longitudinal records, that detail every patient’s risk scores, medical history, admissions, and discharge events. These records can be further analyzed to understand the

gaps in care, learn about the impacts of ongoing care programs, and plan timely interventions for the patients. With a close monitoring of care programs impact the patients, the care teams can address the specific blind spots, and even link community resources to assist patients with their varying needs. One such organization, with the use of an integrated, data-driven approach, was able to reduce SNF visits in their network by 12% and cut down their 30-day readmission rate by 7.14%!

The Road Ahead In the present healthcare scenario, patient engagement is like the medicine which is to be prescribed to every patient as well as provider. Changing the entire nation’s healthcare ideology to a single patient-centric approach is tough, but this transition is vital. It is nearly impossible to realize engaged patients without a strategic approach covering the overall domain of the healthcare. Being an integral part of healthcare, patients serve as one of the major drivers in the improvement of the overall picture. Properly engaging them not just to improve their individual health but for improving the entire population health is a must and cannot be neglected in the long run.

Abhinav Shashank, Co-Founder & CEO at Innovaccer, is an expert in population health management and robust technologies. For the better part of the decade he has been working to revolutionize healthcare delivery with 25+ valuefocused organization and making over 10 million lives better. Visit www.innovaccer.com

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Healthcare Crisis:

Overmedicating of Residents, AI to Rescue?

By PHILIP REGENIE

In 1972 a friend of mine worked in a senior home located in Santa Cruz California. At the time he would horrify our young novitiate minds with stories of what they asked him to administer to the seniors in his care. 40 years ago, polypharmacy and drug abuse of seniors was alive and well.

Today, with the explosion of the pharmaceutical industry, both the effective use of multiple drugs and the abuse of multiple drugs are prevalent in senior care. On average, seniors take six different medications, and more than 15 percent of seniors use at least 10 drugs at the same time. The drugs are often prescribed by multiple doctors for multiple symptoms without a clear understanding of their possible interaction.

The point person for drug administration for a senior might change between family members and between staff without clear communication and understanding of the potential problems. Just two nights ago a woman shared with me a story about her husband who has suffered some electrical problems with his heart having fallen and broken his hip due to drug interactions.

The societal problem is significant enough that Stanford has researched and developed sophisticated polypharmacy AI to identify risks associated with the interaction of multiple medications.

This is, in fact, the tip of the iceberg.

The use of an additional sedative might seem very appealing to a single person on staff, left alone by a staff illness and lack of available replacements, responsible for 50 to 100 residents at 8:00pm. Just meeting the immediate needs of the community in toileting, medications, showers, and calls for help leave staff traumatized for years.

The United States assisted living communities are regulated by individual states.

For assisted living communities in California there are no specific staffing ratios. California law requires that facility personnel shall at all times be sufficient in numbers, qualifications, and competency to provide the services necessary to meet resident needs, and to ensure their health, safety, comfort, and supervision. It should be obvious that this flexible standard can be interpreted, and that enforcement is difficult.

Staff must be 21 years of age, have at least a high school diploma and receive 40 hours of training within the year of employment.

These minimal staff qualifications allow for staff in RCFEs, Residential Care Facilities for the Elderly, to assist residents with medication self-administration.

The bar for being employed as staff in 20

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senior care communities is low but so are the wages. The 8th lowest paying job in America is personal and home care aides with institutional positions for senior care not far behind with an average annual income in 2017 of $26,269 a year. It is no surprise that retaining caregiver positions is a difficult task and that there is a widening gap in delivery of service to seniors.

According to an assisted living employee survey the number one retention issue in assisted living communities is manager employee relations. Training managers is an absolute must in ALFs and should include acceptance of measurement of performance and ownership of improvement.

Measurement needs to be done without putting an extra burden on management as they are likely taking on staff responsibilities in order to meet service requirements.

Technology can help ALFs maximize the effectiveness of their personnel and keep personnel happier. Technology optimizes scheduled behavior with assessment and just in time delivery of service with improved communication. ALFs can improve performance by employing staff as firefighters who answer technology notifications for help calls, bed exits, and falls allowing other staff to perform scheduled walks, showers, and bathroom assistance to proceed unencumbered. AI is being used to identify the frail who need extra assistance, improve scheduling, performing polypharmacy analysis, and analyze real time data notifying caregivers of emergencies. Integrating it into existing systems is as easy as installing TV Players in rooms with some sensors. The technology does the rest with dashboards, smart mobile clients, and reports of staff effectiveness and resident needs.

We have come a long way since 1972 but still need to ensure quality of care. We can assure quality by establishing legal standards for resident to staff ratios and increase educational standards for management. Staff ratio and management quality should be enforced through technology that does not require human resources such as smart phone check-ins and knowledge of ALFs capacity. Technology is a great equalizer when resources are stretched. ALFs need to adopt in order to meet minimum care standards.

Founder and CEO Philip Regenie established Zanthion after experiencing the challenges his parents faced in their final years of life. His personal experience with the indignity of his parents’ deaths inspired him to enter the market and invest his personal finance to build a business based on dignity and care. With 35 years working in IT as a programmer, analyst and project engineer and eventually CEO/CTO in military aircraft systems, IOT (Internet of Things) and electronic medical record management, Regenie was uniquely positioned to understand and solve the complex problems associated with senior care. Realizing that no one else in the industry was providing the solutions he knew, from his personal experience, that seniors and their families need today, he decided to create Zanthion.

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320,000 Dead: It’s Time for a New Approach Drones: The missing link in cardiac arrest’s chain of survival

By GORDON FOLKES

Three hundred fifty-six thousand: This is the frightening number of people in the United States who are affected

by Sudden Cardiac Arrest (SCA) each year. Now, take into consideration that SCA’s mortality rate is roughly 90 percent. Close to a daunting 320,000 men, women, and children, lose their lives in the United States each year due to SCA alone - this isn’t an insignificant problem.

Despite the proliferation of nearly 2.4 million publicly accessible Automated External Defibrillators (AED) alongside increased efforts to spread SCA awareness and treatment education, this mortality rate has remained stagnant over the past 30 years. The current “Chain of Survival” explains a few, seemingly simple steps for successful treatment: recognize cardiac arrest, perform early CPR, provide rapid defibrillation, have effective advanced life support, and receive integrated post-cardiac arrest care. Following these steps will increase the likelihood of survival to upwards of 66 percent. So why the stagnant mortality rate? What’s missing? Why so much death?

SCA must be recognized quickly, CPR must be performed immediately, and an AED shock must be swiftly administered because for every minute without defibrillation the chance of survival decreases nearly 10 percent. The devil lies here, in this crucial detail – swift defibrillation. The initial steps in SCA treatment have very few variables: Do you have a phone to dial 911... Yes/no?

Can you perform CPR...Yes/no? The process of swift defibrillation however, has enormous amounts of variability, and thus, is the most inconsistent and time-consuming: Is there an AED? Do you know its location? Where at that location is the device stored? Do you know where you are relative to that location?

Is it close enough to retrieve quickly? Do you have the stamina to run there and back? Should you stop CPR to retrieve it? Can you contact someone who is closer? How do you contact them? How do you explain where you are to that individual? The list goes on... Take for example a golf course with an AED in the club house; Do you know the club house phone number? Are you calm enough to find that number? What hole are you on? Each one of these variables further opens the door to inconsistencies, time, consumption, and death. There is a fatal incongruency between the assumed simplicity of “swift defibrillation” and the reality of today’s current, stationary AED implementation paradigm. The good 21

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news: The abundance of LTE networks, smart phones, IoT cloud infrastructure, and today’s general climate of connectivity, when paired with the advancements in Multi-rotor Small Unmanned Air System reliability and performance has positioned us for a paradigm shift. Stationary, mounted AEDs are no longer the only implementation option. The era of dynamic, movable, intelligent AED implementation is upon us.

Should we eliminate the variables and inconsistencies surrounding AED retrieval and instead, simplify the process, defibrillation would be quicker, and the rescuer can shift his/her focus on performing effective CPR. Enter the utilization of small Unmanned Air Systems (drone/SUAS). SUAS are extremely athletic and programable pieces of robotic hardware capable of transporting a plethora of medical equipment such as Narcan, tourniquets, and importantly AEDs, quickly over large geographical areas. The concept of strapping an AED to a drone is not a new one. In fact, it’s a rather obvious solution – SUAS can fly quickly, over infrastructure, and directly to a victim in need. I refuse to patronize the readers of this article with the argument that SUAS can help solve this problem...because, for reasons stated above, of course they can. Instead, I want explain why this solution is viable right now, and more importantly how.

It may seem counter-intuitive, but I am often frustrated by people’s infatuation with the vehicle itself. Today’s SUAS are jam packed with advanced Flight Controllers, Electronic Speed Controllers, “smart” Lithium Polymer power supplies, accurate GPS units, sense/ avoid sensors, and are stably conducted by powerfully effective flight algorithms called P.I.D.s. These vehicles are reliable, have redundancies on almost every component, and do exactly what they are told. Given this information, lets hold the vehicle to the side and assume it will perform as expected. Instead, lets focus on a lesser considered detail; the actual deployment of SUAS – how do we enable these vehicles to effectively be used within the time crunch of a SCA event? In order to effectively utilize SUAS for this purpose and to enable rapid/immediate deployment, the system needs; a network connect housing solution, a reliable vehicle, an on-vehicle LTE enabled computer, a robust monitoring and alerting system, a dynamic routing solution, and (very important) an easy to use and affordable activation medium that the general public has access to. Off the bat, this list sounds fairly

complicated...and it is, but with 320,000 annual deaths sitting on the other side, this type of solution is brutally necessary.

The common denominator underlying all of these requirements is connectivity; we must be able to “communicate” (be it digitally) through the entire processfrom lay rescuer to flight controller. Fortunately, today’s existing communication infrastructure already facilitates this type of communication every day; whether it be your iPhone controlled garage door opener, or the smart lock on your front door, the Internet of all Things already utilize a persistent connectivity to communicate from end-user to edge-device.

Cognitive consideration must shift from an infatuation with “sexy” flying “drones”, and instead, narrow in on the process and solutions that are necessary to define a SUAS as a network connected edge device. Doing so will make it rather apparent that when your golfing partner

collapses, a single app on a smart phone can enable these athletic machines to safely and immediately transport an AED directly to friend in need. The network infrastructure is in place, the technology is primed and ready, and with a cardiac arrest death every 1.6 minutes my only question is... What are we waiting on?

Gordon Folkes is the CEO/Founder of Archer First Response Systems, an Orlando Based technology company.

Archer First Response Systems is a suite of integrated components that form an end-to-end solution for immediate small Unmanned Air System (drone) deployment. The system enables the athleticism of Multi-rotor Small Unmanned Air Systems (SUAS) (drone) to immediately transport an Emergency First Response Payload that can consist of an Automated External Defibrillator, CPR Mask, Narcan Nasal Spray and other first response medical equipment. The system is capable of transporting its payload over 11 square miles in 3 minutes or less but is not limited to a 11 square mile coverage area. The system can be activated via 911 Dispatch CAD system or by a smart phone mobile application. Archer First Response Systems LLC installs, programs, proactively maintains, remotely monitors, and resets our systems in their entirety- effectively providing a turn-key First Response Small Unmanned Air System Deployment solution to decrease EMS dispatch times and cardiac arrest fatalities. Folkes can be reached at gfolkes@archerfrs.com

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Virtual Reality for Pain Management: An Alternative to Opioids

By MIRANDA FELDE, MHA, CPHRM, The Doctors Company In 2016, science teacher Bob Jester fell off a roof, broke 19 bones, and underwent surgery for his badly broken back. Doctors prescribed Oxycodone, an opioid, during Jester’s extended recovery. Jester worried that he would become dependent on opioids, so he jumped at the chance to try Virtual Reality (VR) as an alternative to opioids when an acquaintance told him about a company that was using VR for pain management. When he started using a mobile headset connected to a smart phone that plays VR apps, Jester found his pain lessened and the effect lasted for several hours each time. About a year after his accident, Jester was able to wean himself off opioids.

Could other patients with severe acute and/ or chronic pain experience the same results?

The State of the Opioid Crisis The number of opioid prescriptions written annually in the U.S. roughly equals the number of adults in the country. And sometimes opioids, though intended to help patients, cause harm: The opioid epidemic claims the lives of 115 people every day.

While the financial costs of the opioid epidemic can be tallied—In 2016, the opioid epidemic’s toll hit $95 billion, with healthcare costs concentrated in emergency room visits, hospital admissions, ambulance use, and Naloxone use— the personal costs to those who have lost loved ones are uncountable. The epidemic’s impact is far-reaching and has emotional, physical, and financial implications for our entire society.

Exploring VR for Pain Management Many physicians are exploring VR technologies as an alternative to prescriptions. The Gate Control Theory of pain, proposed by Melzack and Wall, suggests that a person may interpret pain stimuli differently depending upon mental/ emotional factors such as attention paid to the pain, emotions associated with the pain, and past experience of the pain. VR addresses both attention paid to pain and the patient’s emotional state: The immersive distraction of VR can help a patient mentally transport to another space, such as an underwater seascape, which may also positively affect the patient’s emotional state.

In 1996, the Harborview Burn Center in Seattle, Washington, successfully piloted the use of VR for burn patients with severe acute pain.

Since then, more providers have found VR can provide relief for patients experiencing acute pain, such as the type Jester experienced following surgery.

Recent studies have explored whether VR can relieve chronic pain. One small, but promising, study of patients with neuropathic pain found that patients experienced a 69 percent reduction in pain during each session and a 53 percent pain reduction immediately after each session.

Getting Started with VR To explore VR as an alternative therapy, first consider the distinctions between two key terms: • Virtual Reality (VR): Provides an immersive experience via a computer-generated 3D environment for the user to explore. The user may be able to move objects or otherwise change the environment.

• Augmented Reality (AR): Adds sounds, videos, and/or graphics to an existing environ-

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ment, such as an outdoor planetarium where AR viewing glasses show constellations highlighted in the sky.

Then, evaluate VR interfaces that are relevant for patients managing pain, such as: • Head-mounted display (HMD): Like a heavy-duty pair of goggles plus headphones.

Completely surrounds the user’s visual field for an immersive experience.

• Treadmills and haptic gloves: Allow the user to physically move around in the virtual environment, and to physically move objects within that environment.

And weigh the value of interfaces that are more relevant for physician use, such as: • Smart glasses: May look more like regular eyeglasses or more like safety glasses. May display information or help the physician capture information for the electronic health record (EHR).

• Desktop VR or Window on a World (WOW): Uses a desktop or laptop computer to run simulation programs, including those for training.

Mitigating VR Patient Safety Risks While therapeutic VR for pain management shows promise, there are patient safety risks.

They include: • Falls: Patients wearing a full-surround headset cannot see their real-world environment and may walk into or trip over objects. Even patients in bed can knock things over while waving their arms around. Create a safe physical environment for VR use.

• Motion sickness: Many people experience some combination of eye strain, headaches, and/ or nausea. Patients who are ordinarily prone to any of these symptoms may not be good VR candidates.

• Psychological effects: The brain can store VR experiences as memories in almost the same way it stores physical experiences. Young children, especially, may confuse VR experiences with real experiences, especially when remembering them later. “If you were to do this in the real world, how would it affect you? That’s the way to think about virtual reality,” says Jeremy Bailenson, director of Stanford’s Virtual Human Interaction Lab. • The unknown: VR technology is still in its infancy, and therefore, little is known about the long-term consequences of VR use.

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The Future of VR for Pain Management Some physicians imagine a future of tetherless headsets that allow patients in pain the freedom to escape reality and transport to another emotional space. To reap the potential benefits of VR while mitigating its risks, clinicians could start with a two-part approach: identifying patients with specific clinical indications that would benefit from the use of VR and assessing patients for potential risk factors. Successful implementation of VR for pain management depends on wisely deciding which patients are VR candidates—and which are not.

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered. orlandomedicalnews

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• You can do the same with your smart phone and record videos or series of pictures of procedures.

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By WENDY SELLERS

I hate micro-managing but I do not trust my employees to get their job done.

It sounds like you might be part of the problem. Why don’t you trust them? Did you hire or acquire the wrong person for the job? Are the job requirements unrealistic? Do you have the wrong leader in charge? Could there be poor communication on your end? Are there any processes and procedures for the employees to follow thereby setting clear expectations for your accountability actions?

We spend most of our waking life at work, so it is very important to trust those around you.

An ironic twist to your dilemma is that a Harvard Business Review survey reveals 58 percent of people say they trust strangers more than their own boss.

Furthermore, the Great Place to Work Institute has documented that committed and engaged employees who trust their management perform 20 percent better and are 87 percent less likely to leave the organization. What does that mean for leaders? To a large extent, the way you lead your people has a dramatic impact on their level of engagement on the job.

I am friends with my staff which is making it very difficult to have performance conversations. What do I do?

Often when people tell me, I was just promoted to manager, I tend to chuckle and say “no, you now have a whole new career.” Managing people is not what it used to be. People not only want to be engaged, mentored and recognized – but todays workforce demands it. Transitioning from a colleague and friend to a manager that has to hold their friends accountable for actions and behaviors is hard on most relationships. The saying “it is business, it is not personal” sounds legit but honestly it is simply not true. As a human being, everything is personal. With that said, I recommend that your approach be professional, empathetic, fair and consistent with all staff – no matter what your former or current friendship status with them is or was. Sit down each staff member, review their job duties in detail, ensure they understand how they will be held responsible for those job duties as well as their be-

I am not great at training but I know my staff needs mentorship to get all this information out of my head so I can focus on our patients and growing the business. What advice do you have?

This is a very common predicament.

A few things you can do are as follows: • Start recording conversations with your employees – or conversations with yourself – that refer to process and procedures and then ask someone to type them up (you can use online and free technology to translate voice to text).

• Organize your notes to use as

Introducing

havior at work. Set up weekly or monthly one-on-one conversations to make sure you are both on the same page with open, two-way communication. Never make assumptions that someone “gets it” because if they don’t, you have one person to blame – yourself.

As a small business owner, what laws do I have to abide by?

A: This information is taken directly from the Equal Employment Opportunity Commissions website.

• If you have at least one employee: You are covered by the law that requires employers to provide equal pay for equal work to male and female employees.

• If you have 15 to 19 employees: You are covered by the laws that prohibit discrimination based on race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, disability and genetic

information (including family medical history). You are also covered by the law that requires employers to provide equal pay for equal work.

• If you have 20 or more employees: You are covered by the laws that prohibit discrimination based on race, color, religion, sex (including pregnancy), national origin, age (40 or older), disability and genetic information (including family medical history). You are also covered by the law that requires employers to provide equal pay for equal work. (https://www.eeoc.gov/employers/ smallbusiness/index.cfm) “The HR Lady,” is Wendy Sellers, leadership coach, author, speaker and COO of BlackRain Partners www.blackrainpartners.com, a business consulting company focused on coaching, training, development and HR. She has a Master of Healthcare Administration, a masters in human resources, SHRM-SCP and SPHR certifications. Wendy’s leadership book, “Suck It Up, Buttercup” is on www.Amazon.com

People. Performance. Profit.

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

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

Do you want consistent Best Practices & Procedures?

Do you want your managers to hold staff Accountable?

Do you want to Improve Customer Service?

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RADIOLOGY INSIGHTS

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Wear It Pink!

October is Breast Cancer Awareness Month, which is an annual international health campaign to help increase attention and support for the awareness, early detection and treatment of breast cancer.

Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast; it is the most commonly diagnosed cancer in women. One in eight women in the United States will be diagnosed with breast cancer in her lifetime, and it is the second leading cause of cancer death among women each year.

Although breast cancer in men is rare, an estimated 2,470 men will be diagnosed with breast cancer and approximately 460 will die each year.

Risk factors for breast cancer include female gender, age (getting older), genetic mutations (ie, BRCA1 and BRCA2), dense breasts, history of chest wall radiation, personal history of breast cancer, and family history of breast cancer. Risk is higher in a mother, sister, or daughter (first-degree relative) or multiple family members on either her mother’s or father’s side of the family who have had breast cancer; furthermore, having a first-degree male relative with breast cancer also raises a woman’s risk.

Modifiable risk factors include but are not limited to physical inactivity, being overweight or obese, hormone therapy use, etc.

Interestingly, death rates from breast cancer have been declining since about 1990, in part due to better screening and early detection, increased awareness,

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and continually improving treatment options.

Early detection of the disease remains the cornerstone of breast cancer control. When breast cancer is detected early, and if adequate diagnosis and treatment are available, there is a good chance that breast cancer can be cured. If detected late, however, curative treatment is often no longer an option. In such cases, palliative care to relieve the suffering of patients and their families is needed.

A mammogram is the only breast cancer screening method proven to save lives; this imaging modality has been shown to reduce mortality from breast cancer by 14 percent to 32 percent. Despite recent controversy in screening mammogram guidelines, the American College of Radiology – the professional organization most responsible for regulating the production and interpretation of mammograms – continues to recommend annual screening mammograms beginning at age 40 for the average risk woman. Annual mammograms should continue for as long as she remains in good health.

Studies indicate that the most lives are saved when screenings begin at age 40 rather than a later age. This is agreed upon by the professional organizations in the United States that provide screen-

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

Under the direction and guidance of Florida Hospital, Radiology Specialists of Florida is fully dedicated to providing our community with excellent medical imaging services.

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ing mammogram guidelines including the American College of Radiology, the US Preventive Services Task Force and the American Cancer Society.

In addition, supplemental screening with bilateral breast magnetic resonance imaging (MRI) is encouraged in those women with dense breasts and increased risk for breast cancer.

The radiologists from Radiology Specialists of Florida at Florida Hospital are very well trained and experienced. We have radiologists specifically trained in breast imaging who interpret screening and diagnostic mammograms, interpret breast MRI exams, perform image-guided biopsies, and who perform wire and radioactive seed localizations prior to surgery. We keep up to date on the latest technology and information so that we can offer patients the best care.

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BEST PRACTICES

EVIDENCE-BASED STANDARDS OF CARE

Venous Disease/Pearls and Pitfalls in Recognition and Treatment Venous disease is estimated to affect 25 million people in the United States.

Venous ulcers, the most significant complication, affect approximately 500 thousand people. More than 2 million working days are lost each year and approximately 3 billion dollars is spent treating venous disease. In addition, venous disease is estimated to account for 1 to 3 percent of the total healthcare budget. Although venous disease cannot be avoided, greater awareness in the general population and especially among physicians can diminish the impact.

Risk factors include heredity, age, gender (females > males), hormonal (estrogen and progesterone), Corona Phlebetatica pregnancy, obesity, jobs with prolonged standing, trauma, and previous superficial or deep vein thrombosis. Graduated compression stockings are the first line of therapy for spider telangiectasias, ankle edema and skin changes, pregnant women, or those who have jobs that entail standing for prolonged periods of time. Patients sometimes complain they are hot or hard to get on, but we must be firm and tell them about the problems that can follow. Insurance companies often insist on 3 to 6 months of conservative therapy with compression stockings prior to approving any treatment.

The majority of patients with advanced skin changes have superficial venous valvular insufficiency. Many will also have perforator or deep vein involvement. Patients with peripheral arterial disease and/or significant type 1 diabetes must be treated cautiously. If pulses can’t be detected, or the patient has ankle/arm index less than 0.5, compression is contraindicated. In patients with chronic swelling or pain in an extremity, obvious varicosities, or florid patterns of telangiectasia (spider vein), the vascular lab is the first step in the treatment algorithm. But, a word of warning, when a venous evaluation is ordered, most hospitals and diagnostic labs perform a test for venous thrombosis. One must specifically ask for an evaluation for venous insufficiency, and even then, most exams are inadequate. A study should be performed with the patient standing using valsalva and compression maneuvers to check for valvular reflux. The deep, superficial and perforator systems should be studied and reflux times should be noted along with the vein diameters. This exam reveals whether a patient has evidence of old deep vein thrombosis with scarring or obstruction. Therapy for superficial veins should not be undertaken if there is a significant obstructive component in the deep system. I see a large number of patients who have had a venous evaluation at an outside lab and 99% of these exams are inadequate for evaluation of venous insufficiency. Patients with severe type 1 diabetes or known arterial disease should have an arterial evaluation

to rule out significant disease, which might contraindicate compression or venous therapy.

Early skin changes consist of pink to red discoloration which may be blotchy and dry (stasis dermatitis).

The underlying tissue may be firm.

These areas should be lubricated and massaged at least two times a day. With time, a darker brown discoloration develops and the tissue becomes firmer. This is referred to as a lipodermatosclerosis. The cause is inflammation, secondary to metalloproteinases, lymphocytes, macrophages, and red cells that traverse the capillary membrane because of the Lipodermatosclerosis hydrostatic pressure of gravity. The brown discoloration is the result of red cell destruction with deposition of feratin. This tissue is very vulnerable to ulceration. Some patients will go on to develop lymphedema with swelling of the foot because the lymphatics in the lower legs are fibrosed by the inflammation. Flare ups of this tissue frequently occur with long periods of standing, and the tissue can become erythematous and even exude fluid. Sometimes this fluid has a scaly appearance or can even appear as a white exudare. It is important to recognize this as an exacerbation of stasis dermatitis, an inflammation, not cellulitis, an infection. In these times of concern about nosocomial and opportunistic infections, we must avoid using antibiotics for this condition.

The erythema will often persist for weeks, and if left on antibiotics for that period of time, patients are vulnerable to fungal infections, MRSA, and clostridia difficil colitis. The best treatment is to focus on the underlying veins, but this takes time. Use of hydrocortisone cream, elastic compression, and elevation are bridge maneuvers. Biopsy of the skin should never be an option.

The only place for a biopsy is at a site of long standing ulceration, or an ulcer, which is refractory to optimal therapy to rule out cancer.

We must be aware of patient’s complaints of aching, heaviness in the leg, and swelling as the day progresses. Varicose veins can lead to significant problems and should not treated as merely a cosmetic concern. Early attention can avoid later problems.

Venous Ulcer

Presented in Partnership by Orlando Medical News and Vascular Vein Centers

Dr. Hugo V. Hart Dr. Hugo V. Hart is a board certified general surgeon with over 29 years experience. His educational background includes a B.A. from Southern Connecticut State University, a M.D. from Universidad Nacional Pedro Henriquez Urena, Dominican Republic, and a general surgery residency at Bridgeport General Hospital. He is certified with the American College of Surgeons and the American Board of Surgeons. He has been practicing in the Central Florida Area for over 30 years. Dr. Hart is an active member of the American College of Phlebology, the society for vein professionals. In addition to doing volunteer work for the underserved in Central Florida, Dr. Hart is an active member of the Hispaniola Medical Charity, the medical mission organization that has been established to provide medical care to the impoverished people in the Dominican Republic. Dr. Hart is fluent in both English and Spanish.

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