Manatee-Sarasota-Charlotte Medical News August 2013

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PHYSICIAN SPOTLIGHT

HMA Loses Florida Corporate Roots

Jason E. Reiss, DO

Nashville-based Community Health Systems acquires Naples-based hospital operator in historic deal

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ON ROUNDS

By LyNNE JETER

NAPLES – The honeymoon wasn’t over for Bayfront Medical Center, a century-old independent hospital located in downtown St. Petersburg. And only 35 days had passed since the Southeast Volusia Hospital District Board of Commissioners, after years of vacillating between suitors, had started exclusive negotiations toward a lease agreement for the 112-bed Bert Fish Medical Center in New Smyrna Beach.

For both hospitals, plus the three rural

Adding Value HMA rebrands 7 hospitals as Bayfront Health... 6

Stacking the Deck FSU channels novel approach to retain medical graduates in Florida... 7

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The Tide is Turning for Geriatrics Ken Brummel-Smith, MD, discusses decade of change in high demand specialty

freestanding center, or an institute into a department,” said Brummel-Smith, noting that nine allopathic medical schools in the U.S. now have a Department of Geriatrics. At FSU, it’s one of five academic departments in the College of Medicine.

Ironically, Brummel-Smith almost bypassed specializing in geriatrics because of the lack of educational opportunities at medical schools during the early 1970s, when he attended, and the lack of geriatric residency slots nationwide.

Instead, it was a chance encounter that sculpted his career path.

By LyNNE JETER

TALLAHASSEE—History was made in 2003 at Florida State University (FSU) when Ken Brummel-Smith, MD, joined the College of Medicine (COM).

To move geriatrics to a priority area in the college’s mission, FSU became the nation’s first allopathic school to be created with a Department of Geriatrics, with BrummelSmith, past president of the American Geriatrics Society, as founding chair.

“Other medical schools added departments later, transitioning from a division within internal or family medicine, or a

(CONTINUED ON PAGE 4)

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PhysicianSpotlight

Jason E. Reiss, DO Advanced Orthopedic Center

By JEFF WEBB

PORT CHARLOTTE - Jason Reiss knew since he was a little boy that he wanted to become a physician. He had a cousin who was in medical school and when they met at family gatherings Reiss would ask to look at his anatomy textbooks. Another early indicator, Reiss said, was that when he got new toys “I loved putting them together and taking them apart.”

Those pre-pubescent predilections notwithstanding, Reiss said his journey through high school to the University of Florida was routine. “I was an average student with average grades for my first two semesters” at UF, he said. “I was partying and rushing fraternities, having a good old time. My grades suffered because of it.” But then Reiss met a professor in the Nutritional Science department, Susan Percival, PhD. “She essentially rededicated me to my studies, and knowing how important research was to medical school admission directors, gave me a job as a lead researcher in her lab. With her help I was able to improve my GPA and ultimately gain entrance into medical school,” Reiss said. In retrospect, Dr. Percival “was the most influential person on me and my career,” he said.

After graduating from UF in 1996, Reiss enrolled at Nova Southeastern College of Osteopathic Medicine in Ft. Lauderdale, which is the area where his dad, a dentist, and mom, a realtor, had raised him and his younger brother, Kenneth. At Nova Southeastern Reiss already had selected orthopedic surgery as his specialty, but said he was sort of at a disadvantage because of the competition to intern at UF. “But up in the Northeast and Midwest there are a number of orthopedic programs,” Reiss said. “Essentially I spent my last 6 months of medical school doing elective rotations in Ohio, Michigan and Pennsylvania. I spent a few weeks at every hospital I could,” he said, “traveling and living out of my car so that I would be able to get a leg up on the other students applying for positions to internship programs.” Reiss said he “finally was accepted into an internship program in Dayton, Ohio. I spent every minute I could with the orthopedic program, while still covering my own ‘internship’ responsibilities through the different scheduled rotations of general medicine, surgery, etc. This meant getting up every day and being at the daily fracture conference beginning at 6 a.m., and even showing up to surgical cases in the middle of the night and holidays,” he remembered.

“It was a pretty rough time” that was made more difficult, he said, because Kristen, a Cape Coral resident whom he had met in Gainesville and married while in medical school, was living and working in Orlando.

Reiss said he was very disappointed when he was not one of the three surgeons selected into the residency program at Daymedicalnews

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ton. But that turned out to be a blessing in disguise, he said, because “I ultimately got a position (at the Philadelphia College of Osteopathic Medicine), which turned out to be the best thing that could have happened for my career.” Reiss was chief resident his last year there in 2005, and then landed a fellowship in joint replacement surgery at the University of Pennsylvania Hospital. One of his proudest moments came during that time when he was one of only three fellowship trainees in the U.S. invited to speak at the annual meeting of the American Academy of Orthopedic Surgeons in Chicago, he said.

Reiss left Philly in 2006 – “It’s a great place to say you WERE living there,” he joked –and he and Kristen set their compass for southwest Florida to be near her family. He worked at the Charlotte Orthopedic Clinic for 5 years before joining the team at Advanced Orthopedic Center in 2011.

Reiss said he divides his time evenly between seeing patients in either Advanced’s offices in Port Charlotte and Punta Gorda, and the operating room, usually at Fawcett Memorial Hospital, where he is medical director of the Orthopedic and Spine Center’s Joint Replacement Program. “My professional goal is to develop a world-class joint replacement program rivaling the well-known centers,” said Reiss, 40. “We have already begun the process by being

awarded the Blue Center of Distinction for hip and knee replacement.”

Fawcett has a “full-service joint replacement and spine floor with dedicated staff and personnel,” Reiss said, and that is easier on him and his patients. There are 16 private rooms, with plans to add 10 more this fall, and there are “upscale amenities,” he said, such as concierge services, a separate dining facility, a hospitality suite, and family activity center.

“But more importantly on the clinical side is they have board-certified orthopedic nurses dedicated to his patients. They are very good at what they do,” he said.

The admiration is mutual for Marsha Mason, RN, who has worked in the orthopedics center since it opened in 2006. “Dr. Reiss treats patients, as well as the staff, like they are part of his family. He is a great communicator and keeps us up to date,” said Mason, 61. “He’s very approachable and very responsive. He’s down to earth and very focused,” she said. “From the first day I met him he has been an inspiration.”

Mason’s appreciation of Reiss has an-

other dimension; she also is his patient.

“He replaced both my hips in March 2012 using the direct anterior (surgical) approach,” said Mason, adding she had seen him do it “hundreds of times” before he replaced hers. Reiss called the direct anterior surgery “a game-changing operation ... the only real minimally invasive way to do a hip replacement.”

Reiss places a priority on charitable work. “I am heavily involved in the St. Vincent de Paul organization in Charlotte County. We help patients in need, often performing surgery and offering our help for free,” he said. “There are a number of physicians in the community who are involved and I am fortunate to be one.”

Reiss and Kristen have sons ages 3 and 1 and they are in training to become avid Florida Gator fans, just like their parents, and to enjoy boating and fishing in the Gulf near their home in Punta Gorda.

No word yet about the boys’ interest in anatomy books or assembling toys.

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The Tide is Turning, continued from page 1 “My first job after fellowship was teaching a family medicine residency, and my director told me about the Society of Teachers of Family Medicine having a conference on teaching geriatrics in the family medicine residency program, and said it was going to be a big deal someday. When asked if I’d go and see what I could find out about it, my first thought was, wow! A free trip to Boston! I really didn’t have much knowledge about geriatrics then,” said Brummel-Smith. “After getting enthused at the conference and involved in developing educational programs, I switched from family medicine to geriatric medicine.”

Since then, the field of geriatrics has exploded. As baby boomers have aged, the need for geriatricians grows. Currently, 38,000 geriatricians are projected to meet the country’s needs.

“We’re nowhere near that,” said Brummel-Smith. “We’re at 7,000 now.

The main problem is we don’t have enough applicants. When I started in 1980, hardly anyone believed it was worth talking about. Now, there’s interest from the general public, but not enough interest from medical students. Lack of money and prestige are two reasons why.”

To address the shortage in Florida, Brummel-Smith routinely encourages high school groups pursuing medical paths to strongly consider geriatrics.

“I always give them data that says: if you look at the top income to the lowest income, geriatricians are at the bottom of the scale,” he said. “We actually make less money with a specialty in geriatrics than we would in our primary specialty of family medicine or internal medicine. But interestingly, you can line up the reverse in job satisfaction. Geriatrics has the highest; neurosurgeons, among the highest paid, have the lowest. We tell them to think about paying your bills and your loans, but don’t think you need to sacrifice your life to do it. Choose a specialty you love rather than one that pays well. And you’ll be happy the rest of your life.”

Brummel-Smith also ensures that all FSU-COM medical students have rotations in geriatric medicine in the school’s community-based curriculum model.

“Otherwise, if you took 1,000 people in a community, 700 would have a reason for thinking about their health during that month,” he explained, referencing the well-known study, “The Ecology of Care,” which first appeared in the New England Journal of Medicine in 1961, and was recently revisited with similar results. “About 300 would have contact with the healthcare system in some way. About 100 would be admitted to a hospital, and one would go to an academic teaching medical center.

So the population of patients who are taken care of, and the doctors taking care of them in an academic medical setting, is almost completely unreal realty. Then medical graduates after residency go into practice where the real situation is. For family medicine physicians, 30 percent will be geriatric patients. For internists, it’s 40 to 50 percent.

And they’re just not prepared for it. So during medical school and residency, students 4

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‘‘

If you look at the top income to the lowest income, geriatricians are at the bottom of the scale. But interestingly, you can line up the reverse in job satisfaction. Geriatrics has the highest; neurosurgeons, among the highest paid, have the lowest. Choose a specialty you love rather than one that pays well. And you’ll be happy the rest of your life.

’’

- Ken Brummel-Smith, MD, Founding Chair, Department of Geriatrics, Florida State University College of Medicine.

get a negative view of geriatrics because you’re not seeing that many older patients in academic medical centers, and they hardly ever see geriatricians as role models. Combined with the negative financial incentives, and the negative emotional incentives that a lot of academic doctors put on geriatrics, it doesn’t surprise me that few people choose geriatrics.”

The tide is slowly turning in favor of geriatric medicine. CMS has elevated geriatrics to primary care status, paying $38,500 per resident annually, a 10 percent payment bonus from $35,000. The shift from production- to value-based medicine will also make a difference. South Carolina has adopted a student loan repayment program as an incentive for geriatricians, a move Brummel-Smith hopes Florida and other states will emulate.

“In general, there’ll never be enough geriatricians to take care of all people over the age of 65,” he said. “Pediatricians have it somewhat easy, even though they fudge the line. They see 18 as the end of the timeline, even though in special cases, patients with disabilities will stay with them into their twenties because it’s hard to find physicians who know their problems.”

Even though baby steps are helpful, it remains problematic for geriatricians, who don’t fit the standard productivity model of many medical groups.

“Geriatric patients don’t fit into the 15-minute visit model,” he explained.

“Older patients have more medical needs and take longer for each appointment. Also, the way our healthcare system is working right now and the way of reimbursement, you’re not being paid to make a patient well. You’re paid to provide certain services. And many things that need to be done aren’t strictly medical. There’s coordination with long term services and supports and social issues and all sorts of things.”

For example, on a recent clinic day, Brummel-Smith spent an hour with the wife and daughter of a geriatric patient who was too demented to understand his condition.

“We wanted time to have an in-depth discussion about care planning,” he said. “I couldn’t bill for that because under Medicare rules, you can only bill for the patient’s care if the patient is there. But we were doing deep patient care planning that was

very emotionally difficult, and it’s going to lead not only to a very good outcome as he nears the end of his life, but also it’ll help save CMS a lot of money for unnecessary care he wouldn’t want in the first place.

There’s no way I could bill for that.”

The PACE Elderplace Program in Oregon, which Brummel-Smith led before relocating to Florida, used a global-capitated model he calls “the ultimate model for reimbursement.”

“If the capitation is fair – and that doesn’t mean exorbitant or skimpy -- then you can appropriately care for the patients, and let the geriatric team and the patient decide the right treatment rather than having insurance companies make the decisions,” he said. “We were free from all billing constraints, and we knew we had a certain amount of money to care for all our participants. We had quality measures to meet -- some were patientgenerated -- so we were doing things they wanted, not just what we thought was good for them. It really was the perfect way to practice medicine.”

Overall, there’s an upside to the gap of supply and demand of geriatricians.

Even though geriatrics is labeled for patients over the age of 65, most seniors up to age 74 are relatively healthy and don’t need a geriatrician, Brummel-Smith said.

“The perfect patients for a geriatrician are those above age 75, and especially those with multiple chronic conditions and longterm care needs, such as dementia, and the kinds of problems that are very difficult for internists and family physicians to take care of in a standard 15-minute visit,” he said, pointing out the American Geriatric Society considers the specialty both a primary care and consultation model.

“We manage primary care for that population of complex and frail elders, and consultations to other physicians for the ‘younger’ old people,” he explained, “and for older people who are generally receiving good care from their primary care provider.”

Even though only two graduates of FSU have completed geriatric fellowships, which reflects the average national percentage, Brummel-Smith is optimistic that more will follow as geriatric fellowships are being developed around the state.

“We’re unhappy it’s not higher, but

that wasn’t our primary goal,” he said.

“Ours was to make sure every physician who graduates is good at taking care of older people regardless of the specialty they choose. We have good evidence that they do, and anecdotal feedback from residency directors that they really like having our students because they’re not intimidated by caring for older patients, and they’re very good at interview skills.”

When funding is available, BrummelSmith plans to pursue a study for a closer look into alums’ medical offices and their care for the older population, including quality measures and comparisons to graduates who attended medical schools without a concentrated geriatrics focus.

The 4-1-1 on Ken Brummel-Smith, MD Ken Brummel-Smith, MD, founding chair of the Florida State University (FSU) College of Medicine’s Department of Geriatrics, graduated cum laude from Loyola University in 1971, the University of Southern California School of Medicine in 1975, followed by an internship and family practice residency at Glendale Adventist Medical Center in California. In 1980, he completed a family practice fellowship in faculty development at the University of Southern California School of Medicine’s Department of Medical Education.

Before relocating to Florida in 2003, Brummel-Smith served as medical director to the PACE Elderplace Program in Portland, Ore., and as Bain Chair of the Providence Center on Aging and professor of family medicine at the Oregon Health Sciences University. In Oregon, he served on the Governor’s Task Force on the Future of Care of Seniors and People with Disabilities and co-chaired the Health and Prevention Subcommittee.

Past president of the American Geriatrics Society, Brummel-Smith was selected by his peers 11 times among the Best Doctors in America, and chaired the Association of Directors of Geriatric Academic Programs. During his first year at FSU, Brummel-Smith chaired the Florida AtRisk Driver’s Council. In 2009, he served on the Tallahassee Senior Center Foundation Board. He holds the Charlotte Edwards Maguire chair and professorship at FSU – Maguire made a gift to endow his chair as part of the school’s strong emphasis on geriatrics and helped recruit Brummel-Smith to Florida – and continues to serve as a state and national advocate for geriatrics training.

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HMA Loses Florida Corporate Roots, continued from page 1 Shands Healthcare facilities that had been aquired for $21.5 million in 2010, it made plenty of sense to tie the knot with Health Management Associates Inc. (NYSE: HMA), a Naples-based hospital operator that had been on a spending spree acquiring struggling hospitals.

In late March, Fortune magazine had named HMA among the World’s Most Admired companies in Health Care: Medical Facilities for the second consecutive year and fifth time in seven years. HMA had also been named the leading company for two subcategories in 2012: Use of Corporate Assets and Social Responsibility.

Yet soon after HMA CEO Gary Newsome announced plans in May to retire to instead preside over a Uruguay mission with the Church of Jesus Christ of Latter-day Saints, rumblings swept through Wall Street that fiscally struggling HMA might be the target of a takeover.

In a May 31 note to investors, Chris Rigg, an analyst with Susquehanna Financial Group, was cautiously optimistic that Community Health Svystems (Nasdaq: CYH) might be pursuing HMA, estimating the Franklin, Tenn.-based hospital operator could acquire the company for $18.50 a share, a premium to HMA’s shares that had recently traded near $14.

“We would be surprised if a transaction were announced in the very nearterm,” he noted. “We don’t believe CEO Gary Newsome would be leaving the company in July if a formal auction process, which we expect HMA would conduct, were currently underway. That being said, we believe Community is the best-positioned name in the hospital group to operate HMA rural focused hospital assets.”

price sensitive. “Insurers will pressure hospitals to become more efficient than ever, and as a result, it’s not surprising to see these two companies merge,” he added.

With a similar focus on non-urban locations, CHS leases, owns or operates 135 hospitals around the country. With HMA’s 71 hospitals, CHS would have 206 acute-care hospitals, with a much larger footprint in Florida.

The antitrust review will focus on highly localized markets, Paul pointed out.

“While the two parties overlap in 29 states, it doesn’t appear that they have substantial overlaps on a localized level,” he explained. “The Federal Trade Commission (FTC) will focus on how many patients in an area would likely view the two operators as substitutes for each other in terms of location, quality and specialties.

Where the two are close substitutes, the FTC could seek divestitures if it were to find that patient choice may be limited.”

The new CHS would be rivaled only by its across-town neighbor, Hospital Corporation of America (HCA), which has fewer hospitals (162), yet reports higher revenue.

Last year, HCA raked in $33 billion; CHS and HMA had a combined $18.9 billion.

“This compelling transaction provides a strategic opportunity to form a larger company with a diverse portfolio of hospitals that is well-positioned to realize the benefits of healthcare reform and to address the changing dynamics of our industry,” said CHS CEO Wayne Smith.

“Our complementary markets and the ability to form networks in key states, along with the synergies that will be available to us, can create value for the shareholders of our companies, the communities we serve,

our employees and medical staffs.”

Both companies’ boards of directors unanimously approved the definitive merger agreement, with CHS paying HMA $3.9 billion in cash and stock and assuming $3.7 billion of debt. The deal would give HMA shareholders a 16 percent stake in the new company. Before the market opened on July 30, HMA shares fell 6.9 percent to $13.89; CHS stock rose 2.4 percent to $48.35.

The Unraveling

The relationship between HMA and its largest shareholder (14.6 percent), Glenview Capital Management, a hedge fund managed by billionaire Larry Robbins, had soured in recent months. Glenview, a private investment management firm established in 2000 with more than $6 billion in assets, also owns nearly 10 percent of CHS. Robbins had been critical of HMA’s sluggish financial results and “unconstructive” executive behavior, pointing to HMA CFO Kelly Curry. Glenview had tried to replace HMA’s entire board of directors with eight candidates in a Fresh Alternative campaign to revitalize the company. In June, Glenview had written HMA about “significant room for improvement,” which it said had fallen short in its financial performance for more than a decade.

“Under the supervision of the sitting board, HMA lacks the financial acumen to deliver on its projections,” Glenview released in a July 30 statement. “Unfortunately, this continues to be the case.”

Another Nashville, Tenn.-based hospital group, LifePoint Hospitals (NASDAQ: LPNT), had also expressed interest in acquiring HMA.

The Next Step

Until the merger is completed – the target deadline is March 31 – John Starcher Jr., president of HMA’s Eastern Group with 23 hospitals in seven states, will step up as HMA interim CEO. HMA’s projected second-quarter earnings show a drop of .05 percent in net revenue to $146 billion, attributing the discouraging fiscal picture to low admissions, increases in observation stays, higher bad debt, a reduction in surgeries, and the federal government’s sequestration. Same-hospital admissions were predicted to fall 6.7 percent, compared to the second quarter of 2012.

In its first-quarter financial filing, HMA reported it had received a subpoena from the U.S. Securities and Exchange Commission (SEC) for documents involving accounts receivable, billing write-downs, contractual adjustments, reserves for doubtful accounts, and revenue. In May and June, HMA received three more subpoenas from the HHS’s Office of Inspector General related to the process by which the company admits people from its emergency department. The new subpoenas supplemented ones the company received in 2011. Another subpoena was issued on physician relationships. In December, a CBS “60 Minutes” segment focused on HMA’s aggressive policies aimed at increasing admissions and “disgruntled former employees.” No stranger to the federal pressure-cooker, CHS recently received a new subpoena for similar allegations from the Department of Justice.

Competing hospital chains and medical schools in Florida, including the Florida Medical Association, declined to comment on the July 30 CHS-HMA announcement.

The Engagement

On July 30, in a power play reminiscent of the 1987 blockbuster movie, “Wall Street,” the news became official: Community Health Systems (CHS) announced plans to acquire HMA for $3.9 billion in a deal valued at $7.6 billion that would create the nation’s largest for-profit hospital chains in terms of number of facilities.

“This is the second biggest hospital deal announced this summer,” said healthcare industry consultant George Paul, antitrust partner with White & Case.

In June, Dallas-based Tenet Healthcare Corp. (NYSE: THC) announced its acqui- George Paul sition of Nashville, Tenn.based Vanguard Health Systems (NYSE: VHS) in a pact valued at $4.3 billion.

“This deal is part of a growing wave of hospital consolidation, as hospitals seek ways to diversify and lower costs in anticipation of a sea change occurring in the healthcare industry with the implementation of the Affordable Care Act, uncertainty over how states will handle Medicaid coverage and reimbursement, and Medicare changes,” he said.

Paul emphasized that under Obamacare, scale will matter greatly as hospitals seek to cope with reimbursement changes and as consumers become increasingly medicalnews

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Adding Value

HMA rebrands 7 hospitals as Bayfront Health

By JEFF WEBB

Like so many other for-profit hospital companies in the U.S., Health Management Associates is jockeying for market position to be a winner in an evolving and uncertain era in the history of healthcare delivery. The Naples-based company’s recent decision to rebrand seven of its hospitals on Florida’s Gulf Coast as “Bayfront Health” is evidence of that strategy.

But the initiative, which was spawned in St. Petersburg and includes HMA’s hospitals from Hernando County to the north to Charlotte County to the south, remains focused more on patients than profit, according to Kathryn Gillette, marketing president and CEO of Bayfront Health.

“We’re here to make sure that we add value to healthcare at the local level first,” said Gillette, who was hired in April to oversee the regional network from its flagship facility in St. Petersburg, formerly the nonprofit Bayfront Medical Center. The six other hospitals comprising Bayfront Health, which span a 150-mile corridor roughly aligned with Interstate 75: • Brooksville (formerly Brooksville Regional Hospital) • Dade City (formerly Pasco Regional Medical Center) • Spring Hill (formerly Spring Hill Re-

gional Hospital) • Port Charlotte (formerly Peace River Regional Medical Center) • Punta Gorda (formerly Charlotte Regional Medical Center) Venice Regional Medical Center (retaining its core name, but adding “an affiliate of Bayfront Health” to its title.

Gillette said her vision is to integrate resources at Bayfront Health St. Petersburg with each hospital in the network. “These hospitals are really excited to have the name Bayfront Health and that will be meaningful in their communities. We are going to add value to them,” she said, “but we are not going to overstep our bounds.” The hospitals’ management teams will remain intact, Gillette said, as will the relationships they have with residents, employees, local governments and the business community.

“We don’t intend to interfere.”

From a practical, patient-centered perspective, Gillette said, Bayfront Health will benefit both patients and HMA. On a corporate level, it offers the opportunity to operate as a unified system in a geographic region, creating more cost efficiencies and capabilities. For patients, it provides options and depth in terms of treatments and locations. According to a statement released

by Bayfront Health in announcing the re-

Kathryn Gillette

Tampa Bay Times

branding, “As Bayfront Health becomes a truly integrated system, our patients will have the benefit of choosing the facility and physician that best meets their medical needs. There will be seamless transitions, from meeting with a specialist to the hospital stay, improving the overall experience for both doctor and patient.” That would include sharing medical records, transfer agreements in certain medical specialties, clinical protocols and technology, as well as about 6,000 healthcare professionals.

HMA also predicted the new Bayfront Health network will account for a combined 66,000 inpatients, 200,000 emergency room visits, 56,000 surgeries and a half-million outpatient visits each year.

Gillette said establishing the Bayfront Health system will enhance HMA’s teaching and research relationship with the University of Florida Health and Shands Hospital. “We are very proud of the fact

that UF and Shands are part of the this relationship. We’ve had a number of meetings about ways that UF can enhance deliveries of their healthcare system, first in the St. Pete market,” she said. “Also, we are immensely proud of the fact that this medical corridor of All Children’s and the University of Florida St. Petersburg is right down the street from us. So, we’re looking for ways to build on that ... There is an awful lot that can be enhanced in the delivery of healthcare when you come together with partners who bring things to the table that you might not have at your fingertips. The University of Florida is one of those that I’m very excited about.

They are well known in this community.

People understand them, and they have a very strong affiliation and feeling about the university. It’s a first-class program.”

Earning buy-in from leaders in each community’s hospital is key, said Kanika (CONTINUED ON PAGE 11)

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Stacking the Deck

FSU channels novel approach to retain medical graduates in Florida

By LYNNE JETER

ORLANDO – When leaders at the Florida State University College of Medicine (FSU COM) began crunching numbers, they were pleasantly surprised to learn that roughly two of three medical graduates are practicing medicine in-state, even if they completed residencies elsewhere.

“We were concerned it was a fluke and hoped the trend kept up,” said Michael Muszynski, MD, dean of the FSU COM Orlando regional campus, and associate dean of clinical research. “Five years later, it’s holding steady between 60 and 64 percent.”

State lawmakers approved the opening of the FSU COM in 2000, after the Board of Regents denied requests in the late 1990s, stating more doctors weren’t needed. The charter class graduated in 2005.

As of May, 82 of 135 FSU COM graduates who have completed residencies are practicing medicine in Florida (61 percent). Of those, 70 percent (57) are in-state primary care providers (PCPs) and 16 percent (13) are practicing in rural, medically underserved areas of the state.

“The reasons why our statistics are much better than the standard 30/60 percent split – that is, 30 percent of graduates from traditional-based medical schools

typically return to the state after completing residency and 60 percent stay where they did their residency – is because of the foundation we laid with our mission statement, which was created by us from the very start,” said Muszynski. “We wanted the foundation firmly established so that whoever inherited the program from the pioneers who started the school wouldn’t be able to vary from the mission.”

First, FSU COM stacks the deck on the front end through a holistic application approach, focusing on applicants who want to live and practice medicine in Florida. Second, the college follows a community-based medical school model during students’ clinical years, where they connect one-on-one with physicians in the community.

And third, medical school faculty makes it fun and interesting to be a community-based doctor with a mentoring system that maintains contact with students during school and afterward.

“We didn’t take a willy-nilly approach,” said Muszynski. “We put a great deal of thought into how our approach might work.

We knew we had to make an impression on medical students when they were making choices about their careers. And it’s working. The only thing that surprised us was how well it’s worked. We would’ve been

We put a great deal of thought into how our approach might work. We knew we had to make an impression on medical students when they were making choices about their careers. And it’s working. The only thing that surprised us was how well it’s worked. We would’ve been happy with a 40 to 50 percent return, but 60 to 65 percent is astounding.

– MICHAEL MUSZYNSKI, MD, DEAN, ORLANDO REGIONAL CAMPUS, FSU COLLEGE OF MEDICINE.

happy with a 40 to 50 percent return, but 60 to 65 percent is astounding.”

During the formulation of their approach, FSU medical school leaders noted behavioral changes before, during and after medical school.

“What you thought you wanted to do for a career when you were in high school was probably different than when you were in college,” he explained. “It changes quickly during those years as you become exposed to more influences. Medical students’ thinking typically isn’t solidified at that point about what they want to focus on in life. They’re still experiencing and sampling. Their choice maturity is young.”

Also, during residency, medical graduates begin to get involved in the community, marry, start families, buy their first home, and/or begin receiving local job offers, making it an easy choice to remain at the residency location.

“We thought graduates usually make

their choices during residency because they picked a specialty,” said Muszynski. “Traditional medical school models aren’t so much about a connection where students are from, but where they are. We wondered about the lack of that connection. I thought back to my Ohio State University days after medical school. My loyalties weren’t to Central Ohio; my warm-and-fuzzies were at Ohio State. We asked the question: How can we change that? We had to make an impression on medical students when they were making choices about their careers. So we embarked on a grand experiment to change the 30/60 ratio with FSU medical school graduates by attacking it on all three fronts.”

Deck Stacking

Rather than reviewing only grades and scholastic ability, the FSU COM application review board selects students with attributes that mirror the school’s mission.

(CONTINUED ON PAGE 8)

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ICD-10: Are You Ready?

By BILL HEFLEY, MD

With the rapidly approaching ICD-10 ‘go live’ date of October 1, 2014, medical practices should be well on their way in preparing for the transition. With implementation of ICD-10, physician offices accustomed to the 13,000 ICD-9 codes must be prepared to transition seamlessly to a new set of 68,000 codes. More specifically, a physician or billing clerk currently using ICD-9 to properly code the diagnosis of ‘patella fracture’ must choose between two possible codes; when utilizing ICD-10 that number explodes to 480 codes. Yes. Get ready.

In 1992 the World Health Organization (WHO) published the International Classification of Diseases, Tenth Revision.

The U.S. made modifications to the WHO ICD-10 creating the ICD-10-CM (Clinical Modification) which is the diagnosis code set that will replace ICD-9-CM Volumes 1 and 2. The Department of Health and Human Services (HHS) published a regulation requiring the replacement of ICD-9 with ICD-10 and later pushed back the compliance date one year to October 1, 2014. Farzad Mostashari, MD, the National Coordinator for Healthcare Information Technology, asserted last month that there would be no extension of the deadline.

While many physicians see the transition to ICD-10 as an unnecessary burden, other physicians and industry stakeholders believe that the ICD-9 code sets are obsolete and inadequate. ICD-10 codes have more characters and a greater number of alpha characters creating space for

new codes and flexibility for future medical advances. ICD-10 has increased specificity that will improve the ability to identify diagnosis trends, public health needs, epidemic outbreaks, and bioterrorism events.

In addition, ICD-10 will improve claims processing, quality management and benchmarking data.

A successful ICD-10 transition requires exhaustive preparation by medical practices. Yet recent research by the Medical Group Management Association indicates that only 4.7 percent of practices reported that they have “made significant progress” when rating their “overall readiness level for ICD-10 implementation.”

The research was derived from respondents in 1,200 medical practices in which more than 55,000 physicians practice.

Preparing to practice medicine in the world of ICD-10 is no small undertaking.

It will require time and money. Having an experienced billing clerk “coder” in the practice will no longer be sufficient to generate accurate codes. Simply converting the practice’s ICD-9 superbill to ICD10 is problematic. Many industry experts don’t see the superbill being preserved at all. The American Academy of Professional Coders (AAPC) recently issued a two page ICD-9 superbill which when crosswalked to ICD-10 became nine pages long. Another industry consultant sites an example of a two page ICD-9 superbill translating into a 48-page ICD-10 superbill.

Preparation for the medical practice begins with internal training and testing of all parties involved in producing proper

MYTHS ASSOCIATED WITH ICD-10 The Go-Live date will most likely get delayed again The only staff members affected will be coders and billing specialists My EMR and PM vendor will be automatically compliant General Equivalence Mappings are a good solution to coding an individual clinical chart After October 1, 2014 payers and clearinghouses will aid practices by automatically crosswalking submitted 9 codes to 10 codes

coding. Administrators must establish a training and implementation schedule; set deadlines; create a project team; identify training resources; perform documentation gap analysis; evaluate and modify the practice’s forms; budget for transition expenses; communicate with practice management (PM) software and EHR vendors; assess hardware and software update requirements; and arrange testing with clinical and billing staff, PM and EHR vendors, clearinghouses and major health plans.

Providers must be trained on the changes in clinical concepts and the level of detail in ICD-10, so that their documentation supports the ability to code to the highest level of detail. For many specialties, it is highly recommended that physicians take anatomy and physiology refresher courses.

Billing staff must increase their knowledge of anatomy and physiology, learn and adopt a completely different coding system and be able to code to the greatest level of detail.

Training options include sending staff for offsite training, hiring an outside trainer to come to the practice, online training,

Stacking the Deck, continued from page 7 “We quickly discovered that students who stated upfront their agreement with our mission had experience supporting that mission alignment,” said Muszynski. “For example, we noted that many applicants from smaller towns and smaller high schools were involved in a meaningful way with their community and seemed more likely to maintain that mission. We made no apologies for those identifying descriptors.”

For several years, FSU COM only accepted in-state applicants. Now, approximately 5 percent of approved applicants hail from out of state. Still, the board remains very selective.

“If we have an applicant from New York, for example, whose goal is to return to that city, we would be more reluctant to accept that applicant,” he said. “We hope applicants are being honest, at least at that time, so we can have better predictive measures.”

All factors considered equal between two applicants – one from a rural area and an urban applicant – the rural applicant may be get a slot above the urban applicant, said Muszynski.

“A student from a rural area is more likely to align with our mission just because of their setting,” he explained. “But the rural applicant who didn’t do much extracurricular-wise, where the urban applicant worked 8

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with the underserved, then it’s different.

That’s part of the holistic approach.”

Middle Ground

To keep the in-state return mindset strong, the FSU COM uses a communitybased curriculum to place third and fourth year medical students in the field.

“Community-based curriculums have been talked down by some schools, particularly the Ivy League types, with objections that they don’t turn out significant researchers,” said Muszynski. “We contend its equal worthiness, and we produce researchers that we support whole-heartedly. We focus on producing physicians who can care for patients in community settings, and a community-based curriculum is central to the process.”

For example, FSU COM has a unique apprenticeship model. Students aren’t assigned to hospitals, wards or residency teams. Instead, they’re assigned to a physician practicing in the community who has been trained to be an educator.

That physician typically receives $2,000 a month on a contract basis. As a result of this model, the FSU COM has no fulltime faculty for years 3 and 4, with the exception of the campus dean.

“You might find some medical schools in Florida that do a little of this here and

there, but nobody to the magnitude we do,” said Muszynski, noting that 19 alumni practicing in Central Florida are educators on the Orlando and Daytona campuses. “Most medical schools assign students to a place, not a particular physician dedicated to a block of time for the student. That strongly connects students to the local community.”

The approach also includes a geriatric rotation component to spark interest in caring for older patients.

“They all like their geriatric experience and can relate to it with their grandparents,” said Muszynski. “Older patients are so appreciative of a physician’s time and that resonates with medical students at an impressionable time.”

Also during the clinical years, medical students typically become “fiercely loyal” to the community, he said.

FSU COM has also established a strong student advisor network. Each student is assigned to a community advisor on an 8-to-1 ratio. Students are counseled not only about their careers, but also life in general, volunteerism, and the delicate yet very important work/life balance that perplexes many physicians. Advisors are overseen by a dean or associate dean, depending on the campus, on a 20-to-1 (students-to-dean) ratio.

“That low of a ratio in the U.S. rarely exists,” emphasized Muszynski.

webinar training and book-based training.

Frequent testing and trial coding for all staff is also highly recommended in the months leading up to the ICD-10 ‘go live’ date.

In addition to internal preparation, medical practices must also arrange testing with their PM vendor, EHR vendor, clearinghouse and major health plans. Many PM vendors and EHR vendors will not be ready to meet the October 1, 2014 ICD-10 compliance date. Practices must communicate with their vendors months in advance to schedule software upgrades and testing to assure readiness. If the practice’s PM or EHR vendor is not going to be prepared for the ICD-10 launch, the practice will need to make plans to switch in time for the transition date. Many practices with in-house billing departments will weigh the benefits of outsourcing the practice’s revenue cycle management.

Costs associated with the preparation for the ICD-10 transition are not insignificant. Industry experts suggest budgeting $200,000 to $280,000 for an eight-physician practice. Expenses include training, testing, hardware upgrades and PM/EMR software upgrades. In addition to the onetime costs associated with implementation, many practices will experience ongoing, recurring costs related to the need for increased coding staff, consulting services, subscriptions to print and software-based coding aids and reduced productivity as a result of increase need for documentation and coding complexity.

The ICD-10 transition will undoubtedly eclipse Y2K and the HIPAA 4010 to 5010 transition in terms of the impact on the healthcare industry. Unprepared practices will face painful disruptions in cash flow and a chaotic scramble to regain practice productivity. Even well-prepared practices that execute ICD-10 implementation flawlessly will likely experience some disruption in cash flow. Remember, a successful revenue cycle requires every entity in the claims processing chain to be fully prepared for ICD-10. The PM system, EMR system, clearinghouse and payer must all communicate properly electronically and adjudicate ICD-10 claims correctly. Some bugs are inevitable. Practices should have in place a line of credit sufficient to cover three months operating expenses prior to ‘go live.’ Preparation will take considerable planning, time and money and should begin immediately.

October 1, 2014 is just around the corner.

Bill Hefley, MD, is President and CEO of MedEvolve, offering a full range of highly evolved application software, interoperability interfaces, and revenue management services focused on practice profitability and efficiency. Visit the website at www.medevolve.com

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Ten Ways to Avoid and Fight a Lawsuit Against Your Assisted Living Facility

By JOHN W. HEILMAN, Esq.

For administrators of assisted living facilities (ALFs), helping residents stay active and healthy while maintaining a high quality of life can be daunting. Many residents are at high risk for injury, irrespective of supervision and assistance levels, and the risk of lawsuits against ALFs is, unfortunately, a constant concern. The best way to fight lawsuits is to avoid them in the first place.

Steps can be taken in this regard. However, if the facility does encounter legal issues, there are also strategies for successfully fighting them. Below are ten ways to avoid and fight lawsuits.

Avoiding a lawsuit

• Focus on the basics The best way to avoid a lawsuit is to have a passion for excellence in operating the facility, fostered in a heart of love. Love is critical for success in this industry – love for the wellbeing of the residents and their families, toward the staff, toward the greater community, and a personal passion for the healthcare field. Focusing this passion on the fundamentals of running an ALF will help the facility exceed the standards of Chapter 429, Chapter 58A-5, and Florida law concerning negligence, helping to keep the ALF out of legal trouble.

• Keep 1823s current The cornerstone of the physician-ALF relationship is of course the Resident Health Assessment, AHCA Form 1823. Be sure that each 1823 is properly and fully completed, signed and dated. Remember, too, that an administrator of an ALF must determine that each resident is appropriate for admission and for continued residency. The 1823 must be updated every three years or after a significant change as defined by Rule 58A-5.0131, Florida Administrative Code, whichever comes first.

• Assist with obtaining third party services (and document) An administrator or his or her designee should coordinate and facilitate third party services to residents. Because physicians and third party providers often have delays unrelated to the ALF’s efforts, it is important, and required by Rule 58A-5.016(8), to document attempts to coordinate third party services.

• Aggressively monitor staffing numbers and transparency Be sure to comply with hours requirements weekly. Calculations should exclude those persons who cannot count toward the total figures. Make sure daily work schedules for direct care staff are available on request.

Further, time sheets and work schedules should be maintained as required by Rules 58A-5.019 and 58A-5.024.

• Maintain records specifically medicalnews

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listed in Rules Rule 58A-5.024 clearly lists records which must be kept regarding 1) the facility, 2) staff, 3) and residents. Precise record keeping helps administrators focus on the basics. For example, we occasionally see charting of medication observation on a day when a resident was at the hospital or deceased. Proactively advise staff that plaintiffs’ lawyers will aggressively point out such errors.

• Create internal incident reports In addition to AHCA incident reports, internal incident reports should be created as a standard practice. Each facility should have a blank form incident report that any employee can fill out if there is an incident with injury, or alleged injury. Internal incident reports should be kept separately from AHCA incident reports in a central and confidential location.

Fighting a Lawsuit

• Notify your insurance company immediately If the ALF is served with a lawsuit, or receives a statutory presuit notice of intent letter, administrators should immediately put the facility’s insurance company on notice. Every presuit notice and lawsuit has the potential to be an existential threat to an ALF, to the economic security of staff members, and the tranquility of residents. The best way to fight it is to immediately involve a lawyer, as appointed by the ALF’s insurer.

As a general rule, after the facility has notified the carrier, administrators should do nothing unless instructed to, or “greenlighted,” by the lawyer.

• Question your lawyer, and ensure he or she practices in longterm care A litigator is someone who spends much of his or her time resolving bitter disputes, being persuasive, and answering difficult and complicated questions. If the lawyer repeatedly cannot answer questions in a manner that instills confidence, administrators need to advise the carrier of their concerns. Communications with the carrier should be in writing, and preferably via fax and mail. It is also imperative, of course, that the lawyer practice in long-term care – as it is a very specialized area of practice.

• Help your lawyer Assuming the lawyer can answer questions consistently, it is critical for administrators to provide assistance. The defense of a lawsuit is a team effort, and it will fail if the client does not play the proper role on the team. This means respecting and generally going along with well-reasoned recommendations. It also means diligently searching for documents and information, and asking (CONTINUED ON PAGE 10)

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9

M&A Trends Reshape How Hospitals Handle Risk and Patient Safety

By JOSEPH WILSON, MD

Healthcare is experiencing a broad trend toward consolidation, with the overall number of mergers and acquisitions across all sectors at the highest level in a decade.

Hospitals and health systems are buying group practices at a rapid pace – and many physicians are looking to sell. This scenario may not be for everyone, as physicians wish to remain independent for a variety of reasons. But for many, the prospect of relinquishing administrative and operational responsibilities is compelling, A survey by management consulting firm Accenture finds that as of 2013, only about one-third of physicians are independent (that is, own a practice) compared to 57 percent in 2000. And the movement shows no sign of slowing down. There are complex and compelling reasons motivating both physicians and hospitals to consolidate, including rising medical costs, the burden of compliance and federal healthcare reform.

And even good change can be hard work.

Acquiring physicians brings with it a host of challenges, from on-boarding new employees to integrating them into the culture, adjusting workflow processes, aligning doctors with the organization’s financial and quality improvement goals—down to making sure you have the right professional liability insurance that provides the best coverage for all risk levels.

What Hospitals and Providers Want

CMS regulation, rising EHR costs, and electronic processing of claims are driving costs and, therefore, the move toward consolidation. Decentralization of providers into small or solo practices has been cited as a reason the healthcare market is inefficient, with patients seeing duplicate providers who may prescribe overlapping treatments or deliver widely divergent, uncoordinated care.

Physicians are increasingly faced with a tough business decision on top of the difficult clinical challenges they address every

day: Whether or not to remain independent. The recession has played a hand by making it harder to run a small business, with fewer patients coming in for care and greater numbers unable to pay. Younger doctors don’t want the long hours and administrative headaches that come with private practice – billing, claims processing and negotiating fee schedules with insurers – not to mention a significant IT investment. According to its 2010 final rule, CMS said the average EHR implementation costs as much as $54,000 per physician on top of annual maintenance costs that run about $20,000 per doctor. Many providers are willing to become an employee in exchange for a regular salary with a productivity bonus and a stable schedule that focuses on patient care, not office management.

For hospitals, healthcare payment reform, compliance and a looming physician shortage is driving consolidation. To enable care coordination, health systems need doctors in the fold – and they need to have adequate staff to meet the influx of millions of Americans projected to gain insurance through regulated health exchanges. By acquiring physician practices, hospitals bolster coordination of services, increase market share, receive a steady stream of referrals and are entitled to incentive payments for providing more efficient, integrated care.

While these new alignments come with a host of benefits, they also carry some uncertainty. Hospitals must integrate and manage physician practices. And beyond operational challenges, clinical and business reputations are at stake. Hospitals need to be cognizant of how the acquisition of physicians can affect the organization’s exposure and risk profile both in the community and among insurance entities that provide professional liability (PL).

Rethinking Professional Liability

Hospitals approach providing coverage in a number of advantageous ways.

Assisted Living Lawsuit, continued from page 9 questions of the staff. Additionally, administrators should be accessible via fax, phone and email, sometimes on short notice.

• Maintain sufficient insurance Inadvertently letting your policy lapse or not carrying enough insurance can destroy an ALF. Even in cases where administrators had thought they were doing everything right, jury verdicts have been rendered in the $1 million to $5 million range, and even higher. In addition to carrying the proper amount of insurance, administrators should make sure that applicable officers, directors, partners, members and owners are named as additional insureds on the insurance coverage as appropriate.

Diligence and organized record-keeping with adherence to State-mandated obligations are the best risk management 10

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techniques an ALF can employ. The areas discussed above are where ALF operators may sometimes fall short. Turning attention to these on a recurring basis can fight lawsuits the best way – by avoiding them altogether. When claims do arise, ensure that your insurance company is immediately “put in the loop,” and that you have a sufficient rapport with your long-term care defense lawyer to fight relentlessly. Such a fight may be needed to protect the good name and viability of your facility.

John W. Heilman, JD, MBA, is an attorney in the Tampa office of Marshall Dennehey Warner Coleman & Goggin, a civil defense litigation firm with more than 450 attorneys in six states. He has defended matters for many of the largest U.S. long-term care and insurance companies throughout Florida and the Southeast. He also practices in general liability defense.

He can be reached at jwheilman@mdwcg.com.

Some hospitals incentivize employment by providing basic coverage, allowing physicians to go above and beyond at their own discretion. In other situations, the employer negotiates premium rates on the provider’s behalf. While there are many ways to provide coverage and many types of insurers, hospitals need a medical professional liability company that goes beyond claims processing and provides value through risk assessment, analytics, patient safety education and defense counsel.

Insurance is not a one-size fits all proposition. Different roles carry different levels of risk. Turning to a company that can provide effective, collaborative risk management for all levels of exposures that hospital staff present—from specialists to primary care physicians to nurses, to administrative employees—enables the hospital and its physicians to improve quality and compliance, enhance decision-making and decrease financial loss to the benefit of all stakeholders.

A PL company that uses analytics has the ability to deliver actionable information.

Physician- and specialty-specific reports and loss analyses, along with risk management expertise, can help hospitals identify claim trends of its physicians. This information can help hospitals find more ways to improve procedures and systems, thus lowering risk within the organization.

The liability environment is changing and hospitals are starting to see the frequency of insurance claims rise, making it imperative to have better control of claims and settlements. Having experts on hand to negotiate and keep those costs low across every medical specialty is essential to a successful operation. Moreover, the insurance company collects and analyzes professional liability claim data, providing hospitals with detailed tracking reports on everything from claims losses to defense costs and legal expenses. It will also provide reporting to data banks as well as state and federal regulators, so that hospital administrators can report data accurately and measure results and expenses separately from hospital-wide trends.

A hospital that turns to professional liability experts for its employed physicians makes better use of the facility’s resources with specialized knowledge, risk management, legal counsel and a coordinated defense that strengthens the collaborative bond between the physician and hospital.

The insurance company can provide immediate access to counsel on urgent matters, as well as advise on HIPAA compliance, how to deal with a difficult patient, and manage adverse outcomes to defuse potentially risky encounters and minimize exposure – all of which improves communication, encourages teamwork and reduces claims.

Joseph S. Wilson, MD, is Chairman and CEO of MagMutual Insurance Company, the Southeast’s largest mutual professional liability insurer. Dr. Wilson has served on MagMutual’s Board since 1999, is Board Certified in cardiology and interventional cardiology, and is a Fellow of the American College of Cardiology.

He can be reached at jwilson@magmutual.com

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GrandRounds Dawn Holcombe Named Vice President of Strategic Partnerships at Florida Cancer Specialists Florida Cancer Specialists & Research Institute (FCS) is pleased to announce that Dawn Holcombe has joined the company as Vice President of Strategic Partnerships. Ms. Holcombe has over 30 years of healthcare industry experience providing strategic oncology leadership for both providers and payers.

Prior to joining FCS, Ms. Holcombe was President of DGH Consulting, providing strategic guidance on a national level for five years to providers, payers, and the pharmaceutical industry. Preceding that, she served as Executive Director of the 60-physician Oncology Network of Connecticut, Executive Director of the Connecticut Oncology Association on a pro bono basis, and was past President of the national Administrators in Oncology Hematology Assembly (AOHA) of the Medical Group Management Association (MGMA).

Ms. Holcombe holds an MBA in finance and marketing from the University of Michigan. She serves as an Editorial Board Advisor for two national publications, Value Based Cancer Care and The American Journal of Managed Care, and is the Editor in Chief of Oncology Practice Management. She also recently authored the 2013 National Association of Managed Care Physicians (NAMCP) Medical Director’s Guide: Oncology. Ms. Holcombe currently sits on the board of

the Community Oncology Alliance (COA) and is a Fellow with the American College of Medical Practice Executives (AMCPE).

Chief of Staff serves as Moderator for World Society of Heart Valve Disease in Italy Dr. Alessandro Golino, M.D. Chief of Staff at Manatee Memorial Hospital just returned from the Society for Heart Valve Disease/Heart Valve Society of America 7th Bi- Dr. Alessandro Golino ennial Congress Conference in Venice, Italy.

Dr. Golino, a cardiovascular surgeon in Bradenton was selected as one of three specialists to moderate and discuss Mitral Valve Repair. The discussion included what has evolved in the last 20 years with Mitral Valve and what is happening today.

Dr. Golino has performed over 375 mitral valve surgeries with a success rate of 97.2 percent which far exceeds the Society of Thoracic Surgeons rate of 59 percent.

Dr. Golino received his M.D. from the University of Naples, graduating with honors in the top one percent of his class.

He completed his European cardiothoracic residency in 1991 also with honors.

As a part of his formal training, Dr. Golino spent 18 months working as a part of the surgical and transplant team at Texas Heart Institute in Houston.

In 1991 Dr. Golino was appointed assistant professor to the department of cardiac surgery at the University of Naples

Adding Value, continued from page 6 Tomalin, vice president of external affairs for Bayfront Health. “As we talked with the boards of directors of all these hospitals about our strategy, all made up of business leaders in each of these communities, they have answered the strategy with great enthusiasm because they have such immense pride in their local hospitals. But they absolutely want to know that their hospitals are sustainable and buoyed by a larger platform that allows them to be viable in the future. They recognize this strategy will (help them) for many years,” Tomalin said.

“A big part of the Bayfront Health network is having a community presence and setting the standard for healthcare as it will be delivered in each of these communities.

HMA delivers healthcare in 23 hospitals across the state and we are looking for ways we can use this same model of leveraging resources to the benefit of our patients.

Finding ways to enhance what each of us do very well individually and creating an aggregate impact across multiple delivery spots,” Tomalin said.

Still, there is uncertainty about how “leveraging resources” may manifest itself when it comes to HMA. National news reports have speculated that HMA may be the target of a takeover by HCA, the world’s largest for-profit healthcare commedicalnews

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pany, which already owns many hospitals in the same market.

That possibility does not faze Gillette.

“It has been talked about, but as a seasoned healthcare executive, it has not changed my approach from day-to-day because I recognize that these business dealings are going to happen at the corporate level. In any system of hospitals that might be being talked about, the job is being on the ground and giving good patient care. It has not affected me, and I say that with the greatest amount of sincerity,” she said. While acknowledging that there has been some need for rumor control among employees, Gillette said “I remind people that our (responsibility) is to the patients.”

Tomalin shed light on the climate of today’s healthcare industry. “Anyone with any familiarity of the industry knows this is an ongoing conversation and developing consideration for every provider of healthcare in this entire nation. Everybody is talking to everybody about how they can find a way to deliver better care to more people at a lower cost ... That means looking at ownership structure,” she said.

“We are very fortunate and proud to have an educated body at Bayfront that really understands the impetus of these changes in healthcare, said Tomalin.

and also held the position of director of mechanical heart devices. In 1992 Dr. Golino, in collaboration with Texas Heart Institute implanted the first left ventricular assist device in Europe.

In 1993, Dr. Golino moved to the United States where he began his formal U. S. residency training. In 1997, he completed his general surgery residency at Saint Joseph’s Hospital in Houston, Texas. In 1999 he completed his cardiothoracic surgery residency at Texas Heart Institute under the direction of world renowned surgeon, Dr. Denton A. Cooley and his staff.

SMH US News Best Hospital List Once again, Sarasota Memorial Hospital is the only local hospital to make the grade onU.S. News & World Report’s “Best Hospitals” list, this year ranking #48 in Gynecology and recognized as “high performing” in six additional specialties.

On a state and metropolitan level, U.S. News again ranked Sarasota Memorial #1 in the Sarasota-Bradenton region and #6 (up from #8 in 2012) among Florida’s 271 hospitals.

Sarasota Memorial CEO Gwen MacKenzie attributed the national recognition to the dedication and diligence its physicians, nurses and staff Gwen MacKenzie demonstrate every day.

Each year, U.S. News evaluates the nation’s 5,000 hospitals and ranks the top 50 in 16 adult specialties. U.S. News also recognizes “high-performing” hospitals that provide care at nearly the level of their nationally ranked peers.

In this year’s study, in addition to the top 50 ranking in Gynecology, Sarasota Memorial was recognized among the top quartile nationally for achieving “high performing” status in the following six specialties: • Diabetes & Endocrinology (High Performer) • Gastroenterology & GI Surgery (High Performer) • Geriatrics (High Performer) • Nephrology (High Performer) • Orthopedics (High Performer) • Pulmonology (High Performer)

Lakewood Ranch Medical Center Names Dr. Robert Hillstrom as Chairman Dr. Robert Hillstrom, Medical Director and President of Hillstrom Facial Plastic Surgery in Sarasota, Florida is adding a new title to his already impressive curriculum vitae- Chairman of the Lakewood Ranch Medical Center Board of Governors. Dr. Hillstrom has served on the Board of Governors for the past 9 years.

The board chairmanship isn’t the first leadership role he’s held at LWRMC. He served as the hospital’s first Chief of Staff from 2004 – 2005.

In addition to the appointment of Dr. Hillstrom as Chair, the LWRMC Board of Governors includes: Dr. Richard Ara-

nibar, Dr. Loren Carlson, Brian Kennelly, Dr. Aaron Sudbury, Ardell Terry, Patrick Wright, Kevin DiLallo Manatee Healthcare System CEO and Group Vice President and Mark Tierney, Manatee Healthcare System CFO.

Florida And Tennessee Hospital Associations Recognized For Leadership In Quality Improvement The Florida Hospital Association (FHA) and the Tennessee Hospital Association (THA) are the 2013 recipients of the Dick Davidson Quality Milestone Award for Allied Association Leadership for their work to improve health care quality, the American Hospital Association (AHA) announced today. The award, given to state, regional or metropolitan hospital associations that demonstrate leadership and innovation in quality improvement and contribute to national health care improvement efforts, were presented July 25 at the 2013 Health Forum-AHA Leadership Summit in San Diego.

FHA has built and sustained an infrastructure around the culture of patient safety in Florida hospitals. The FHA Board of Trustees and Quality and Patient Safety Committee sought to develop programs that addressed key issues such as readmissions and surgical complications through visionary approaches, transparency, collaboration and engagement.

The Florida Surgical Care Initiative (FSCI), created through a partnership between FHA and the American College of Surgeons, was developed to prevent surgical complications, save lives, improve care and reduce costs. Over a 15-month period, participating hospitals reduced surgical complications by 14.5 percent, at an estimated cost savings of more than $6.67 million. Surgical site infection dropped 15.8 percent, pulmonary embolism decreased 37.9 percent and the risk of pneumonia dropped 56 percent.

The FHA also launched an initiative to reduce hospital readmissions. The goal of the collaborative was to understand readmission causes and adopt practices to significantly reduce the number of patients returning to the hospital after discharge, focusing on those most likely to be readmitted: patients experiencing heart failure, heart attack, pneumonia, hip replacement or cardiac bypass surgery. A total of 107 hospitals were a part of the initial program and were able to reduce readmissions by 15 percent, saving $25 million.

The award is named for AHA President Emeritus Dick Davidson, who strongly promoted the role of hospital associations in leading quality improvement during his tenure as AHA president and as president of the Maryland Hospital Association.

Medical News is pleased to provide space for press releases by providers in our Grand Rounds section.

Content and accuracy of the releases is the sole responsibility of the issuer.

AUGUST 2013

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