Orlando Medical News August 2013

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PHYSICIAN SPOTLIGHT

HMA Loses Florida Corporate Roots

Sara Hiott Irrgang, MD

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

PAGE 3

ON ROUNDS

By LyNNE JETER

The Tide is Turning for Geriatrics

Ken Brummel-Smith, MD, discusses decade of change in high demand specialty ... 7

Setting the High Bar

Florida Hospital CIE developed around talent, mission ... 11

Reaching a Consensus

Zurich 2012 Concussion Consensus Statement clarifies issues, muddles others, exemplifies mystery of TBI ... 12

ONLINE: ORLANDO MEDICAL NEWS.COM

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 (CONTINUED ON PAGE 4)

Stacking the Deck

FSU channels novel approach to retain medical graduates in Florida 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.

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 (CONTINUED ON PAGE 6)

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PhysicianSpotlight

Sara Hiott Irrgang, MD Medical Director, Lifeforce Cryobanks

By JEFF WEBB

ALTAMONTE SPRINGS - Sara Irrgang spent 37 years dealing with death.

But now that she has retired, Irrgang’s passion is prolonging life.

“It’s a different branch from the same tree of knowledge,” said Irrgang, whose career as a full-time pathologist and associate medical examiner ended in January when she left the District 9 office in Orange County. Although she continues to work occasionally as an expert witness on homicide cases, Irrgang’s primary professional focus now is on Lifeforce Cryobanks, where she is medical director.

The Altamonte Springs facility collects and stores donated umbilical cord blood and placenta tissue. Both are used to provide stem cells to patients who rely on them to combat serious diseases, Irrgang said, adding she is excited about other promising uses of stem cells. “They are using them to treat some rare diseases where they need genetically modifying factors. They also are using them on people with spinal cord injuries now, inserting cord blood stem cells to achieve regrowth of nerve cells. This may actually develop into a successful treatment for people who have paralysis. It’s fascinating,” she said.

“The women who donate cord blood do it through the goodness of their hearts.

Others choose to store it for their families. We must have 18,000 units stored,” Irrgang said, noting that Lifeforce works with the National Marrow Donor Program and the Caitlin Raymond International Registry.

As she settles into retirement, it would appear Irrgang is as busy as ever. The 72-year-old also volunteers at the Seminole County Health Department as the physician member of the Healthy Start committee. And at the Seminole County Medical Society (she’s been a member for 37 years) Irrgang is still on the executive committee, where she helps “develop priorities and agendas that we forward to the Florida Medical Association, which then has some political pull in the state Legislature. She was a delegate to the FMA meeting in July.

But not all of Irrgang’s pursuits are professional, and one of the most satisfying is spending time with her five grandchildren. She has two sons and a daughter, who trains horses and riders on Irrgang’s 45-acre spread near Mount Dora. There are 10 horses, rabbits, chickens, three rescue dogs and one cat in her menagerie.

That comes in handy for her daughter’s two sons, both of whom are active in 4-H, an organization Irrgang has volunteered with for more than 20 years.

Irrgang was in 4-H, too, when she was a child growing up in South Caro-

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lina. She is the eldest of seven children raised by parents who were both educators. Every sibling has earned advanced degrees, ranging from masters, to PhDs to medical doctorates.

“A high priority was placed on education in our family,” said Irrgang, especially for the five girls. “My daddy would stress to us that we needed to have some sort of job or profession so that we could support ourselves. His oldest brother had died unexpectedly and left a widow who had no training and three daughters. Dad always said we couldn’t count on marrying someone and having them support us. That was the lecture” for she and her sisters, Irrgang recalled.

Irrganag said she decided as a young girl that she wanted to be a physician.

“My family talked me into pursuing a pre-med pharmacy degree (at the University of South Carolina) so I’d have that in case I didn’t make it into med school,” she said. But she was admitted to the Medical College of South Carolina on her first attempt, one of only three women in a class of 80.

“One of the professors said ‘You girls better work hard because you’re taking the place a man could have.’ He also told us that he didn’t think we’d still be practicing medicine in 10 years,” Irrgang said.

“Well, I went back to our 10-year class re-

union and told him I was still practicing.

By then he was president of the school,” she said. After feeding him his his crow, he acknowledged that he had since had second thoughts about women doctors. As a matter of fact, Irrgang said, she went to a medical school reunion just last year “and both the president and the dean are females.”

In her senior year of medical school Irrgang, who was in a U.S. Navy program requiring active duty after graduation, said she “met and eloped with a Navy pilot.” After four years on active duty, Irrgang completed a residency in pathology at Baylor University Medical Center in Dallas. She said she chose pathology as a specialty because it would afford her a fairly regular schedule as she raised her family.

Her husband left the Navy and became a commercial airline pilot based in Florida, so they moved to Sanford, near his mother, in 1974.

Since then she has worked as a pathologist in four hospitals and in four medical

examiners offices.

“It’s quiet and your patients don’t complain,” she quipped.

But Irrgang said she has always found her work “mentally stimulating and rewarding,” although it has taken a toll on her physically.

“Thirty-seven years: That’s a lot of autopsies. I’ve had carpal tunnel surgery on both hands and a joint replacement on my thumb. And standing on a cement floor for six or seven hours a day was uncomfortable,” she said.

“You can’t keep pushing so hard when you get older.”

Irrgang said that’s the reality, as opposed to the forensic pathologists folks may see as they watch popular television shows like NCIS or CSI Miami. “There’s one lady who always wears her white coat and fancy dress clothes and high heels while doing autopsies. It’s not very true to life.”

And she is amused, for instance, when TV pathologists talk to their patients. “I don’t talk to dead folks,” she said.

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HMA Loses Florida Corporate Roots, continued from page 1 Shands Healthcare facilities that had been acquired 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 Latterday 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 near-term,” 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.”

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. George Paul (NYSE: THC) announced its acquisition 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

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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 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;

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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 writedowns, 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.

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Stacking the Deck, continued from page 1 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 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-andfuzzies were at Ohio State. We asked the question: How can we change that? We had to make an impression on medical

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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.

“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 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 full-time 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.

Stage 3 To further strengthen community ties and the job placement network, Florida Hospital recently provided a $2 million gift to establish the Florida Hospital Endowed Fund for Medical Education to help the FSU COM support its educational mission.

“Our mission aligns strongly with Florida Hospital’s except that we’re not a faith-based school; we’re public,” said Muszynski. “These students are highly sought after, and relationships end up being life-long. We have 16 graduates already practicing in Central Florida. You might think: only 16? But it’s impressive when you consider the number of graduates during our ramp-up years between 2005 and 2010, and those who are just finishing 5-year residencies. We’ve now created a number of scholarships to encourage students to return to Central Florida.”

Fittingly, said Muszynski, the scholarship application requires students to write an essay explaining why they want to return to the area.

Maintaining connectivity with graduates throughout their residency is also a driving force to “having them come home,” said Muszynski.

“I follow them through the last two years of development and know them pretty well by the time they graduate,” he said. “Then we all (advisors) keep connected to the students after they graduate, tuning in to changes in their lives and what they want to pursue, and then working with our strong alumni network to find opportunities for them to return home.”

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

‘‘

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 Brummel-Smith, 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 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.

“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 inorlandomedicalnews

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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.

terestingly, 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 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 (CONTINUED ON PAGE 10)

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ing 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 (CONTINUED ON PAGE 10)

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M&A Trends Reshape, continued from page 8 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.

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 decisionmaking 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.

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The Tide is Turning, continued from page 7 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 long-term 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 At-Risk 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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Setting the High Bar Florida Hospital CIE developed around talent, mission

By LYNNE JETER

The historic news is impressive: Florida Hospital establishes a one-of-a-kind Center for Interventional Endoscopy (CIE), an international referral center located at Florida Hospital Orlando and created to effectively integrate advanced therapeutic endoscopy with minimally invasive surgery for patients with complex digestive health disorders.

Yet the behind-the-scenes story of how Florida Hospital recruited two of the nation’s leading endoscopic specialists –they had worked together for decades, sometimes thousands of miles apart – and the potential from their collaborative research that made the CIE a truly special project.

“It was the concept of (Florida Hospital Orlando Administrator) David Banks to recruit top physicians to create the center,” said CIE director Scott Bond, MBA. “He spearheaded the two-year-plus journey to bring Dr. Robert Hawes to Florida Hospital. Once we’d nailed down his arrival and started the center, we formally developed an operations team. As an organization, we were totally brought Dr. Robert into the idea of bringing Hawes advanced therapeutic endoscopy to our community and beyond.

There was no selling involved.”

The timing was ripe for Hawes, a gastroenterologist who spent a year in London completing an advanced endoscopy fellowship that concentrated on endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic laser therapy under the tutelage of Peter B. Cotton, MD. Hawes had reconnected with Cotton in 1994 at the Medical University of South Carolina (MUSC) to create the new Digestive Disease Center. Since then, MUSC has become recognized internationally for its work in endoscopic ultrasound (EUS), ERCP and therapeutic endoscopy.

During his 2005-06 term presiding over the American Society for Gastrointestinal Endoscopy (ASGE), Hawes’ limelight rose nationally. Among the specialty advancements, he co-organized the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) joint committee for the ASGE and the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) to develop a new paradigm in minimally invasive surgery dubbed NOTES (natural orifice translumenal endoscopic surgery). In 2006, MUSC awarded Hawes the Peter B. Cotton Endowed Chair for Endoscopic Innovation.

“I love Charleston and had a really good situation there, but the opportunity here in terms of working with people I really wanted to work with, and within a system to create something special and new, was compelling,” said Hawes. “Also, my wife and I became empty nesters. Our twins – a boy and a girl – will graduate

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from college this year. Mostly importantly was the opportunity at Florida Hospital.”

Building Blocks When Hawes joined Florida Hospital last January, he partnered with Steve Eubanks, MD, whom Hawes calls “a brilliant minimally invasive surgeon, a world expert at fixing reflux through minimally invasive surgery, and a good friend,” to build the Florida Hospital Institute for Minimally Invasive Therapy, where he serves as medical director.

Shyam Varadarajulu, MD, was another key recruit for the CIE. An associate professor of medicine for the University of Alabama in Birmingham (UAB), he studied at MUSC Dr. Shyam under Cotton and Hawes Varadarajulu for advanced training in ERCP and EUS. Co-editor of the most widely read textbook on EUS, his research focuses on EUS-guided tissue acquisition, interventional EUS, pancreatic endotherapy and sphincter of oddi dysfunction.

“The 10 years we weren’t working together, Rob and I were collaborating on research and publications,” said Varadarajulu, medical director of the CIE. “For most people, they take another job because of money or prestige. We were very happy to have this opportunity to bring services needed by many people. We wanted to work as a group to make this happen.”

Varadarajulu, also a professor of medicine at the University of Central Florida, has been working with EndoMaster Pte Ltd., a medical robotics startup company in Singapore that has developed EndoMaster, a robot prototype capable of performing endoscopy procedures. The robot, he noted, is “very different” from the da Vinci robotic systems that are becoming prevalent in U.S. hospitals.

“We’re very close to being the first center in the U.S. to have this robot, which isn’t FDA approved for use on humans.

However, we can use it in the lab to develop robotic endoscopy techniques. We’re very anxious to get it here and see it FDAapproved,” he said.

Hawes pointed out the instrument “holds great promise for removing earlystage tumors from the GI tract and may facilitate the removal of an early tumor

without needing to remove any organ.”

Inner Workings Hawes, Varadarajulu and Muhammad Hasan, MD, director of the Advanced Endoscopy Fellowship at Florida Hospital, collaborate within the flexible endoscopy therapeutic groups; Eubanks leads the academic surgery department at Florida Hospital. Within the CIE, of the two disciplines, Hawes primarily works with a flexible endoscope; Varadarajulu and Hassan mostly work with laparoscopes.

“One of the reasons for coming to Florida Hospital was the important foundational aspect of interventional endoscopy,” said Hawes. “Advancing minimally invasive therapies is going to very much depend

on close collaboration between minimally invasive surgeons and minimally invasive endoscopists.”

The CIE technically opened with its first case on May 13, when 200 GI specialists from around the world ascended on Orlando to participate in a live unit projection from Florida Hospital to a conference room at the Walt Disney World Resort in Lake Buena Vista. The CIE was officially dedicated on June 24.

“When Dr. Hawes joined us, we started doing cases and procedures in our main endoscopy center while the new one was being constructed,” said Bond. “The grand opening of the CIE was quite thrilling. However, work had been going on …

(CONTINUED ON PAGE 15)

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Reaching a Consensus Zurich 2012 Concussion Consensus Statement clarifies issues, muddles others, exemplifies mystery of TBI

By LYNNE JETER

No RTP (return to play) on the same day, regardless of circumstances. An earlier return to light exercise, recommended. And the differential between pediatric and adult patients, clarified.

Those are among the highlights of the 2012 Concussion Consensus Statement derived from the 4th International Consensus Conference on Concussion in Sport, held last November in Zurich.

Every four years, the International Ice Hockey Federation, International Olympic Committee, International Rugby Board, International Federation for Equestrian Sports, and FIFA (International Federation of Association Football) host the conference, which results in an updated concussion consensus statement.

“Overall, there weren’t substantial changes between the 2008 and 2012 consensus statement,” said Leonardo Oliveira, MD, FACP, director Dr. Leonardo of quality and safety for Oliveira UCF Pegasus Health, and assistant professor of internal medicine and sports and exercise medicine at the University of Central Florida College of Medicine. “I was very happy with the changes regarding pediatric assessment.

It was a great contribution.”

The 2008 conference resulted in the development of the Sport Concussion Assessment Tool (SCAT2), a standardized method of evaluating athletes ages 10 years and older for concussions. The Child-SCAT3, a tool for younger athletes who may sustain concussions, has a background section that complements the SCAT2, and has clinician instructions on its own page, rather than after each section.

Marc Hilgers, MD, PhD, director for sports medicine fellowship, sports medicine research, and a sports medicine physician at Dr. Marc Level One Orthopedics Hilgers with Orlando Health in Central Florida, said he didn’t expect major changes in the 2012 consensus statement.

“I knew what was coming down the pike,” said Hilgers, also the team physician for Orlando City Soccer and the Minor League Umpire Association, medical advisor for the Florida Orthopaedic Institute, and assistant professor of family medicine at the University of South Florida. “That’s why I wasn’t surprised, especially with the broad spectrum of specialists from all over the world who met to write the updated statement, that 12

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Notable Highlights Todd Ross, MS, ATC, an athletic trainer for OrthoSurgeons, emphasized other notable 2012 Concussion Consensus Statement highlights: In the preamble, “ … therapists, certified athletic trainers … coaches and other people” were replaced with “primarily for use by physicians and healthcare professionals,” which better addresses who should be diagnosing concussions and handling RTP decisions concerning concussions.

“Brain injury” was added to the first sentence to read: “Concussion is a brain injury and is defined as a complex pathophysiological process affecting the brain induced by biomechanical forces.” “One could argue the point of, by definition, a concussion isn’t an injury but a process,” he said. “Adding the language of brain injury nullifies this objection.”

A timeline for concussion status was identified as “in some cases, symptoms and signs may evolve over a number of minutes to hours,” which could broaden the clinician’s interpretation of signs and symptoms.

The “Classification of Concussion” subtitle was changed to “Recovery of Concussion.”

In the neuropsychological assessment subtitle, the second and third paragraphs were rewritten and show less of an emphasis on the patient seeing a neuropsychologist. However, the emphasis changes to neuropsychological (NP) testing and a multidisciplinary approach to concussion management.

it was kept general and not too progressive.”

Todd Ross, MS, ATC, an athletic trainer with OrthoSurgeons, highlighted the 2012 consensus statement’s importance “because it continues the worldwide awareness Todd Ross of concussions (and) shows the dedication the medical society has for learning more about concussions, how to recognize concussions, how to properly manage athletes with concussions, and how to properly and safely return an athlete to play after a concussion has subsided.”

The only major blip noted repeatedly: the altered position on CTE (chronic traumatic encephalopathy). Hilgers called it “an interesting update … on an issue that had ‘percolated up’ since 2008.”

The 2008 section on chronic traumatic brain injury (TBI) notes: “Epidemiological studies have suggested an association between repeated sports concussions during a career and late life cognitive impairment. Similarly, case reports have noted anecdotal cases where neuropathological evidence of CTE was observed in retired football players. A panel discussion was held, and no consensus was reached on the significance of such observations at this stage. Clinicians need to be mindful of the potential for long-term problems in the management

of all athletes.”

The 2012 TBI section notes that “clinicians need to be mindful of the potential for long-term problems in the management of all athletes. However, it was agreed that CTE represents a distinct tauopathy with an unknown incidence in athletic populations. It was further agreed that a cause and effect relationship has not as yet been demonstrated between CTE and concussions or exposure to contact sports. At present, the interpretation of causation in the modern CTE case studies should proceed cautiously. It was also recognized that it’s important to address the fears of parents and athletes from media pressure related to the possibility of CTE.” “It seems unclear what their true position is between the two consensus statements and needs to be better explained,” said Ross, particularly given the unfortunate trend of former and current professional athletes taking their own lives for their families “to donate their brain … to prove CTE is in fact an issue.”

Among high-profile, self-inflicted deaths in recent years are professional athletes Junior Seau, Derek Boogard, Dave Duerson, who may have been the only one to commit suicide and leave instructions donating his brain for the study of CTE. Former NFL Chicago Bears quarterback Jim McMahon has agreed to donate his brain to science after his death.

“CTE is an area that needs much more research,” said Oliveira. “As we

move forward, we don’t completely understand it. There’s evidence that current traumas due to the brain and overall lead to CTE. We’re just now beginning to understand more about the physiology and how to address that. It should be a hot topic in the next two years.”

Another point of controversy: concussion determination. A Florida neuropsychologist in the field of treating concussions pointed out the 2004 consensus statement was driven largely on a grading scale (1-3) for concussion with loss of consciousness serving as a means of grading the severity of concussion, from which the 2008 consensus statement began to deviate.

“My take is that a concussion is more black and white,” he said. “Either you have a concussion or you don’t. When you get into grading scales and severity ratings, you oftentimes relay misinformation to patients and the other providers involved in the case. Calling it a yes-orno decision takes that away. Oftentimes, athletes get caught up in whether their concussion was mild or severe, which leads to poorly-based expectations about recovery. A concussion is a concussion and everybody recovers differently.”

In the clinical treatment and management of concussion, the clinician is the key, said the neuropsychologist.

“The consensus statements, the most recent one included, spend a lot of effort discussing sideline assessment tools, baseline testing, cognitive assessment tests, balance testing, RTP decisions, and preferred means of assessment or treatment,” he said. “All these components are tools that, when used correctly by a well-trained clinician, can be extremely valuable. But the clinician remains the most important piece in terms of concussion treatment and management. The consensus statements do very little in terms of providing practical guidelines for the clinical care of concussion with respect to the individual clinician.”

The questions at the end of the Zurich statement will lead researchers to clarification and easier understanding by concerned people who don’t see concussions daily, said Oliveira.

“The questions help other healthcare providers and the public to better understand the movement forward,” he said. “What should we change? What should we take a look at? The answers will hopefully lead to further delineation of additional parameters in the 2016 consensus statement.”

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Grand Entrance HCA opens Poinciana Medical Center to serve Osceola and Polk counties

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POINCIANA— Last month, HCA Holdings (NYSE: HCA) unveiled Poinciana Medical Center, a new $65 million HCA hospital to bring expanded access to care to residents in Osceola and Polk counties.

Located in Kissimmee, the 100,000-square-foot medical center officially opened earlier this month with 30 beds – 24 private medical-surgical beds and a 6-bed ICU – and also an 11,000-square-foot Emergency Department with helicopter pad for rapid transport of critically ill patients. Also, the campus houses a 42,000-square-foot medical office building with leasable space for physicians.

“For many years, I’ve spoken with residents of Polk and Osceola counties about their unmet healthcare needs – and how excited they are to have a hospital,” said Joanna Conley, FACHE, CEO of Poinciana Medical Center. “Ultimately, we’re here to improve the health of our community by providing quality, life-saving services to our patients – but the impact extends even beyond that. Already, Poinciana Medical Center has created jobs, increased the availability of physician services and created economic opportunities for new businesses in this vibrant, growing community – and I’m confident that this is just the beginning.”

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chief of staff for the new hospital.

Approximately 5,000 Poinciana residents toured the facility during its ribboncutting event, VIP tour, and open house in mid-July featuring entertainment, locally-made food, and Radio Disney activities for children.

“My excellent co-pilot Sandy Grimes (CNO) helped guide our clinical development and recruit our top-notch leadership team,” said Conley, who was promoted to the new post Jan. 1, after serving as associate COO and ethics and compliance officer for Osceola Regional Medical Center, a sister HCA facility in Kissimmee. “In the past few weeks, we’ve had an opportunity to meet the heart of this hospital – the dedicated physicians and staff who will serve our patients. As an HCA hospital, our culture is focused on quality care, and we believe patients will experience this in every interaction with our team.”

The new medical center offers a full range of inpatient and outpatient acute/ emergency care services, including surgery, laboratory, pharmacy, diagnostic imaging and cardiac catheterization.

“We’ve been fortunate to be joined by many dedicated professionals,” said Conley. “Our architectural and engineering teams from Earl Swenson Associates, IC Thomason, and Hanson Walters designed a building that’s both beautiful and functional. The HCA Construction Management teams ensured we had state-of-the-art medical equipment and information systems. And the general contractor team of Robins & Morton ensured that our hospital was built both on time and under budget.”

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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, epi-

ICD-9 § § § § § §

~ 13000 Codes 3-5 Characters 1St Digit May Be Alpha (E Or V) 2-5 Are Numeric Limited Space For Adding New Codes Lacks Detail & Laterality

ICD-10 § § § § § § §

~ 68000 codes 3-7 characters 1st digit alpha 2nd & 3rd digit numeric 4th– 7th digits alpha or numeric Flexible for adding new codes Very specific & utilizes laterality

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 cross-walking submitted 9 codes to 10 codes

demic 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

Setting the High Bar, continued from page 11 for nearly a year and a half.”

Building the CIE at Florida Hospital Orlando was “a key component we were missing,” said Bond. “Florida Hospital continues to evolve as a tertiary facility, and this was one of the premier services we wanted to make sure we could offer at our campus. Dr. Hawes and his colleagues not only have stellar reputations, but also the drive and research focus we knew could not only service our community, but also help the CIE become a destination facility for therapeutic GI.” The CIE will further advance healthcare while also trimming medical costs via minimally invasive procedures on an outpatient basis versus inpatient surgery, noted Bond.

“What makes us unique is our ability to have collaboration between our physicians at the hospital, the cutting-edge research that our physicians do that continue to allow us to stay at the forefront of therapeutic endoscopy and advance that within healthcare, and training the next generation of therapeutic endoscopists,” he said.

“To stay on the forefront of education, you have to provide good clinical care and stay involved in research.” orlandomedicalnews

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Already, more than half of referrals to the CIE originate outside of Central Florida. Patients represent various foreign countries, as far away as the Middle East.

The referral base extends in the U.S. as far west as Utah, and includes common visitors from the Carolinas, Georgia, Mississippi, Missouri, Oklahoma and Tennessee.

“The broader the reach, the better,” said Hawes, noting that the CIE’s mission mirrors Florida Hospital’s academic mission: “Practice advanced medicine, do new things, and make progress from a clinical standpoint. Advance research to address the questions that need to be answered to improve patient care. And provide educational opportunities.”

The CIE also houses two advanced fellowship positions, including one for a gastroenterologist from Sydney, Australia.

“Other than the (Sutter Health’s Paul May and Frank Stein) Interventional Endoscopy Center at California Pacific Medical Center in San Francisco that has a fairly unique system,” said Hawes, “there’s not another center like this anywhere that’s focused on endoscopic therapies.”

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 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

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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, 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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Medical Identity Theft, Too Easy to Commit

By DANIEL ANDREWS

Medical identity theft can have devastating consequences. Just ask Anndorie Sachs, a Salt Lake City mother of four who got a call from the Utah Division of Child and Family Services in April of 2007, informing her that agents were on their way to remove her four young children from her home as the result of a stolen driver’s license.

It usually takes a jolt like that opening sentence to get most people to take identity theft seriously. In the medical profession, where the HIPAA rules have long been in effect and are applied rigorously by most practices and practitioners, the significance of identity theft can be even slower to sink in. It would be helpful, at this point, to make a clear distinction between lost data and identity theft. Every commercial entity (business, non-profit, educational institution, or other) that has, holds, or collects personal data has a moral and legal obligation to protect that data. Once Personally Identifying Information (PII) has been obtained by someone with ill intent, identity fraud of various types can be perpetrated upon the victim. One type of fraud is medical identity theft, which can have far-reaching and serious consequences that most victims don’t anticipate. Medical professionals have long protected the medical details of patients’ treatments and condi-

tions; however, preventing imposters from getting treatment, prescriptions, or medical devices requires a significant shift in awareness and methods. This is complicated somewhat by the fact that now practically ALL data is considered private and protected – something as simple as a name, address, and phone number all as part of one record need to be secured, whether or not medical information is attached. The point, in short, is that medical identity theft is not a HIPAA issue, and to the degree that HIPAA compliance is in place has really no bearing on the issues surrounding medical identity theft.

The Poneman Institute, in a study directly detailing the effects of medical identity theft, found that roughly 5.8 percent of American adults had been victims.

Almost half of those (48 percent) lost their medical coverage as a result of the fraud.

The direct economic impact, on average, was in excess of $20,000; that’s money paid by the victims for treatments and devices that they never received, attorney’s fees to fight the errors, and more. The indirect impact is impossible to measure; since many employers now want details of credit histories (which can be impacted by unpaid medical bills) and medical his-

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tories, how many people are NOT getting hired simply because they are the victims of fraud?

Let’s return to the case of Anndorie Sachs.

Her driver’s license was used (without alteration, it should be noted) by a pregnant woman with a methamphetamine habit, Dorothy Bell Moran. Ms. Moran was checked into not one, but two different hospitals using the stolen ID; she gave birth to a premature baby at University Hospital in Salt Lake City. Knowing that giving birth to a chemically-dependent baby constitutes child abuse in every state in the U.S., Ms. Moran walked out of the front door of the hospital and left the infant behind. Naturally, an investigation ensued, and using the information on the driver’s license that had been supplied at the registration desk, Utah DCFS mistakenly concluded that Ms. Sachs was a criminal, and a danger to her other children. Although that element of the crime was eventually resolved, Ms. Sachs is left with a particularly disturbing residual effect: since it has been determined that the treatment received by the criminal is now a part of Anndorie’s medical file, she cannot see her own records lest the privacy rights of Ms. Moran be violated. As frustrating as that obviously is, those in the

medical profession will recognize that an inaccurate medical history file can actually be deadly.

Is the answer simply to check for a photo ID when a potential patient checks in? The scope of the solutions and approaches that need to be considered, practice by practice, is too large and two “personalized” to be treated as a “onesize-fits-all” issue. But, it should be noted, that with $20 and two or three weeks of patience, any one at all can purchase a “novelty ID” that looks exactly like a stateissued driver’s license, with whatever picture and identifying details the buyer cares to supply. Take into consideration the fact that a patient’s medical insurance policy number is linked to his/her SSN, and that an SSN is linked to a driver’s license, and it becomes easy to see that medical identity theft is a relatively easy crime to commit. When the victims come looking for someone to blame, will it be YOUR practice named in the lawsuit?

Daniel Andrews is president of Solutions on the Spot, consulting and insurance.

He is a Certified Identity Theft Risk Management Specialist and has been educating employers and employees about identity-theft issues since 1988.

He is qualified to offer guidance and advice across a wide range of industries, and is a sought-after speaker on various aspects of identity theft in a variety of settings. He can be reached at SolutionsOnTheSpot@gmail.com

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Doctors Going Digital: Social Media for Medical Marketing

By ANDREW MCINTOSH

During my career as an executive producer for a national health news organization that provides stories to 150 stations across the country, and my ten years as a local TV news reporter, I witnessed the evolution and learned the power of social media. A popular story or video clip shared on various social networks can go viral in an instant. A news report I did in 2008 was picked up by CNN and within a week had more than one million views on YouTube. Five years later, it still gets thousands of hits every month.

The explosion of online video is not specific to news clips. A recent survey found consumers don’t just want video while they search for services or products, many now expect it. That demand is having a big impact on how people choose doctors and hospitals.

A Google study found 60 percent of people who watched a video from a credible healthcare source made direct contact with the doctor or hospital featured in that video.

Tech savvy healthcare professionals are rapidly learning the benefits of creating their own web videos. 101 hospital marketers polled by Acsys Interactive ranked online video as the most effective social media marketing tool. More than half expected to significantly increase resources for web video and social media.

More than 35 percent said online channels would likely become the core of their integrated marketing budgets.

An industry news report cites the success of an orthopedic surgeon who posted a series of educational videos online. They were full of useful information, but didn’t advertise specific procedures. Still, the videos proved to be a very effective marketing tool for his practice. It was reported that the surgeon now gets about half of his referrals through social media.

A solid online marketing strategy is important to stay competitive. Medical professionals with YouTube, Facebook, Twitter and other social media accounts attract more patients and can be seen as more reputable. A survey by online market research firm YouGov found: • 57 percent of consumers polled believe a social media connection with a healthcare provider was likely to have a strong impact on their decision to choose that provider.

• 25 percent are likely to connect with healthcare providers through social media in the future.

• 81 percent believe a healthcare provider with a strong social media presence, is likely to be more “cutting edge.”

Marketing experts believe because the majority of the population are visual learners websites and social media pages

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with text only are not as appealing to consumers compared to sites featuring video.

While some are still hesitant to embrace web videos and social media, many hospitals and private practice doctors are reaping the benefits of creating content on their own. The Pew Institute’s “State of the Media 2013” report shows TV news coverage and time allotted for stories is shrinking while coverage of weather, sports, and traffic grows. Cutbacks in newspaper staffing is also affecting the ability of doctors and hospitals to bring attention to new procedures and programs they offer.

The report found individuals and organizations that want to get their message to the public are successfully doing so by using digital technology and social media while bypassing traditional media outlets.

This is allowing healthcare professionals to get information out while maintaining editorial control.

Healthcare professionals can activate social media accounts or start a blog in minutes and in most cases it costs little to nothing to get up and running.

Creating web videos can be done with help from a hospital’s in-house video department or by hiring a production company. Costs for those services will vary based on a variety of factors including location and the length of each production.

Whatever route healthcare professionals go when producing online videos, they need to remember the quality of the produc-

tion has the potential to help or hurt their public image. A survey done by e-commerce consulting company, the e-tailing group, could give some important clues on how potential patients view web videos.

The group polled more than 1,000 consumers to study the impact of online product videos on purchasing decisions.

More than 50 percent of consumers preferred to watch professionally produced web videos. 73 percent believed the most important decision in watching a video was the overall quality.

There are a wide variety of web videos healthcare professionals can use to attract new patients. For example: • Video bios that include a doctor talking about himself, his family, and his practice offer potential patients the opportunity to “meet” a specialist at their convenience. With a quick click, people can start building a connection and trust with a doctor before they ever enter an exam room.

• Patient testimonials can help potential patients learn what to expect before, during, and after a specific operation from people who’ve already had it done. They also allow patients to share their positive experience with a hospital or doctor.

• Surgical videos can give patients a step-by-step breakdown of how procedures will be performed. Using animations and graphics in place of

actual surgery footage can help cut out the “gore factor” that might make people queasy or nervous about an operation.

Utilizing social media and web videos is a trend in healthcare that is quickly becoming the standard for connecting with new patients and educating current ones. Healthcare professionals who are not active on sites like YouTube, Facebook, and Twitter should strongly consider engaging in the social networks to keep up with an increasingly competitive healthcare environment. Social media and web videos are an affordable and effective way to bring in business, grow practices and showcase new medical devices and procedures without having to depend on traditional media.

Andrew McIntosh is the Co-Founder/CEO of MVProductions which specializes in producing videos for doctors, hospitals, and medical organizations. Andrew was executive producer for Ivanhoe Broadcast News where he oversaw two medical news series and produced medical stories that had an audience reach of more than 50 million viewers. He has won two Telly Awards for his reports and is a member of the Silver Telly Council.

Andrew also spent ten years reporting and anchoring for local news affiliates in Texas and Florida. He can be reached at amcintosh@m-v-productions.com or through MVProduction’s website: www.m-v-productions.com.

Medical Office Resources of Florida MOROF is a professional team of service and supply companies, practice administrators and healthcare professionals providing valuable knowledge for the Florida medical industry through one unified source

www.mor-of.net Go to the “Events” section of www.mor-of.net for upcoming events and presentations AUGUST 2013

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The Industry Secret for Increasing Your Practice Profitability Immediately

By PETER WINCUP

This article is not for everyone. If you are satisfied with the prices you are paying for your practice’s pharmaceuticals, products, supplies and services, there is no need for you to read any further. If, on the other hand, you suspect there may be a better way to get much larger discounted prices and improve your profitability, please read on.

Does your current practice buying program sound like this? Your talented practice manager or office manager searches the Internet for suppliers or invites a bevy of suppliers to give them a quote. This takes a lot of time and energy. It is not unusual for your favorite medical distributor sales representative, who is skilled at this tactic, to convince someone to show him/her the lowest price your staff has found so the medical distributor rep can meet the quote or invoice price and keep your business. Who wins in that deal; your practice or the sales rep?

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Thursday from your medical distributor representative, but that does not mean you are getting the best purchase price for your needs. In truth your talented, valuable practice manager or office manager may be spending an inordinate amount of time searching the Internet for the lowest prices when, in fact, they will never find these prices on the Internet. Just think. If you could save them some time, they could in turn focus on a much higher value need for your practice and contribute even more significantly.

Why and where are these discounted prices to be found? The answer for you is to join a U.S. healthcare industry Group Purchasing Organization (GPO). There are a half dozen good GPO’s, some better than others, and some second tier GPOs. You may hear the names of only one or two in any market but the good ones are your best source for significantly discounted prices.

So why would your practice want to join a GPO? Here are some key reasons and benefits for becoming a member and buying through a good healthcare industry GPO. • Most good GPOs have several high quality suppliers for any one product or service category. Therefore, your office’s practice manager or office manager can survey the very best discounted prices available from the authorized GPO suppliers instead of wasting their valuable time on the phone or on the Internet searching all potential suppliers.

• In many instances, your current supplier already offers its products or services through any GPO you would join so you would not need to change suppliers.

• The good GPOs have hundreds of supplier programs available to their membership as well as hundreds of excellent quality suppliers. They can offer the ‘soup to nuts’ needs of your practice.

• The good GPOs will offer you a membership fee free. That’s right; for no cost. The supplier’s pay the GPO’s operating costs. There is no cost for you to join!

• To actually join you need only complete the GPO application which is not a contract and requires no minimum volume purchase or, in fact, any commitment to buy.

• The good GPOs aggregate their members’ purchases so the GPO suppliers

PUBLISHED BY: SouthComm, Inc. FLORIDA MARKET PUBLISHER John Kelly johnkelly@orlandomedicalnews.com

offer discounts much larger than any one GPO member could achieve on its own.

For example, let’s say you are one of a thousand independent practices in Central Florida considering who to buy from. If you buy directly from a distributor or supplier, you will receive a price consistent with the volume being purchased by your practice. If you buy as a member of a GPO, you get the price based on the aggregated or collective total volume of the thousand independent practices in the GPO. How good are these discounts you ask? Well I could tell you some of the discounted prices but I would have to shoot you. I am kidding of course but, in answer to that question, GPO prices are generally considered confidential to GPO members only and for good reason. The best U.S. healthcare industry suppliers offer these discounted prices in recognition of the GPO’s collective, huge purchase volume and leverage. As one buyer in the marketplace, you simply can not attract these large volume discounted prices on your own.

The simple fact is that U.S. healthcare industry GPO’s are a huge asset and resource for independent practices to help the practice reduce its operating costs. GPOs serve other healthcare providers as well including hospitals, LTC facilities, nursing homes, surgical centers and all acute and non-acute healthcare providers. While almost every hospital belongs to a GPO, too many independent physicians have not been aware that a GPO membership is also available to them and their practices until now.

Now you know the U.S. healthcare industry purchasing secret; buy through GPOs. You also now know how to get the best value for your dollar spent as well as how to realistically improve your practice profitability. Get ready to enjoy your practice operating costs savings and improved profitability because they are real and they are significant year after year.

Peter Wincup is the Chief Savings Officer and Owner of The Wincup Group, a purchasing consultant for both public and private industry clients as well as a sponsor organization for the Premier GPO located in Florida. He has over thirty years of experience working with purchasing processes, practices and in helping clients to reduce their operating costs. He is also an active supporter of physicians by working with the County Medical Societies in Lake/Sumter, Orange, Seminole, and Volusia Counties. He can be reached at peter@wincupgp.com.

AD SALES: John Kelly 407-701-7424 Gloria Johnson: 407-227-0511 Koreen Hart-Morales, 321-662-1660 Tony Smothers 407-247-1308 LOCAL EDITOR Lynne Jeter lynne@medicalnewsinc.com NATIONAL EDITOR Pepper Jeter editor@medicalnewsinc.com CREATIVE DIRECTOR Susan Graham susan@medicalnewsinc.com GRAPHIC DESIGNERS Katy Barrett-Alley Amy Gomoljak Christie Passarello ACCOUNTANT Kim Stangenberg kstangenberg@southcomm.com CIRCULATION subscriptions@southcomm.com CONTRIBUTING WRITERS Lynne Jeter, Cindy Sanders, Jeff Webb —— All editorial submissions and press releases should be emailed to: editor@medicalnewsinc.com —— Subscription requests or address changes should be mailed to: Medical News, Inc. 210 12th Ave S. Suite 100 Nashville, TN 37203 615.244.7989 (FAX) 615.244.8578 or e-mailed to: subscriptions@southcomm.com Subscriptions: One year $48 Two years $78

SOUTHCOMM Chief Executive Officer Chris Ferrell Chief Financial Officer Patrick Min Chief Marketing Officer Susan Torregrossa Chief Technology Officer Matt Locke Business Manager Eric Norwood Director of Digital Sales & Marketing David Walker Controller Todd Patton Creative Director Heather Pierce Director of Content/Online Development Patrick Rains Orlando Medical News is published monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm, Inc. ©2012 Medical News Communications.All rights reserved. Reproduction in whole or in part without written permission is prohibited. Medical News will assume no responsibilities for unsolicited materials.

All letters sent to Medical News will be considered Medical News property and therefore unconditionally assigned to Medical News for publication and copyright purposes.

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GrandRounds Osceola Regional Medical Center Announces Permanent CEO Robert “Bob” Krieger has been appointed Chief Executive Officer for Osceola Regional Medical Center.

Krieger’s appointment comes at a very exciting time for the hospital.

Osceola Regional is currently undergoing a major expansion that will increase its bed capacity to 317 by the end of 2013. In addition to planning for a Level II Trauma Center, the hospital was recently approved to be a teaching hospital for the University of Central Florida’s College of Medicine with the first physicians-in-training arriving in 2014.

Krieger took over as Osceola Regional’s Interim CEO in March 2013 with more than 25 years of hospital executive experience. He previously served as CEO of Delray Medical Center in Delray Beach, HCA’s Orange Park Medical Center, Humana Hospital Biscayne in Miami, and Humana Hospital in Louisville, Kentucky.

The New Jersey native earned a Bachelor of Arts degree and a Master in Business Administration from Florida State University.

Krieger ‘s first priority is to continue to facilitate a smooth leadership transition by building collaborative working relationships with the medical staff, senior leadership team and employees.

Krieger added that his ultimate goal is to help Osceola Regional build upon its reputation of high-quality care and patient satisfaction.

Clinical Trial at MD Anderson Cancer Center Orlando Looks at Radiation Treatment Traditionally, women undergoing radiation treatment for breast cancer go through a lengthy process receiving radiation five days a week, for nearly two months. Now, MD Anderson Cancer Center Orlando is participating in a clinical trial that could shorten that treatment by a third, making it easier and more convenient for patients to get treated successfully for their cancer. MD Anderson – Orlando is the only site in Florida offering this clinical trial which is available to breast cancer patients who have undergone a lumpectomy.

Patients on the study will either receive 4 weeks of radiation or the conventional 6 weeks. The four week course will deliver the equivalent amount of radiation over the shortened period, but will cut the number of treatments down by a third. Past studies have shown that giving radiation treatment faster may be as safe and effective as the standard longer treatment, without increasing the risk of side effects.

For more information on this radiation study contact MD Anderson – Orlando at 321-841-1620 or visithttp://www.clinicaltrials.gov/ct2/show/ NCT01266642?term=2010-0559&rank=1.

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Dr. Martin Klapheke Wins National Innovation Award Dr. Martin Klapheke, professor of psychiatry at the UCF College of Medicine, is the winner of the 2013 Innovations Award from the Association of Directors of Medical Student Education in Psychiatry (ADMSEP). The national award recognized Dr. Klapheke’s leadership of a Clinical Simulation Initiative (CSI) that provides a free national database of online psychiatric teaching cases.

Dr. Klapheke and co-honoree Dr. Howard Liu, from the University of Nebraska Medical Center, were honored for their “innovative, creative and inspiring approach to medical student education.”

The online modules include a variety of psychiatric cases, including dementia, bipolar disorder, adolescent depression, post-traumatic stress disorder, and personality disorders. Standardized patients play the role of the mentally ill patient based on a detailed script provided by CSI. Students see how a psychiatrist interviews and interacts with the patient and determines a proper diagnosis and treatment plan. The 30-minute modules also include video clips from follow-up visits so students learn how patients improve and how treatment can be adjusted for optimal results..

Dr. Klapheke uses the interactive sessions in the Brain and Behavior module for second-year UCF College of Medicine students and in third-year didactics during the students’ psychiatry rotation.

The advantages of the online interactive system are many. For example, students are able to see a variety of cases they might not otherwise encounter in a sixweek rotation. The interactive sessions allow students to work individually, in groups, or with Dr. Klapheke so they can discuss treatment options, observations and different aspects of the patient-doctor therapeutic relationship.

Dr. Klapheke was one of 13 faculty members who received funding from the UCF College of Medicine in its inaugural competitive research grant program in 2012.

Translational Research Institute Researcher Receives Grant from ADA The American Diabetes Association (ADA) has awarded a research grant to Lauren M. Sparks, Ph.D. of the Florida Hospital-Sanford-Burnham Translational Research Institute for Metabolism and Diabetes (TRI-MD). The ADA Junior Faculty Award, which is a three year award, will support Dr. Sparks’ work in diabetesfocused research and contains funding of up to $425,000 over the award period.

This marks an important milestone for the TRI and the Central Florida community by bringing ADA funding for human research to the area.

The global aim of the project is to identify those individuals with type 2 diabetes that do not respond favorably to

exercise and investigate the underlying mechanisms that may be responsible for the “roadblock. She will use these findings to develop a strategy to treat these individuals so that they can reap the metabolic benefits of exercise in order to prevent the onset of type 2 diabetes or treat their current metabolic status through lifestyle interventions such as exercise, according to Sparks.

Dr. Lauren Sparks earned a B.S. in Zoology and a B.A. in Spanish in 2002 and continued on to earn her Ph.D. in Biological Sciences, with a concentration in molecular biology, in 2006 from Louisiana State University. From 2006-2009, Dr. Sparks was a postdoctoral fellow at Pennington Biomedical Research Center in Baton Rouge, Louisiana. She received a training fellowship from the National Institutes of Health (NIH) in 2007 and conducted a clinical exercise trial that investi-

Lauren M. Sparks, Ph.D.

gated the effects of different types of exercise on the ability of the muscle to burn fat and carbohydrate more efficiently in men and women with type 2 diabetes.

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.

Employed Physician Opportunity $160K Competitive salary Competitive benefits

Established High Volume INTERNAL MEDICINE Practice Managing Diseases and Conditions of Adult Patients • Medical assessment of acute issues, monitoring of patient recovery, proactive Wellcare visits- supported by a physician assistant , 3 nurse practitioners and 4 LPN’s • Create Treatment Plans Incorporating Therapy, Medication, Nutritional Changes and /or Surgery • Inhouse Ancillary and Lab Services for efficient diagnosis including Echos, Ultrasounds, Bone Density and Blood/Urine Testing • Complete Electronic Medical Record & Established Medical Office Infrastructure • Trained Staff Assists in Providing Quality Care • Clinical Philosophy is WELLNESS CARE

Clinical Philosophy is WELLNESS CARE • Preventative Medical Care • Pharmaceutical Grade Vitamins • Healthy Lifestyle

Physician Responsibilities Include: • Available for Reference and Oversight of the Provider Staff • General Office Visits • Physicals and Physicals with PAP • Wellness Visits • Acute Visits & Hospital Follow-Up visits • Analysis of Lab results • Review of Imaging Studies, EKG’s, Ultrasounds, Echos and Diagnostic Tests

Contact apike@adultmedfl.com with current CV AUGUST 2013

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