Orlando Medical News February 2016

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PHYSICIAN SPOTLIGHT PAGE 3

Robert Hirschl, MD

Physicians Displeased with Aetna/ Humana Proposed Merger Process AMA, FMA, FOMA Claim Florida’s OIR Provided Insufficient Information

By LyNNE JETER

ON ROUNDS

Prevent, Protect, Improve Healthways Continues Expansion of Ornish Heart Disease Reversal Program When two wellness giants joined forces in 2013, the hope was that millions of people would benefit ... 9

Challenging Population Health Management Issues PHILADELPHIA, PENN. – Thomas Jefferson University’s College of Population Health is once again serving as the exclusive academic partner for the nation’s leading forum on innovations in population health in the City of Brotherly Love ... 12

TALLAHASEE – In mid-December, the Florida Medical Association (FMA), Florida Osteopathic Medical Association (FOMA) and the American Medical Association (AMA) joined forces to oppose Aetna Inc.’s application to acquire Humana Inc., in Florida.

Aetna, the fourth-largest insurer, announced July 3 that it plans to buy Humana, the largest insurer of Medicare Advantage, for $37 billion to form the largest Medicare Advantage insurer in the state.

“We believe that high insurance market concentration is an important issue of public policy because the anticompetitive effects of insurers’ exercise of market power poses a substantial risk of harm to consumers,” according to the joint letter. “Our analysis of data related to the proposed merger reveals significant concerns with respect to the impact on consumers in terms of healthcare access, quality, and affordability.”

The trio of associations sent a letter Dec. 17 to the Florida Department of Financial Services’ Office of Insurance Regulation (OIR), concerning the potential combination of Aetna and Humana.

(CONTINUED ON PAGE 6)

Osceola Regional and Nemours Expand Specialty Pediatric Care

By LyNNE JETER The collaborative agreement also involves Nemours CareConnect, a technological link that remotely brings pediatricians who specialize in rare conditions from Nemours into Osceola Regional Medical Center. It allows the specialists to visually assess a patient in Kissimmee through an iPad.

KISSIMMEE— Under a new agreement with Osceola Regional Medical Center, Nemours Children’s Health System now provides hospital-based pediatric physicians who specialize in treating acutely ill infants, children and adolescents to the Kissimmee hospital.

The affiliation expands Osceola Regional’s existing team of pediatric ER physicians, neonatologists and local pediatricians.

Doctors from Nemours now provide on-site care at Osceola Regional’s 13-private room pediatrics unit.

Also, when Osceola Regional completes construction on its $7 million, 6-room pediatric intensive care unit (PICU) this summer, and expansion of its existing Pediatric Inpatient Unit and Neonatal ICU Level II, Nemours will staff the unit with pediatric intensivists (CONTINUED ON PAGE 10)

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PhysicianSpotlight

Clinical Collaboration Neurosurgery Program Adds Robert Hirschl’s Expertise

By JEFF WEBB

ORLANDO - When Robert Hirschl makes a new acquaintance, the 38-yearold frequently receives a well-intentioned, but awkward, compliment. “Most people who meet me say ‘I can’t believe you are a neurosurgeon. You seem so normal!’” he said.

Or, a quip along the lines of “Well, it’s not exactly brain surgery,” might follow. “That gets old, but it’s always in good fun,” said Hirschl.

To a layman, Hirschl’s expertise might appear unlikely. But to his colleagues and patients, it is anything but unexpected. Hirschl is medical director for the University of Florida Health Neurosurgery Clinic at Orlando Health, headquartered at Orlando Regional Medical Center. Hirschl also is associate chairman and associate professor of neurosurgery at UF’s College of Medicine in Gainesville.

Hirschl’s arrival in August 2015 added depth to the existing surgical team, which now includes five neurosurgeons and one endovascular neurologist, said William Friedman, MD, professor and chairman at UF Health Neurosurgery.

“We are thrilled to have him in our department,” said Friedman. “He is a very experienced neurosurgeon with expertise in endovascular, cerebrovascular and minimally invasive spine neurosurgery. He is also an experienced leader,” Friedman said.

Hirschl gained a good deal of that leadership experience in his previous post at Mercy Medical Center in Des Moines, Iowa. He was the architect of the neurosurgery department at the hospital, which was the “biggest and busiest hospital in the state. I was lucky to be in a situation where I could build the program, which I really enjoyed,” said Hirschl. “But I missed the academics,” an area in which he had excelled during his neurosurgery residency and neuro-interventional endovascular fellowship at his medical school alma mater, Ohio State University. During residency, Hirschl said, he was awarded attending privileges at the Ohio State University Medical Center, the only time that has ever happened.

So, “When Dr. Friedman offered me the position I just couldn’t pass it up,” said Hirschl. The clinical collaboration between UF and Orlando Health has been “phenomenal. … First class. And the (ORMC) staff is incredible. It has been a great experience,” he said.

As medical director of Florida Health Neurosurgery at Orlando Health, Hirschl said he spends two days a week in clinic and two days in the operating room. Another day is devoted to “catching up” and administrative chores, he said. “I split most of my time between orlandomedicalnews

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minimally invasive spine surgeries and endovascular work,” said Hirschl, adding that trauma and emergent cases demand “a large portion of our time because we are the only Level 1 trauma center in the area.”

There also is a hands-on teaching component for Hirschl at Orlando Health.

“There’s a chief resident rotation, so the chief residents at UF in Gainesville come down and rotate, usually for 3 months at a time. There’s always one here. Occasionally we will have med students from UF as

well as Florida State (University’s) medical school,” he said.

Hirschl’s accomplishments reach beyond his leadership, academic and surgical skills; he also is an accomplished inventor.

“I started tinkering when I was an undergrad, but it really was when I was a resident that I got serious about inventing,” he said. “I’ve always enjoyed coming up with solutions to problems. Trying to make minimally invasive spine surgery more effective and safer is something I’ve been passionate about, so most of my innovations have been surrounded by that.”

“A lot of it was done on my own. I’d either sell the IP (intellectual property) to private industry, and then have my own company develop instrumentation,” he said.

Hirschl described his current patent project: “One of the main challenges of minimally invasive spinal surgery is decreased fusion, or bone healing, due to lack of exposure. I have invented and am studying a novel spinal implant … to promote bone healing and increase fusion rates.”

That’s lofty terrain for a young man who grew up in gritty Youngstown, Ohio, the youngest of three children and the only son of a high school science teacher and stay-at-home mom. Hirschl said he didn’t even consider a career in medicine until his sophomore year at Youngstown

State University. “I realized that at some point I needed to figure out what I would do with my life,” he recalled. “There was a flyer on a bulletin board about a shadowing rotation for general surgery and cardiovascular surgery. I went and l loved it.

I knew then (surgery) was what I wanted to do.”

By then, Hirschl had met the love of his life, Erica, a fellow chemistry major with whom he found his element. “We’ve been together ever since,” he said. The couple married in 2001, and eight years ago son Issac joined the family.

Making time to accommodate his personal and professional lives is a priority, Hirschl said, and it requires a team effort. “It’s really about being around people who are understanding. I married well (with) my wife being very understanding and not expecting a lot of my time in terms of being home when most people would be home. That certainly helps. But it’s always tough to have work-life balance, and we certainly try. I work more than I probably should; it’s just what we do.”

For those who encounter Hirschl and wish to avoid the perils of the “You-seemso-normal-for-a-neurosurgeon” conversation, try this: Last year, before he left Iowa and at the urging of his friend and colleague Pat Hood, Hirschl skydived. He’s glad he did it, but he won’t do it again.

“Once was enough,” he said.

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The Times They are A-Changing

By ANN BITTINGER

Leo Tolstoy once wrote that “Everyone thinks of changing the world, but no one thinks of changing himself.” In this era of great change in the healthcare industry, stakeholders point fingers at CMS, at the Obama administration, at the payers, at the hospitals.

The successful individuals, however, look at themselves. Physicians will survive in these changing times if they look at changing their own practice settings, their groups and their relationships to fit the times.

I have spent the last 17 years working with physicians organizing their individual practices and internal corporate group structures and aligning them in the greater healthcare market to lay the proper foundation and structure – legally – for my physician group clients to flourish. In this three-part series, I will share ways that practices in Florida are adapting to the changing market.

These are structures that you can learn from, and modify to fit your own needs and goals.

Alignment This first article will address the issue of alignment. Alignment and consolidation are not the same thing.

As more and more physician groups

sell their companies to hospitals and become hospital employees, the distinction between alignment and consolidation is important. A group can consolidate into a hospital system but never truly align. Reciprocally, a group can align with a hospital without consolidating with it (or selling out to the hospital). An experienced healthcare attorney can help you restructure your practice and align it within a looselyintegrated delivery system without the sacrifices that becoming an employee involve.

Incentives to stay Independent When a physician sells a practice and becomes a hospital employee, that physician sacrifices a number of important things. First, long term profits from his or her direct and indirect labor become profits of the hospital. Recent cases involving hospital excessive payment to physician employees have put great pressure on health systems to pay very conservative salaries to employed physicians. The Halifax case made hospitals very wary of giving physicians any type of bonus based on profits from his or her division or subspecialty. Other cases have impacted the industry such that many hospital systems are not paying physician employees any bonus unless it is directly tied to his wRVUs.

Astute physicians know that they are not going to get ahead in life if all they are earning is based solely on the direct patient care they provide. Employed physicians cannot be paid for work they refer to the hospital without violating the Stark Law. Employed physicians cannot be paid for diagnostic work, lab work, prescriptions, and therapy that goes through their practice setting without violating the Stark Law. The fact of the matter is that even though physician groups are selling out to hospitals in epidemic proportions, there is great incentive for physicians to retain their own groups. Not only are there financial benefits, most physicians agree that their practices are more effective in patient care when they are operated by physicians rather than midlevel hospital administrators.

So how does a physician group survive without selling out to a hospital?

Let’s take a look. First, I guide clients through a process of identifying what is their biggest threat and what strengths and power they have in the market.

Reimbursement If the self-evaluation process reveals that reimbursement rates are the biggest threat, I ask my client to look closely at that. It seems that it’s a knee jerk reaction for my physician group clients to

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say “I’ll make $20 more per 99214 if I join the hospital.” This is a very narrow way to look at things. First, sure the hospital contracts with payers may be better than the group’s payer contracts, but what about collections? Can the hospital properly capture the work, bill for it, and collect on it as effectively as the physician group? I’ve been involved with a number of groups who consolidated with a hospital with better payer contracts, only to find that the hospital wasn’t collecting well, which impacted the physicians’ collectionsbased bonuses.

IPAs Instead of consolidating with a hospital by selling outright, many of my clients examine ways to align with other providers – including ancillary providers. If there’s one mantra that’s true in 2016 in healthcare it is: “what’s old is new again.” HMO enrollments are on the rise, for example. Another example, in the alignment arena, is the IPA, for Independent Physician Association.

IPAs are loose (but not too loose) associations of independent practices that organize to negotiate contracts with the payers.

Integrated Groups The IPA concept could take a tighter approach by actually merging groups together in some degree. One approach is to join already-existing physician groups together by way of a jointly-owned parent company. We form the parent company as an umbrella company, owned by individual physicians. The existing physician groups become subsidiaries of the new umbrella company. The umbrella company has the volume in terms of physicians that the payers want in order to give good reimbursement rates. And the physicians still operate somewhat independently in their individual subsidiaries in terms of the day to day operations.

These are just a few of the many variations that alignment can take to retain a good amount of independence for the physicians from the hospitals. Next month’s article will explore ways that are a little closer to integration of the hospital and group without constituting a full-fledged sale of the practice.

Ann M. Bittinger specializes in advising healthcare entities in their business transactions. Her particular expertise is in legal relationships between hospital systems and physicians or physician groups, such as co-management agreements, joint ventures, clinical integration arrangements, practice acquisitions and employment agreements. Board certified by The Florida Bar in health law in 2005, she is in particular demand from companies located outside Florida that are expanding their businesses into Florida.

She has serviced client companies headquartered in Dallas, Nashville, Boston, New York City, San Francisco, Los Angeles and London, U.K. She can be reached at Ann@bittingerlaw.com.

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Physicians Displeased with Aetna/Humana Proposed Merger, continued from page 1 “We’ve analyzed the likely competitive effects of this proposed merger both in the sell-side market for insurance and the buyside market for physician services,” according to the joint letter. “We’ve considered data on competition in health insurance in recent studies on the effects of health insurance mergers, and the testimony of Aetna’s executives and expert, Dr. Thomas R. McCarthy of NERA Economic Consulting. We’ve reviewed this matter from our long-standing perspective that competition in health insurance, not consolidation, is the right prescription for health insurer markets. Competition will lower premiums, force insurers to enhance customer service, pay bills accurately and on time, and develop and implement innovative ways to improve quality while lowering costs.

“Competition also allows physicians to bargain for contract terms that touch all aspects of patient care.”

Monopsony Concerns The result, medical association leaders emphasized, will be detrimental to consumers.

“The merger would create, enhance or entrench monopsony power in Florida markets for the purchase of physician services,” said Thomas L. Greaney, a national leading antitrust expert, Chester A. Myers Professor of Law, and co-director of the Center for Health Law Studies at the Saint Louis University School of Law in St. Louis, Mo. “The lessons of oligopoly are pertinent here: consolidation that would pare the insurance sector down to less than a handful of players is likely to chill the enthusiasm for venturing into a neighbor’s market or engaging in risky innovation.

One need look no further than the airline industry for a cautionary tale.”

Northwestern University’s Leemore S. Dafny, PhD, a professor of strategy, the Herman Smith Research Professor in Hospital and Health Services, and director of Health Enterprise Management at

the Kellogg School of Management, explained in recent Senate testimony on the merger that monopsony is “the mirror image of monopoly; lower input prices are achieved by reducing the Dr. Leemore S. quantity or quality of serDafny vices below the level that is socially optimal.”

Dafny also noted that “if the past is prologue, insurance consolidation will tend to lead to lower payments to healthcare providers, but those lower payments will not be passed on to consumers. On the contrary, consumers can expect higher insurance premiums.”

Impetus of the Letter The Dec. 17 letter was prompted by questionable actions by the OIR that occurred nearly a month earlier. On Nov. 20, the Friday before Thanksgiving, the OIR published in the Florida Register notice of a Dec. 7 public hearing on Aetna’s application for the proposed acquisition of Humana. Even though physicians practicing in Florida have substantial interests that would be affected by the OIR’s decision on the application, the OIR didn’t serve a copy of the notice to the FMA or FOMA. The notification and scheduling snafu made it unlikely for those impacted by the decision to conduct due diligence on the issue to adequately participate, according to the joint letter.

In addition, a submission of comments by Dec. 17 had been hampered because the OIR “has been dilatory in producing requested application-related documents, such as Aetna’s competitive analysis, which the OIR still hasn’t produced,” according to the joint letter.

Politico Florida’s report described the OIR hearing as “oddly lacking the participation of anyone except Aetna and Humana executives and witnesses for the companies,” according to the joint letter,

adding the report characterized the hearing as a mere gesture inconsistent with important public policy issues at stake.

“At the capital on (that) Monday, no critics appeared to oppose the merger, which would impact about 2.4 million people spanning four licensed Humana insurance companies in Florida,” according to the report.

The Fallout The mega-merger’s impact would exceed federal antitrust guidelines and be presumed to enhance market power in three Florida metro areas: Jacksonville, Sarasota-Bradenton-Venice, and TampaSt. Petersburg-Clearwater, the joint letter read.

According to the U.S. Department of Justice, “a merger enhances market power if it’s likely to encourage one or more firms to raise price, reduce output, diminish innovation, or otherwise harm customers as a result of diminished competitive constraints or incentives.”

The AMA analysis, continued the joint letter, also shows the proposed merger would raise significant competitive concerns in an additional four Florida metro areas, including Fort LauderdalePompano Beach-Deerfield Beach, Lakeland-Winter Haven, Miami-Miami Beach-Kendall, and West Palm BeachBoca Raton-Boynton Beach.

“Physicians charge that Aetna has yet to address findings showing the negative competitive effects of the proposed merger,” according to the joint letter.

“Physicians noted to Florida insurance regulators that Aetna hasn’t met its burden of proof to show the merger wouldn’t substantially lessen competition, or tend to create a monopoly in Florida’s commercial health insurance market.”

Bottom line of the joint letter: Physicians believe that Florida is at a critical decision point on the Aetna-Humana merger and urged state regulators to reject Aetna’s application to acquire Humana.

Aetna/Humana’s Take In an Aetna/Humana joint press release, company leaders said the complementary combination brings together Humana’s growing Medicare Advantage business with Aetna’s diversified portfolio and commercial capabilities to create a company serving the most seniors in the Medicare Advantage program and the second-largest managed care company in the United States.

“The combined entity,” according to a company press release, “will help drive better value and higher-quality healthcare by reducing administrative costs, leveraging best-in-breed practices from the two companies — including Humana’s chronic-care capabilities that measurably improve health outcomes for larger populations — and enabling the company to better compete with more cost effective products.”

Aetna CEO Mark T. Bertolini put it bluntly: “The acquisition of Humana aligns two great companies and will significantly advance our strategy of more effectively serving members in a rapidly changing healthcare industry.”

Humana CEO Bruce D. Broussard summed up the transaction as “a testament to the accomplishments of Humana associates and an outstanding outcome for our shareholders, who will receive an immediate premium and the opportunity to (CONTINUED ON PAGE 8)

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Physicians Displeased with Aetna/Humana Proposed Merger, continued from page 6 participate in the growth potential of the combined organization.”

Next Step If approved, Aetna has said it doesn’t anticipate closing on the Humana acquisition earlier than mid-year.

In the meantime, association leaders asked the OIR to grant a 30-day continuation of the hearing to allow critics of the proposed merger to have timely access to documents and to testify before the hearing panel.

Florida law places the “burden of proof” on Aetna to show “the effect of the acquisition wouldn’t substantially lessen competition or wouldn’t tend to create a monopoly.”

“In other words, Aetna must produce the evidence and carry its burden of persuasion that the merger wouldn’t substantially lessen competition,” according to the joint letter. “Accordingly, this statement will begin by examining the evidence presented by Aetna through its expert, Dr. McCarthy.”

The proposed merger, they say, violates NAIC competitive standards and federal antitrust merger enforcement standards.

Perhaps the greatest obstacle, association leaders pointed out, is the so-called chicken-and-egg problem of health insurer market entry: health insurer entrants need to attract customers with competitive premiums that can only be achieved by obtaining discounts from providers.

The American Medical Association analysis, according to the joint letter, also shows the proposed merger would raise significant competitive concerns in an additional four Florida metro areas, including Fort Lauderdale-Pompano Beach-Deerfield Beach, Lakeland-Winter Haven, Miami-Miami Beach-Kendall, and West Palm Beach-Boca Raton-Boynton Beach.

“However, providers usually offer the best discounts to incumbent insurers with a significant business—volume discounting that reflects a reduction in transaction costs and greater budget certainty. Hence, incumbent insurers have a durable cost advantage,” according to the joint letter.

AMA pointed to the presence of significant entry barriers in health insurance markets that was demonstrated in the 2008 hearings before the Pennsylvania Insurance Department on the competition ramifications of the proposed merger between Highmark Inc. and Independence Blue Cross. In a report commissioned by the Pennsylvania Insurance Department, consulting firm LECG Corporation concluded it was unlikely that any competitor would be able to step into the market after a Highmark/IBC merger.

Another wrinkle: According to a recent New York Times article, the Obama administration will pay only 13 percent of what insurance companies were anticipating to receive through “risk corridors” that were expected to help insurance companies with too many sick people and too little cash to operate in the first years under the health law.

“There have been reports that UnitedHealth Group Inc. may leave the marketplaces,” according to the joint letter.

“Moreover, only two for-profit companies that weren’t already health insurers have entered the state marketplaces.”

One company is Oscar, touted by Bertolini as an example of successful entry in his testimony before the Senate Judiciary Committee. However, Oscar estimated in a regulatory filing that it lost about $27.5 million in 2014, roughly half its revenue. The CEO of Oscar, one of the very few new companies to even attempt entry, described the task as “quite daunting.”

Rejecting the Merger AMA, FMA and FOMA leaders noted that any remedy short of rejecting the merger application wouldn’t adequately protect consumers, and that a divestiture wouldn’t protect against the loss of potential competition that occurs when one of the largest health insurers is eliminated. Also, divesture could be highly disruptive to the marketplace and cause harm to consumers, especially in Medicare Advantage markets where the elderly

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would be faced with a new insurer.

“As a practical matter, the overwhelming number of markets adversely affected by the proposed merger, along with the barriers to entry to health insurance, makes unlikely that the OIR could find proposed buyers of assets that could supply health insurance at a cost and quality comparable to that of the merger parties in the huge number of affected markets,” according to the joint letter. “Moreover, any qualified purchaser able to contract with a cost competitive network of hospitals and physicians, if found, would likely already be a market participant, and a divestiture to such an existing market participant wouldn’t likely return the market to even pre-merger levels of competition.”

Accordingly, association leaders have urged the OIR to reject the parties’ application to merge so consumers are protected from premium increases, lower plan quality and a reduction in the quantity and quality of physician services.

“Physicians strongly believe that any remedy short of rejecting the merger wouldn’t adequately protect Florida’s consumers,” according to the joint letter. “A divestiture wouldn’t protect consumers against the loss of potential competition that would occur when one of the largest health insurers is eliminated from the marketplace.”

At press time, Orlando Medical News was unable to reach the OIR for comment.

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Prevent, Protect, Improve

Healthways Continues Expansion of Ornish Heart Disease Reversal Program

By CINDY SANDERS

When two wellness giants joined forces in 2013, the hope was that millions of people would benefit. Nearly three years later, the partnership between Dean Ornish, MD, and global well-being improvement company Healthways continues to expand, bringing evidence-based lifestyle programming to ever-increasing numbers of individuals across the nation.

Based in Franklin, Tenn., Healthways is a provider of well-being and health improvement solutions to nearly 68 million people on four continents. The company entered into an exclusive agreement with Ornish in July 2013 to operate and license his Lifestyle Management Programs, which included interventions addressing early-stage prostate cancer, type 2 diabetes, and heart disease.

A cornerstone of the partnership is Dr. Ornish’s Program for Reversing Heart Disease™ (Ornish Reversal Program), which is scientifically proven to not only treat … but also to reverse … the progression of heart disease through comprehensive lifestyle changes.

“What’s different about it is recognizing lifestyle is a viable treatment alternative for cardiac disease that can actually reverse the disease at its root cause,” said

Robert Porter, managing director of the Ornish Reversal Program for Healthways.

He added integral parts of the program focus on diet and nutrition, exercise, stress management and group support. “One of the unique things about the program is that it is offered to people in cohorts of eight to 15,” Porter said. “The reality is we Robert Porter

are social animals. We’ve discovered the power of that group support and community in helping individuals make and sustain a behavior change.”

Each small group participates in 18 four-hour interactive sessions. In addition to learning new strategies and techniques from a staff leader, participants also use group time to share suggestions and practical solutions to incorporating new habits into daily ‘real’ life. During a session, the group might share a meal, practice yoga

together, work on stress reduction exercises and learn how to choose wisely from restaurant menus. “They don’t just learn what they should do … they actually do it,” Porter said. “They’re actually living the program during those 18 sessions.”

He pointed out the support system functions in much the same way as having a workout buddy, mixing social interaction with a degree of accountability. “It’s a really powerful way to provide support, a bond and a covenant among the group that helps them build (program elements) into their new lifestyle,” he explained.

Porter added the bond is so strong that participants formed alumni groups to continue to foster encouragement and maintain interaction. The Ornish Reversal Program website (ornishspectrum.com) states 87.9 percent of participants continue to get together regularly after finishing the 72 hours of active programming. In fact, Porter noted, some of the participants from the early research studies, which go back decades, continue to keep in contact.

“Dr. Ornish, over 30 years, has done the most rigorous research you can imagine,” Porter said of the science behind the program. Starting with the notion that it’s easer to turn off the faucet than to mop up the floor, Ornish began formulating ideas (CONTINUED ON PAGE 13)

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Use Video to Attract More Patients

By GENE LaNIER

If you have a web site and no video, you are missing one of the best opportunities available on the Internet. Today it is all about video. You can take a deadly dull website and bring it alive with just a few short videos.

Do you have a few pages of instructions for patients to prepare them for an upcoming procedure? Consider using a video explaining the same material except you are delivering the message. This does two things; it is clearer for the patient and it creates more trust because the patient feels he knows you a little better. Videos like this are an eyeball-to-eyeball experience and second only to actually being there.

Many websites include testimonial sections but most of those are written. It is a known fact that people much prefer video to having to read something.

We often hear people say they only use word-of-mouth advertising. However, when we look closer we find that word of mouth advertising doesn’t always work. In fact, it is such a small percentage of successful advertising that it hardly shows on the radar. The reason is simple; people who want to use word of mouth don’t want to put any money into it and so by not promoting word of mouth advertising, it doesn’t happen very often. Look at

it yourself. Let’s say you have dinner at a new restaurant and really enjoy the experience. You have been there. You have had that experience. How many people did you tell about the restaurant? How many did you tell a week later? It’s just something we don’t do.

Now, how would you like to have your patients telling people about how much they like and respect you, your staff and how satisfied they are with the care they received? How would you like having those people doing eyeball to eyeball with other people twenty four hours a day – every day?

To that end, we have developed a program that will work for you and is not expensive. Let’s use tracking of a virus to show you how this works.

As you know, a virus begins with an agent of infection that moves out and becomes a contagion; the contagion spreads and we eventually have an epidemic. And that is why we call this program an endemic epidemic because this program will create an epidemic for you.

Step one is to select your target. You may have one or many, depending on the nature of your practice. If you were a bookseller you would have a lot of different targets: children’s books teenager books, adult books, books on different subjects. If your practice is limited to one particular area, that’s one target. If not, it

will have more than one target.

After you have found your target(s), you have to design an agent of infection.

This will be your website coupled with email, as a secondary agent. Next comes the virus. This is very important because it is the part that sells. The virus must be very positive and very contagious. An example would be a dentist who specializes in dentures. Is he selling teeth? No, he is selling a smile, the ability to chew again.

Maybe it’s just about making you feel good about yourself. You don’t sell soap, you sell cleanliness. Now, we have to get the virus ready to go. So, what is the virus?

Your patients and their enthusiasm.

The question arises, how do we deliver the virus? This is really simple; we get your patients, the ones who will volunteer to do this, to come in and just talk to us on camera about why they like you as their physician. We talk with the patient for a few moments to get them warmed up and then ask them one simple question: why do you prefer this doctor for your healthcare? Then, we shut up and let them talk.

The interesting thing we have learned, having done a little over 1200 of these, is that this method we use produces a testimonial that is so believable. We do not script these testimonials nor do we practice. We warm them up with light conversation and let them talk right off the top of their heads. Interestingly too, is that the

average person will only talk about 45 to 60 seconds, which is perfect timing to hold a person’s attention.

When we have finished, we process the video and send HTML code to your webmaster so it can be imbedded on your website. We also send you links to your videos so you can send them out to prospective patients, current patients and anyone else you wish to see them.

To increase the epidemic and speed the virus along, ask patients and friends to email the testimonials to friends close by.

Since we are dealing with video links, it is really simple to email any video.

At this point, to create contagion, we begin to drive people to your website using blogs, social media and email. If someone inquires about your practice, send a testimonial along with any other information you normally send.

Gene LaNier is a native of North Carolina and a graduate of The University of North Carolina at Chapel Hill. He continued his education with postgraduate studies at New York University and the University of Central Florida.

He is listed in Who’s Who in Public Relations, Sixth Edition, 1992. He was named one of the “world’s top public relations professionals” in the book, The Pro Challenge, 1994. He is accredited by the Public Relations Society of America.

He is currently CEO of My Marketing Group, Inc., a virtual company with affiliates in India, New Zealand, Hong Kong, North America, the United Kingdom, Germany, Sweden and Romania. Visit www.mmgfla.com

Osceola Regional, continued from page 1

Join us

Join us Wednesday, February 17th for cocktails and dinner in the Mills Memorial Hall WEDNESDAY, FEBRUARY 17TH on the Rollins College Campus.

After dinner we will take a leisurely stroll to the for cocktails and dinner in the Mills Memorial Hall the Rollins College Campus.

Annie Russellon Theatre to enjoy the play Expecting Isabel.

After dinner we will take a leisurely stroll to the Annie Russell Theatre

Proceeds will benefit the to Orange Society Foundation and its mission. enjoy County the playMedical Expecting Isabel.

5:30 - 7:30 PM Medical Cocktails and Foundation Dinner and its mission.

Proceeds will benefit the PM Orange County Society Rollins College, The Galloway Room in Mills Memorial Hall, 1000 Park, 32789 5:30Holt PM -Avenue, 7:30 PM Winter Cocktails andFL Dinner Rollins College, The Galloway Room in Mills Memorial Hall,

8:00 PM Annie Russell Theatre "Expecting Isabel"

1000 Holt Avenue, Winter Park, FL 32789 8:00 PM Annie Russell Theatre $150 Individual "Expecting includes cocktails,Isabel" dinner, and theatre ticket $275 Per Couple includes cocktails, dinner, and (2) theatre tickets

$150 Individual includes cocktails, dinner, and theatre ticket $275 Per Couple includes cocktails, dinner, and tickets (2) theatre tickets $1200 Table sponsor includes cocktails, dinner, and (8) theatre plus table signage. $1200 Table sponsor includes cocktails, dinner, and (8) theatre tickets plus table signage. $75 of your individual ticket and $600 of a table purchase represents the charitable contribution to the $75 of your individual ticket andand $600 of deductible a table purchase represents the charitable OCMS Foundation is tax for charitable purposes. contribution to the OCMS Foundation and is tax deductible for charitable purposes.

To register please visit www.ocms.org

TO REGISTER PLEASE VISIT WWW.OCMS.ORG Orange County Medical Foundation, together we are making a difference.

Orange County Medical Foundation, together we are making a difference.

Orange County Medical Foundation, Inc. was founded by the Orange County Medical Society in September of 1988. The Orange isCounty Medicalarm Foundation, wasMedical founded byand the Orangeexclusively County Medical Society Foundation the philanthropic of the OrangeInc. County Society is organized for charitable, in September of 1988.

The Foundation is the philanthropic arm of the Orange County Medical educational and scientific purposes.

Society and is organized exclusively for charitable, educational and scientific purposes.

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and neonatologists, who work closely with primary care providers and other pediatric specialists at the 318-bed, Trauma Center Level II Osceola Regional, including those in the hospital’s pediatric emergency department.

“Osceola County is one of the nation’s fastest-growing counties, and our community has needed greater access to specialized pediatric care for years,” said Bob Krieger, CEO of Osceola Regional Medical Center. “We’ve now added the expertise of Nemours physicians and are finalizing the construction of our state-ofthe-art PICU, slated to open this summer.

Our experts are well-equipped to treat children dealing with a range of health issues, from minor illnesses to acute injury or disease.”

The agreement also includes Nemours CareConnect, a technological link that remotely brings pediatricians who specialize in rare conditions from Nemours into Osceola Regional Medical Center. It allows the specialists to visually assess a patient in Kissimmee through an iPad. “When our physicians have the opportunity to put their eyes on a patient, it will provide an added level of communication that you just cannot get over the phone,” said Robert Bridges, CEO of Florida Operations for Nemours Children’s Health System. “We think Nemours CareConnect allows care teams to better determine the safest and most necessary care for the child and family.”

Osceola Regional CNO Rick Naegler said working with Nemours “allows us to combine the best of what they do – specialty pediatric care – with the best of what we do as a full-service community hospital.

This partnership also increases continuity and coordination of care by helping to ensure that patients see the same medical experts throughout their stay in our hospital.”

In addition to pediatric care, Osceola Regional offers the only NICU Level II facility in Osceola County, which provides special medical care for newborns and is adjacent to the recently-renovated $1.6 million Baby Suites for birthing mothers.

Tawni Price, administrative director of Women’s and Pediatric Services for Osceola Regional, said when families come to Osceola Regional to deliver their babies, “they can rest assured knowing that our experts are prepared to handle any medical scenario. “And as their children grow up, we will continue to serve as a trusted resource for these families.”

The financial bottom line for both institutions likely prompted the partnership.

According to WMFE News, “Nemours was only 37 percent occupied in 2014, and lost $54 million on operations.

Osceola Regional made $42.3 million in net income in the same year.” Reporter Abe Aboraya called the deal “interesting in part because Osceola Regional’s parent company is for-profit HCA, while Nemours is owned by a charity.” orlandomedicalnews

.com

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Challenging Population Health Management Issues

By LYNNE JETER

PHILADELPHIA, PENN. – Thomas Jefferson University’s College of Population Health is once again serving as the exclusive academic partner for the nation’s leading forum on innovations in population health in the City of Brotherly Love.

Slated March 7-9, the 16th Population Health Colloquium will be held onsite at the Loews Philadelphia Hotel or via webcast with 24/7 access for six months.

Co-sponsored by the Population Health Alliance, the 3-day conference will bring together industry stakeholders – healthcare providers, payers, pharmaceuticals, leading technology and solutions companies, academia and government – to share best practices, case studies, expert insights and industry trends in the quickly-growing field of population health.

Conference 2016 highlights include two special dinner programs. On Sunday, March 6, Stephen K. Klasko, MD, MBA, president and CEO of Thomas Jefferson University (TJU) and Jefferson Health, will engage in an extended conversation with conference participants to share his unique vision regarding innovation and transformation. The interactive session – moderated by David B. Nash, MD, MBA, dean of the Jefferson College of Population Health,

the nation’s only degree-seeking school of its kind – will also include a special guest to discuss how a traditional academic medical institution is transforming to reimagine healthcare, health education and discovery, and also detail Jefferson’s journey toward its transition into a consumer-centric healthcare enterprise. On Tuesday, March 8, a dinner and panel discussion will be held focused on population health analytics and featuring dozens of exhibitors.

A March 7 morning preconference symposia will highlight population health management projects and best practices nationwide for integrated delivery systems and large medical groups that are struggling to adapt. The session will show how three very different entities are making it work: a Midwest academic medical center that implemented a $12 million Medicare/ Medicaid innovation grant to improve rural cardiovascular health; a state medical society that developed cutting-edge antibiotic stewardship programs; and a West Coast community’s program to combat childhood obesity. Speakers represent PYA Analytics: CMO Kent Bottles, MD, and Principals James Michael Keegan, MD, and Martie Ross, JD. Day 1 begins after lunch, with a keynote presentation and discussion of the healthcare landscape by Peter Orszag,

TMS

Citigroup’s vice chairman of corporate and investment banking and chairman of its financial strategy and solutions group.

Day 2 begins with Klasko presenting the inaugural winner of the Hearst Health Prize for Excellence in Population Health, who will receive a $100,000 cash prize in recognition of outstanding achievement in managing or improving population health.

Following the presentation, Julie Gerberding, MD, MPH, Merck’s executive vice president of strategic communications for global public policy and population health, will discuss the case for a new population health protection agenda.

Other second-day topics on the agenda: accelerating change toward a better healthcare system; population health in the era of cognitive computing; and innovative provider collaborations and enablement strategies. Afternoon mini-summits sponsored by Accenture, Evolution Health, athenahealth, and Sage Growth Partners/ WellCentive, involve achieving the promise of data exchange; shortening the ROI in population health; driving results in the accountable care era; and creating a platform for care transformation in value-based care environments.

A special evening dinner program – What’s Inside the Data? – features population health experts sharing insight, using

case studies to illustrate how healthcare organization are using analytics tools to support and implement successful population health management programs. Participating experts include Nathan Gunn, MD, president of population health for Valence Health; Gregory G. Kile, CEO of Populytics and senior vice president for insurance and payer strategies for the Lehigh Valley Health Network; Sally Okun, RN, MMHS, vice president of advocacy, policy and patient safety for PatientsLikeMe; Jonathan Ware, MD, medical director of population health management for Phytel, an IBM company; and Adrian Zai, MD, PhD, chief medical informatics office with SRG Technology, and clinical director of population informatics with the computer science laboratory at Massachusetts General Hospital.

Day 3 features presentations on the critical role of community in population health; controlling the rising costs of specialty drugs; and perspectives from an ACO. Within the conference for attendees wanting to take a deeper dive into the Colloquium’s subject matter is Jefferson’s Population Health Training Program. Also, the conference has been approved for up to 20.85 NASBA CPE credits for accounting professionals.

For full program information, go to www.populationhealthcolloquium.com.

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Prevent, Protect, continued from page 9 about how to improve health while he was still in medical school. By 1978, Ornish and colleagues at the University of California, San Francisco showed heart disease could be reversed after only 30 days, as demonstrated by improved blood flow to the heart, in a pilot study that utilized the tenets of the Ornish program.

Based on nearly four decades of ongoing research, which has been widely published in peer-reviewed journals, the program was approved for Medicare reimbursement under the category of ‘Intensive Cardiac Rehabilitation’ beginning in 2011. In addition to nationwide reimbursement through Medicare, commercial payers in 17 states also cover the program for heart disease.

“As the evidence grows, as we gain experience, the science would seem to predict there is the possibility for this program to expand to a larger number of chronic diseases,” said Porter. He added a few payers have extended the criteria for coverage to include those with diabetes and early-stage prostate cancer.

The core program, however, is currently focused on heart disease. With the exception of congestive heart failure, which Porter said he hopes will be added in the near future, the program is approved under Medicare for the same diagnoses as traditional cardiac rehabilitation.

The six qualifying conditions are: • Acute myocardial infarction in the preceding 12 months, • Coronary Artery bypass surgery, • Current stable angina pectoris, • Heart valve repair or replacement, • Percutaneous transluminal coronary angioplasty or coronary stenting, and • Heart or heart-lung transplant.

A focus on lifestyle modification and prevention has increasingly become more mainstream in healthcare, but transforming the delivery system remains an ongoing challenge.

Phil Newbold, CEO of Beacon Health

System in Indiana, which launched the program in August 2015, noted, “If you look at the mission and vision statements of most hospitals and health systems, the word ‘health’ is all over them … but if you look at where we spend our resources, about 99 percent goes to the medical side of things and very little actually focuses on health.

When we looked at the Ornish Reversal Program, we saw that it was the best way for us to really embrace health in a scientific way and better align ourselves with our mission of creating a healthier community.”

Echoing the sentiment, Porter said, “I think our whole healthcare system was built around passively waiting to treat people when they presented with a problem. We’ve found that is unsustainable. It’s unsustainable financially, and we’re not optimizing the health status and qualify of life for people.” He continued, “The best way for us to promote health is to adopt a healthy lifestyle that prevents the onset of chronic disease.”

The Ornish Reversal Program is rapidly gaining a foothold in the medical community since rolling out nationally about 18 months ago. At the end of 2015, four new partner sites were announced in Texas, Florida, North Carolina and Virginia. At press time, Healthways had implemented the program in 22 sites across 14 states with two more programs in the process of being launched and numerous others in the discussion phase.

While Porter said it was too early to have hard financial figures in terms of savings to the health system, he noted early indicators have been impressive. “We’re certainly seeing incredibly solid clinical results,” he said. “Based on those clinical results, the predictive variables would indicate we expect to see solid results in other outcomes like readmissions and costs.”

Physician groups and hospitals interested in learning more about the program and research behind it should go online to ornishspectrum.com or call Healthways at 877-888-3091.

GrandRounds Orlando Health Announces Three New Executives

Orlando Health today, announced the addition of three new senior vice presidents. The new executives will join CEO David Strong’s executive cabinet.

R. Erick Hawkins is the new Senior Vice President of Strategic Management.

Mr. Hawkins most recently served as chief financial officer and vice president of heart and vascular services for University of North Carolina REX Healthcare in Raleigh.

In that position, he was the executive responsible for the organization’s strategic innovations. Other leadership positions Mr. Hawkins has held include President of the Board of Directors for Hospice of Wake County, member of the Executive Leadership Team for the American Heart Association’s Triangle Heart Ball, and member of the Leukemia & Lymphoma Society’s Triangle Light the Night Walk’s Executive Leadership Council. He received a bachelor’s degree from Yale University and a MBA from Duke University’s Fuqua School of Business.

Greg P. Ohe, FACHE, is the new Senior Vice President of Ambulatory. Mr. Ohe, will transition over the next few weeks, from his current position as president of Orlando Health’s Health Central Hospital. In addition to having oversight over the 171-bed hospital, Mr. Ohe also oversees Health Central Hospital Park, a long-term care and rehabilitation facility, Express Care, an urgent care walk-in clinic, and a state-of-the-art surgery center. Mr. Ohe is a Fellow in the American College of Healthcare Executives and is a member of the Healthcare Financial Management Association. He has served as the President of the Central Florida Healthcare Executive group and as a member of Community Advisory Committee for the Health Services Administration program at the University of Central Florida. He has functioned as a mentor for young professionals associated with the University of Central Florida and Xavier University. Mr.

Ohe has served on numerous healthcare committees throughout Florida and the Southeastern United States. He has a Bachelor’s Degree in Chemistry and a Master’s Degree in Hospital and Health Administration from Xavier University in Cincinnati, Ohio.

Andrew J. Snyder is the new Senior Vice President of Marketing and Communications. Mr. Snyder most recently served as vice president and chief marketing officer for AMITA Health in Arlington Heights, Illinois where he oversaw all aspects of marketing, brand management, and web/social media strategy. Mr. Snyder is a frequent presenter at industry events and universities such as the Harvard/Chan School of Public Health, Loyola University, the Society for Healthcare Strategy and Market Development, and the Forum for Healthcare Strategies. Other leadership positions Mr. Snyder has held include Board Member of the Elgin Symphony Orchestra, the Chamber of Commerce of St. Joseph County, AIDS Ministries of Northern Indiana and United Way of Porter County. He received a Bachelor’s Degree in Biology from Wabash College in Crawfordsville, Indiana.

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Don’t Miss the Big Event OrlandoMedicalNews.com

From industry conferences and continuing educational units to fun ways to support the area’s many non profits ... check the calendar for healthcare happenings.

For event submission, email your information to editor@ orlandomedicalnews.com

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STOP INVESTING IN COMPUTER SYSTEMS...

GrandRounds Jess Parrish Medical Foundation Partners with TD Bank to Support Healthcare Initiatives Jess Parrish Medical Foundation recently received a cash contribution from TD Bank, America’s Most Convenient Bank®, through the bank’s Affinity Membership Program.

Jess Parrish Medical Foundation re-

lies on support from community partners, like TD Bank, to raise funds that sustain and enhance healthcare services offered

by Parrish Medical Center.

TD Bank’s Affinity Membership Program helps non-profit organizations raise money by receiving an annual cash contribution from TD Bank based upon the participation of qualified member accounts.

UF Health Cancer Center - Orlando Health Opens At South Lake Hospital

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South Lake Hospital, in affiliation with Orlando Health, has added a new collaborative cancer center to its growing medical campus. The new center, which will provide radiation oncology services, will be managed by UF Health Cancer Center - Orlando Health and Integrated Oncology Network (ION) and give patients in and around Lake County local access to the cancer center specialists, vast resources, leading-edge treatments and ongoing medical trials.

The 4,800 squarefoot practice will be staffed by UF Health Cancer Center-Orlando Health radiation oncologists and an advanced nursing team, providing comprehensive cancer care.

The center’s technology - provided by ION - will offer breakthrough technologies, including IntensityModulated Radiation From left Randy Sklar, Senior Vice President, Integrated Oncology Network; John Moore, President, South Lake Hospital; Mark Roh, MD, President, UF Health CanTherapy (IMRT) and cer Center – Orlando Health; Tomas Dvorak, MD, radiation oncologist, UF Health Image-Guided Radia- Cancer Center – Orlando Health. tion Therapy (IGRT).

IMRT is the most technologically advanced and most precise method of external beam radiation therapy available. IGRT takes this technology one step further. Daily imaging assures the radiation is delivered precisely to the treatment area while sparing surrounding tissue. Treatment may be able to be delivered in as few as 1 to 5 treatments.

These advanced radiation technologies provide cancer treatment more precisely, with less risk, and are beneficial for many different types of cancer.

ION has been focused on expanding its networks across the United States of more than 250 multispecialty oncology-focused physicians to affiliate with larger providers and healthcare systems in their market to provide quality and cost-efficient patient care.

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JOIN CFMGMA & RECEIVE 6 EDUCATIONAL PRESENTATIONS AND MUCH MORE!

PUBLISHED BY: SouthComm Business Media, Inc. MARKET PUBLISHER John Kelly johnkelly@orlandomedicalnews.com AD SALES: John Kelly 407-701-7424 Karen Dicembre KDicembre@orlandomedicalnews.com 407-493-7287 LOCAL EDITOR Lynne Jeter Lynne@MedicalNewsInc.com CREATIVE DIRECTOR Susan Graham susan@medicalnewsinc.com GRAPHIC DESIGNERS Katy Barrett-Alley, Amy Gomoljak, Abbie Leali, Liz Loewenstein CIRCULATION subscriptions@southcomm.com CONTRIBUTING WRITERS Daniel Casciato, 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

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Speaker: Leslie Witkin, Physicians First, Inc. Time: 3-5:00 PM Location: Winter Park Civic Center Address: 1050 W Morse Blvd,Winter Park, FL 32789 Challenges in the Medicare Quality Program Initiatives ….and what you should be doing to overcome them • Penalty Impacts 2016 thru 2018 – PQRS, Value Modifier, EHR Incentive.

• Transitioning to the Merit Based Incentive Payment System (MIPS).

• Changes you can make for PQRS & EHR CQM reporting to align and simplify.

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Vice President of Production Operations Curt Pordes Vice President of Content/ Communication Patrick Rains Controller Todd Patton Creative Director Heather Pierce Orlando Medical News is published monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm Business Media, Inc. ©2016 Medical News Communications.All rights reserved. Reproduction in whole or in part without written permission is prohibited.

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Introducing Fresh

Healing Potential Realized

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bioACTIVE Announcing a breakthrough in regenerative medicine: Affinity fresh amniotic allografts.

NuTech’s breakthrough proprietary preservation system, AlloFreshTM, maintains the integrity and viability of fresh amniotic tissue. For the first time, surgeons can take full advantage of this unique tissue’s strength, flexibility, and healing potential. Affinity provides a natural solution for regenerative healing. 1–3

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Contact NuTech at 800-824-9194 Learn more about how Affinity fresh allografts are transforming regenerative medicine: info@nutechmedical.com www.nutechmedical.com References: 1. Niknejad H, Peirovi H, Jorjani M, et al. Properties of the Amniotic Membrane For Potential Use in Tissue Engineering. Eur Cell Mater. 2008(15):88–89. 2. Wolbank S, Hildner F, Redl H, van Griensven M, Gabriel C, Hennerbichler S. Impact of human amniotic membrane preparation on release of angiogenic factors. J Tissue Eng Regen Med. 2009;3(8):651–654.

3. Gruss J, Jirsch D. Human amniotic membrane: a versatile wound dressing. Can Med Assoc J. 1978;118(10):1237–1246.

© 2015 NuTech Medical, Inc. NuTech name and logo are registered trademarks, and Affinity is a registered trademark of NuTech Medical, Inc. AlloFresh is a trademark of NuTech Medical, Inc. All Rights Reserved.

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