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PHYSICIAN SPOTLIGHT PAGE 3
Jason Pirozzolo, DO ON ROUNDS Passage of the 21st Century Cures Act Will Impact Local Research Institutes Act Will Increase Funding for Research Research institutes in the Orlando and Tampa area such as Sanford Burnham Prebys (SBP) and H. Lee Moffitt Cancer Center (MCC) are curious to see the outcome in Washington DC of the 21st Century Cures Act ... 4
Health Central COO Moves Chapter Forward Rick Smith Earns ACHE President’s Award When American College of Healthcare Executives of Central Florida (ACHE) members were mulling the recipient of the ACHE President’s Award, a prestigious award for an individual who has truly gone above ... 6
Florida Telehealth Summit ‘Energizing and Informative’
Speakers Share ‘Lessons Learned’ from Successful Telehealth Programs By LyNNE JETER
WINTER PARK – The 2015 Florida Telehealth Summit provided substantial information for state lawmakers and healthcare industry partners to accelerate the practice and parity of telehealth in the Sunshine State. “The second annual 2015 Florida Telehealth Summit proved to be an energizing and informative event for the 125-plus attendees who came from all corners of Florida and beyond,” said Lloyd Sirmons, director of the Southeastern Telehealth Resource Center (SETRC). The multi-day summit was held in early December at the Alfond Inn in Winter Park. “Holding this event at the Alfond Inn and at the beginning of the holiday festivities in Winter Park enhanced the overall experience to those fortunate enough to attend,” he added. Michael P. Smith, MA, MPA, program director of the Center for Strategic Public Health Preparedness and principal investigator for the Center for Universal Research to Eradicate Disease (FLCURED.org) at Florida State UniverLloyd Sirmons
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Cancer Genetics Center Now Open at UF Health Cancer Center-Orlando Health Orlando Health Provides Road Map for High Risk Patients By DANIEL CASCIATO
Patients in Orlando, Fla. who are at high risk for cancer now have access to a specialized center with a dedicated oncologist, nurse practitioner and genetic counselor to assist them with their unique healthcare needs. The Cancer Genetics Center at UF Health Cancer Center — Orlando Health, the first and only one of its kind in Central Florida, is a comprehensive center that will serve patients to not only assess their risk for genetic cancer but also assess their risk for acquired cancer. “We will offer one-stop shopping in terms of having a geneticfocused physical exam, a thorough comprehensive counseling session, and then providing those patients with, depending on the findings, what (CONTINUED ON PAGE 12)
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PhysicianSpotlight
Happy Feats Multi-tasking Keeps Jason Pirozzolo on Task By JEFF WEBB
ORLANDO - “Doing multiple things as well as I possibly can,” said Jason Pirozzolo, “is what keeps me happy.” That being the case, it would appear Pirozzolo has spent most of his life pursuing happiness. Growing up in Elmira, N.Y., Pirozzolo was drawn to sports. At age 12 he already was a talented wrestler grappling with life’s lessons. “We were driving back from a wrestling tournament in our rustedout station wagon. I was squished in the middle seat with my two brothers who had lost their matches that day. I ended up getting second place, which came with a huge 2-foot-tall trophy,” Pirozzolo recalled. “I may have been antagonizing my brothers and gloating about the size of my trophy when my dad slammed on the brakes, pulled over, took the trophy from my hands and threw it out the window. I was speechless. He later explained he was trying to instill upon me an inner drive not to be happy with second place, and always be humble,” he said. Not long after, Pirozzolo was wrestling in the New York State Free-Style Wrestling Championships, and slipped a headlock, landing on his outstretched arm. “I fractured my radial head,” said Pirozzolo. “I remember sitting in a wheelchair waiting to get that initial X-ray, and I was taken aback by everything that was going on. It was my first time in a hospital,” he said. “From that point, I was hooked on medicine.” The next year a school project enabled Pirozzolo to shadow an orthopedic physician. “I read all these books beforehand. My research impressed them” and they let him observe 150 hours of surgeries, he said. In high school, Pirozzolo said he didn’t see the need to exert extra effort to make grades that would land him an academic scholarship to college. “I was the kid who never had to do much studying, but I still did as well as everybody else. I wasn’t number one in my class, but I was doing a lot of different things and still doing well,” he said. Pirozzolo was recruited to wrestle at Cornell University, but had his heart set on attending Pennsylvania State University as a pre-med student. But, after watching Penn State finish undefeated his freshman year, 1994, Pirozzolo said he regretted not playing football. “So, I tried out every semester for Coach Joe Paterno and tried to walk-on. I trained every day. Unfortunately, I just did not have the speed to compete with those athletes, but it was a challenge I enjoyed and will never forget,” said Pirozzolo. Although practicing medicine had been his brass ring since childhood, Pirozzolo had another dream he had set aside – flying. “I would occasionally ask (my parents) what they thought about me not orlandomedicalnews
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becoming a doctor, and becoming a professional pilot. They would always come up with good reasons to talk me out of it,” he said. So, when Pirozzolo reported to Nova Southeastern University College of Osteopathic Medicine in Ft. Lauderdale, he indulged his fascination with flight. “On the very first day of medical school, when everyone was scurrying around joining study groups and buying books, I took what little money I had left of my student loans and enrolled in flight school,” said Pirozzolo. After earning his MD, Pirozzolo completed an internship and residency in family medicine at Duke University Medical School, before accepting a sports medicine fellowship at The Ohio State University. That specialty training brought him to Orlando, where he spent the next five years at director of sports medicine for Florida Hospital Centra Care. In 2011, Pirozzolo joined Orlando Hand Surgery Associates, where he specializes in non-surgical orthopedic sports medicine and trauma. It was there, working with orthopedic surgeon George White, MD, that Pirozzolo conceived and co-founded the IP Network, an integrated network of independent physicians that is using proprietary technology to lower costs and improve quality for patients. “Dr. White and I started talking about the frustrations we and our colleagues were going through. We were anticipating what was coming down the pike. A lot of these insurance companies were going to the narrow network, where they were being bullied by the large hospitals and the large hospital-owned physician groups. And they really had no option for independent doctors other than to say ‘We’re going to pay you chicken scraps because we have to pay so much to the hospital systems,’” Pirozzolo explained. “Meanwhile, the patients are the ones who end up losing their doctor and having to go to a hospital-affiliated office, which charges three to 10 times more than an independent physician. So, we had to do what we needed to stay independent and there was nothing out there that met our needs,” he said. The IP Network is an attempt to redefine the current healthcare system. Pirozzolo said he believes the concept is unique to the U.S. and he already has more than 700 area physicians who have paid $150 each to join the IP Network. “The corporate structure is an LLC and the doctors are the owner and the owner is the doctors. No one doctor has any more say than anyone else,” he said. “We’re trying to be as transparent as possible, and I don’t think there’s any better way than to have every doctor own an equal share. “All that said, we still want a relationship that works with Florida Hospital and Orlando Health. They are an integral component to the community and we want
them to be successful and continue doing what they do. We can work with them and develop some strategies and have our systems coordinated in such a way that we can share data,” he said. Best of all, Pirozzolo predicts, “patients will see the continued affiliation with their independent doctors. As you know, independent doctors are typically the best around because they have been able to sustain their practice for the long term. They are able to fight it out with the hospitals and insurance companies because they are the best.” But Pirozzolo’s policy-making pursuits
don’t end there. The 39-yearold is very active in the Florida Medical Association, where he was elected to the board of governors last year. And those flight lessons he took in medical school turned into 1,000 flight hours and Pirozzolo being an instrument-rated single and multiengine pilot who flies Cessnas and helicopters. That aeronautical experience earned him a gubernatorial appointment to the Greater Orlando Aviation Authority, where he served four years. For the past 6 years, Pirozzolo also has been the physician for the Florida House of Representatives in Tallahassee, where he has traveled every week during the last month of the spring session. “All the people I’ve met are absolutely brilliant in one way or another, and they all did things that I didn’t. That intrigued me,” he said. But no matter how busy he is, Pirozzolo said he keeps his priorities in focus “being a good physician, a good role model and a good father” to his 3-year-old daughter, Ellyson.
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Passage of the 21 Century Cures Act Will Impact Local Research Institutes st
Act Will Increase Funding for Research By MELISSA BUCKLEY
Research institutes in the Orlando and Tampa area such as Sanford Burnham Prebys (SBP) and H. Lee Moffitt Cancer Center (MCC) are curious to see the outcome in Washington DC of the 21st Century Cures Act. The act is a bipartisan bill to promote medical research and accelerate the process in which medical discoveries reach patients in the form of new medicines and new medical devices by increasing funding for the National Institute of Health (NIH) and making research and healthcare policy changes. The bill was introduced to the house in May and was passed with a 344 to 77 vote in July. Institutions in Orlando receiving funding from the NIH include the University of Central Florida, SBP, University of Florida Research and Academic Center in Lake Nona, and Florida Hospital. Many of these institutions reside in the Lake Nona Medical City creating Orlando’s medical hub. It’s no secret that the Medical City has contributed to the major growth and development of that section of Orlando. Institutions in Tampa receiving funding from the NIH include the Uni-
versity of South Florida and MCC. These institutions recruit STEM professionals to the region and create economic development and jobs in the area. The bill will help maintain these institutions and will allow these institutions to contribute to cures faster and more efficiently. The bill intends to address several issues slowing the progress of medical research. One major issue is decreased funding from the NIH. The director of MCC, Tom Sellers, PhD, MPH described the funding as dismal and said “When you adjust for inflation, Dr. Tom funding is at the same Sellers amount as we were 10 years ago. If they double the funding for the NIH, this will get us only to where we were in 2008.” Sellers also said, “When the pay lines are dismal what ends up funded are the incremental next step obvious sorts of questions that are not going to lead to significant advances.” Basically, the NIH can’t afford to make risky investments. Sellers also mentioned “there’s a
three year trend in this country for decreasing number of post-doctoral fellows.” Post-doctoral fellows are scientists at the beginning of their career and are training to become advanced researchers. Lack of post-doctoral fellows means a lack of individuals trained to perform research. “It’s a very dangerous trend that will take us a long time to correct unless something like the 21st century cures act gets affected.” We are also entering an age of precision medicine. This comes from the recognition that an individual’s disease is as unique as the individual themselves. Stephen Gardell, PhD, Senior Director at SBP, described precision medicine as the “ability to assemble a signature of health, a signature of disease, a signaDr. Stephen ture of one person versus Gardell another person, and then act on that signature for a personalized treatment regimen.” Yet, clinical trials and research and healthcare policy are not up-to-date with this modern form of healthcare. The bill addresses many of the issues
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facing research institutes. First and foremost, the bill proposes to increase funding from the NIH and the funds should go toward high risk high reward research as well as to early stage investigators. Gardell said “Increased funding from NIH puts gas in the tank for us to engage in the activities that we do. It’s the discoveries that we make that serve as the beginnings of innovative strategies to combat the large number of unmet medical needs.” Sellers said, “We shouldn’t fund everything that gets submitted for review because not everything is a good idea.” Rather, as Gardell put it “The NIH is making an investment in the work of researchers and looking for a return on that investment. The return of that investment is the discoveries that will provide the foundation for new therapies and new devices that will improve human health and combat disease.” The act also proposes to make changes to the clinical trial process that will cater to precision medicine treatment. Gardell said that SBP has expertise in basic discovery, drug discovery, and biomarker discovery and therefore is equipped to turn medical discoveries into treatments. Gardell described the drug discovery program as “A unique and powerful infrastructure that rivals what has been established in the pharmaceutical companies.” Basic research identifies molecular underpinnings of disease. Drug discovery identifies molecules targeting molecular pathways of disease. Biomarker discovery allows identification of patients suffering from specific subtypes of disease and which patients will benefit from specific drugs. The Act also encourages data sharing to accelerate discoveries. MCC has been a leader on this front and developed a program called ORIEN (Oncology Research Information Exchange Network) that allows several cancer institutes across the country to share patient data. The program allows these institutions to gain consent from patients to collect and profile their tumors, use their medical records for research, to share the data and to re-contact them should researchers learn something from the tumor that may benefit the patient. In fact, John DeMuro, Federal Legislative Affairs Director at MCC, said ORIEN was given as an example of data sharing when congress wrote the bill. DeMuro and the government relations John DeMuro team at MCC have been active in advocating for increased funding from the NIH. He commented, “The work is not over yet for this bill. We need a passage of a companion bill by the Senate and a signature by the President. We are nearly half-way there.” orlandomedicalnews
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Leveling the Playing Field in Your Next Office Lease Negotiation By KEN JORGENSON
The current commercial real estate market has been dramatically affected by the economy in the past several years. This has resulted in a very favorable environment for tenants, as landlords are extremely motivated to attract new tenants and retain existing ones – especially high quality tenants such as healthcare practices. Some of the current opportunities include reducing your monthly rent payment, upgrading your office’s appearance through an improvement allowance, as well as obtaining free rent and other favorable concessions. One of the keys to a successful negotiation is to take advantage of the free services of a real estate broker or agent. This is important because most landlords are in the business of real estate and typically have the upper hand when negotiating with tenants directly. Additionally, the majority of landlords hire a real estate broker to represent their interests and provide expertise. Though dramatic concessions are available, a specific posture and negotiation strategy are paramount to achieving the best possible terms.
When the time comes to evaluate your current lease situation, you’ll need to consider the pros and cons of renewing the lease in your current location versus relocating to a new property. Since economics and concessions will have a dramatic impact on the decision, it is essential to understand all of your available options and implement a strategy to leverage them. It is critical to the success of your negotiation that your landlord knows that you have the option to relocate, which means that you need to begin negotiations well in advance of your lease’s expiration; ideally 9 – 24 months before your current term ends. When you begin negotiations, you have two options available to you: You can work with the landlord’s agent and represent yourself, or you can hire a real estate broker. Here are some things you need to know if you choose to represent yourself in a lease negotiation. Under state law, a real estate broker can enter into an agreement to serve clients as an Agent. An agent is obligated to serve his or her client’s interests with
the utmost good faith, loyalty and fidelity. Clearly, it is not practical for an agent to act with utmost loyalty to two parties on opposite sides of a transaction, meaning the landlord or landlord’s broker should not also represent your interests. Simply put, if you do not bring an agent into the negotiations, no one will be protecting your interests but yourself. If you deal directly with the landlord or landlord’s agent, it is crucial to remember that he or she is not legally or logically in a position to advocate on your behalf, so it is important to exercise discretion with the information you share with the landlord’s agent. Even if your building’s ownership and management are pleasant to work with, respond to issues quickly, and maintain the building well, their primary interest is maximizing profits. Landlords know that without market knowledge, tenants have no baseline against which to compare a lease offer. Therefore a landlord will most likely offer the highest lease terms that they believe an uninformed tenant will accept. The only way to know if any offer is
Health Central COO Moves Chapter Forward Rick Smith Earns ACHE President’s Award By LYNNE JETER
When American College of Healthcare Executives of Central Florida (ACHE) members were mulling the recipient of the ACHE President’s Award, a prestigious award for an individual who has truly gone above and beyond to support the chapter’s mission, a “fast mover” within Orlando Health came to mind. On Jan. 9, at the Dr. Phillips Center for Performing Arts during the 2016 FACHE Gala and Awards Presentation of the ACHE of Central Florida, chapter president Jake Kirchner, DPM, MHSA, presented the ACHE President’s Award to Rick E. Smith, FACHE, COO of Health Central Hospital in Ocoee. “All active members of the chapter board Rick E. Smith were carefully considered for the President’s Award,” said Kirchner. “Following a call for nominations process, Rick was nominated by his peers and selected by (me). In addition to Rick’s exemplary service on the board, he’s proactively mentored many ACHE Central Florida members within his organization and personally sponsored multiple new chapter members over the past year. Rick has served on a number of chapter committees, leveraging his wealth of healthcare 6
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leadership experience and his professional networks for the benefit of our board, our programs, and ultimately our members.” Smith, a board-certified healthcare executive from Winter Garden, specializes in leadership development through clinical practice and executive healthcare experience, and also key differentiators to operationalize market drivers, leverage relationships, and “lead success through fierce resolve,” he said. Smith’s career trek began in 1982 as a radiologic technologist at Baptist Hospital in Gadsden, Ala. By 1987, he was elevated to radiology supervisor at Crestview Medical Center in Crestview. Nearly a decade later, he completed a fellowship in radiology administration with the American Healthcare Radiology Administrators, followed by earning a science healthcare management degree from Kennedy Western University, and a master’s degree in health administration from Warren National University. In between degrees, he worked as director of radiology at Laurens County Hospital, a 115-bed facility in Clinton, SC, performing 40,000 exams annually with a staff of 25. Smith then joined Bulloch Memorial Hospital as director of radiology, a 200-bed facility in Statesboro, Ga., performing 60,000 exams yearly. As manager of radiology services for Bay Medical Center in Panama City, Smith managed an operating budget of $6.5 million, increased procedure volumes by 15
percent, for the nearly 100,000 exams annually, with a staff of more than 80. He then moved to manager of patient care operations for Bay Medical Center, working closely with the COO to provide operational and financial analysis of various services lines throughout the organization. In 2003, Smith was named executive director of Bay Behavioral Health Center, a 90-bed psychiatric hospital in Panama City. After serving as vice president of two divisions – behavioral, outpatient psychiatric (OP) and support services; and professional and ancillary services – at Bay Medical/ Sacred Heart Health System, Smith was named COO of Orlando Health Central in January 2014. Among other responsibilities, he’s overseeing the 50,000-square-foot expansion of the emergency department, a $50 million construction project slated for completion in July; and the expansion of a 40-bed tower to bring the hospital’s total to 202 private rooms, also slated for completion this summer. Last year, Smith completed the Leadership West Orange program through the West Orange Chamber of Commerce. He’s active in the American Heart Association, was a team leader for three consecutive years for the Bay County Heart Walk, and played a volunteer role in the Covenant Hospice Gala in Panama City. He previously served as an advisory board member for Big Brothers/Big Sisters.
truly competitive is to compare it to the market. To do this you need to identify all the available properties which suit your needs, and then tour a significant number of them to determine which ones will be best suited for you and ensure that you don’t miss any opportunities. You then need to negotiate with the landlord at each property to receive the best offers for a suitable space for your practice. These offers will include terms for the base lease rate and any increases in the lease rate, as well as concessions such as free rent and an improvement allowance. You’ll also need to know the lease terms and concession that new tenants in your current building are receiving from your landlord. At each step along the way, you’ll be dealing with a professional real estate broker who is hired to achieve the best possible terms for the landlord. If this sounds daunting to handle yourself, you do have an alternative. You can hire an experienced real estate professional as your agent – to act on your behalf with your interests in mind. He or she can provide you with comparable properties’ lease rates, build out allowances, and other concessions, which can then be used as valuable leverage on your behalf in the negotiations with the landlord. Ideally, you should select an agent with experience representing healthcare practices because they will be able to achieve specific terms and concessions that are not generally available to other types of tenants. Your agent will handle all the research and communication with the landlords, while maintaining a professional negotiating posture on your behalf. Fortunately for you as a tenant, landlords and sellers have agreed to pay for an agent’s services on your behalf, so it costs you nothing. Commercial real estate is structured similarly to residential real estate. If you were to sell your home, you might list it with a broker and agree to pay a commission. The commission is split between the listing broker and the broker who brings the buyer. If the listing broker is able to find the buyer directly, then he or she would earn a double commission. The same kind of arrangement is made in the commercial real estate market, and you as a tenant or buyer have access to professional representation at the seller’s expense. Most healthcare providers have plenty to do serving their patients and running a successful practice. Spending hours on end making sure your lease renewal is competitive and handled properly is typically not the best use of your time. Since professional representation does not cost you anything as a tenant, it makes a lot of sense to let a licensed real estate professional review your lease, represent your interests in your negotiations, and then help you capitalize on the current market conditions so you can achieve the best possible terms. Ken Jorgenson is a sales associate with Carr Healthcare Realty, the nation’s leading provider of commercial real estate services for healthcare tenants and buyers. He can be reached at ken.jorgenson@ carrhr.com
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Medical Marijuana Bill Goes Up in Smoke Legislature to Try Again to Pass Marijuana Legislation in 2016 By DANIEL CASCIATO
One of the biggest healthcare legislative issues was snuffed out this past year. The 2015 legislative session adjourned in Florida with state legislators failing to pass any comprehensive medical marijuana legislation. Although Gov. Rick Scott signed into law the strain of marijuana known as Charlotte’s Web a year ago, there have been several blockages in the courts and in the legislature since then. Charlotte’s Web is cannabis low in euphoria-inducing THC which means users are unable to get high. Proponents of the bill had hoped to finally get medical marijuana into the hands of patients who desperately need it, notably those with human immunodeficiency virus, epilepsy, amyotrophic lateral sclerosis, autism, multiple sclerosis, Crohn’s disease, Parkinson’s disease, paraplegia, quadriplegia or terminal illness and to alleviate symptoms caused by a treatment for such disease. The law survived a challenge in the courts but at issue now is distribution. Originally, a lottery was going to determine which five growers statewide could grow and distribute it. That idea was scrapped and a scorecard system had been proposed. Attorney Michael Smith of The Health Law Firm, headquartered in Altamonte Springs, and with offices in Orlando and Pensacola, said the legislature is expected to try to pass legislation again in 2016. Michael “The state has been Smith struggling with this issue
for several years now,” Smith said. “While Charlotte’s Web is approved, it has taken a long time to finalize the rules.” Smith added there had been numerous challenges to the initial rules and several lawsuits were filed. “Numerous appeals were filed. There’s a lot of money on all sides of that issue and everyone is very aggressive in exercising their legal right regarding how that’s to be worked out.” According to the Marijuana Policy Project, in addition to considering comprehensive medical marijuana legislation, the state legislature was presented with legislation that would have taxed and regulated marijuana like Colorado does. The legislation, introduced by Rep. Randolph Bracy, was not brought up for a vote. United for Care, the largest organization in Florida fighting for a medical marijuana law, announced that it would collect the necessary signatures to put the issue before voters in November 2016. In November 2014, a similar
measure received 58 percent of the vote, just shy of the 60 percent needed for voters to enact a constitutional amendment. „We collected over a million petitions in 2014 and nearly 3.4 million people voted ‘yes’ for medical marijuana. There’s no question in my mind that we’ll get medical marijuana back on the ballot for 2016,“ said Ben Pollara, campaign manager for United for Care, in a statement released by the organization this summer. John Morgan, chairman of United for Care, added that the legislature had an opportunity to keep this off the ballot by passing a law. “They turned their backs on the patients of Florida but we can‘t and we won’t,” he emphasized. “We’re going to win this war and help suffering Floridians in 2016. I’ll do whatever it takes to get this done. This is about compassion for hundreds of thousands of very sick people in Florida.” In November, Sen. Jeff Brandes (R-St. Petersburg) proposed new legislation to allow qualified patients with a range of conditions or symptoms to access medical marijuana if recommended by their physician. The bill also establishes a robust and freemarket regulatory approach to the governance of cultivation, processing, and retail sale of medical marijuana in
Florida. “This legislation recognizes the growing support in Florida for the medicinal use of marijuana as an additional option for physicians in the treatment of their patients,” said Brandes. „We build on the best practices of the 23 other states that have legalized medical marijuana. The bill creates a responsible regulatory framework, offers patients with debilitating conditions access to this course of treatment, and focuses funding on valuable medical research.“ The legislation allows a patient with either a specified medical condition or symptom to use medical marijuana as recommended by their physician. The bill licenses cultivation, processing, and retail facilities and fully replaces the existing Charlotte’s Web licensing system. The legislation establishes rigorous requirements over the medical marijuana distribution system, including product tracking and independent laboratory testing. All state tax revenues raised from the sale of medical marijuana are designated for medical research focused on the use of marijuana by patients.
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Healthcare Group Hopes to See Legislation to Improve Access to Care Lack of Access to Healthcare Could Doom Industry By DANIEL CASCIATO
As he looks ahead to 2016, Ken Peach, executive director of the Health Council of East Central Florida (HCECF), is concerned about increasing access to primary care. “If there’s not a way to increase access, we’re going to be in trouble,” he said. The private, nonprofit healthcare planning agency serves the four- Ken Peach county region of Brevard, Orange, Osceola and Seminole. Three key legislative issues the organization would like to see progress on are all models that can increase access to primary care. That’s where its focus has been, according to Peach. “Because of the last short legislative session, we’re focused on the same issues this year as last year,” said Peach. First, the Florida House is hearing a bill, which will significantly expand nurses’ scope of practice. This bill does the following: Allows ARNPs to administer, dispense
and prescribe controlled substances and narcotics. Allows nurse practitioners to practice independently without any physician supervision. “The expanded scope of practice is so clinicians can practice at the so-called ‘top of their license,’ as our state faces a shortage of physicians by 2020,” said Peach. Florida will also attempt to move forward again with telehealth parity legislation. This would prohibit private insurance plans, Medicaid fee-for-service and managed care plan from denying services provided via telehealth. “With telehealth payment parity, physicians may be reimbursed for the time they spend with a patient either in-person or face-to-face using telehealth,” Peach explained. Chris Chowquan, founder of Miamibased Healthchat, a mobile app that allows patients and their doctors to communicate with each other using short, 30-second video messages, believes that telehealth parity legislation should be a priority for the legislature in 2016. «From Healthchat’s perspective, the healthcare issue the state legislature should
prioritize next is reimbursement for telemedicine,” said Chowquan. Chowan said to address shortages of nurses and physicians, and to reduce overall care delivery costs, the healthcare industry needs to more readily embrace telemedicine options. «And physicians must be reimbursed for these patient encounters to accelerate widespread adoption,” he added. Finally, HCECF is watching legislation regarding direct primary care (DPC). The legislation specifies that DPC agreements permit physician offices to offer their health services without falling under state insurance regulations. Rep. Fred Costello (R-Ormond Beach) renewed efforts in August to help clear the way for doctors and patients to enter into DPC arrangements. Costello pre-filed a bill (HB 37) that will be considered during the 2016 legislative session. This would free doctors and patients from the onerous requirements and regulations under the state insurance code. The bill would make clear that the agreements aren’t regulated by state insurance laws. In this fee-for-service model, patients would pay the physician office a fixed monthly
fee for all care received, which means that insurance is typically not part of the mix. Earlier in the year, Garrison Bliss, MD, co-founder of a successful direct primary care practice called Qliance and chairman of the Direct Primary Care Coalition, was part of a panel that provided members of the House Subcommittee on Health Innovation a primer on DPC. Bliss told the subcommittee that although primary care doctors are usually the lowest paid providers, they can play a critical role in transforming the healthcare delivery system and to help expand access to care under the Affordable Care Act. Not only could DPC achieve superior health outcomes, but Bliss mentioned that it can also lower costs and enhance the patient experience. Peach said that HCECF sees DPC agreements as a real solution and a different approach to healthcare. “From our standpoint, direct primary care really changes the parameters,” said Peach. “This would lower the cost of healthcare by allowing patients to purchase primary care directly from the medical office with a catastrophic health insurance policy in place for major expenses.”
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Cancer Genetics Center Now Open, continued from page 1 their appropriate pathways should be, either for intervention, prevention, surveillance or lifestyle changes,” said Rebecca Moroose, MD, Medical Director of the Cancer Genetics Center. Led by Moroose, nurse practitioner Deborah Nosotti, ARNP, and genetic counselor Ryan Bisson, the Cancer Genetics Center focuses on educating and supporting patients through genetic counseling and will extend to genetic testing if necessary. A board certified genetic counselor, such as Bisson, will analyze the patient’s personal and family history, various risk models and determine the patient’s risk of carrying an inborn (germline) mutation that can increase cancer risk above the average rate for the population. Based on the patient’s goals and the calculated risk a shared decision will be made whether to pursue testing and what specific genes should be tested. “Most cancer is not hereditary and therefore genetic testing is usually not needed,” said Bisson. “Our center is able to obtain and analyze the personal and family history in order to determine if genetic testing is appropriate for each patient.” With the advent of the human genome project, and being able to map the entire human genome, Moroose said that more cancer genes have been discovered, studied scientifically, interrogated with family information, and then have ultimately shown to be markers of an increased susceptibility to different cancers. “There are now over 90 different hereditary cancer syndromes,” she said. “In addition, with new genes we are learning about almost monthly, it’s difficult for the general physician, physician assistant or nurse practitioner to keep up with all of that. That is why a qualified, certified
Dr. Rebecca Moroose meets with patients and sisters from left: Nancy Clutts and Beverly Cunningham. Beverly and Nancy are BRCA 1 positive. Beverly is a breast cancer survivor and Nancy underwent prophylactic surgery to reduce her risk of developing cancer in her lifetime.
genetic counselor is the real focus of our center. Clinicians who understand the physical manifestations of cancer genetic syndromes are also important. They understand the guidelines in terms of what happens if you find a patient with a cancer-predisposing mutation—how should that patient be followed and what should be offered to him or her.” According to Bisson, there are many genes associated with hereditary forms of cancer. With new technology, there are many genetic testing options that are difficult to keep up to date with unless your specialty is cancer genetics. “Our center is able to provide the pros and cons of each testing option to patients that are interested in pursuing genetic test-
ing,” he said. “The most appropriate relative to undergo genetic testing is usually a relative with a personal history of cancer. During a genetic counseling appointment with our center, we are able to determine which family member is the most appropriate person to initially undergo testing.” Along with genetic testing and counseling, Nosotti added that the center also offers comprehensive care for patients at high risk for breast cancer based on personal and family factors. “This includes increased surveillance and risk reduction through lifestyle and medication,” she said. “The Cancer Genetics Center was developed to offer genetic counseling and testing for patients who may be at risk for cancer due to a
For more information, visit www.ufhealthcancerorlando.com.
Florida Telehealth Summit, continued from page 1 sity, opened the summit on a positive note with the keynote address, “Telehealth: It’s Here, It’s There, but Not Everywhere.” He encouraged participants to become telehealth champions to their elected officials, in their communities and organizations, and to collaborate to advance telehealth across the state in an effective, powerful and united manner, noted Sirmons. Lunch keynote speaker Curtis Lowery, MD, director of Maternal Fetal Medicine and ANGELS at the University of Arkansas Medical Sciences (UAMS), shared how the highly successful UAMS ANGELS Telehealth Program has transformed the delivery of healthcare to many underserved and unreached residents in rural communities across the country. “His story inspired all to continue to work toward the expansion of telehealth in Florida,” said Sirmons. The line-up of expert speakers produced an outstanding agenda that addressed successful telehealth programs within and outside the state, said Sirmons. Chris Pittman, MD, president of the 12
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Florida Medical Association’s (FMA) Political Action Committee (PAC), and Tamara Demko, JD, of Florida TaxWatch, explained how both organizations view telehealth as a tool that can positively impact the delivery of healthcare statewide. Several out-of-state speakers presented “lessons learned” from their successful telehealth programs, and encouraged participants to continue their good work in Florida, expand programs, and encourage positive telehealth policies with regulators and policymakers. “The interest in moving telehealth forward in the state is strong and those who attended this year’s conference left excited and determined to champion the cause in their communities and organizations from the beaches of the south to the steps of the capitol in Tallahassee,” said Sirmons. Among the programs highlighted: • The NICU at Sacred Heart Hospital in Pensacola is receiving care from a geneticist located in Gainesville; • Many children have been positively impacted by clinical telehealth via the
University of Miami’s Pediatric Mobile Clinic; • Gravely ill patients in south Florida ICUs received care from intensive care specialists located at Baptist Health South in Coral Springs; and • Telehealth is providing improved management of tuberculosis (TB) patients in central Florida. “We’re delighted that this ‘Floridafocused’ summit met our goals of bringing Florida telehealth champions and stakeholders from across our state together to network and move telehealth closer to the day when Floridians can experience increased access to healthcare through the adoption and use of telehealth throughout the state,” said Sirmons. “We appreciate those who supported and attended this summit. Thanks go to Florida State University, Florida Partnership for Telehealth, Florida Telehealth Workgroup members, speakers, sponsors, and most importantly, those who attended. We look forward to another engaging and successful summit next year.”
genetic mutation. The evaluation of risk is based on personal and family factors and follows the NCCN guidelines.” To help its members improve their well-being, health insurance companies like Cigna and United Healthcare are encouraging genetics testing at qualified centers. “Last year Cigna, the health insurance carrier, required that any patient undergoing genetic testing be seen by a board certified genetics counselor,” said Moroose. “In January 2016, United Healthcare will join on board. Cigna’s pilot project last year showed millions of dollars in savings if genetic counseling and testing was done in a qualified center. Patients got more accurate testing in terms of testing for the right genes, while patients who did not require testing did not have this very expensive testing done.” Moroose expects the center to benefit the local community because it offers genetics counseling and testing to anyone in the community regardless of where their medical care is delivered. “When we get our findings and recommendations, we send a roadmap to their primary care physician or referring physician,” she said. “We also offer to patients who may not have a doctor who is comfortable in monitoring them, especially if they were found to have serious mutations, a place where they can come and be scheduled, followed and monitored appropriately. We also help patients facilitate risk-reducing surgeries and other riskreducing strategies.” In 2016, the center will be launching a web-based software that can really help patients compile their family history of cancer, called Their Cancer Pedigree. If the patient agrees, the software will be able to transmit the data to institutions in the state and nationally collaborating in genetics registries. “The Cancer Genetics Center will be doing research with University of Florida, City of Hope, Moffitt Cancer Center, and other institutions to continue to search for important genetic alterations that inform us about cancer risk,” said Moroose. “This will also make it easier for patients to do their preliminary work which is so important for us to analyze when we decide what panel of genes or what types of genes that we need to test if testing is appropriate.” Further down the road, Moroose said they will look at opportunities with collaboration with the University of Florida Gainesville to provide resources for training and outreach. “This is part of our loftier goal to be accomplished in the next calendar year but could be accomplished for something later in the future,” she added. Patients can be referred to the Cancer Genetics Center by their physician or do a self-referral. Interested patients will complete a health inventory and genetics questionnaire and then have an appointment scheduled. The initial visit will take approximately 2 to 2 1/2 hours.
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Helpful Hints in Evaluating Medical Professional Liability Policies By JERI CASCIO
The only thing constant is change. Insurance companies are continually redesigning their insurance policies to cover the ever-growing exposures for clients. Medical professionals can help protect their assets by shifting certain risk exposures to an insurance company for an agreed premium. In return, the insurance company provides immediate legal defense from seasoned claim professionals and policy coverage to provide legal liability protection up to the limit purchased. Here are some basic questions to review with your professional liability insurance counselor to help evaluate various Medical Professional Liability Policies. What types of coverage are currently available in the insurance marketplace? In Florida, depending on the type of professional liability policy, most companies issue a “Claims Made” policy form; there are also a few companies that issue an “Occurrence” policy form, but these tend to be more expensive due to the long “tail” exposure included in the premium. What is the difference between a Claims Made and an Occurrence form? The claim trigger that activates the policy is the difference and here’s why: Claims Made policy form: designed to provide coverage for claims against the insured which are reported to the Company during the active policy period; provides liability protection for medical professional services rendered after the retroactive date and before the expiration date of the policy. With few exceptions, if the malpractice insurance policy is terminated by either the insurance company or the Named Insured, then an Extended Claim Reporting endorsement or “tail” must be purchased to keep the policy open and active in order for claims to be reported. Tail rating formulas vary widely by company and have many factors to be considered, such as length of policy period, exposure, the Insured’s claims history, actuarial claim trends in the medical specialty, the legal environment, and length of reporting period to be provided. Generally, a tail premium range may be anywhere from 175 percent to 250 percent of the mature undiscounted premium. Occurrence policy form: designed to provide coverage for claims against the Insured which occurred during the policy period regardless of when the claim is reported. Since the insurance company may not discover the severity of the claim for years to come from losses claimed to have occurred within the policy period, this policy form is said to have a long tail exposure that can be very unpredictable. Also, the legal environment is always subject to change, and the limit carried previously may be severely inadorlandomedicalnews
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equate by the time the claim is reported, so there may not be enough coverage at claim time, or even worse, the insurance company may no longer be in business. Occurrence policy form premiums are usually much higher than Claims Made premiums due to the unpredictable long tail exposures being factored in, and thus not widely used for professional liability. How much of my personal assets do I want to risk in the event of a large claim? Shifting your risk to an insurance company and choosing the proper limits for your liability is a personal choice and a business decision to consider, based on many factors including: current contractual obligations; the unpredictable legal environment including recent jury awards, and trends in claim frequency and severity for similar medical professions. Consider what limits you are required to carry by contract. What is your estimated legal responsibility? How much are you willing to risk via large deductibles? Are your asset protections reviewed annually? What are your choices? What premium options are available, including any eligible discounts? Each insurance company establishes their own actuarially-sound rates and discount programs which must be filed and approved by the Florida Department of Financial Services (FLDFS). Insurance rates are highly regulated and a lengthy bureaucratic process with many rigid legal guidelines. Typically, premium rates can vary by practice location (territory), limits, deductibles, eligible discounts, medical specialty, as well as claims history – all of which are subject to company underwriting guidelines. Premium payment plans also vary by company – some offer flexible direct bill pay plans; others have only annual or quarterly plans, or possibly offer outside finance company options which incur additional fees. What is the company’s defense posture and what are their historical closed claim results regarding Total Indemnity Paid versus Total Claims handled by the company? Medical professional liability provides protection for claims arising out of the rendering of medical care for which the medical professional is legally responsible. It is very important to have a financially strong and stable carrier that is experienced in defending medical professionals - especially one with a favorable track record. Companies with proactive Risk Management programs and an aggressive approach to defense, backed by a policy with broad coverage (incident sensitive, with defense coverage provided in addition to the indemnity limit), and one that does
not cap legal counsel fees would be most favorable to Insureds. What is not covered under the policy and what are the restrictions? The exclusions in a policy take coverage away, or restrict coverage to the Insured; it’s important to know what the policy does not cover by reading the policy exclusions. Sometimes the exclusion can be covered by purchasing other policies designed to best cover that exposure on a separate basis; sometimes exclusions can be “bought back” for a higher premium. Your insurance counselor should help you navigate the coverage options. What is the policy definition of a claim, and what is the procedure to report to the company a claim or incident that could reasonably lead to a claim? Read your policy carefully to find out how it defines the claim “trigger” and other important claim-related factors, including whether it is based on an incident or an actual demand for money. Find out if a request for records constitutes a claim and what the company procedures are in this area. Be sure the definition of “Insured” and other pertinent policy definitions are broad and well-defined in the policy form. Also, the procedures on how to report a claim to the company should be very clear. How broad is the coverage? It’s important to consider how broad and flexible the policy form is as it relates to your individual needs; evaluating the complexity of your business; anticipating growth needs and your exposures is very important. Does the policy cover only patient injury, or does it extend to other related professional activities, such as peer review, credentialing, and utilization reviews or licensing defense, including Medicare or Medicaid legal liability? Is there additional premium to include staff members? Does it have territorial restrictions in certain geographical areas? Is the entire practice covered including all procedures? Are there endorsements available to customize your coverage needs and what is the premium basis? Key: identify and communicate your particular needs and find out how each would be addressed by the policy. If there is a practice change, what are the company procedures to address increased or decreased exposure? Many times a medical professional will have a change in the practice environment or procedures; is no longer performing; or has additional training. It’s important to have a broad from policy and a flexible company that can address changes and provide premium quotes
upon receipt of your written intent of change. Most all companies require written notice of any/all practice changes as they occur during the policy year, so they will always have accurate current information in their files in the event of a claim. Does the company and/or the agent of the company provide prompt, friendly proactive service and a positive customer service attitude? Good communication, timely information and a friendly professional on the other end of the phone is a must! Customer satisfaction-oriented companies and agents should always be servicing your account. The business relationship should be open, professional, and friendly with prompt easy access. What are the cancellation procedures of the policy? A medical professional may need to cancel coverage due to an unforeseen change in practice, or retirement, et cetera. All policies specify cancellation procedures, however options can vary by company. Some have cancellation penalties (usually either a fee of 10 to 25 percent of the unearned premium). The policy should specify how the company may cancel under different circumstances; what specific procedures would take place; a time frame for each; as well as if the Insured chooses to terminate the policy. Nonpayment of premium cancellations may also forfeit the extended reporting (tail) coverage. All carriers require written notice. These Medical Professional Liability Policy Hints were summarized from MPL section of The Informed Physician’s Guide to Coverage Decisions. Jeri Cascio, AAI, CPIA, PIAM is an Insurance Counselor and Healthcare Division VP at Merrill Insurance. As a Professional Liability Specialist, Jeri has been providing affordable risk solutions and value-added services to Florida Physicians and other Medical Professionals for over 20 years. Jeri Cascio can be contacted by email at Jeri@merrillinsurance.com.
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WHO’S TENDING OUR DOCTORS?
8 Steps to Improve Revenue Cycle Efficiency By LYNNE JETER
Editor’s Note: This article is part of a Medical News exclusive series, “Who’s Tending Our Doctors?” to focus on ways the industry can help alleviate physician stress and allow physicians to return to the joy of practicing medicine. Even though patient care is top priority for doctors, administrative drills remain a nagging worry. To take the pressure off the financial side of a medical practice, the American Medical Association (AMA) recently launched a module on revenue cycle efficiency in the AMA STEP Forward series, aimed at making life easier for physicians nationwide. “An efficient revenue management system is critical for your practice’s financial health and sustainability,” said Dr. Christine A. Sinsky Christine A. Sinsky, MD, FACP, an internist with Medical Associates Clinic, a multispecialty group practice with sites in Iowa, Wisconsin and Illinois, and the AMA point person for STEPS Forward. “Electronic methods can streamline revenue-related processes, such as eligibility checks, claims submissions and payments, all allowing your practice to maximize the amount of time available for patient care.” To improve revenue cycle efficiency, doctors may follow eight steps: 1. Select a practice management system (PMS) that fits your needs. 2. Verify insurance eligibility electronically before every patient appointment. 3. Reduce prior authorization burdens through electronic transactions. 4. Submit claims electronically to save time and money. 5. Determine the status of submitted claims. 6. Leverage electronic remittance advice (ERA) to simplify processing of payment information. 7. Review electronic payment options and make an informed choice for the practice. 8. Maximize collection of patient payments. “As with any technology selection, the ‘right’ PMS for your practice is the one that will best meet the needs of you and your staff,” said Sinsky. “Whether purchasing your first PMS or changing to a different product, first turn your attention inward to your practice. Soliciting input from all staff who use and interface with a PMS and including them in the selection process will ensure that you pick a vendor and product that matches your 14
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practice’s priorities and needs. A thorough analysis of your practice’s revenue cycle process and workflow will provide valuable insight into your system’s requirements. Additionally, this type of analysis will help to identify opportunities for automation through the PMS that will improve the efficiency of your practice.” Verifying insurance eligibility electronically before every patient appointment is greatly underrated. “Ideally, this eligibility check should be performed electronically,” said Sinsky. “Although most health plans allow patient eligibility to be verified over the phone or via a health plan web portal, these methods are often inefficient and may not provide you with all the necessary information.” Because reducing prior authorization burdens via electronic transactions dovetails nicely with the AMA’s belief that prior authorization is overused, the AMA urges health plans to limit the use of these programs to true utilization outliers, instead of broadly applying coverage restrictions to all practices. To reduce the physician’s time spent on prior authorizations, the AMA recommends incorporating a team-based model into the practice routine. (Medical News will cover the teambased model in 2016.) “Ideally, a physician will be aware of drugs’ prior authorization requirements before sending a prescription to the pharmacy, which minimizes the chances of patient medication nonadherence,” said Sinsky, pointing out that electronic prescribing system vendors are in various stages of implementing electronic prior authorization technology. To save time and money, submit claims electronically. “Healthcare claim submission used to require a cumbersome, manual process of completing a paper form, mailing it to a health plan, and waiting – sometimes weeks! – for a response,” said Sinsky. In addition to time and cost savings, “electronic claims submission often speeds heath plan adjudication and payment.” Determine the status of a submitted claim via the electronic claim status inquiry to confirm receipt of submitted claims, and to garner claim status. “Health plans are required to support real-time claim status processing,” said Sinsky. “To electronic eligibility inquiries, practices can also send ‘batch’ transmissions to health plans to check the status of multiple claims at the same time. By law, the practice must receive a response by the next business morning, although some practices report receiving these responses much sooner. Rather than waiting two or more weeks before taking action on a submitted but unadjudicated claim, using the electronic claim status request provides
the practice with an immediate status report on the claim. The practice can then fix a problem, resubmit the claim and lower the days in accounts.” Leverage the ERA, an electronic version of a paper explanation of benefits (EOB), to simplify processing payment information. “Manual reconciliation processes and sifting through stacks of paper EOBs can be sizable administrative hassles,” said Sinsky. “The standardized ERA offers a way for practices to reduce these burdens, more quickly identify those claims that require reworking, and generally have staff spend more time on higher-value activities.” When determining electronic payment options, consider the hassle attached to paper checks, a time-consuming activity that’s ripe for fraud. “Using electronic payment can simplify your practice’s revenue cycle and lead to faster payment from health plans,” said Sinsky, pointing to the industry standard Automated Clearing House electronic funds transfer (ACH EFT). “However, be aware of the benefits and risks of various electronic payment options to make the best choice for your practice.” For example, even though health plans and their vendors may offer supplemental “value-added” services for an additional, percentage-based fee, all health plans are required to offer basic ACH EFT upon physician request and at no additional cost beyond a nominal, per-transaction banking fee of approximately 34 cents. “In addition to ACH-EFT payments, health plans frequently use virtual credit cards (VCCs) for physician claims payments,” said Sinsky. “Practices are charged interchange fees of up to 5 percent of their total payment to receive these VCC payments. In some cases, health plans are receiving cash-back incentives of up to 1.75 percent from the credit card merchants for using this payment method.” Collecting payments at the time of service is the vital first step in any effective patient collections strategy. “Especially because of the growing prevalence of high-deductible health plans leaving many patients to bear additional financial responsibility for their treatment, doing so will increase your practice’s cash flow, decrease accounts receivable, and reduce billing and back-end collection costs,” said Sinsky. In summary, “Every workflow that a practice converts from manual to electronic process will save valuable time and resources while also reducing the overall administrative burdens of practicing medicine,” said Sinsky.
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Obesity Worsens Lung Function in Young Adults with Asthma
Washington University Study Chronicled Asthmatic Patients from Elementary Age to Post College By LYNNE JETER
ST. LOUIS, MO. – A new study following nearly 800 asthmatic patients over 15 years shows the progression toward worse lung function in those who become obese as they age. None of the participants of the Washington University School of Medicine study were obese at the beginning of the research project (ages 5-12), yet 25 percent were obese by the end of the study (early twenties). Researchers reported that pediatric asthma patients who had become obese by their early twenties had measurably worse lung function than those with asthma who didn’t become obese by the end of the study. Surprisingly, both groups showed no difference in the severity of their asthma symptoms. “In extreme situations in adults (morbid obesity), the chest wall is so thick that it interferes with movement and there are decreases in lung function on that basis,” explained Robert C. Strunk, MD, a pediatrics professor at Washington University, who treats patients at St. Louis Children’s Hospital in St. Louis, Mo. “This is a different kind of abnormality (a restriction because of the interference with movement) than we found, which was obstruction due to the airways being more narrow and nothing to do with the chest wall. Others have shown in adults with asthma and obesity (and the same obstruction we found) that there’s likely to be some connection between the airways being narrow and molecules that come from fat tissue and cause inflammation. We didn’t collect data to examine this possibility in our study population, but the obstruction in those who became obese is likely to be related to some type of increased inflammation related to the fat tissue.” Study findings differ from research in older obese patients with asthma, who have more difficulty controlling their symptoms and as a result, need more medications. “Our study suggests that younger obese patients can expect worsening lung function as they age,” said Strunk. “We want to emphasize that doctors and patients need to pay attention to weight.” Strunk noted it’s encouraging that obese young adults in the study don’t report worse asthma symptoms. “But it’s worrisome that their lung
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function has clearly gotten worse,” he quickly added. The CAMP (Childhood Asthma Management Program) research group has published more than 150 articles on the study results, with many publications focusing on the genetics of asthma and/or clinical outcomes. “We’re now working on determining characteristics of the children when they were school age that were associated with the onset of smoking cigarettes,” he said. “In spite of our best efforts and their asthma, yes, some 20 to 25 percent were smokers.” Strunk noticed no difference in outcomes by gender. “Young men and women gained weight and had decreased lung function,” he said. When asked about indications whether asthma symptoms had any effect on gaining weight, Strunk said many thought participants with more asthma symptoms might exercise less and therefore gain more weight. “Or that those who gained weight were the sickest and took more steroid medication,” he said. “Neither symptoms nor steroids were related to the changes in lung function … and thus on gaining weight.” Trial patients were enrolled in CAMP, a nationwide study originally designed to determine best practices in treating asthmatic pediatric patients. In 2000, the study produced a landmark paper in The New England Journal of Medicine that altered the standard of care for children with asthma when it demonstrated that a regular medication routine was superior to as-needed asthma treatments. “That paper launched a whole new approach to childhood asthma management, changing the guidelines for physicians treating those patients,” Strunk pointed out. “We were fortunate to be able to continue following this group of children all the way to their mid-twenties. Nobody had been able to do that before. We could answer a lot of questions with data gathered over such a long period of time.” Because CAMP study patients were only their twenties, they weren’t old enough to have developed COPD. “Good studies show that childhood asthma is a clear risk factor the development of COPD,” he said. Research from the Washington University study was published in a 2015 edition of The Journal of Allergy and Clinical Immunology.
Vascular Vein Centers & Orlando Medical News Open House Join Dr. Sam Martin, Dr. Dan Arnold, Dr. Hugo Hart and the VVC team for an evening of: Casual conversation dedicated to venous and lymphatic disease Tour of our new office Enjoy Heavy Hors D’Oeuvres & Wine Tasting Q&A Networking with other health professionals Compression and lymphatic vendors
Thursday, March 3, 2016 4:00 - 6:30 pm RSVP: mrembert@vvcenters.com or 407-437-0905 Vascular Vein Centers; Waterford Lakes - East Orlando Office 100 N. Dean Rd., Suite 201, Orlando, Florida 32825
JANUARY 2016
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