Orlando Medical News July 2013

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PHYSICIAN SPOTLIGHT PAGE 3

Khristian A. Noto, MD ON ROUNDS

Mending Cherub Hearts

Florida Hospital for Children opens new 10-bed PCICU and launches Johns Hopkins Children’s Heart Surgery Program to provide comprehensive cardiology care

By LyNNE JETER

All Children’s President Jonathan Ellen, MD; Florida Hospital CEO Lars Houmann; Dr. Jeffrey Jacobs, cardiothoracic surgeon at All Children’s Hospital; Dr. Constantine Mavroudis, medical director of the Pediatric and Congenital Heart Center at Florida Hospital for Children; and Martha Silliman, administrator of Florida Hospital for Children officially open the new Pediatric Cardiac Intensive Care Unit at Florida Hospital for Children and launch the new Johns Hopkins Children’s Heart Surgery program at Florida Hospital for Children.

In early June, Florida Hospital for Children leaders Constantine Mavroudis, MD, and administrator Marla Silliman, along with All Children’s Jeffrey Jacobs, MD, executives and more than 300 well-wishers celebrated the opening of the new 10-bed Pediatric Cardiac Intensive Care Unit (PICU) at Florida Hospital for Children and the official launching of the new Johns Hopkins Children’s Heart Surgery program at Florida Hospital for Children.

The red-letter event marked the end of a decade-long journey for Florida Hospital for Children.

(CONTINUED ON PAGE 4)

Quality Outcomes

Orlando Health pilots transparency program at South Seminole Hospital ... 5

Tapping into Hospice and Palliative Medicine

PCPs benefit from services of underutilized specialty ... 9

ONLINE: ORLANDO MEDICAL NEWS.COM

Kaizen Movement Nemours Children’s Hospital embraces lean supply system as part of ‘continuous improvement’ process

By LyNNE JETER

When Nemours Children’s Hospital in Orlando began its lean healthcare cultural transformation journey in 2008, the executive team huddled to define very specific and focused strategic goals, while also aligning all associates in the organization around those goals.

“We’ve achieved great results but still had variation in those results, and we wanted to find something that would really help us catapult our work in a constant quest for perfection in everything we do – the highest

quality, no safety errors, a 100 percent engaged workforce. Clearly, we’re focused around quality and patient care and safety, engaged people, and stewardship,” said Mariane Stefano, vice president of service and operational excellence for Nemours, whose healthcare career began “as a nurse, rummaging through supply closets.”

As part of this quest, hospital leaders began seeking a more efficient and effective management system for medical supplies, the second largest expense for most health systems, accounting for up to 20 percent of hospital costs. They were encouraged to

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learn about a 250-bed pediatric hospital in the Pacific Northwest that recaptured an estimated 48,000 hours for patient care instead of searching for needed supplies.

(CONTINUED ON PAGE 6)

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PhysicianSpotlight

Khristian A. Noto, MD

Colon and Rectal Surgery Specialists of Orlando Health

By JEFF WEBB

LONGWOOD - It has been only a couple of years since Khristian Noto came here to practice medicine. But his broader involvement in the medical community would suggest a longer tenure.

Noto is a member of the three-person, fellowship-trained team at Colon and Rectal Surgery Specialists of Orlando Health. Noto sees patients at the group’s office in Longwood, while colleagues Alice Lee, MD, and Paul Mancuso, MD, staff the office in Orlando. Noto operates at Orlando Regional Medical Center and Dr. P. Phillips Hospital, but said he performs most surgeries at South Seminole Hospital, and that is where he has invested much energy in a progressive quality and safety improvement program.

“For the last year I have been working under the guidance of Thomas Kelly, MD, to improve the quality of care to the surgical patients at South Seminole,” said Noto, referring to the physician who is the chief quality control officer. “There is a tremendous amount of work being done (by) administrators, nurses, technicians, environmental workers and physicians that has already reaped benefits you can see in our Leapfrog scores,” said Noto, “but maintaining high standards and reaching for perfection requires unprecedented collaboration and willingness to think outside the box. What I have found in my limited involvement is that the process, per se, is immensely rewarding even without looking at the outcomes.”

Kelley said he has been impressed with Noto’s contribution as a surgical services unit director on his team. “Dr. Noto was one of the very first physicians I approached because I recognized his leadership skills and his interest in quality initiatives early on,” said Kelley.

Programs like this one will become the new standard for hospitals, Kelley said. “At Orlando Health we are always trying to achieve the best quality care for our patients, which goes without saying.

But we know that with healthcare reform and the Affordable Health Care Act, the economic model in healthcare is shifting from one of volume-based payment to one of outcome-based,” he said. “There has been a major push within Orlando Health in the past 3-4 years to focus our attention on quality of care. There has been a major reorganization of the quality care structure,” Kelley said, and Noto has had a significant role in that.

“It has been a very eye-opening and very rewarding experience,” said Noto.

“Dr. Kelly is a true inspiration ... This is not work that comes easy. There is a lot of trial and error. You really have to push constantly and have a good outlook,” he said.

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But Noto’s so-called volunteer duties reach beyond his work at South Seminole.

He also is very active in the Seminole County Medical Society, where he has “become a tremendous asset,” according to executive director Carrie Pope. Noto serves on the scholarship committee.

“We get to interview super-bright kids from Seminole County and then decide how best to invest the scholarship money.

These are not just bright kids, but rather it is bright kids with a sensitivity for community service who will come back to serve,” he explained.

Noto also serves on the Medical Society’s legislative committee, which took him to Tallahassee in the spring to meet with state legislators and discuss issues important to physicians and patients back home. “We got some good feedback, but it requires more than one visit a year to be heard,” he said.

In addition, Noto serves on the society’s membership committee and will be a delegate at the Florida Medical Association’s annual meeting. All told, Noto’s “constructive input in our committees has proven to be priceless to the organization,” said Pope.

If all that wasn’t enough, Noto also has worked with Hispanic Health Initiatives in Casselberry and the Orange County Colon and Rectal Clinic to raise

awareness about colon cancer and prevention, and said he is exploring “how I can fit into the medical mission” of Harvest Time International in Sanford.

Noto said his practice is “still in a growth period,” but he is very busy. He does major surgeries on Tuesday and Thursday, minor procedures on Monday and Friday, but sees patients and makes hospital rounds five days a week.

His speciality affords him “a threepronged work schedule,” Noto explained.

“You have not only the office and inpatients, you have anal-rectal disease, colonoscopies and advanced colonoscopies. and then you have the abdominal surgeries, which are both open and laparoscopic.

You’re doing a lot of different procedures in different settings, which is very stimulating for me. I not only get to prevent or diagnose cancer, I get to treat it,” he said.

That facet of his work is sometimes difficult, Noto said, noting that he has to break the news to about half of his cancer patients. “Maybe I talk too much, but I want to be very frank with the patients.

I want them to know where we are and talk about all the stages of (the treatment process), and all the possibilities – surgery, chemotherapy, radiation, (or a combination of all three). And I talk to them about the follow-up schedule after surgery. That is very important” because of the inci-

dence of recurrence, he said. He lets cancer patients know “from the get-go that this is not like a hernia operation, where you perform the surgery and move on.

This is a process.”

When he arrives at his Maitland home, Noto’s role changes from doctor to daddy. He and his wife Paola Solari have two children: Marco, 3, and Eva, 18 months. Solari, whom he met while attending medical school in his native Venezuela, is an infectious disease physician who teaches at Orlando Regional Medical Center, he said.

Solari’s parents live with them now, which is “a big help” with the children, he said. “Besides, when I was in medical school, I spent half my time in their house, so now they can stay with me as long as they want!”

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Heart Mender

The 4-1-1 on Constantine Mavroudis, MD, who leads the Johns Hopkins Children’s Heart Surgery program at Florida Hospital for Children

By LYNNE JETER

When world-renowned cardiovascular surgeon Constantine Mavroudis, MD, was recruited to be site director of the Johns Hopkins Children’s Heart Surgery Program at Florida Hospital for Children (FHC), it was an especially appealing invitation to practice medicine among colleagues in a warmer climate than the Great Lakes region.

“Several factors attracted me to Central Florida,” said Mavroudis, who was recruited to Florida Hospital for Children, as director of the Congenital Heart Institute in 2012. “One, I had an opportunity to work with colleagues of 15 to 20 years who are based in St. Pete, and the organizational structure at Florida Hospital and Florida Hospital for Children wanted to partner with All Children’s to develop this program. After All Children’s became part of Johns Hopkins Medicine and I was recruited to Florida Hospital for Children, I liked the challenge of building a new program.”

Mavroudis is a vital part of the sixmember team of heart surgeons among three Johns Hopkins sites, bringing international expertise in the fields of complex congenital heart repairs, arrhythmia surgery, coronary artery surgery in children, and adult congenital heart interventions.

“In terms of operations for newborns to 18, we have a comprehensive congenital heart program, with special expertise in

arrhythmic surgery that’s relatively unique in this region,” said Mavroudis, noting that one of 125 babies in the United States is born with a congenital heart defect.

“We also perform operations that patients with adult congenital heart surgery might need, of which the population of Central Florida hasn’t been well served.”

Florida Hospital recently opened two new operating rooms (OR) specifically designed for pediatric heart surgeries. The unique hybrid OR functions as a place for surgical procedures and a catheterization lab, or electrophysiology lab, and is designed with smaller equipment for pediatric patients that’s also adult-friendly. Ten new high-tech cardiovascular intensive care unit rooms feature a serene, naturethemed environment for care of surgical patients.

“We’ve established a new program that’s working; all the kinks have been removed from the process,” said Mavroudis, who recently led an international symposium in Orlando on arrhythmic surgery and various related issues. “Our clinical results have been excellent, and we anticipate they’ll continue to be excellent. With adults, we had higher levels of complexity and still had a zero mortality rate. That’s noteworthy.”

Mavroudis also sees “blue babies” who previously had surgery to repair their pulmonary valve and then return for a new pulmonary artery to be placed.

“We’ll eventually develop a desti-

nation service for Tournament in 1968 people outside the before earning a region to come and biological sciences be treated,” he said. degree. After graduBorn in Thasos, ating from the UniGreece, Mavroudis versity of Virginia moved with his famSchool of Medicine in ily to the United 1973, he completed States as a toddler. general surgery trainFor years, he visited ing, thoracic-cardioGreece, where his vascular training, and first cousins reside, a research fellowship to perform complex at the University of pediatric cases pro California-San Franbono for the Helcisco. lenic Heart ProMavroudis’ apgram he established. pointments have Unfortunately, the varied from the Unieconomic climate versity of Louisville in Greece is so poor School of Medicine, that he hasn’t visited to Children’s MemoDr. Constantine Mavroudis his native country rial Hospital-Northfor several years. western University, “I regret it,” The Feinberg School said Mavroudis. “I speak the language of Medicine. Most recently, he served as and I’m simpatico with the culture. My Chair of Congenital and Pediatric Cardiofirst cousins and I keep in touch, speaking thoracic Surgery at Cleveland Clinic ChilGreek to one another.” dren’s Hospital and Surgeon-in-Chief for In the United States, Mavroudis the Department of Surgery and Division thrived. Growing up in Jersey City, NJ, Head of Cardiovascular-Thoracic Surhe participated in Boy Scouts, student gery at Children’s Memorial Hospital in government, and varsity sports – football, Chicago. fencing and baseball. At Rutgers UniverA leading researcher, Mavroudis has sity, he was captain of the fencing team published more than 400 peer-reviewed and represented the United States in the articles and book chapters, and recently Martini and Rossi World Invitational (CONTINUED ON PAGE 8)

Mending Cherub Hearts, continued from page 1 “When I came to Orlando 10 years ago, one of the first projects I assessed was whether Florida Hospital was going to start the pediatric heart program the year I arrived,” said Silliman. “We had an approved CON (certificate of need) then, but I told them we probably weren’t ready as an organization to move forward just yet.”

Ironically, the CON was approved three times. “One time, our surgeon on record died in an accident,” she recalled.

“Another time, a surgeon (left) during our transition. So this was our third start.

We had 250 mothers and babies leaving Central Florida. As CEO of the hospital, I wanted to be very careful as we were launching this program. It was highly important to get it right.”

To assist Florida Hospital’s pediatric team, cardiovascular specialists from All Children’s Hospital in St. Petersburg had been commuting to Orlando every Friday for joint conferences and consults, including pediatric patients who were being transferred to the Tampa-area pediatric hospital.

“The families of pediatric patients didn’t want to lose the relationships they’d built with the team in St. Pete because often 4

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families who have surgery when patients are young need to stay connected to these doctors for more surgery,” explained Silliman. “We wanted to keep the relationships strong with the teams that had been developed between Florida Hospital and All Children’s and we agreed to work together.

We jointly went forward with the CON this time, and agreed to create a partnership in a way that would outlive past partnerships.”

In the middle of Florida Hospital’s plan to move forward, Johns Hopkins Medicine (JHM) acquired All Children’s, providing the St. Petersburg pediatric hospital the opportunity to expand its research and academic missions.

“Johns Hopkins has an unbelievable brand,” said Silliman. “A new (executive) came to town (Jonathan Ellen, MD, initially vice dean/physician-in-chief and now president of All Children’s) and we instantly created a collegial relationship and sat down to see how we could best work together. As we were thinking through opening the site in Orlando, a proposal came out of the collaboration that we all accepted. Why not let this be the Johns (CONTINUED ON PAGE 8)

Florida Hospital for Children recently opened the Pediatric Cardiac Intensive Care Unit, adding 10 high-tech cardiovascular intensive care unit rooms to provide critical care for pediatric patients.

Fast Facts about Johns Hopkins Medicine • It’s a $5 billion nonprofit global health system.

• U.S. News & World Report has ranked it the nation’s leading hospital for 20 consecutive years.

• It’s considered the birthplace of modern pediatrics.

• The first “blue baby” operation to correct a congenital heart problem took place in 1944.

• Leo Kanner, MD, conducted groundbreaking research with autistic children in 1943, becoming the first physician to apply the word “autism” to the childhood psychiatric disorder.

• John Howland, MD, pioneered discoveries, such as fluid replacement for diarrhea.

• Edwards Park, MD, defined Vitamin D’s role in bone loss.

• George Dover, MD, serves as director of the Johns Hopkins Children’s Center and chairs the Department of Pediatrics for Johns Hopkins School of Medicine.

• Johns Hopkins scientists typically receive the greatest single chunk of federal research money; $435 million in 2009.

SOURCE: Johns Hopkins Medicine.

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Quality Outcomes Orlando Health pilots transparency program at South Seminole Hospital

By LyNNE JETER

Orlando Health is taking its quality and patient care initiative to the next level.

The Central Florida-based healthcare organization rolled out its pilot data transparency program at South Seminole Hospital in Longwood to share medical outcomes with patients and their families using digital technology inside the hospital.

Digital boards located in patient care units now display information about the number of patients with blood infections, blood clots, urinary infections, falls with injury and bed sores. Readily accessible data includes the actual outcomes, the hospital’s goals for the outcomes, and information about ways families and visitors can help ensure a healthcare environment of quality and safety.

The organization began the quality and safety transparency program at South Seminole Hospital in Longwood on Feb. 20.

“Hospital data has a long history of being reported to government agencies and regulatory entities,” said Thomas Kelley, MD, chief quality officer for South Seminole Hospital. “And in recent years, hospital Dr. Thomas Kelley data has become more publically accessible through government reports and other annual releases of information for old or outdated data. What we’re doing is new and different from two

Digital boards at South Seminole Hospital

perspectives – one, we’re bringing our information directly to patients; and two, we’re sharing very current data.”

For example, the first digital board reveals zero falls with injury during the first quarter of the fiscal year for the Progressive Care Unit. The hospital’s goal was zero. Another example, five patients developed a blood clot during hospitaliza-

tion within the same time period for the same unit. The hospital’s goal was zero.

The first quarter time period is from Oct. 1 to Dec. 31, 2012. The hospital’s fiscal year period is Oct. 1, 2012 to Sept. 30, 2013. The digital boards are updated monthly to reflect the previous six-month period. However, the initiative launches with only three months because the timing follows the start of the fiscal year.

“We recognize this is new territory for hospitals and patients,” said Jamal Hakim, MD, chief of quality and transformation for Orlando Health. “Few facilities are so transparent and Dr. Jamal forthcoming with this Hakim kind of information. We see this as not only an opportunity to share specific information about our outcomes, but also as an opportunity to educate the public about our initiatives, what we’re doing to improve, and cultivate a more open dialogue with our patients and their families to discuss steps we can all take to ensure better health in the hospital and at homes in our community.”

For example, components of Orlando Health’s falls prevention strategy include nurses checking on patients’ needs hourly, limiting medications that cause dizziness, and educating all patients and families about fall prevention. Also, the initiative to prevent blood clots includes new software and a risk factor assessment to

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ensure clinicians more readily identify, evaluate and treat patients at higher risk.

Clinicians and other team members involved in the initiative communicate meaningful information about the data with patients and families, and also address questions or concerns.

“We recognize every outcome won’t be easy to share and we recognize every question from a patient or family member won’t be easy to answer,” said Kelley.

“We’ve always been committed to quality care and we’ve always sought ways to improve. This new journey allows us to share more information, and share it more often, strengthening our commitment to accountability. Educating patients and families about the reasons behind the hospital’s safety and quality requirements and expectations contributes toward diminishing the normal concerns and anxieties associated with a hospital stay.”

The initiative is part of Orlando Health’s new model of care that places the patient first by promoting seamless coordination of all aspects of the patient experience by delivering integrated, high quality, outcome-driven care. Healthcare teams continue to review data and use it to identify opportunities for continued improvement in patient care.

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Kaizen Movement, continued from page 1 The executive team embarked on a study trip to Autoliv, a manufacturer of air bags and other components for the automotive industry, followed by a tour of the Toyota plant in Kentucky to see how lean tools and principles impacted the end product.

“It was totally fascinating to see how a fully lean manufacturing system works,” said Stefano.

The team’s next stop: Seattle Children’s Hospital and Research Institute, now a 400-bed pediatric hospital that’s been on a lean journey since the late 1990s.

They met with Charles Hodge, the primary architect of the health system’s redefined supply chain processes, BlueBin, which had immediately garnered significant savings and cost reductions.

“We saw firsthand how these tools that were being used in the automotive manufacturing industry could easily be applied to a healthcare environment,” said Stefano. “We knew the tools and principals of a lean environment could really help in terms of problem solving, removing waste and inefficiencies from our system, and making sure that everything stays focused on the customer.”

When the team returned to the east coast and gathered around the Nemours table, “we knew this is exactly what we needed as part of our organizational transformation journey. We were sold on it once we saw how it worked.”

Nemours is only the fifth hospital in the nation to adopt the unique supply management system.

“This is still relatively new in the healthcare industry, and I like to think we’re at the forefront of this work,” said Stefano.

Nemours implemented BlueBin three months before the children’s hospital opened last October, a timeline that proved challenging and in hindsight was “way too fast,” said Stefano, primarily because of changes in the vendor and supplier distribution flow.

“It was a very fast process and we had bumps in the road,” she explained. “We had to change our main supplier to make sure we had suppliers that would work in this type of Demand Flow system and would be willing to deliver supplies daily rather than weekly, and in the quantity we needed instead of bulk. If we need 10 Band-Aids for a supply unit, that’s now what we get.”

The investment of upfront manpower implementing the system “will be recouped 10 times over,” said Stefano. “One, you’re no longer holding inventory so that cost decreases; two, the most powerful point of the BlueBin system is that it takes the clinical staff totally out of the supply management work.

“I remember 30 years ago as a nurse, I’d be hoarding supplies because we’d often run out of them. I’d get a call for supplies and have to run to the supply room and put in purchase orders. I spent too much time chasing supplies instead of patient care. Now the nursing staff doesn’t have to do anything but go to the supply room and pick up the supplies waiting for them. They’re so happy!”

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Visionary Clarity Expensive technology not needed. Barcodes are the key.

Get rid of the warehouse. And take doctors and nurses out of the inventory control process.

Charles Hodge gave that advice on ways to streamline hospital supply inventory in 2009, when he served as chief procurement officer and vice president of supply chain management at Seattle Children’s Hospital.

healthcare industry’s supply management realm.

Hodge’s just-in-time inventory system eliminated the hospital’s need for its $5 million, 40,000-square-foot warehouse and millions in inventory. In its first year, the $200,000 system achieved a $2.5 million return, said Hodge.

Particularly because the supply management process was new to the hospital industry, executive sponsorship was critical for BlueBin to succeed, said Hodge.

At the time, Hodge was in the midst of a four-year journey at the major pediatric referral center to implement BlueBin, This is Charles Hodge from BlueBin touring healthcare/hospital representatives during the “There’s no substitute for a smarter inventory process GEMBA Walk at Nemours last Friday. executives who are firmly involving barcodes, simple committed to continuous bins and basic wire racks at key traffic areas and points of care. He process improvements,” he said. “Make sure you secure their strong had developed BlueBin after working in the automotive industry for support and communicate your results early and often to keep the 15 years, and transferring its lean manufacturing processes to the momentum in place.”

The BlueBin Demand-Flow Supply Replenishment Model

A dedicated supply technician uses kanban scanning to initiate the automated supply management process.

Here’s how it works:

• Supply areas are stocked with two bins for a particular supply.

• The front bin holds a specified level of supplies.

• When the last item of the front bin is used, nurses place it in a designated holding area, triggering a replenishment order.

• Then, nurses pull the second bin to the front.

• Before the second bin is emptied, the first bin’s supplies will have already been reordered, restocked and replaced in the supply area.

SOURCE: BlueBin Inc.

Meeting of the Minds Last month, healthcare leaders from around the country converged at Nemours Children’s Hospital in Orlando to see a unique supply management system that ends the time-wasting task of hunting and searching for supplies, while also ensuring the patient care team has needed equipment to treat its young patients.

own supplies and supply rooms began bulging at the seams because they were so afraid of running out. Now I can say these problems are completely gone; the process has been amazing.”

Before opening its doors last fall, Nemours implemented BlueBin, a lean supply management system found in only five hospitals in the United States: Seattle Children’s Hospital; Mercy Hospital and Medical Center, Chicago’s first hospital; Presbyterian Hospital in Albuquerque, NM; and Martin Health South in Stuart.

“Before, things were just wherever there was a spot for it,” said Linda Landers, a patient care technician in the surgical intensive care unit (SICU) at Martin Health South in Stuart. “Now there’s a flow to it.”

“Before we implemented BlueBin, our store rooms were being overused and we weren’t centralizing the purchase of supplies,” said Rick Cerceo, executive vice president and COO of Mercy. The 410-bed acute care hospital transitioned to the BlueBin system in July 2011. “Our staff was running out of supplies, which delayed procedures and patient care. This forced nurses to start ordering their

When Martin Health South implemented BlueBin, the rollout schedule began last summer in various ICU areas and concluded in February.

Nemours’ Alfred I. duPont Hospital for Children in Wilmington, Del., is the sixth location deploying the BlueBin system.

Touring Nemours to see how BlueBin works were representatives from Stanford’s Lucile Packard Children’s Hospital, Oregon Health & Science University, UCLA Health, the University of Michigan Health System, and Vancouver Coastal Health.

Supply Chain Process Redefined Hospital executives typically knock on Charles Hodge’s door because they have a “burning platform” or are taking the next step on their lean journey.

I implemented the BlueBin system at Seattle Children’s Hospital, other hospitals started calling me, asking how we did it, and the timing seemed right to start my own consulting firm.”

“I often hear something like, ‘My supplies are out of control and nurses can’t find anything,’” said Hodge, president of BlueBin Inc., a Seattle-based supply chain solution provider for healthcare organizations he established in April 2011. “Or they want to think about pull systems to implement their lean journey.”

With the BlueBin system in five hospitals across the nation, from brand new to nearly 160 years old, and in the midst of the sixth system implementation, Hodge said consulting groups are quite interested in learning more about the lean manufacturing conversion from the automotive to the healthcare industry.

Hodge, the primary architect of BlueBin, may perhaps seem to be an unlikely source of such an innovative, low startup cost supply management system. His career began in 1993, after earning a business administration degree from California State University. An MBA from the same university in 2001 helped him traverse growing roles of responsibility in capital equipment, electronic chemicals, and automotive manufacturing sectors. Before joining Seattle Children’s Hospital, where he rose to chief procurement officer and vice president of supply chain management, he served as regional director in charge of supply chain management operations for Sutter Health’s peninsula coastal region, and a member of the health system’s corporate strategic sourcing group.

“For example, Joan Wellman & Associates is the consulting firm for Nemours that brought us together,” he said. “When hospital leaders start to think about hospitals more like a manufacturing environment, the supply chain bubbles up as a problem because traditional management systems (like the par cart and automation methods) haven’t been changed in decades, and they just don’t work very well. They only work because clinicians and technicians are heavily involved in managing their own supply chains.

“I took the lessons learned from kanban systems and applied them to elements of patient flow and care delivery,” said Hodge. “After

“Our program says no to that. Get those folks back to the patients, the bedsides, and the families. Let the supply chain do it all, and more efficiently. No inventory. No stat calls. No urgencies. No ‘hey, where is this?’ No off contract purchases. It saves a lot of money, space and time, and gives that time back to the patient.”

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Mending Cherub Hearts, continued from page 4 Heart Mender, Hopkins Children’s Heart Surgery program with one standard and multiple sites, so that care can be delivered in the communities where we partner, as if it had one oversight with the Hopkins name? We all agreed it would be an ideal program, that Florida Hospital could have all of its patients from within its network, and keep it local. The surgeons would all be one team, all appointed at Hopkins. Where it mattered, we’d do joint database submission, joint research and publications, and we’d have one quality of standard that could serve over 1,000 children a year, and jointly be a leading national pediatric hospital and a collaborative model to other programs.”

The contractual agreement began a year ago, followed by many months of training to one standard.

“Doctors and nurses were trained, and administrators were at the table,” said Silliman, noting the first surgery took place last September. “We’ve had close to 90 surgeries with zero mortality … and we’ve The new Johns Hopkins Children’s Heart Surgery program at Florida Hospital for Children is a joint collaboration with All Children’s in St. Petersburg, a 259-bed pediatric hospital that became a Johns Hopkins Medicine member in 2011, and Johns Hopkins Children’s Center in Baltimore, Md.

clearly had good, healthy volume in the program with great outcomes and strong oversight. Every week, partners from all sites teleconference to review potential surgeries.

Working as a team, patients having surgery in Orlando are also getting input from Baltimore and St. Pete. We couldn’t be more pleased with the level of collaboration. The unit opening was a great milestone for us to have a physical space, and it was a visual moment for us of a progressive relationship.”

Orlando Pediatric Cardiology Standings When the new Johns Hopkins Children’s Heart Surgery program was officially launched at the Florida Hospital for Children in Orlando, many local patients and their families were able to stay closer to home.

“Orlando didn’t need another pediatric open-heart program,” said Bill DeCampli, MD, co-director of Orlando Health’s Arnold Palmer Hospital for Children Arnold Palmer’s heart center, adding that another program would dilute expertise because of reduced volume at both places.

Florida Hospital CEO Lars Houmann disagreed, pointing to a global view of the move.

“Each time we add to the services we have available, we’re on mission,” he said.

“Our goal is to be a destination.”

In 2015, Nemours Children’s Hospital in Lake Nona Medical City plans to initiate a pediatric heart-surgery program, according to Nemours CEO Roger Oxendale.

continued from page 4 published the 4th Edition of Pediatric Cardiac Surgery, which has been the gold-standard reference for pediatric and adult clinicians in the field. His professional leadership positions have involved presiding over the Southern Thoracic Surgical Association in 2002, and the Congenital Heart Surgeon’s Society from 2004 to 2006.

Other reasons why Mavroudis, who turns 67 on July 19, was attracted to Central Florida? The warmer climate for his wife of nearly 30 years, Martha, an artist and gourmet cook, and a longer triathlon competition season for him.

“When we lived in the north, I could compete in three to four triathlons a year at the most,” said Mavroudis, who has completed 11 marathons and 34 triathlons in the United States. “Here, I can compete in eight to 10 triathlons, maybe 11 a year, with great pleasure and frequency.”

Their firstborn, Paula Carrie Mavroudis, 28, a graduate of the University of Iowa, is a senior account executive for Edelman Public Relations Firm in Chicago. Their son, Constantine David Mavroudis, 26, is a fourth-year medical student at the Loyola University Chicago Stritch School of Medicine, planning a career in cardiothoracic surgery.

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aap.orlandomeetinginfo.com (CONTINUED ON PAGE #)

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Tapping into Hospice and Palliative Medicine PCPs benefit from services of underutilized specialty

By LYNNE JETER

Not long ago, hospice referrals for end-of-life care were typically made only a few weeks before the patient’s death.

Now, good hospice referrals are made six months to a year in advance to allow time for patients and their families to transition to the final phase of life. Palliative care comes in sooner for patients suffering from serious illness, with specialists having the advantage of focusing on the patient, not the disease.

“Just about any patient with a serious, life-limiting illness can benefit from palliative care,” said Robert Lehmberg, MD, FACS, assistant professor of hospice and palliative medi- Dr. Robert Lehmberg cine at the University of Arkansas for Medical Sciences (UAMS). “It improves the patient’s quality – and sometimes length – of life.”

Hospice is definitely underutilized in the United States, said Derrick O’Connell, RN, MBA, chief quality officer for Esse Health, a St. Louis-based practice group with nearly 100 Derrick O’Connell physicians and specialists.

“There are barriers to hospice because of the inability to confront mortality as a psycho-social issue,” he said, “and barriers within the medical community to refer patients to hospice because physicians and their teams may feel they’ve failed in the medical management of a patient.”

Miguel A. Paniagua, MD, FACP, concurs.

Because so many great technological advances in medicine have been made, he said a patient’s treating physician may view their death as failure. Dr. Miguel A. Paniagua O’Connell, a former hospice manager, said the emerging Patient Centered Medical Home (PCMH) model has a mechanism in place to assist primary care providers (PCPs) with the transition of patients to hospice and palliative care.

“Primary care providers and their teams can facilitate the documentation of advanced directives for each patient,” he explained. “Each patient is counseled on choices in the event of a life-ending medical condition or event. It’s important when provider teams recognize that the patient is nearing the end of their life cycle and can begin the patient-centered collaboration for appropriate end-of-life care with a statement like: ‘there’s nothing more medicine can do for you. We’d like to refer you to hospice care because they’re experts at keeping you comfortable at end-of-life care and can enable

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Palliative v. Hospice Care

Outside the Box

Palliative care: • provides comfort and relief from pain and other distressing symptoms; • is meant to neither hasten nor postpone death; •integrates the psychological and spiritual aspects of patient care; • affirms life while regarding dying as a normal process; • assists patients in living as actively as possible until death; • helps the family cope during the patient’s illness; • uses a specialized team approach including physician, nursing, chaplaincy and social work; and • is provided in conjunction with therapeutic treatments such as chemotherapy and radiation.

Hospice: • focuses on caring, comfort and dignity at end of life; • provides relief from pain and other distressing symptoms; • is meant to neither hasten nor postpone death; • integrates the psychological and spiritual aspects of patient care; • helps the family cope with the patient’s end of life and their own bereavement • uses a specialized team approach including physician, nursing, chaplaincy and social work.

you to die with dignity.’”

Paniagua, associate professor and director of the Department of Internal Medicine Residency Program at Saint Louis University (SLU) School of Medicine in Missouri, said a smooth transition is easier when the primary care provider (PCP) team clearly communicates the endof-life plan with patients.

“We similarly teach many high-tech and high-reimbursing procedures in medicine, but in my view, the most delicate and nuanced procedure we can teach and learn is the bedside conversation about goals of care and treatment planning,” he said.

“Like any procedure in medicine, there are effective and ineffective ways of doing it. Unfortunately, not enough emphasis is

placed on teaching and learning this procedure, which leads to much variability in the way it’s delivered, as well as providers’ discomfort and unease with doing it.”

Paniagua also noted that mainstream media’s sensationalized coverage of euthanasia and physician-assisted suicide issues has hindered progress in the advancement of the specialty and public perception.

“In reality, (euthanasia and physicianassisted suicide) is such a miniscule practice, and in only three states,” he emphasized. “But my view is that too often patients feel they have no other way out of their suffering. More often than not, we providers don’t do an adequate job providing palliative care to most of the

When it was established 25 years ago, the American Academy of Hospice and Palliative Medicine (AAHPM) had 250 charter members. Now, the professional organization has 5,000 members.

Yet even though four of five larger U.S. hospitals now have palliative care programs, and consultations for the specialty have spiked, new growth isn’t keeping pace with the coming demand.

New hurdles hinder progress – a rapidly aging baby boomer generation coupled with the existing senior population, continued segmentation of care, and limited funding for specialty training programs.

AAHPM leaders recently proposed a solution to the specialty shortage problem: Timothy E. Quill, MD, FACP, and Amy P. Abernethy, MD, FACP, president and president-elect of the AAHPM, respectively, suggested reserving palliative medicine physicians for more challenging cases, while also increasing the palliative skills of primary care providers (PCPs) and specialists who see patients daily.

Using their model, PCPs would receive appropriate education to address management of pain and other symptoms and other basic palliative care needs. Palliative medicine physicians would be called in to manage difficultto-treat pain, complicated depression, anxiety and grief and other more complex needs.

SOURCE: AAHPM.

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For the seniors who decided to retire in the Sunshine State, there is a great desire to live as independently as possible, for as long as possible. But the reality is, with age, also come the health complications that threaten this independence. So, what options are out there for those who are in need of healthcare support?

Right here in the heart of Florida are

By JENNIFER DAVID, RN, BSN, MHA

Florida is a best known for being the place where retirees go and live productive lives with the warm weather and year round sunshine! There is no better place to enjoy life and do the things they like to do indoors and outdoors. As Floridians, they have learned that they must do all outdoor activities earlier in the day, before the afternoon showers get the chance to

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There are hospitals in the state that have been ranked high relative to the specialties in cardiology, diabetes, trauma, etc. For those who need additional care following either a hospitalization or an acute illness, there are multiple rehab centers, skilled nursing and outpatient facilities that can supplement their needs. Hospice care is also available for those who need it. And then, there is home healthcare.

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Home healthcare is a cost effective way to provide healthcare in the comfort of one’s home. Services can include Skilled Nursing, Physical, Occupational and/or Speech Therapy, Medical Social worker and home health aides as needed. As long as a patient is homebound, Medicare will cover for these services at 100 percent.

With a prescription from a licensed physician, these professional healthcare providers are able to come to the home and be the eyes and ears of the doctor/s relative to the condition of the patient and the progress or lack of progress, whichever the case may be, so that appropriate action can be taken to help the patient meet his/her healthcare goal.

Skilled nursing visits are focused not just on monitoring vital signs, but also on medication reconciliation, diet management, and most importantly, patient education of the disease process. The more the patient understands their health status, the better they can participate in their care and be more compliant with follow through, thus reducing the risk for rehospitalization.

Skilled physical therapy can be multi faceted. For patients who are at a high risk for falling in the home, an environmental evaluation is completed as well as a comprehensive assessment that identifies why the patient is falling in the first place.

Once the comprehensive assessment is completed, a targeted approach toward addressing the root cause of the fall can be designed. Physical therapy in the home is always tailored to the patient’s needs.

Sometimes, due to cardiac, neurological and/or pulmonary complications, physical therapy is primarily focused on caregiver education, positioning supports, assistive devices, body mechanics and establishing a home exercise program that the patient can perform with assistance from the caregiver.

Regardless of the health issue, the skill of the Physical therapist is invaluable in the total recovery and achieving of maximum rehabilitation potential.

Skilled occupational therapy services help a patient regain as much independence in activities of daily living as possible. Appropriate exercises are designed by these professionals geared towards a patient performing self care with the least amount of energy expenditure. Sometimes assistive devices such as shower chairs, grab bars, long handle shoe horns, to name a few, are recommended to make showering and dressing easier to accomplish independently. For those who fatigue rather easily with minimum exertion, occupational therapists work with them on energy conservation strategies and work simplification.

Speech therapists are not just experts on helping patients regain the ability to speak or express themselves after a stroke or a neurologic problem. They also help with the patient’s ability to receive and understand information, increase reading comprehension, improve chewing and (CONTINUED ON PAGE 12)

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Noncompetes are Once Again Relevant for Recruited Doctors

By JEFFREY L. COHEN

When the Stark II (Phase III) regulations were released in August, 2007, they clarified that when a hospital recruits a physician to a medical practice, the employment agreement between the medical practice and the newly recruited physician may contain practice restrictions as long as they do not “unreasonably restrict the recruited physician’s ability to practice medicine within the recruiting hospital’s service area. This stymied many medical practices which were reluctant to hire a new physician without a noncompete and nonsolicitation provision. A 2011 CMS Advisory Opinion (No. CMSAO-2011-01) changed this.

The Advisory Opinion involved a pediatric orthopedist who was recruited by a hospital to a medical practice. The medical practice wanted to hire the new doctor, but was not willing to do so without a noncompetition provision and other restrictive covenants. The practice asked CMS for guidance because the Stark regs suggested that perhaps a noncompete could not be contained in the employment agreement of a physician recruited by a hospital to join a local medical practice.

In fact, a prior version of the Stark regs was clear that noncompetes were not permitted in the employment agreements of physicians recruited by hospitals.

Hospital recruitment transactions involve bringing a physician into a new area and funding the start up period (usually a year). The nice thing for a medical practice is that the dollars given by the hospital to the practice (the difference between salary and benefits and collections) can run into the hundreds of thousands of dollars!

The down side was that the medical practice could not tie the recruited physician’s hands with a noncompete or other similar restriction. The Advisory Opinion is, however, a game changer because it allowed the medical practice to impose a noncompete on the recruited physician.

As mentioned, the practice would not hire the recruited physician without the noncompete. The noncompete had a 25 mile radius, and the Opinion cited the following relevant facts: • The recruited doctor would remain on one of five hospitals within the 25 mile zone; • The recruiting hospital’s service area extended beyond the 25 mile zone, in which there were at least three other hospitals within a one hour driving range; • The noncompete complied with applicable state law.

Based on these facts, the OIG permitted a one year noncompete because it did not “unreasonably restrict the doctor’s ability to practice in the recruiting hospital’s service area. Certainly, many other medical practices can be sure to follow suit.

Physicians interested in nocompetes orlandomedicalnews

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Thomas Edison once predicted, “The physician of the future will give no medicine, but will interest his

patients in the care of the human frame, in diet and in the cause and prevention of disease.” While his vision has not yet materialized, recent trends in health care indicate a shift in that direction. Although it is likely that most 21st century healthcare providers will continue to “give medicine” as well as prescribe other forms of high-tech care, there are signs that these practices will more often occur in a holistic context that encourages self-care and supports self-healing and wellness.

must be familiar with state law. Getting to the bone of the issue, noncompetes are enforceable in Florida if: The geographic zone in the noncompete is reasonable. This depends on where the practice draws its patients. If patients come to the practice from just down the street, a ten mile radius is probably overbroad; • The duration is two years or less (though it can be longer in some limited circumstances); • The employer has complied with all of the terms of the employment agreement. If the employer has breached the contract that contains the noncompete, most courts will reject a claim to enforce it; • The employer does the type of thing that the departing employee does. If the employee is the only person performing toe surgery for instance, and the practice will not provide toe surgery services once the employee leaves, the practice probably does not have a legitimate business interest to protect by enforcing the noncompete; and • Stopping the ex employee from practicing in the geographic zone does not create a healthcare crisis

or shortage. This is tough. Very few practice areas are in such dire straits that the departure of one doctor will adversely affect the provision of such services in the area. Physicians should also be familiar with the practical aspects involved in noncompetes.

Mistake 1 - Racing to litigation Going to court is a crap shoot. Once litigation begins, it takes on a life of its own and costs can be nuts, sometimes in the hundreds of thousands of dollars. You may think it’s a simple noncompete case.

There rarely is such a thing. And if you sue someone on a noncompete breach, they may turn around and sue you in the same lawsuit for something. And...insurance does not cover any such claims. That means you are paying out of pocket for a lawsuit, the certainty of which can never be guaranteed and which will seem endless once you run out of patience or money for the process. Often, the reality is that noncompete litigation involves the strategy or seeing which party can outspend the other one.

If you are an employer, ask yourself the following two questions before com-

mencing litigation: • Does it make good economic sense to enforce the noncompete? Is the former employee a business threat?

• Is there a way to work out a deal with the employee, short of litigation?

In some situations, it makes no business sense to pursue a noncompete. For instance, if the employee has been employed for several months and if the patients are all referred by the employer, then the employee may not be a competitive threat to the employer.

The employer will find a replacement doctor at some point and refer the business to the new doctor. Case closed.

It is also possible to work out settlements before going to court. For instance, you might avoid litigation by lowering the geographic zone or the duration.

You might also negotiate a buy out of the noncompete.

If you are an employee who wants out of the noncompete, sit down with the employer and see if you can agree on a way out, so that both of you can have peace and move on.

(CONTINUED ON PAGE 12)

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Health care business seminars are sold on an individual basis, giving attendees the ability to create their own educational experience. Come learn from business pros. Early seminar registration is encouraged since seating is limited for each seminar.

More Information – Contact Larry Henry, St. Louis Medical News Phone: 314-917-6107 Email: lhenry@medicalnewsinc.com Seminar Registration – Seminar registration begins July 26. You can register on-line at www.stlouismedicalnews.com where you can also view detailed information about each seminar.

Directions – Physicians Business Conference will be held at the Sheraton Westport Lakeside Chalet at 191 Westport Plaza, St. Louis, MO 63146. We suggest those flying to St. Louis Mapquest directions from Lambert International airport to the Conference site.

Hotel Accommodations – Rooms can be booked at the conference site for $99 per night when you register for seminars at www.stlouismedicalnews.com.

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Noncompetes are Relevant, continued from page 11

Mistake 2 - Doing it Yourself Noncompetes are governed by state law. There are both statutes and cases that inform lawyers about what types of noncompetes are enforceable and which are not. Do not work off of an old contract to create a new noncompete, since the laws (and the cases that construe them) change often. Do not use a friend’s noncompete, since you will not be able to tell if it will be enforceable at this time or under the circumstances that apply to you. The enforceability of noncompetes is extremely fact specific. Since noncompetes are strictly construed by courts, drafting them requires a trained eye.

The Advisory Opinion marks a significant development in the area of noncompetes for physicians recruited to medical practices by hospitals. Though some states do not allow noncompetes to be applied to physicians, many states do, including Florida. Finding a way to satisfy both the federal and state authorities will be essential for ensuring an effective and enforceable noncompete.

With over 24 years of healthcare law experience following his experience as legal counsel for the Florida Medical Association, Mr. Cohen is board certified by The Florida Bar as a specialist in healthcare law. With a strong background and expertise in transactional healthcare and corporate matters, particularly as they relate to physicians. Mr. Cohen can be reached at www.floridahealthcarelawfirm.com

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Tapping into Hospice, continued from page 9 suffering.”

Lehmberg, who switched specialties to hospice and palliative medicine after a neck injury prevented him from continuing his nearly 30-year plastic surgery practice, said the most common misperceptions about the specialty are the differences between palliative care and hospice, and getting the team involved early enough to “truly assist the patients, their families and the treating physicians.”

“Most people, physicians included, think of us only in terms of hospice and end of life,” said Lehmberg. “However, palliative care improves the quality of life of patients and their families with lifethreatening conditions through the pre-

vention and relief of suffering, and also the treatment of pain and other problems – physical, psychosocial and spiritual.”

Palliative care may be extremely helpful to physicians and patients in conjunction with therapeutic treatments, such as chemotherapy and radiation, said Lehmberg, noting that requests for hospice and palliative care consultations for the UAMS Department of Hematology and Oncology has increased significantly – from 400 in 2007 to more than 2,200 estimated this year.

“As evidenced by our program growth, an awareness of the role of palliative care is increasing,” he said. “Still, I’d like to continue to contribute to a

better understanding of our subspecialty and how we can help. Once a patient has been diagnosed with a life-threatening illness, it’s really never too early to involve a multi-disciplinary palliative care team.”

Palliative care transitions to hospice care when the illness progresses to the point that therapeutic treatments are no longer applicable, explained Lehmberg.

“In palliative care, an experienced team is best at fitting in with the primary medical approach, not rivaling it,” said Lehmberg.

“As consultants, the palliative care team … complements the treatment and care provided by the primary physicians.”

Home Healthcare, continued from page 10 swallowing skills as well as learn exercises to improve breath support for those who have difficulties coordinating their breathing with their speaking. Those who end up with aspiration pneumonia, for example, can benefit from speech therapy evaluation to determine if there is a swallowing issue.

Medical social workers are an integral part of home healthcare. They are able to support the patients with information related to community resources. Incidents of depression can be high in the senior population due to the limitation or complete lack of independence. For this reason, the medical social worker is helpful in providing short term counseling.

Choosing your home healthcare provider is up to you. Under the law, you have the right to choose your healthcare provider so be sure you find out about your alternatives.

Look for home healthcare with a strong reputation for compliance with state and federal regulations, high standards for hiring clinicians and a focus on continuing education. It is also important that your provider be large enough to have the resources and knowledge base to keep up with the latest advances in care and best practice. A provider treating hundreds of thousands of patients annually can use its vast experience to identify the best courses of treatment for many

health problems that it can then apply throughout its organization Choosing the option of home healthcare – from the right provider – can make all the difference in helping a loved one achieve his/her highest level of independence and continue to enjoy the Florida lifestyle they he/she came to the Sunshine state for!

Jennifer David, RN, BSN, MHA is a Home Health Clinical Specialist with Gentiva Health Services. She graduated from Broward Community College in south Florida with an AS Degree in Nursing in 1978 and later a BS Degree in Nursing at University of South Florida. She later earned a Masters Degree in Healthcare Administration at University of St. Frances. She can be reached at jennifer.david@gentiva.com.

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A Wealth of Health: Benefits of Integrating Conventional and Alternative Medicine

By M. RACHELLE SMITH, AP and Clinical Nutritionist

These days, when illness strikes, many people feel like they’re on their own. Perhaps their healthcare coverage is inadequate. Or perhaps they avoid using the coverage they have for fear of establishing “pre-existing conditions.” Indeed, more and more Americans are becoming disenchanted with conventional medical care and try to find more gentle and natural ways of dealing with illness. This may be in the form of them taking better care of themselves, eating healthy foods, and exercising. However, studies show that the use of complementary and alternative medicine (CAM) is on the rise. For many different ailments and diseases, more people are using alternative forms of healing like naturopathy, homeopathy, osteopathy, acupuncture, or chiropractic care. In fact, a recent study found 38 percent of adults 18 and up were using some form of CAM. Let’s define the terms complementary and alternative. Complementary and alternative medicine is the popular term for health and wellness therapies that have typically not been part of conventional Western medicine. “Complementary” means treatments that are used along with conventional medicine. “Alternative” means treatments used in place of conventional medicine.

CAM focuses on the whole person, including physical, emotional, mental and spiritual health. For example, CAM includes mind-body medicine (such as meditation, acupuncture and yoga), manipulative and body-based practices (such as massage therapy and spinal manipulation), and natural products (such as herbs and dietary supplements).

Most CAM studies in the U.S. show that few people forgo conventional medicine. So the term “integrative medicine” is increasingly preferred. Integrative medicine combines, or integrates, the best of conventional medical care with the best of evidence-based CAM. With that in mind, what are some benefits our patients can expect with these two forms of medicine converging?

More Options It’s our nature to be curious about the unknown. Where conventional medicine fails to provide a positive or worthwhile outcome, many people are satisfying their curiosity by seeking a second opinion.

The result? More options for healthcare leaves patients feeling empowered. These options may mean their quality of life is sustained or that the physical demands of their job or hobbies can me maintained.

Either way, more options are good. When orlandomedicalnews

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Kenneth M. Wing M.D. is a Board Certified Surgeon who is currently welcoming new patients to his practice.

a patient has the option to choose which health path they want, they are more likely to comply – a problem every physician in the health care field dreads.

Less Side Effects One of the greatest benefits of alternative medicine is that there are very few side effects. Despite rumors, a welltrained alternative medicine practitioner is well aware of drug herb interactions and stays up to date with the latest advances in technology – both in the pharmacological world and the diagnostic world. Can conventional doctors say the same thing?

In fact, the integration of alternative medicine with conventional medicines can lead to the use of fewer drugs, fewer symptoms, and ultimately fewer sick people. Many alternative practitioners are even able to diagnose future problems within a person’s health by mere observation. This, in turn, allows them to council their patients on the importance of preventative medicine.

Which brings me to my next point.

Prevention Alternative medicine focuses on the prevention of disease rather than just the treatment of symptoms. For example, after knee surgery a chiropractor or acupuncture physician can facilitate rehabilitation and strengthen the muscles and bones to prevent further injury. Post cancer patients can also greatly benefit from the use of alternative medicine in dealing with possible recurrence and even fertility.

Most patients that we see are looking for ways they can prevent a genetic predisposition or return their bodies back to health.

No alternative healthcare physician would try to treat someone during a gallbladder attack, the same way a general practitioner would turn away a patient in the midst of an emergency situation, seeing to it that they receive proper treatment at an emergency health care facility. In many cases, where conventional medicine leaves off, alternative medicine picks up.

However, the mere coexistence of different healing modalities does not automatically produce an integrated system of care. Only when physicians of different fields learn to communicate more effectively with each other can our patients truly benefit. A “healthy,” effective system of integrative care will require a conscious, thoughtful approach to combining different healing modalities.

M. Rachelle Smith, AP and Clinical Nutritionist practices at Active Living Health Center.

She graduated from the Florida College of Integrative Medicine and is a board certified Acupuncture Physician and Clinical Nutritionist in the state of Florida. She can be reached at activelivingacuuncture@gmail.com.

We are a specialty practice that performs in office excisions of lesions with local anesthesia. We treat the following conditions: Malignant Melanoma Basal Cell Carcinoma Squamous Cell Carcinoma Sebaceous Cyst Hidradenitis Suppurativa Dysplastic Nevis Lipoma We accept most insurance carriers please call the office for more details.

We are a Medicaid and Medicare provider.

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GrandRounds Orlando Health Performs Florida’s First Vascularized Lymph Node Transfer The surgical team at Orlando Health performed the first ever vascularized lymph node transfer (VLNT) in the state of Florida. This microsurgical procedure transfers lymph nodes from one area of the body to another that is affected by a blockage in the lymphatic vessels, also called lymphedema. The surgery is expected to reduce a patient’s symptoms such as swelling and heaviness and relieve their pain and discomfort, which will allow them to use their arms and legs again and resume their daily activities. The surgery was followed LIVE by thousands of people on Orlando Health’s social media channels including Twitter, Instagram, Facebook, Google+ and YouTube: . Via Facebook, more than 7,000 people

saw the pictures and posts from the surgery . Via Twitter, Orlando Health tweeted 42 times to their 1,800+ followers . Via Instagram, Orlando Health posted 29 photos throughout the surgery . More than 1,200 people read the online blog about the surgery at www.accordingtowinnie.com and more than 200 people

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followed the surgery LIVE via the blog.

Dr. Richard Klein, who oversees MD Anderson Cancer Center Orlando’s Plastic and Reconstructive Surgery Center, Dr. Kenneth Lee and Dr. Jeffrey Feiner brought VLNT to Orlando Health, which is the first and only hospital system in the state of Florida to offer the procedure. Drs. Klein, Lee and Feiner are among a handful of surgeons in the country who are currently performing this unrenowned procedure to treat lymphedema. Prior to the VLNT procedure, the patient went through lymphatic therapy to prepare her body for surgery.

The VLNT procedure takes approximately 3 to 4 hours. Lymphatic studies after this procedure have shown growth of new vessels and active function of the transferred lymph nodes and patients begin to see improvement within 1 to 2 months following the surgery. Patients undergo additional therapy post-surgery to gain mobility in their arms or legs.

Florida Hospital Celebration Health is Recognized as a Center of Excellence in Gynecology Florida Hospital Celebration Health has been approved as a Center of Excellence in Minimally Invasive Gynecology (COEMIG), making it the first hospital in Central Florida to receive this distinction. This recognition is on behalf of the Surgical Review Corporation (SRC).

The COEMIG program was initiated in 2010 to recognize only surgeons. In 2011, the program grew to recognize surgeons, surgery centers, and hospitals worldwide that excel in minimally invasive gynecological surgeries and procedures. The goal of the COEMIG program is to continue to enhance and develop the safety and excellence of gynecologic patient care internationally. This prestigious program works to increase patient knowledge and access to minimally invasive gynecologic procedures, an innovation in women’s healthcare.

Medical facilities recognized as COEMIG exceed these criteria. By being honored with this respectable title, Florida Hospital Celebration Health is seen as among the best in the field of gynecology.

Palm Beach Cancer Institute Joins Florida’s Largest Community-Based Oncology Network Florida Cancer Specialists & Research Institute (FCS), announced that Palm Beach Cancer Institute (PBCI) joined the practice, effective June 1, 2013. According to William Harwin, M.D, President of Florida Cancer Specialists, the new merger will increase the number of locations of the state’s largest independent oncology/hematology practice and provide expanded services to cancer patients on the east coast.

The merger with PBCI will add four

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GrandRounds clinical sites to the Florida Cancer Specialists’ network, extending service areas to the communities of West Palm Beach, Palm Beach Gardens, Wellington and Atlantis in Palm Beach County.

Patients will now benefit from additional financial assistance programs, fully-integrated electronic medical records with a user-friendly patient portal, and increased access to the latest cuttingedge treatments.

Florida Cancer Specialists & Research Institute offers a full range of oncology and hematology services, including clinical research and the use of evidence-based medicine and proactive patient support services.

Central Florida Regional Hospital Opens New Rehabilitation Center In response to the need for an intensive and comprehensive rehabilitation facility in Seminole County, Central Florida Regional Hospital has opened The Rehabilitation Center at Central Florida Regional Hospital.

The Rehabilitation Center, the only facility of its kind in Seminole County, offers rehabilitation for patients with complex conditions that may include stroke, spinal cord injury, amputation or brain injury. The center helps patients minimize physical or cognitive disabilities and gain greater independence after illness, injury or surgery. It has 13 large private rooms, a physical therapy gym, a home care therapy area and 24 hour immediate access to all hospital services. The Rehabilitation Center’s team of doctors, nurses and therapists is dedicated to improving, maintaining or restoring physical strength, cognition and mobility through a customized plan for each patient.

New Director of Laboratory Services at LRMC Andrea Clark has joined Leesburg Regional Medical Center’s team as the new Director of Laboratory Services.

She will be responsible for ensuring the accuracy and timeliness of patients’ laboratory work at LRMC. Andrea came to LRMC from Wellington Regional Medical Center where she was Laboratory Manager. She has a B.S. Degree in Medical Technology and has served in a variety of leadership roles.

With a reputation for accuracy and proficiency, our team performs tests quickly and results are readily available to physicians.

St. Cloud Regional Medical Center Opens New Sleep Lab in Kissimmee St. Cloud Regional Medical Center announces the opening of The Center for Sleep, a lab for the diagnosis and treatment of potentially serious sleep disorders, such as sleep apnea, excessive snoring, narcolepsy, restless leg orlandomedicalnews

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syndrome and periodic limb movement disorder.

The Center for Sleep is located in Kissimmee which is off-site from the main campus of St. Cloud Regional Medical Center. With the addition of The Center for Sleep, the hospital continues to demonstrate its commitment to offering high quality services to the local community.

Muhammad K. Shaukat, MD, is serving as the medical director for The Center for Sleep.

The overnight sleep studies are conducted by highly trained sleep technologists while patients enjoy the comfort of private sleep rooms said Scott Bellek, Director of Respiratory Therapy at St. Cloud Regional.

Set-up involves the placement of various electrodes on the surface of the patient’s scalp, face, chest, and lower leg to monitor brain waves, eye movements, respiration, heart rate and muscle activity. There are no injections, drugs, or x-rays associated with this procedure -- and no pain associated with the placing or wearing of electrodes. A second night at the laboratory may be required for patients diagnosed with sleep apnea.

Treatments can range from airway pressure appliances, medication, lifestyle changes, weight loss, ENT surgery and laser therapy, dental appliances, light therapy, and internal body clock adjustments. The treatment or treatments recommended depend upon the type of sleep disorder diagnosed.

For more information on The Sleep Center at St. Cloud Regional Medical Center, please visit StCloudRegional. com or call 407-891-2920.

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Oviedo ER Update Construction continues on Oviedo ER, a department of Central Florida Regional Hospital. The freestanding emergency department is located at the intersection of Red Bug Lake Road and the 417 Greenway.

The goal is to complete construction by the end of October said Wendy Brandon, CEO. The 11,000-square-foot facility is expected to serve more than 10,000 Oviedo and East Seminole County residents each year. Unlike other medical facilities in the surrounding area, the freestanding emergency department in Oviedo will operate as a full-service emergency room providing 24/7 emergency care for both pediatric and adult patients. The new facility will offer comprehensive emergency services including a dedicated trauma room, laboratory, imaging services and 12 private patient care rooms. The $9.7 million ER will employ 35 full-time staff and four emergency medicine physicians.

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