Orlando Medical News June 2015

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PHYSICIAN SPOTLIGHT PAGE 3

Michael Muszynski, MD ON ROUNDS

Helping Men Get Healthy

American men live sicker and die younger than their female counterparts ... 9

The Competing P’s: Provision & Payment

The Rock Star of Stroke Valerie Greene transformed from devastated stroke victim into global outreach advocate for stroke recovery

By JULIE PARKER

On June 10, 1996, only weeks before the Food & Drug Administration (FDA) approved tissue plasminogen activator (tPA) as what remains the only approved management for ischemic strokes and myocardial infarction, Florida native Valerie Greene suffered a massive stroke that left her, as she described it, “mangled up in a wheelchair.”

Greene was only 31, a healthy and successful entrepreneur with a busy social calendar and a flourishing financial planning practice that she’d established three years earlier in Winter Park.

Not long after the FDA approval of tPA,

Greene participated in a press conference at the state capital in Tallahassee comparing two stroke victims: one who benefitted from tPA administration immediately following a stroke, and one whose stroke preceded the approval date.

“The gentleman I was paired with talked about how he played golf the next week,” recalled Greene, a former Olympic-caliber

swimmer who ran the 100-yard-dash in less than 11 seconds. “There I was, unable to function. It was the hardest moment to bear.

It was shocking to me the difference.”

Because she suffered a massive brain stem stroke preceded by a TIA only a few months prior, both sides of her body were severely affected, leaving her unable to move from the neck down, powerless to speak, and (CONTINUED ON PAGE 4)

Benefitting from Return on Engagement

Changing reimbursement for new models of care ... 12

Unique data-driven platform propels Medical News’ website re-launch

By JULIE PARKER

When Orlando Medical News’ website is re-launched soon, it will feature arguably the most advanced business-to-business (B2B) platform in the industry.

“I’m not aware of any other platform that has quite the breadth of capability,” said Eric Kammerzelt,

ONLINE: ORLANDO MEDICAL NEWS.COM

ING COMON: SO NEW THE

vice president of technology at SouthComm, parent company of Medical News Inc. “We’re creating a 360-degree profile around our audience, and it will totally revolutionize how editorial content is generated.”

Kammerzelt, listed among Folio magazine’s annual Top 40 list in recent years, joined SouthComm via Cygnus (CONTINUED ON PAGE 4)

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PhysicianSpotlight

Every Step of the Way

Dr. Michael Muszynski has More Than Exceeded Expectations

By JEFF WEBB

ORLANDO - When Michael Muszynski was born with a congenital heart defect in 1952, doctors told his mother they did not expect him to live more than two years.

When he made it well past that age, they reconsidered their previous prognosis and predicted he might make it to his teenage years.

“By the time I was a teenager, they had more information and understood the condition (complete heart block) more,” said Muszynski. “Then they said ‘He’ll live a long time and die from something else. Maybe he’ll need a pacemaker,’ which back then was brand new and as big as your head,” he remembered.

In the interim, Muszynski enjoyed an active life, physically and mentally. “I could do anything any other kid could do, I just couldn’t do it as long. I could run, for example, but I couldn’t run a mile. … So, I became a smarty pants,” he said. “If you looked in the dictionary for the definition of ‘nerd,’ you’d see a picture of me. I actually enjoyed reading, studying and learning just about anything they threw my way,” said Muszynski, who went on to play trombone in the marching band and “win just about every graduation award the school gave out.” By the time he earned his undergraduate degree in biology (with honors) at Youngstown State University, the young man with the delicate heart also had been certified a “century cyclist” who biked 100 miles a day on numerous occasions, and was on his way to medical school at Ohio State University.

The ability to exceed expectations would appear to be a lifelong pattern for Muszynski, whose 25-year career as a pediatric infectious disease physician now seems supplanted by his multiple titles and responsibilities with the Florida State University College of Medicine: Orlando Regional Campus Dean, Associate Dean for Clinical Research, and Professor of Clinical Sciences.

Muszynski was the first dean of the FSU Orlando campus, which is one of six regional campuses in FSU’s distinctive medical school

model, where third- and fourth-year students are dispatched from the main campus in Tallahassee to receive concentrated training in clinical settings throughout the state.

Muszynski is responsible for directing the clinical education program for students assigned to the Orlando campus, where there typically are about 40 students assigned. “I have a supervisory and leadership role, not just the day-to-day crunching, but looking at what we’re going to do next, how we’re going to get better, how we are going to solve problems, stuff like that,” he said.

Muszynski also is responsible for the administration and development of research in clinical settings, including the statewide FSU Clinical Research Network and its collaborative affiliations. “That’s a lot of work. But if we hit the next three grants we have in the pipeline, I’m going to be so busy handling ($10-12 million), I’m not going to be able to be that other dean guy. I see this position splitting into two eventually,” he suggested.

The research job might have some appeal because “it goes full circle back to my background in research,” he added.

“I had a pretty exciting laboratory career as a young researcher. I developed a microbiology agar plate medium for special processing of sputum cultures used in hospital laboratories across the world. It’s called called OFPBL. I formulated it in 1984 and clinical application began in 1987. It re-

mains in use to this day,” he said.

That was when he was completing his fellowship at what now is named Children’s Hospital of Oklahoma, and just before he accepted a position at Orlando Health.

“I never even thought of Florida as a fun place to live — until I got here, of course,” he recalled. “I had other options,” he said, but ultimately it was the appeal of being “the first pediatric infectious disease specialist to set foot in central Florida, build a research and residency training program from scratch, and get in on the ground floor of Arnold Palmer Children’s Hospital. It seemed like the sky was the limit.”

Accompanying him on that adventure was his wife Jane and their two very young sons. Muszynski met Jane when he was completing his internship and residency at Columbus Children’s Hospital (now Nationwide Children’s Hospital) in Columbus, Ohio. Jane was a registered nurse. “Here I was, this whippersnapper of an intern, and the first time I asked her out, she said ‘I don’t date doctors!’ I said ‘We’ll see.’” Muszynski laughed. “But I won her over by just being really nice. … We dated for a year and then got married. It was a whirlwind romance, but here we are 35 years later!”

After their sons made it to middle school, Jane got her advanced nursing degree and worked as a pediatric nurse practitioner in two private practices. Now she is a full-time

Professor at Seminole State College School of Nursing. Their oldest son Michael is a professional orchestral bassoonist in Atlanta, and his brother Matthew controls satellites from an astrophysics laboratory in Colorado.

When Muszynski is not in his work routine, he is working in his kitchen. “I cook.

Everything I can try. I cook almost every night for my wife. It’s actually relaxing and every night is like a new experiment in the lab of my kitchen. We rarely go out for dinner because she says only the highest-end restaurants can top me. I don’t think that is true, but I’ll take it,” he said.

“I am primarily self-taught, but had great mentors in my mother and my aunts,” one of whom was a caterer, he said. Muszynski also said he learned very early from his dad, a steel worker in Youngstown whose workplace collar evolved from blue to white, that “it was OK for a guy to be in the kitchen.”

Sadly, his father died from pancreatic (CONTINUED ON PAGE 5)

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Benefitting from Return on Engagement, continued from page 1 Business Media Inc., an international B2B media company. SouthComm, niche publisher of consumer and B2B weeklies, monthlies, and regional magazines primarily in the South and Midwest, acquired Cygnus’ 11-magazine and 7-trade show public safety group last November, chiefly for the industry’s most sought-after technologies – BASE. BASE is a content management system hosting thousands of market-specific articles. This need-driven platform was built with open source tools and technologies for a comprehensive solution for editorial and design publishing teams. A leading content strategy serves as a cor-

nerstone in sales-lead generation, and was developed by a small WI team.

The Listening Phase “Back in 2007, we began asking the editorial team at Cygnus: what are your challenges? What are your needs? How can technology help? At that time, print editors were being asked to also manage content online, in addition to managing social media and newsletters. We heard overwhelmingly they needed an easy way to share and organize content,” said Kammerzelt, who joined Cygnus in 1998 as network administrator, and was promoted to corporate IT director in 2006,

the same year Twitter was launched. “We looked around and weren’t happy with what we were finding in the industry, so we built our own system. We met with editors weekly to advance to their needs.

The system has grown and evolved, and has become quite popular.”

The platform intuitively maximizes use of responsive design and compelling content.

“The way we organize our content allows us to be smarter about the content we provide,” he explained. “Our analytics platforms helps us understand our audience – what’s being consumed, read or simply grazed, and insights into how read-

ers are navigating the site. It’s been very enlightening to many editors who may think the audience is interested in particular content but instead are interested in something different that editors may not have thought would hold their interest.”

Historically, editors and sales have been distinctively separate departments.

In the digital age, the entire team – editorial, production and sales – has become more collaborative with its partners, yet remaining so in ethical fashion.

“The bottom line is to maximize impact,” pointed out Kammerzelt.

tar since the age of seven. “I tried for years to relearn the guitar with the opposite hand and it was too frustrating,” she said. “I finally gave it away.”

She also doesn’t stew over the inability to balance her checkbook.

“I don’t get hung up on those things and whine, or say woe is me,” she said.

“Now I say thank God I could do all those things! I’m resolved that I’ve moved into a different level of life. If you always look in your rear view mirror, you’ll never see where you’re going. So many times in life, people try to get back to where they used to be or thought they were. Perhaps there’s something better behind the next door?”

A significant part of her life revolves around Bcenter, an organization of support for stroke survivors and caregivers based in Orlando she founded that has evolved into Global Stroke Resource, a registered 501(c) (3) nonprofit organization supported by the medical community and devoted to bringing hope to stroke survivors worldwide. (See companion article, “Reaching Stroke Survivors around the World,” in this edition of Orlando Medical News.)

These days, Greene has a different

sort of busy social calendar. She starts every morning scrolling emails, stopping to immediately answer those from people who reached out following a stroke for themselves or a loved one. As a stroke coach, she provides support via online coaching, sometimes around the clock.

“With Skype and phones, anywhere is a stone’s throw away,” she noted.

Once, she dropped everything to travel to the west coast to meet a survivor in person.

“His son called and asked, ‘what are your credentials?’ I thought carefully about the answer,” recalled Greene. “I’m a messenger of hope, I told him, and he said, ‘well, please, get here quick!’”

A two-time published author and contributor to various heart-healthy cookbooks published by national organizations, Greene has appeared on ABC, CBS, FOX and NBC to raise awareness of stroke prevention and recovery.

“Before the stroke, I never thought about being a public speaker,” marveled Greene. “It’s amazing what you can do when circumstances change and helping others dictates it.”

A legislative advocate for stroke awareness, Greene was instrumental in helping pass the Florida Stroke Act in 2004, the same year she walked 13.1 miles in the Walt Disney half –marathon for the ASA. She was the nation’s top fundraiser for the organization’s 2004 Train to End Stroke program.

The World Health Organization has applauded her efforts, along with the National Stroke Association and an impressive array of celebrities and dignitaries.

On Oct. 20, 2014, Orlando Mayor Buddy Dyer recognized Greene for leading stroke awareness in the Central Florida region and proclaimed Oct. 29 as “World Stroke Day,” a move followed by Orange County Mayor Teresa Jacobs.

Greene’s next mission: to build a world-class destination for stroke survivors and their loved ones to visit for healing, restoration, support and retreat.

“My long-term vision is to take this to a whole new level,” she said. “For me, that would’ve been remarkable. People want it and deserve it and I’m trying to answer that call the best way possible.”

(CONTINUED ON PAGE 6)

The Rock Star of Stroke, continued from page 1 with permanent hearing loss in her right ear.

“I was lying in a hospital bed, paralyzed, couldn’t talk, and was drooling,” she recalled. “I was told I may not live because I’d had a stroke in the worst area in the brain to be attacked, with the main artery totally occluded. Imagine a highway funneling into one lane ... the flow is significantly interrupted.”

Instead of accepting a dismal fate, Greene worked diligently to recover from the physical – and often-undiscussed emotional and mental – effects of the stroke. She focused on understanding stroke’s causes and symptoms, and grew a quiet determination to help others on their journey to recovery.

“There’s nothing like walking in someone’s shoes,” she emphasized. “I remember what it’s like to have no one to talk to. Remember those crazy psychic lines back in the dark ages that advertised on TV channels late at night, just before the national anthem was played and the channel went off the air? It cost $5 a minute, an unbelievably crazy rate. But I didn’t realize that, and was so enthralled and desperate for someone to talk to, until I got a bill for $400! Despite

that, I knew on the other end of the phone line was a stranger who wouldn’t judge me. I told them I was scared and lonely.

They’d say ‘it’ll get better’ and I thought, but when?”

Over time, Greene recovered most functions, though she still walks with a limp, has hearing loss, and speaks with a slight deficiency. Yet she’s transformed her life from stroke victim to global stroke advocate. For many years, she was a spokesperson for the American Stroke Association (ASA), and continues to give motivational talks across the United States.

“When I walk into a room, it’s astounding to see the reaction,” said Greene. With movie star looks, she’s often referenced to as the Rock Star of Stroke. “They’ve seen my picture in the wheelchair, and they’ve seen my picture as I am now, but when they see I’m for real, it’s very powerful. They see the light inside of me. I’m a vessel, a messenger of hope. I can’t take credit for that. It’s God working through me. It transcends the human spirit to never give up. Encouragement … is greatly underrated.”

Greene doesn’t fret over activities she can no longer enjoy, such as playing the gui-

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Reaching Stroke Survivors Around the Globe Bcenter and Global Stroke Resource serve as a ‘beacon of hope’ for stroke survivors and caregivers

By JULIE PARKER

WINTER PARK— At an early spring Bcenter Hive of Hope support group meeting at the Winter Park Civic Center in Central Florida, cheers erupted when “Ana,” a formerly wheelchair-confined stroke survivor in her forties, made an entrance with her caregiver father, using only a cane to join more than 40 fellow survivors and their caregivers.

“I was moved to tears,” said Nancy DeVault, a community healthcare advocate from Winter Garden. “The whole room applauded her; it was incredible!”

Valerie Greene, founder of Bcenter based in Orlando, said it speaks volumes “when others are cheering you on. I get chills just thinking about it.”

The close-knit support and social group meets every third Monday of the month for a lecture, roundtable chatter and complimentary lunch and dessert. Recent topics have covered laughter in healing, art therapy at the Albin Polasek Museum & Sculpture Gardens, and energy medicine.

“This group is different than others that I’ve experienced as it’s so positive,” said DeVault. “Participants are uplifted, empowered with useful knowledge, and encouraged to engage with one another. Even just meeting in a beautiful setting, in comparison to a meeting room at the hospital … not a fun place for survivors … makes such a difference.”

Greene, a stroke coach and crusader for stroke advocacy, programs and education worldwide, established Bcenter as a simple website in 2010, knitted with tidbits of information she believed would be helpful to recovering stroke victims such as herself.

“I was starving for snippets of support,” she

PhysicianSpotlight

Dr. Michael Muszynski, continued from page 3

tive access to experts and the opportunity to participate in forums.

“My story has been somewhat supernatural,” admitted Greene, who suffered a brain stem stroke June 10, 1996. “In hindsight, I believe I was sent as a messenger to help the suffering of my fellow survivors.

I’ve been in that valley and know the depths of despair. It’s a gift and an honor to help another person. It’s what drives me every morning. It’s so important for survivors to have someone lead them who’s been through this experience.”

Greene recalled having “an uneasy time” after being released from the hospital after her stroke. When she asked her doctor about recovery and rehabilitation, he didn’t have much to offer.

“Now physicians can say, ‘Bcenter is where you go after your stroke,’” said Greene, noting the physician community has embraced the center. “They know the support group is phenomenal. As are the activities. As their leader, I address the real gritty day-to-day challenges to the human

spirit, and provide encouragement and empowerment. They learn their life isn’t over.”

Greene is quick to tell stroke survivors the candid truth: “Yes, it’s tough. Yes, there are bad days. But we’ll get to the other side. I’m living proof, and so are many others. We’re in this together.”

Greene noted that national statistics show a spike in strokes in younger adults, especially women under 40.

“It’s scary how more young people are having strokes,” she said. “When I had mine at the age of 31, it was unusual. These days, not so much. That’s why I focus on stroke prevention. I wouldn’t of had a second stroke six months later if I’d known what I do today.”

For example, the South is also known as the Stroke Belt for its fried and sticky foods.

“Stickiness only adds to the problem of platelets sticking together,” she said. “If you don’t have oil in your car, that necessary slippery element, the pistons don’t function properly and the engine will blow. Fortunately, our body was designed to heal.”

Greene also highlights the importance of krill oil, a cold water source in the Arctic that keeps the blood “nice and slippery.”

Greene also pointed out that all ages and genders of stroke survivors and their caregivers access Bcenter.

“It’s interesting to find out what works for one survivor and not another,” said Greene. “It’s not cliquish, but it’s interesting to see how survivors flock to groups with people of their gender, age or interests. The important thing is, we’re all there for each other.”

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cancer at age 51, when Muszynski was just 12 years old. “It was a defining point in my life. It was a dark time from which I had to emerge,” he said. “Not appreciating it when I was young, the event shaped my resiliency to survive any situation. My father was a giant in my mind of what it meant to be a good man, to be determined toward one’s goal, to constantly want to learn and understand, and to do good deeds.”

Muszynski said he was “fortunate to have the strong support from four uncles who, in essence, became my father surrogates. I am the product of my father’s, mother’s and uncles’ upbringing. Each stood as my hero in different attributes. I was fortunate to have such a strong, caring and responsive family.”

As Muszynski has so many times, he probably exceeded their expectations. orlandomedicalnews

recalled. “It wasn’t easy to find.”

(See companion article, “The Rock Star of Stroke,” in this edition of Orlando Medical News.)

Bcenter provides stroke survivors and their caregivers with treatment resources, hope and direction. Its mission: to educate, empower and light the path to recovery.

“With Bcenter, and now Global Stroke Resource, Valerie helps doctors answer the question, ‘now what?’ that stroke survivors often ask when they’re released from the hospital,” said DeVault. “Physicians understand that stroke patients need continual support. Bcenter is a valuable tool for physicians to know about and, in turn, share with their patients.”

Greene named the resource center to embrace the symbolism of a bee, the metaphoric pillar of recovery. Bees aren’t designed to fly, noted Greene, but they do, therefore reinforcing how a belief in recovery from a stroke starts with the belief that you can and will recover, despite the odds.

In May, Greene launched a more userfriendly, interactive website that may be easily translated into any language and viewed on any device. Described as a “GPS for stroke survivors,” the website’s easy navigation provides three primary functions: • Resources: B-well includes an outline of 20 conventional and holistic therapy choices, such as hyperbaric oxygen, stem cell and speech therapy.

• Hope: B-empowered provides motivational resources, including survivor testimonials, educational videos and uplifting books.

• Direction: B-connected offers interac-

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Benefitting from Return on Engagement, continued from page 4 Industry’s Dirty Little Secret The platform has received accolades for the way optimized in-view impressions are measured.

“The dirty little secret of many websites is that ad impressions further down the web page are still counted as having value to advertisers when clearly they have no value if no one ever sees it,” he said.

“That’s how sites were designed for years.

About a year ago, we implemented technology that allows us to fire the ad only when it’s on the screen and the user has the ability to actually view it. A big conversation among ad agencies is that advertisers are catching on and don’t want to pay for impressions not seen. They want effective ads.”

For example, Cygnus approached Caterpillar about advertising in its B2B construction industry publication.

“Their content wasn’t generating as much industry interest and exposure as

they’d planned,” he said. “We brought data to them that showed readers were hungry for the information but there was a wrinkle: either it wasn’t marketed well, found easily, or consumed well. Caterpillar asked for our help, and we created a section of the site built around a specific type of legitimate content, combined with content they already had, and it resulted in a very successful sales program for Caterpillar.”

Another example: Cygnus built a buyer’s guide platform, a collection of product and company data, and infused content in the database for users to easily find.

“We gathered information on the people who were interested in that approach, and then built a buying capacity to show advertisers and potential advertisers a group with potential buying propensity for particular products,” he said.

Return on Engagement Success stories resulting from the in-

novative platform spurred Kammerzelt’s invention of the Return on Engagement (ROE) report.

“The engagement report is built specifically for advertisers and potential advertisers to show content consumption trends to better reach their target audience, compared to competitors in the same category with the same audience while answering the question: how can we better pinpoint the target audience?

Sometimes it’s content; sometimes it’s advertising,” said Kammerzelt. “We crafted the engagement report as a way to educate advertisers and give them more transparency and visibility on the popularity of their content. We keep hearing: what have you done for me lately? Have you run articles relevant to me, my needs and my market? Finding specific examples used to be laborious. Now it’s instantaneous.”

The revised Orlando Medical News website will have opportunities for rapid-

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response polls and surveys to learn more about reader engagement, and will feature tools for article response and possibly access to white papers and other readerdirected information.

Once the website is re-launched, Kammerzelt estimates 90 days for data collection to be absorbed.

“The platform will allow us to response rapidly to reader trends,” he said.

“For example, the systems may not show a void in editorial content, but data analytics will make it easier to discern specific editorial needs.”

If advertising support warrants it via data feedback, the system will allow Medical News to quickly add new markets, such as Jacksonville, Fla., Columbia, SC, or Portland, Ore., and revitalize existing ones, such as Charlotte, NC, and Research Triangle, NC, including Raleigh, Durham and Chapel Hill. The sites could quickly evolve into separate yet connected markets. It will also allow Medical News to easily and inexpensively test the waters on other ideas, such as potential awards programs or niche market sections, perhaps one targeted to medical students.

“No longer do you need to wait months for a site,” he emphasized. “It’s much more fluid now.”

Design Features & Improved Ad Performance The Orlando Medical News platform has a responsive design optimized for mobile and tablet sites, each laid out differently for an advanced viewing experience.

Audience and content segmentation will route through half a dozen “channels” for better content organization. “Let’s say ‘education’ falls under ‘business,’ but data show that ‘education’ is popular and could be its own channel or maybe even a separate site. That’s data analytics driving change.”

Other features include related content for deeper site engagement; advanced techniques and best practices for optimizing online readability and engagement; and social media integration including sharing, social sign-on, and user comments.

Improved advertiser offerings: all impressions are “in-view,” data analytics provides the ability to target within segments and “own” a channel; ad placement is more integrated with content; placement is variable; click-through rates and total clicks provide higher overall clicks; ad impressions are optimized on mobile and tablet devices; and the platform generates availability for page peels, billboards and other rich media ad capabilities.

Backend highlights include a unified workflow for print and digital products; real-time editorial control, allowing for more frequent updates; automated image and media handling; and rich taxonomy and organization/relation of content.

“We’re very excited about re-launching our Medical News markets,” said Kammerzelt. “The more thrilling part will occur when we have enough data to drive changes to truly make a difference to those who support us.”

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Alternatives to Low Fixed Interest Investments The Inverse Relationship of Fixed-Rate Bond Prices and Interest Rates

By SCOTT L. OLSON

The stock markets are too high and overdue for another crash. CD’s, money markets and bond rates are the lowest in history. Are there any good high-income investments?

We are asked all the time where investors can get 5 percent to 8 percent income like “the Good Ole’ Days.” Today, a small percentage of financial advisors offer a relatively new generation of public and private funds offering income of 4.25 percent into the 9 percent range (depending on the investment and duration).

Market interest rates are historically low, and most fixed-income portfolios are concentrated in low yield assets. This presents challenges for income investors who want better potential for increased income.

As a result, more and more investors are looking to alternative assets for income.

Collateralized loan obligations (CLOs) hold diversified pools of 100 to 200-plus corporate debt. CLOs are emerging as a compelling alternative for income investors.

CLOs that invest in senior secured bank loans (SSLs) have historically provided attractive current income while buffering fixed-income portfolios from market volatility and the risks associated with rising interest rates. Although SSLs are typically issued to borrowers with credit ratings below investment grade, SSLs have provided positive cash yields in all years since 1997, and

If Interest Rates Fall

If Interest Rates Rise Prices Fall

Yields Rise

only one year of negative returns in 2008.

This is due to several factors including the senior position of SSLs in the capital structure, which gives them repayment priority ahead of all other debt obligations, and first liens against corporate assets. As a result, SSLs have had historically low default rates with high recovery rates.

CLOs traditionally have been available only to institutions and highnet-worth investors. However, a new generation of public fund offerings is now providing a wider range of individual investors with the opportunity to participate in CLOs. Actively managed CLOs enable investors to access the expertise of highquality managers with expertise in analyzing the creditworthiness of borrowers, monitoring current market interest rates for non-investment-grade credit, and forecasting how a business is likely to perform during the next downturn. Due to the particular features of SSLs, including interest rates that periodically recalibrate rather than remaining fixed, CLO investors can

Yields Fall Prices Rise

be better-positioned for varying scenarios in which interest rates either remain stable or increase in the years to come.

The Search for Yield Investors attach far greater importance to income-generating products today than they did five years ago. The survey results demonstrate that investors’ income expectations are not being met by the income they are achieving with traditional income investments such as Certificates of Deposit (CDs), Annuities, Bonds, Cash, Investments in real assets.

A Compelling Alternative for Income Investors Seeking Higher Yield In today’s environment where interest rates are near historical lows but widely expected to rise, investments in CLOs provide an alternative strategy for income investors seeking higher yields than can be achieved via traditional fixed-income investments.

Traditional fixed-income securities

pay investors a fixed rate of interest, which is also known as a coupon, for the duration of the investment.

CLOs performed very well during the recent financial crisis, experiencing virtually no defaults during that time.

This level of performance surpasses that of investment-grade bonds.

Floating interest rates potentially provide investors with protection from interest rate and inflation risk. Because their yield rises and falls with changes in the LIBOR rate, floating-rate loans are relatively less sensitive to interest rate movements than other fixed-income investments.

CLOs holding SSLs can provide a higher return than other fixed-income investments due to their floating interest rates and the higher interest rates provided by investments in loans that are not investment grade. However, investor payouts can be reduced by operational and administrative costs, which generally constitute 0.15 percent to 0.20 percent of (CONTINUED ON PAGE 10)

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Helping Men Get Healthy

By CINDY SANDERS

HELP ON THE HILL

American men live sicker and die younger than their female counterparts.

However, Men’s Health Network is working to change the status quo by reaching out to men where they work, live, play and pray.

“We want to make sure we are every place where men can be reached,” stated Ana N. Fadich, MPH, CHES, vice president of Men’s Health Network (MHN).

It’s mission critical, she noted, given some of the sobering statistics about men and their well-being. Men have lower rates of health insurance coverage, a higher prevalence of death rates for nine of the 10 leading causes of death, fewer physician visits and cultural barriers to seeking help.

“A lot of times, men feel they are invincible,” Fadich said. She added phrases like ‘man up,’ or ‘big boys don’t cry,’ or ‘walk it off’ are deeply engrained in the American experience. A lack of awareness and education coupled with persisting cultural behaviors have had a sustained, negative impact on men’s health in the United States. To reverse this trend, MHN is employing a number of strategies in an effort to impact health in five key areas: • Reducing premature mortality of men and boys, • Enhancing physical and mental health of men for happier, fuller, healthier lives,

In April, Rep. Markwayne Mullin (R-Okla.) and Rep. Donald Payne, Jr. (D-N.J.) were announced as cochairs of the newly re-authorized Congressional Men’s Health Caucus of the American Public Health Association.

The Caucus is dedicated to raising awareness of male health issues, encouraging men and boys to take an active role in their personal health, and promoting legislation that has a positive impact on the health of American men, boys and their families. The bipartisan Caucus, which was formed in 2010, works closely with Men’s Health Network to ensure issues affecting men and boys have a place in government healthcare priorities.

“After witnessing my father lose his battle to colorectal cancer, it became my mission to raise awareness about the importance

• Reducing cycles of violence and addiction, • Energizing government involvement in men’s health issues, and • Encouraging women to expand on their traditional role as the family’s healthcare leader to promote healthcare services and healthy choices.

The Weaker Sex While males might celebrate their physical prowess, the reality is men are statistically the weaker sex. Fadich said men start out at a slight advantage with 105 boys being born for every 100 girls. However, she continued, “Once they hit (age) 34, the numbers for men begin to decline. At retirement age, there are

of preventive care and to help reduce health disparities across diseases from cancer to diabetes,” said Payne.

Co-chair Mullin added, “I consider fitness a necessity to a good life so I’m proud to help lead the Men’s Health Caucus in its mission to promote healthy living across the country. It’s incredibly important that our nation’s youth understand how to exercise and eat right so that they can live healthy, productive lives.”

The Caucus has established a Prostate Cancer Task Force, which is charged with increasing awareness of the disease. The group is also conducting outreach to three groups with especially high risk of developing prostate cancer – African-Americans, veterans exposed to Agent Orange, and individuals with a family history of the disease. Additionally, the Caucus, in conjunction with Men’s Health Network, has led briefings on a number of topics impacting men’s health and will continue these efforts to educate Congress and the general public.

about 80 men to every 100 women.”

In general, men’s life expectancy tends to be five years less than that of women – 76.3 vs. 81.1 years, according to the latest data from the National Vital Statistics System. For non-Hispanic black males, life expectancy is even lower at 71.6 years. Additionally, the gender gap widens during teenage years and early 20s when more men than women are lost to accident, violence and suicide.

In fact, suicide across all age groups is more prevalent in men. In 2013, men had a suicide rate of 20.2 vs. a rate of 5.5 for women. That year, death by suicide was 77.9 percent male compared to 22.1 percent female, according to the 2013 CDC Fatal Injury Report.

A December 2013 report from the U.S. Department of Justice noted the nation’s homicide rate fell to 4.7 homicides per 100,000 residents in 2011, the lowest level since 1963.

Even so, of the 14,610 homicides in 2011, men accounted for 11,370 victims. From 2002 to 2011, the average homicide rate for males was 3.6 times higher than that of females, and young adults ages 18 to 24 had the highest homicide rate of any age group.

Changing Trends Fadich said strategies including national awareness and educational campaigns, partnering with providers and organizations nationwide, and conducting screen(CONTINUED ON PAGE 13)

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Alternatives to Low Fixed Interest, continued from page 8 the assets of the CLO. Some of the bestknown brand names in the United States are associated with companies that do not issue investment-grade debt. Examples of such companies include H. J. Heinz Company, Dell Computer Corporation, Burger King Corporation, and The Hertz Corporation. Only a small percentage of American companies issue debt that is classified as investment grade.

Strong Historical Performance of CLO Investments Over the past 16 years, there have been impairments on less than 1.5 percent of CLO notes, and most were cured with no losses to note holders. This level of performance surpasses that of investment-grade bonds.

Low Historical Default Rates Recent rates of default on senior secured bank loans tracked by the S&P/ LSTA Leveraged Loan Index have been below the average historical level. The trailing 12-month default rate by principal amount on senior secured bank loans was 1.27 percent at the end of 2012, according to the S&P Capital IQ LCD. High Historical Recovery Rates SSLs are secured by a first lien on the borrower’s assets, and the lender has the first priority for repayment. For these reasons, SSLs generally have a higher recovery rate after default than borrowings further down the capital stack. Since 1987, the

average annual recovery rate on defaulted SSLs has been 80.6 percent, as compared to 63.7 percent for senior secured bonds, 48.6 percent for senior unsecured bonds, and 28.5 percent for subordinated bonds.

SSLs are corporate loans, as opposed to loans to individual borrowers. Unlike various forms of collateralized debt obligations (CDOs) linked to residential real estate, CLOs also have no exposure to commercial or residential mortgages, sub-prime debt or consumer-based debt. In this way, CLOs are very different from the varied versions of CDOs that were prominent features of the sub-prime mortgage challenges that resulted in the financial crisis of 2007–2009.

SSLs typically are loans to large- and mid-size businesses that are secured by a first lien on the cash flow and assets of the corporation. Senior secured bank loans held by CLOs have unique features that potentially benefit investors, including: • senior priority in repayment; • floating interest rates based on a reference rate such as LIBOR; • security provided by a first lien on the borrower’s collateral; • minimal correlation with other fixedincome asset classes, negative correlation with U.S. Treasury notes, and low correlation with equity and real estate asset classes; and • lower rates of default and higher recovery rates after default than unsecured corporate bonds.

For the reasons outlined above, the his-

torical long-term profile of the senior secured loan market suggests stability of income, low correlation with other fixed-income sectors, and solid performance in a rising-rate environment. Investors who are willing to look beyond traditional fixed-income investments are likely to find that CLOs offer a compelling value proposition that addresses the significant gap in expectations between what they want from their income investments and what they actually receive.

CLO investments involve a high degree of risk and may be considered speculative. They have limitations on liquidity and significant operational and administrative costs. Distributions and Quarterly tender offers not guaranteed. Investors are advised to consider the investment objectives, risks, and charges and expenses which are detailed in the prospectus. Please read it carefully before investing. Past performance is not necessarily indicative of future results.

Scott L. Olson is president of Atlantic Financial Advisors, LLC, and is a Registered Investment Advisor.

With 36 years’ experience in Financial and EstatePlanning, Wealth Preservation and Wealth Transfer, Scott has been a popular speaker across the U.S. to groups of Attorneys, CPAs, Financial and Estate Planning professionals. He provides Continuing Education courses to Attorneys, and CPAs. Scott’s expertise includes, not just Roth-Conversion, but taxfree, or “Substantially Discounted Roth-Conversion©” and the Annuity Arbitrage, a tax-favored income and estate-tax free wealth transfer technique. He can be reached at scott@atlanticfinancialadvisors.com Securities offered through Financial West Group (FWG).

Member FINRA/SIPC. Atlantic Financial Advisors, LLC, Registered Investment Advisor not FWG affiliated. For educational purposes only and NOT an offer to sell any security. This information is based on sources we believe reliable but is not considered all-inclusive.

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The Competing P’s: Provision & Payment Changing reimbursement for new models of care

By CINDy SANDERS

First the good news … providers are generally excited about the idea of moving to more holistic, integrated care with a focus on prevention, quality and outcomes.

Now the not-so-good news … we have to figure out how to pay for it.

“Providers are on board for the potential benefits from changes to the way we provide care, which is different from the way we pay for care,” noted Dion P. Sheidy, a partner in KPMG’s Health Care Advisory Dion Sheidy Practice. “This is a little bit of the elephant in the room.”

Nashville-based Sheidy said the Centers for Medicare and Medicaid Services have stated their plans to significantly increase value-based payments to providers over the next few years. In a fact sheet released in late January, CMS noted improving quality and affordability of healthcare was as much a pillar of the Affordable Care Act as expanding access. The goal, the memo continued, is to reward value (measured by quality of outcomes) and care coordination and efficiency rather than volume and duplication. To that end, the Department of Health and Human Services has adopted a framework of four categories of payment: • category 1: fee-for-service with no link of payment to quality, • category 2: fee-for-service with a link of payment to quality, • category 3: alternative payment models built on fee-for-service architecture, and • category 4: population-based payment.

Value-based purchasing includes

payments in categories two through four.

The stated goal is to have 30 percent of Medicare payments in alternative payment models (categories three and four) by the end of 2016 and 50 percent by the end of 2018. Additionally, HHS hopes to have 85 percent of Medicare fee-for-service payments in categories two through four by the end of 2016 and 90 percent by 2018.

“Although they have put that out there, they have yet to put out guidance about how they expect to achieve it,” noted Sheidy. “These are huge jumps.

We’re going to go from less than 10 percent in fiscal year 2015 to 90 percent with some link to quality in fiscal year 2018.”

Sheidy added there is some ambiguity as to what CMS calls ‘alternative fee arrangements’ and that at this point there are a lot more questions than answers. While he doubts normal market forces would push payment reform fast enough to hit the HHS targets in the next three years, he said regulatory changes could be the driver to hasten the transition to value-based payment.

“There are elements of the Affordable Care Act that have some pretty significant

unknowns attached such as the Cadillac tax,” he continued. The chief unknown, he continued, is “Does the Cadillac plan tax survive and get implemented as it stands today?” That question, he added, probably won’t be answered until after the presidential election.

The 40 percent excise tax, which is currently scheduled to go into effect in 2018, is levied on healthcare benefits that exceed certain pre-set limits. Despite the name of the tax, Sheidy said its impact would be felt far beyond affluent circles. In fact, the thought is that a significant number of employers could wind up incurring the tax. “This cuts across political parties when it comes to the impact of this,” he said, noting teachers, labor unions and public officials often have strong healthcare benefit packages. “You’re talking about having an excise tax that indirectly impacts a significant amount of the population through employer-provided benefits.”

He continued, “If this Cadillac tax survives, employers are going to be faced with having to change benefits, maintain benefit levels under a different cost struc-

ture, or pay the tax.” Sheidy added that since there doesn’t seem to be much enthusiasm for paying the tax, employers are going to look at how to bend plan design or the cost curve and will be more willing to consider value-based network designs.

“The government … through statements around the move to the 80 percent (value-based purchasing) along with the continuing lingering effects of the Affordable Care Act … has really set the industry up for the opportunity for some significant impact on payment reform over a fairly short time frame,” he noted. “On the payer side, CMS is looking to change the payment mechanism. On the commercial side, we’re looking at the Cadillac tax and how to get costs under control. And all of those things share the potential to come into play over the next several years. It’s almost like the perfect storm.”

It’s not that the industry hasn’t taken any steps to prepare for a move to a different type of payment mechanism. Sheidy said the industry is already involved in demonstration projects, quality reporting and capturing data points. However, he pointed out, the true impact on payment of all that collection and monitoring is still pretty narrow.

“People confuse population health with risk and payment,” he said. Now, we’re at the intersection of how to more effectively, efficiently manage the health of a population while simultaneously figuring out how to link payment to these new practice models.

While the industry has floated along with a foot in both the fee-for-service and value-based worlds for quite a while, Sheidy said the drivers are now in place, barring any changes, to force the movement to a more outcomes-based payment methodology in a very short window of time.

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Helping Men Get Healthy, continued from page 9 ings at events where men gather all enhance MHN’s efforts to change those trends.

From experience, Fadich noted, when a man is asked why he hasn’t gone to the doctor, the answer more often than not is because he can’t afford the time away from work. The answer, she continued, is to bring the ‘doctor’s office’ to the workplace.

Fadich said MHN has been to worksites from John Deere to Harley Davidson. “We bring the information to them,” she said.

“Sometimes we do screenings – cholesterol, glucose, blood pressure, body fat and grip assessment.” Fadich added MHN also works with partners nationwide to provide information and brochures for those planning health fairs or lunch and learn series at workplaces throughout the country.

The organization and its partners also have a strong presence at sporting events and in churches. “That’s where we do a lot of screenings and events – in the ‘play and pray’ portion of our mission,” Fadich said.

She noted they have worked with the National Football League, National Basketball Association, and Major League Baseball in an attempt to reach men and boys.

Churches also play a key role in getting the message across. “A lot of the folks we reach are underserved and minority populations, and they are very connected to their churches,” she explained. Fadich added, “We always recommend they speak to their healthcare provider, but we get the conversation started.”

Provider Push Fadich said physician visits really drop off for men after they age out of a pediatrician’s office. After that, she noted, “Women get called all the time for their pap smear or mammogram. Men aren’t getting those kinds of calls.”

Knowing that physician encounters aren’t as frequent, the hope is that providers will start deeper conversations with men about family history, diet, prostate and testicular cancer, and other health concerns any time an opportunity presents … whether it’s after a sports injury, work accident or a collegiate STD scare.

“We want men to start thinking about health at a younger age and recognize what they are doing now will affect health in their 50s and 60s,” Fadich said.

Men’s Health Month Fadich noted Men’s Health Week – the week leading up to Father’s Day – started in 1994 and was signed into law by President Bill Clinton. “We encourage men to wear blue during that week in recognition of men’s health,” said Fadich, who added the number of events has grown so significantly over the years that one week is no longer sufficient. “Now we use the entire month of June to raise awareness about men’s health.”

To request materials and resources or to learn how to partner with MHN, go online to menshealthnetwork.org or call (202) 543-MHN1 (6461).

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Bending the Cost Curve with Telehealth

By CINDy SANDERS

Richard S. Bakalar, MD, who has two decades of experience in telemedicine following a decade of clinical practice, has witnessed an evolution in the field that has moved distance medicine from being deployed almost exclusively to address exceptions to care to being employed to reach a much broader audience.

Denver-based Bakalar, a managing director for KPMG, spent 25 years in nuclear medicine and internal medicine practice in the U.S. Navy. “I was asked by the Navy Surgeon General to set up a Navy telemedicine program,” he recalled, adding the goal was to provide continuity of care across 30 ships, 23 clinics and hospitals and four medical centers around the world … including the South Pole.

“We had underserved populations on ships without access to specialty care,” he explained. With the telemedicine initiative, he continued, “They got the same kind of care as if they were in a major U.S. medical center.”

The Navy’s use of the program mirrored what most telemedicine programs looked like 20 years ago, but Bakalar said the field is expanding beyond its traditional uses. “Today, telemedicine initiatives are around not only access to care but also quality of care and reducing costs,” he said.

Telemedicine allows smaller facilities and those in rural areas to maintain the quality typically found in major academic medical centers. With shortages in a number of specialties, Bakalar pointed out, telemedicine offers a unique solution to allow more patients access to specialty care.

Cost and reimbursement were initially a concern for payers. However, Bakalar said time has allayed those fears. “The concern for the payers was this would become something that would be overused and abused

and wouldn’t be affordable,” he said. “The evidence hasn’t borne that out.”

In fact, it has shown the opposite. For example, Bakalar said, a family with a child who becomes sick with an infection could utilize a virtual visit for a cost to the system of about $50, to a clinic for a cost in excess of $100, or to an Emergency Department for a bill typically in the neighborhood of $1000.

Now, he continued, “Utilization is being driven by payers who are seeing the savings that can be accrued by these alternative models of care.”

The difference in ‘telemedicine’ and ‘telehealth’ Bakalar explained is initiation by the consumer. Where telemedicine is a provider-to-provider interaction, telehealth is driven by consumers, who go online to see a virtual doctor licensed in their state.

“That’s a newer, more modern approach of using technology to give patients the control and the ability to engage with their health providers in a way that’s more timely and convenient,” he noted.

Obviously, Bakalar continued, remote care doesn’t work in every instance. “If you have chest pains, you are still going to go to the ER,” he said. Bakalar added virtual visits are a great option, however, for complaints that are relatively minor or chronic in nature that could be addressed without emergency intervention.

Despite the promises of the technology, there are still issues to be addressed. “One of the challenges with telehealth or telemedicine is to keep the network of providers connected,” Bakalar said. The technology is there. “The cloud has made mobile health very effective,” he noted. However, the biggest hurdles are issues with governance, regulation, reimbursement and licensing … which are more programmatic in nature … that need to be resolved before telehealth reaches its full potential.

The Virtuous Cycle

Everyone’s heard of a vicious cycle … why not a virtuous one?

As individuals become more conscious of their health, they engage in healthy habits and activities more frequently … the more they engage in activities to get healthier, the more they change their behaviors and become more conscious of their health.

Richard Bakalar, MD, said telehealth applications have the ability to expand beyond care provision to increase this type of health promotion.

“Where we really want to start impacting people is before they become sick so we can reduce consumption of health resources,” he said.

Telehealth – which encompasses all the mobile health application devices plus personal computers – has a range of decision support tools and data to help individuals make more informed choices. “Both tools and information allow people to become more engaged and more proactive in changing behaviors,” Bakalar noted.

Increasingly, the reimbursement piece is being addressed as states adopt parity laws that mandate reimbursement for telemedicine and telehealth. The technology also plays into the Affordable Care Act’s emphasis on prevention and can help ACOs more easily address health promotion. Additionally, it has the opportunity to engage patients in a way that healthcare hasn’t before.

“People are having choices they didn’t have before,” Bakalar said of the bottom line.

“As we get into quality-based or value-based purchasing, we believe telehealth will become more prevalent and more widely accepted and more widely desired,” he concluded.

Celebrate Medicine with the FMA at the 2015 Annual Meeting

Registration is now open for the 2015 FMA Annual Meeting, which will be held July 31-Aug. 2 at Disney’s Yacht & Beach Club Resort in Orlando.

In addition to networking with your colleagues and enjoying family-friendly activities in the heart of Disney, you can take advantage of three CME tracks, which include mandatory topics to help you maintain your Florida license and courses addressing key health issues for Floridians. Visit celebratemedicine.com to learn more.

Join the FMA today @ www.FLmedical.org.

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Shepherd’s Hope Hosts 15Th Annual Celebrity Golf Classic July 23-24 KISSIMMEE—Shepherd’s Hope will host its 15th annual celebrity golf classic July 23-24 at the Reunion Resort, a Wyndham Grand Resort in Kissimmee, on award-winning courses designed by Jack Nicklaus, Arnold Palmer, and Tom Watson.

Philanthropic-minded foursomes – comprised of community members, business professionals and national sports legends – will play rounds of golf at the ThursdayFriday event to help provide free primary and secondary medical services to the uninsured and underserved in Central Florida, accessible at Shepherd’s Hope five free health centers.

Two New Team Members Join Orlando Medical News Associate Publisher Pat Berline After working with several publishing houses in the Orlando area and most previously Physician Dispensing Company, Pat Berline turned her attention, once again, to Orlando Medical News, metro Orlando’s only local, editorial-driven healthcare news reaching the area’s physicians and healthcare administrators.

“I treat my customers as I would want to be treated,” said Berline. “I listen to what their particular needs are and help them project that into their marketing. Bottom line: their success is our success!”

Berline had extensive experience as an office manager and executive recruiter before moving to sales. Before relocating to Florida, she marketed Safeguard Systems, one-write pegboard systems, to doctors and dentists in a 5-county area surrounding Northfield, Ohio. In Kissimmee, she marketed the Osceola News Gazette, The Lakes News in Lake Nona, andOsceola Community Source in St. Cloud for nearly a decade.

Berline’s “pay-it-forward” attitude puts her on the community front lines, volunteering at the Osceola Council on Aging and Osceola Riders Inc., which supports non-profit organizations such as Osceola County School’s Oasis Program, “Dreams for Teens,” and St. Cloud Food Pantry.

At Kissimmee Elks Lodge #1873, she is a 3-year trustee and house committee chairperson. The group supports the Orlando Veterans Nursing Home, Harry-Anna Trust Fund, Florida Elks Youth Camp, Florida Elks Children’s Mobile Therapy Units, Soccer Shoot, and Hoop Shoot, and the Elks National Foundation via scholarships and working with Harbour House of Central Florida.

Berline and husband of 21 years, Paul, have five daughters, 14 grandchildren and 2 great nieces and nephews. They hit the road as often as possible visiting family and friends in Louisiana, Ohio, and around Florida.

“I take pride and have a great passion in working, once again, for Orlando Medical News, and with our great Med News team here in Florida,” said Berline. “Change is upon us all with the upcoming relaunch of our new website. Now’s the time to look

forward while remembering lessons learned personally and professionally! Please share with us your victories and new methodologies, so others may begin to grow and/or start their businesses/practices through your insights. We’re only a phone call away!”

Contact Pat Berline via (407) 414-3054 or pberline@orlandomedicalnews.com.

Associate Publisher Dan O’Connell Dan O’Connell, a product specialist in Florida since 1997, recently joined the Orlando Medical News publishing team.

O’Connell was born and raised in the South Boston suburbs. After earning a humanities degree from Providence College, he launched a sales and marketing career in the dental industry. While furthering his education at Babson College in Wellesley, Mass., he covered a New England/Upstate New York territory for major dental manufacturers. With an MBA and marketing concentration, he joined the world’s largest dental manufacturer as a product manager, overseeing the marketing of Dentsply/Caulk’s posterior restoratives line of products.

O’Connell’s success led to roles of rising responsibility and numerous accolades, including the prestigious Salesman of the Year as product specialist for Siemens/Pelton & Crane’s CEREC project.

After relocating to Florida, O’Connell soon ventured into other areas of business consulting for sales and marketing, including print sales for Alphagraphics in Lake Mary, and as an account executive for one of Lake Mary Life’s group of popular Seminole County magazines. His civic involvement has included membership in five Orlando-area chambers of commerce, serving on the board of the Lake Eustis Chamber and chairman of the ambassador committee for Medical Office Resources of Florida (MOROF), and countless volunteer hours on community projects.

In 2013, O’Connell returned his focus to healthcare with a start-up local online scheduling company, which led to his new role with Orlando Medical News.

A resident of Lake Mary, O’Connell has three daughters, all University of Florida alums: a dentist in Baltimore, Md., an RH/ MPH in St. Petersburg, and a bank corporate vice president in Charlotte, NC.

Create Health for your Patients and Practice JOE PECORARO, MD Lost over 100 pounds over 9 years ago and has kept it off

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JUNE 2015

ORMC Surgical Areas Add More ORs The Orlando Regional Medical Center (ORMC) Redesign and Renovation Project continues with its Surgical Services expansion and renovation. The 28,000-square-foot addition includes 10 new operating rooms, a new Post Anesthesia Care Unit area with 24 patient bays. The areas will open for surgery cases, in phases beginning Monday, May 18.

There are 55 to 60 scheduled surgeries per day at ORMC. In addition to the planned procedures, it is not uncommon for 10 or more emergency same day surgery cases to be added to the schedule.

As a Level One Trauma Center, new cases are added throughout the day at any given time.When emergent surgeries are added to the schedule, it can change the timing of planned procedures or result in delays in getting these added surgeries done in a timely manner. The new operating rooms will help keep planned surgeries on time and allow us to add cases without much adjustment to scheduling.

With the additional operating rooms, ORMC will have 21 operating rooms.

Surgical systems such as the da Vinci® Xi™ Surgical System by Intuitive Surgical, and the Medtronic O-arm® Surgical Imaging System have been added to the new area.

The O-arm is a multi-dimensional surgical imaging platform that is designed for use in spine, orthopedic, and trauma-related surgeries. It provides real-time, intraoperative imaging of a patient’s anatomy with high quality images and a large fieldof-view in both two and three dimensions.

In addition to the surgical systems and surgical imaging systems technology, the operating rooms are also fitted with video integration technology. Video integration technology allows clinicians to broadcast surgeries from the operating rooms to conference room settings for teaching purposes.

The Post Anesthesia Care Unit is a specialized patient care unit that provides care for patients following surgery. In the unit, vital signs are monitored and pain management begins along with other monitoring and care needs before the patient is admitted to their next patient care unit.

In addition to the new operating rooms, advanced technology, and Post Anesthesia Care Unit, the Surgical Services expansion and renovation will include an expanded Pre-Operative Care Unit and new Endoscopy Care Unit. The two new units will be completed later this year.

The Surgical Services expansion and renovation is part of the South Expansion phase of the ORMC Redesign and Renovation Project. Other areas to be completed by summer include cardiovascular and laboratory services areas. Also part of the project, the new Emergency Department

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PUBLISHED BY: SouthComm, Inc. FLORIDA MARKET PUBLISHER John Kelly johnkelly@orlandomedicalnews.com AD SALES: John Kelly 407-701-7424 Pat Berline, 407-414-3054 Dan O’Connell, 407-923-1350 Tony Smothers 407-247-1308 NATIONAL EDITOR Pepper Jeter editor@medicalnewsinc.com LOCAL EDITOR Julie Parker jparker@medicalnewsinc.com CREATIVE DIRECTOR Susan Graham susan@medicalnewsinc.com GRAPHIC DESIGNERS Katy Barrett-Alley Amy Gomoljak, James Osborne CIRCULATION subscriptions@southcomm.com CONTRIBUTING WRITERS Julie Parker, Cindy Sanders, Jeff Webb —— All editorial submissions and press releases should be emailed to: editor@medicalnewsinc.com —— Subscription requests or address changes should be mailed to: Medical News, Inc. 210 12th Ave S. Suite 100 Nashville, TN 37203 615.244.7989 (FAX) 615.244.8578 or e-mailed to: subscriptions@southcomm.com Subscriptions: One year $48 Two years $78

SOUTHCOMM Chief Executive Officer Paul Bonaiuto President Chris Ferrell Chief Financial Officer Ed Tearman Executive Vice President Of Digital and Support Services Blair Johnson Director Of Financial Planning And Analysis Carla Simon Vice President Of Human Resources Ed Wood Vice President of Content Patrick Rains Vice President Of Production Operations Curt Pordes Group Publisher Eric Norwood Chief Revenue Officer Dave Carter Director Of Digital Sales & Marketing David Walker Controller Todd Patton Creative Director Heather Pierce Orlando Medical News is published monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm, Inc. ©2014 Medical News Communications.All rights reserved. Reproduction in whole or in part without written permission is prohibited. Medical News will assume no responsibilities for unsolicited materials.

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

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GrandRounds opened in April and the ORMC North Tower opened in January. The entire redesign and renovation project, an estimated cost of $297 million, represents one of the largest and most significant projects in the organization’s history.

Brasfield & Gorrie served as the general contractor for the project. The architectural firm was HKS Architects, Inc.

Orlando Health Earns Top Common Care Ratings When it comes to hip replacement, knee replacement and treatment for chronic obstructive pulmonary disease (COPD), physicians at Orlando Health represent some of the best in the nation. Their care in these specialties has been rated high performing, according to the newest “Best Hospital” rating program from U.S. News & World Report. Only eight percent of U.S. hospitals that were evaluated for COPD treatment were rated high performing.

High performing knee and hip replacement hospitals represented just 10 and 11 percent respectively.

Both programs have been recognized for their leading-edge innovations.

Orlando Health’s pulmonary program offers clinical trials and procedures that are unavailable elsewhere in the area. For example, 10 years ago the practice started doing electromagnetic navigational bronchoscopies to detect cancer when it’s only in Stage 1. And it was one of the first in the state to perform the bronchial thermoplasty procedure to help asthma patients.

In 2008, Orlando Health’s Orthopedic Institute was the first in greater Orlando to perform the anterior approach for hip replacement, a procedure that eliminates the need to cut the hip muscle and enables patients to regain mobility faster than traditional hip-replacement surgeries. Orlando Health orthopedic surgeons also have been involved with the development of innovative total knee replacement technologies that have shown improved function and earlier return of range of motion. The surgeons are internationally recognized for their expertise in hip and knee replacements.

In 2011, the Orlando Health Heart Institute was officially dedicated, ushering in a new collaborative approach to patient care that includes advanced diagnostic services, the most current surgical and non-surgical treatment options, comprehensive education and innovative research. The organization also implemented structured heart failure outpatient comprehensive treatment programs on all Orlando Health campuses.

Heart failure directors were appointed on each campus and at the corporate level to enhance system-wide collaboration.

Florida Hospital Transplant Institute Welcomes Dr. Scott Silvestry Florida Hospital is pleased to announce Dr. Scott Silvestry, a cardiothoracic surgeon, has joined the Cardiovascular Institute’s Advanced Heart Failure and Thoracic Transplant programs to offer lifesaving treatment options for heart failure patients.

Dr. Silvestry specializes in implanting left ventricular assist devices (LVAD), a pump that supports weak hearts and improves orlandomedicalnews

.com

function and blood flow. He brings a minimally invasive approach to the procedure, which is being used increasingly as a bridge to heart transplant and long-term therapy.

Prior to joining Florida Hospital, Dr. Silvestry held various positions at Barnes Jewish Hospital and Washington University School of Medicine, including associate professor in the division of cardiothoracic surgery and surgical director of surgical cardiac transplantation & mechanical circulatory assist. Under his leadership, Washington University School of Medicine’s LVAD and transplant program rapidly became one of the nation’s busiest. Dr. Silvestry has authored and coauthored groundbreaking research and served in leadership roles at organizations within his field. Dr. Silvestry has lectured nationally and internationally, and is recognized as an international innovator of surgical technique and applications of mechanical assist technology.

Originally from New York City, Dr. Silvestry completed undergraduate studies at Cornell University, and attended medical school at the University of Pennsylvania School of Medicine. He completed a residency, fellowship, and advanced fellowship in cardiac transplantation and ventricular assist devices at Duke University Medical Center.

Orlando Health Hospitals Awarded an “A” for Patient Safety Four Orlando Health hospitals were recently honored with an “A” Hospital Safety Score by The Leapfrog Group, an independent national nonprofit run by employers and other large purchasers of health benefits. The hospitals are Orlando Regional Medical Center, Health Central Hospital, Dr. P. Phillips Hospital and South Seminole Hospital. South Lake Hospital, in affiliation with Orlando Health, received a “B” score. The scores were awarded based on a number of factors including the hospitals’ adherence to best practices in the process of providing care as well as rates for preventable medical errors, injuries, accidents, and infections. The scores reflect Orlando Health’s commitment to increasing the quality of care it delivers to all its patients.

SAFE is an acronym for Strategic Action for Excellence. Each Orlando Health hospital has a SAFE team that consists of a physician chief quality officer, a project leader who is typically a clinical professional, and up to a dozen additional team members who may be clinical or non-clinical. The teams use best practices, evidence-based medicine, and a variety of tools and methods to reduce or eliminate conditions or behaviors that could impede patient care.

Grace Medical Home Celebrates Fifth Birthday In May, Grace Medical Home celebrated 5 years of providing the highest level of healthcare to the uninsured of Central Florida.

Grace Medical Home has also played a significant role in the reduction of Emergency Room visits since it opened. Of the Grace patients surveyed in 2014, 67 percent said they would have gone to the ER for treatment if Grace did not exist.

Some of the other additions and changes have come in the last year alone. In 2014

Grace expanded to a second building to provide mental health care to patients and celebrated its second year of partnership with the University of Central Florida, helping to train 114 future physicians with the Knights Clinic.

The number of uninsured in Florida and Central Florida continues to be much higher than the national reports. In Florida, nearly one in four people lack health insurance, according to a recent report by the U.S. Census Bureau, the second largest rate of uninsured in the country, just behind Texas. Orange County’s uninsured exceeds state or national trends, with roughly 250,000 – or 24.5 percent - without health insurance coverage.

Central Florida Regional Hospital and Osceola Regional Medical Center Designated Provisional Level II Trauma Centers In an effort to expand access to lifesaving medical care for critically injured patients, Central Florida Regional Hospital and Osceola Regional Medical Center have been designated as Provisional Status Level II Trauma Centers by the Florida Department of Health. The hospitals began accepting Level II trauma patients on May 1.

Both hospitals have successfully completed the state’s provisional review phase and are able to accept Level II trauma patients with critical injuries, such as victims of car accidents, sports injuries, shootings and stabbings.

When emergency medical services personnel respond to patients, they transport them to the nearest trauma center capable of providing appropriate treatment. Previously, many patients in Seminole, West Volusia, South Orange, Osceola and Polk counties were transported more than 20 miles to the nearest trauma center.

The hospitals aim to reduce transport times during the “golden hour” – a 60-minute window for bringing patients to a designated trauma center. Studies show that the sooner care is given within that hour, the better the outcome.

Trauma is the leading cause of death among Floridians under the age of 44, and Florida’s death rate for trauma remains higher than the national average. Prior to Central Florida Regional Hospital and Osceola Regional Medical Center’s desig-

nations, there was only one trauma center serving Central Florida’s 2.2 million permanent residents and the 1 million tourists visiting the region annually.

Both hospitals have implemented continuous in-house physician staffing for trauma surgery, emergency medicine and anesthesia, along with increased physician staffing of surgical and non-surgical specialties. Additionally, both have joined Florida’s first and largest statewide network of trauma centers, developed as an affiliation between the University of South Florida (USF) and HCA to improve access and outcomes of injured patients.

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