Orlando Medical News September 2015

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PHYSICIAN SPOTLIGHT PAGE 3

Ricardo Ogando, MD ON ROUNDS

Fifth Third Bank Is Launching Third SU2C Campaign More Than $4.2 Million Has Been Raised Nationwide ... 6

UF Health Researchers Discover Signal That Impacts the Link Between Body Fat, Stress And Metabolism

Orlando Health ‘On a Tear’ Organization Fulfills Mission by Investing in Services, People

By JONATHAN SCOTT

When it comes to expanding, whether its medical services, facilities or physician practices, Jamal Hakim, MD, chief operating officer of Orlando Health, admits that this private not-forprofit healthcare organization has been on “a little bit of a tear” in the past two years.

Consider the following: This hospital system invested some $300 million for the Orlando Regional Medical Center’s (ORMC) new North Tower and renovated South Tower. It also acquired Health Central Hospital, Physician Associates, Boston Diagnostics and Pediatric Associates – all since April, 2012.

This investment in structures and (CONTINUED ON PAGE 4)

WHO’S TENDING OUR DOCTORS?

The AMA Steps Up with STEPS Forward

... 7

Gateway To the Future

When the Need Arises, Florida Hospital Able to Expand Services in Lake Nona Medical City ... 11

Ambitious New Initiative Offers Physicians Strategies to Revitalize Medical Practices and Improve Patient Care

By LyNNE JETER

Editor’s Note: This article is part of a Medical News exclusive series, “Who’s Tending Our Doctors?” to focus on ways the industry can help alleviate physician stress and allow physicians to return to the joy of practicing medicine.

Several years ago, Christine A. Sinsky,

ONLINE: ORLANDO MEDICAL NEWS.COM

MD, FACP, made two significant time-saving changes to her practice life that allowed her to leave work sooner and have more time for family and personal interests.

The first: taking a streamlined approach to prescription management.

Second: taking proactive planned care measures with patients via previsit labora-

Now Serving Orange and Osceola Counties

tory tests.

“Just making a single change – prescription management – decreased phone calls to the practice by 50 percent. It saved 30 minutes of doctor time and 60 minutes of nursing time per doctor per day,” said Sinsky, an internist and partner in Medical Associates (CONTINUED ON PAGE 8)

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PhysicianSpotlight

‘A Condensed, Long-term Relationship’ It’s How Ricardo Ogando, MD, Connects with His Wound-Care Patients

By JEFF WEBB

WINTER PARK - For Ricardo Ogando, the medicine matters, but it is the bond with patients that makes it meaningful.

“I believe that few areas in medicine are as rewarding as wound care,” said Ogando, one of three physicians and three ARNPs at Florida Wound Care Doctors, “the only practice in Central Florida that is solely dedicated to full-time outpatient wound care.”

The impact in a patient’s life “is almost immediate and very objective. It’s something we all can appreciate,” said Ogando.

But it is the investment of time that distinguishes this specialty from what he did previously as a hospitalist, he said. “Since we see our patients on a regular basis, we also have the chance to connect with them and create that patient-physician relationship that is the core of medicine. In our field we get the best two things that medicine has to offer as a career,” he said.

As a hospitalist, Ogando said, the patients “don’t really know you until they meet you in the hospital, and it could be one of the worst times of their lives. There is really not much time to establish a relationship. The goal is to get them better and get them out,” explained Ogando, who worked at Orlando Regional Medical Center before becoming a full-time wound care physician.

“Once you get into an environment like this (outpatient wound care) you get to see patients on a weekly basis usually. You get to know them, their habits, what they like and what they don’t like,” he said. “You have to, because sometimes they may be doing something at home they aren’t even aware is keeping the wound open. So, you get to know them more personally, and because you are sharing this wound (healing) and they can see it, they get to appreciate it,” he said.

Ogando compared it to “the relationship you have with your primary care doctor for many years, but in an intense course.

When you see someone every week for 16 weeks, it’s a condensed, long-term relationship. You get that connection and that reward, as well as the reward of seeing a finished product — the healed wound. It is one of the best things about wound care,” said Ogando. And it is one of the reasons he did not hesitate to join Florida Wound Care Doctors in 2012, an opportunity that presented itself coincidentally.

At Orlando Regional, there was “another hospitalist who went to work for Dr, Conlan (Walter Conlan III, MD, founder of Florida Wound Care Doctors). When she told me what she was doing I asked ‘Do you guys need a doctor? I want to do wound care,’” he remembered. About three months later that physician called and told him she was leaving to join her husband, who was in the armed forces, in California. “She asked ‘Do you want my job?’ And that was it.”

These days, Ogando distributes his orlandomedicalnews

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time “fairly evenly” among several locations where Florida Wound Care Doctors is established, including Health Central Hospital in Ocoee, Osceola Regional Medical Center in Kissimmee, South Seminole Hospital in Longwood, Orlando Regional Medical Center’s Lucerne Annex, and a few nursing care facilities. The schedule allows him to stay for an entire day in one location, where most of the patients he treats have diabetic foot ulcers and venous ulcers. “I don’t have to drive around so much (and) it is refreshing to go to a different center every day and get a different view of things,” he said, adding that about 5 percent of patients require hyperbaric therapy.

Ogando said his interest in wound care emerged during his internal medicine residency at Seton Hall University School of Medicine in New Jersey. “I was attracted to it right away. But I was just getting started in residency and I had a long way to go until I could think about practicing and making that transition,” he said.

It had not been so very long since Ogando had made a much more substantial transition: Moving to the United States after completing medical school and practicing for a couple of years in his native Dominican Republic. Ogando recalls “leaving everything I knew behind” as one of the most challenging in his life. “Luckily, I wasn’t alone; I had the support of my wife. She’s

kept me going, and now as a family we’ve created our home here,” he said, referring to Yaritza, also a physician. They met in medical school in the Dominican Republic in 1997 and married in 2005.

“The process of getting here is easy once you get all of your exams and licenses,” said Ogando. “But you get here and you realize how different everything is … Other than my wife I had no social support, especially when we were in Michigan,” where he was a hospitalist for three years at Northern Michigan Regional Hospital in rural — and

wintry — Petoskey. “It was just us. There was no one to relate to in terms of our culture. It gets lonely, especially when you are in training and you are doing 30-hour shifts without sleeping,” he said. In the middle of the night sometimes you ask yourself ‘What am I doing here?’…. It takes a while to adjust, but you move forward and create your own families,” which is what the couple has done in Orlando with their children, 7-yearold Ricardo and Sophia, 4.

Ogando is creating more than a family in his home in Ocoee. He also is honing a hobby: Home-brewing beer. “I’ve been playing around with it. It’s fun and does not take much time. The yeast does most of the work; just keep it clean and happy. My latest brew was an oatmeal potter. It didn’t end well, so I am taking a step back before moving forward with the next,” he said. “It is something to distract yourself with. You can share with others and have some conversation (about the process),” he said.

Ogando also has a strategy to burn the calories from the beer. He runs every other day.

“I’d love to do an Ironman triathlon, but keeping up with the training has been difficult. I’ve managed to do some marathons and half-marathons,” he said, including his first one, which ended in the Green Bay Packers’ Lambeau Field. “That was pretty cool,” he said.

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Orlando Health ‘On a Tear’, continued from page 1 new medical practices reflects Orlando Health’s commitment to its mission, which is to provide the best medical services to everyone who lives in Central Florida, regardless of their financial means, Hakim said.

“We want to offer the highest-quality and the lowest-cost services,” he explained. “But to do that, we had to make some fundamental changes in our system, and we started doing that four or five years ago and a lot of that is now panning out.

We are now the leader in the value equation for both the customer, who are our patients, as well as the employer - those people actually having to pay for health insurance and services.”

To fulfill its mission, Orlando Health had to find a way to integrate the delivery of healthcare across a continuum, Hakim notes.

This required Orlando Health to bring in existing practices that not only contained some of the best doctors in the area, but also those who already had a proven track record of adhering to a successful “value equation” business model that mirrored Orlando Health’s. This lead to the acquisition of Physician Associates in 2013 and most recently Pediatric Associates.

The company also had to ensure the medical services patients needed were both abundant and convenient, so that has resulted in Orlando Health’s expansion of healthcare programs such as its outpatient oncology services throughout the community at Dr. P. Phillips Hospital, Health Central Hospital and South Seminole Hospital.

To achieve its mission, Orlando Health is providing sufficient space for these many services and locating these

offices in a wider delivery area. Consequently, it’s invested in structures to house an expanded emergency room and catheterization lab. In addition to opening the Physician Associates clinic in Lake Nona, Orlando Health is increasing its presence in places outside Orlando, such as Ocoee and Lake Mary.

And last year, Orlando Health came on board as the official healthcare provider and jersey sponsor for the new MLS expansion soccer team Orlando City Soccer. Orlando Health orthopedic surgeons and primary care sports medicine physicians serve as Orlando City’s official

medical team proving the organization’s commitment to be a leader in sports medicine.

“Clearly, Orlando Health’s board and its executives have always known that we are the mission-driven health facility in Central Florida,” Hakim said. “We feel that, ultimately, Orlando Health is the best place to turn for healthcare and Central Floridians can count on us.

“Whether it’s from producing top doctors to having the first teaching hospital in Central Florida, the first pediatric hospital in Central Florida, the first trauma hospital in Central Florida and the first women’s hospital in Central Florida – all these align with our mission.”

In taking the steps needed to realize its mission, Orlando Heath has managed to cut waste to cut costs, he added. It has also managed to reduce duplicity in an attempt to give its patients what they need in terms of healthcare.

“At the same time, we’ve driven up our quality outcomes across our system, which shows our dedication to our patients, our community and to the future of healthcare,” Hakim said.

Altogether, these efforts are positioning Orlando Health, which was founded in 1918, to continuing serving as a healthcare leader in Central Florida for decades to come.

“We’ve been here almost a 100 years and we need to make sure we’re still a servant of the community for the next 100 years,” Hakim said. “And that’s what we see ourselves as – servants of the community.”

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Achieving its Mission To achieve its mission to provide low-cost, high-quality healthcare services to patients who come from as many as 20 counties in Central Florida, Orlando Health has been busy in recent months expanding services, investing in the facilities for these services and integrating itself further into the community.

Here are a few of Orlando Health’s recent and future accomplishments: • Acquired Health Central Hospital in April 2012, enabling the organization to better provide West Orange County residents with convenient access to services in their own community, while expanding the number of key services available.

• Acquired Physician Associates in January 2013, one of the largest multi-specialty healthcare groups in Central Florida. Recently expanded opening an office in Lake Nona providing pediatrics, adult medicine and obstetrics and gynecologic services.

• Extended its partnership with the Orlando City Soccer Club in 2013, becoming the first jersey partner in Major League Soccer history to commit to an expansion club prior to admittance into the league.

Orlando Health is also the official medical team of Orlando City MLS and Orlando City Youth Soccer.

• In January 2014, began a partnership with UF Health (ending its 21-year affiliation with MD Anderson) and forming UF Health Cancer Center - Orlando Health. The cancer center also launched a partnership with the Cancer Support Community, becoming the second such hospital partnership in the nation bringing free cancer support services to the community. In September 2015, the cancer center opened a Cancer Genetics Center, specializing in high risk cancer cases and genetic counseling and testing to address the ongoing need of cancer patients in Central Florida.

• In December 2014, teamed up with a radiology practice group to purchase Boston Diagnostic Imaging, an Orlandobased outpatient diagnostic center with five locations in Central Florida.

• In January 2015, opened ORMC’s new 245-bed, 10-story, 345,000-square-foot North Tower. The hospital’s redesign and renovation project included an expanded emergency department, cardiovascular service areas, operating suites and other ancillary services located inside ORMC’s South Tower. The South Tower expansion was completed in the spring. The entire redesign and renovation project cost about $300 million.

• On Sept. 1, 2015, Orlando Health Physician Associates acquired Pediatric Associates, one of the oldest pediatric practices in Central Florida comprised of 11 physicians.

• In spring 2016, will open the first Proton Therapy Center in Central Florida, the multi-million dollar facility, currently under construction along Orange Avenue will provide oncology patients with a specialized form of radiation treatment using proton beams. Treating tumors using proton therapy delivers a lower dose of radiation to surrounding normal tissue, which results in fewer side effects, especially for pediatric patients. orlandomedicalnews

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SEPTEMBER 2015

By LyNNE JETER

As Fifth Third Bank was rolling out its new campaign for Stand Up to Cancer (SU2C), Jose Pena received the unfortunate news that one of the Florida region’s banking center managers was diagnosed with Stage 4 cancer.

“We were heartbroken,” said Pena, senior vice president and Florida regional director for retail at Fifth Third Bank (NASDAQ: FITB). “She’s an advocate for the support of cancer research and has inspired me and all of our teammates to join her in the fight.”

Pena has also dealt with cancer closer to home. Six years ago, his wife, Edith, was diagnosed with thyroid cancer. Since having the diseased thyroid gland and connected lobes removed, she’s been cancer-free, and remains a staunch supporter of Fifth Third’s efforts to raise awareness of the disease.

“Like me, many team members have experienced cancer in some form – themselves or a loved one – and for the same reason, cancer really resonated with employees and customers,” he said.

Fifth Third Bank recently launched its third campaign for SU2C, a charitable program of the non-profit Entertainment Industry Foundation tasked with raising money to accelerate innovative cancer research, enabling scientific collaboration to quickly connect new therapies to cancer patients.

A $142 billion bank headquartered in Cincinnati, Ohio, Fifth Third Bank has raised more than $4.2 million for SU2C. The latest campaign launched July 27 and runs through Oct. 17.

When customers open a new Essential Checking Account with $150, with direct deposit and three online bill payments made, Fifth Third Bank will donate $150 to SU2C. The bank will also donate $1 to SU2C when people share eligible posts using the #howifight hashtag on Facebook, Instagram, Twitter and Vine, up to $100,000 during the campaign.

The promotion, at 53.com/howifight, follows the national trend of companies giving customers a variety of ways to give back to the community as they shop or conduct business.

“With cancer impacting so many, we asked ourselves, ‘Could a bank help in the fight against this disease?’” noted Maria Veltre, senior vice president and chief marketing officer for Fifth Third Bank.

“That was more than two years ago, and

we’ve proven since that we can make a difference with the help of our customers, employees and members of our communities, and we’re now leveraging the power of celebrity with (actor and cancer advocate) Patrick Dempsey. With this campaign, we want to highlight all the ways that we help fight (cancer) every day.”

A $50 minimum deposit is required to open all accounts and obtain the $150 bonus. All requirements must be met and qualifying activity must be initiated and post to the account within 90 days of account opening. The bonus will be deposited into the new account within six weeks of completing requirements, and may be taxable as interest income and reported on IRS Form 1099-INT. The offer is limited to one bonus per account per household.

Fifth Third began working with SU2C in 2013 when the bank rolled out exclusive SU2C credit and debit cards, which generate donations to SU2C for every qualifying purchase made using those cards. Fifth Third Bank is the only card issuer to offer the SU2C payment cards.

“Through this campaign, Fifth Third has made an everyday necessity a more meaningful experience for their customer by supporting Stand Up To Cancer’s innovative cancer research,” said Rusty Robertson, co-founder of the organization, pointing out the dismal national statistics: one in two men and one in three women will be directly affected by cancer in their lifetime, according to statistics collected by the Surveillance Epidemiology and End Results program at the National Cancer Institute. “We’re humbled by the incredible engagement this campaign has received from Fifth Third customers, and honored to continue this collaboration.”

SU2C was founded in 2008 on the belief that everyone can make a difference in the fight against cancer, Robertson pointed out.

“We’re profoundly grateful to each and every donor, of any level,” said Robertson.

Celebrity Patrick Dempsey will lend his image to Fifth Third’s new SU2C Campaign this year. He will be featured in a Fifth Third Bank and SU2C spot highlighting ways people can fight cancer.

As SU2C’s scientific partner, the American Association for Cancer Research (AACR) and a Scientific Advisory Committee led by Nobel Laureate Phillip A. Sharp, PhD, conduct rigorous, competitive review processes to identify the best research proposals to recommend for funding, oversee grants administration, and provide expert review of research progress. orlandomedicalnews

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UF Health Researchers Discover Signal That Impacts the Link Between Body Fat, Stress and Metabolism

By LYNNE JETER

GAINESVILLE — A group that includes two University of Florida Health researchers has found that body fat can send a signal that affects the way the brain deals with stress and metabolism.

Even though the exact nature of those signals remains mysterious, researchers say simply knowing such a pathway exists and learning more about it could help break this vicious cycle: Stress causes a desire to eat more, which can lead to obesity. And too much extra fat can impair the body’s ability to send a signal to the brain to shut off the stress response.

Findings of the NIH-funded study are important and unique because they show that it’s not simply the brain that drives the way the body responds to stress, said James Herman, PhD, a co-author of the paper and a professor in the department of psychiatry and behavioral neuroscience at the University of Cincinnati.

“It moved our understanding of stress control to include other parts of the body,” explained Herman. “Before this, everyone thought the regulation of stress was mainly due to the brain. It’s not just in the brain.

This study suggests that stress regulation occurs on a much larger scale, including body systems controlling metabolism, such as fat.”

The findings, which reveal a novel fat-to-brain feedback network, were published in Psychoneuroendocrinology, “Adipocyte Glucocorticoid Receptors Mediate Fat-to-brain Signaling,” by a group that included Annette D. de Kloet, PhD, a research assistant professor in the UF College of Medicine’s department of physiology and functional genomics, and Eric Krause, PhD, an assistant professor in the UF College of Pharmacy’s department of pharmacodynamics.

Researchers discovered that a glucocorticoid receptor in fat tissue can affect the way the brain controls stress and metabolism. Initially, such signals from the re-

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ceptor can be lifesavers, directing the brain to regulate its energy balance and influencing stress responses in a beneficial way.

“The stress response in the short term is adaptive. It’s going to help you cope with stress,” Krause said. “The idea that fat is actually talking to the brain to dampen stress is new.”

The researchers found that steroid hormones known as glucocorticoids activate their receptors within fat tissue in a way that affects a main component of the metabolic stress response. Using mouse models, they found a unique connection

between glucocorticoid signaling in fat tissue and the brain’s regulation of energy balance and stress response. Because glucocorticoid signaling is crucial to regulating the hypothalamic-pituitary-adrenal axis, fat tissue can directly affect central nervous system functions that link obesity, metabolic disease and stress-related problems, researchers concluded.

Understanding fat-to-brain signaling is a first step toward someday being able to influence the broad, complex relationship between stress, obesity and metabolism.

Herman credited de Kloet for pressing

the search for a fat-to-brain signaling network.

Now that researchers have established that a fat-to-brain signaling pathway exists, a fuller understanding of how it functions could someday lead to drugs or other therapies that ward off the negative effects of long-term stress, said Herman.

“The big question is the nature of that signal to the brain,” he said. “We need to learn how to go in and break that cycle of stress, eating and weight gain.”

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The AMA Steps Up with STEPS Forward, continued from page 1 Clinic, a multispecialty group practice with sites in Iowa, Wisconsin and Illinois.

Sinsky is also the point person at the American Medical Association (AMA) for an Dr. Christine ambitious new initiative Sinsky offering physicians strategies to revitalize their medical practices and improve patient care. The practice changes she references are found in the initial 16 modules available online – free for AMA and non-AMA members – via www.STEPSforward.org.

“If you can follow one or two recommendations and go home earlier by reengineering the way you do your work, that’s a win-win all around,” said Sinsky.

The AMA took action to improve the lives of practicing physicians after a recent RAND survey showed the satisfaction physicians derive from their work is quickly eroding as time continues to be taken away from direct patient care because of grueling, bureaucratic obstacles.

“Research shows that rates of overall burnout among U.S. physicians approach 40 percent,” said AMA CEO James L. Madara, Dr. James L. MD. “That’s why the Madara

AMA is taking a hands-on approach to meeting their day-to-day concerns through the new online series, AMA Steps Forward.”

Broadly, the 16 modules address four key areas: practice efficiency and patient care, patient health, physician health, and technology and innovation.

Specifically, the modules cover these topics: • Conducting effective team meetings • Creating strong team culture • Electronic health record (EHR) implementation • EHR software selection and purchase • Expanding rooming and discharge protocols • Improving blood pressure control • Improving physician resiliency • Medication adherence • Panel management • Preventing physician burnout • Preventing type 2 diabetes in at-risk patients • Pre-visit laboratory testing • Pre-visit planning • Starting lean healthcare • Synchronized prescription renewal • Team documentation Each module requires only snippets of time to study either online or printed in PDF format for a more traditional approach to learning. Live events provide yet another learning option. To earn AMA PRA Category 1 Credit™, par-

ticipants must view the module content in its entirety, successfully complete the quiz answering four of five questions correctly, and complete the evaluation.

Modules include steps for implementation, case studies and downloadable videos, tools and resources.

“Within 30 minutes, physicians will know how to take the next step in their practices to work smarter, not harder,” said Sinsky.

For example, the module on effective team meetings begins with a 10-step process: • Identify the team.

• Meet routinely and “on the clock.”

• Agree on ground rules.

• Set a consistent meeting agenda.

• Rotate meeting roles.

• Solve problems as a group.

• Record action steps, owners and due dates.

• Practice good meeting skills.

• Have fun!

• Celebrate success.

Under ground rules, helpful hints include starting and ending each meeting on time, being fully present in the moment, staying on topic, focusing on the issue and not the individual, stepping up or back as needed, and giving thanks to the staff for their time. To stay on topic and maintain efficiency during the dedicated meeting time, it’s suggested that: “if the discussion wanders, the chair or other member can

say, ‘Let’s take that offline,’ or ‘that sounds like an issue to put in the “parking lot” to talk about at another meeting.’ If the discussion strays, there may not be time at the end of the meeting for all the items on the agenda.”

In October, 10 modules will be added to the website. By the end of 2016, the AMA plans to have up to 50 modules available online.

Concurrently with the rollout, the AMA and the Medical Group Management Association (MGMA) issued a practice innovation challenge, seeking more high-value, easy-to-adopt, and transformative medical practice solutions. Proposals were submitted through Sept. 1; the best solutions were eligible for one of several $10,000 prizes, in addition to having the ideas developed into future STEPS Forward modules. Winners will be announced at MGMA’s annual conference Oct. 11-14 in Nashville, Tenn.

“We issued the innovation challenge to tap into the creative energy that we know is present among physicians,” said Sinsky. “The goal is to help physicians take better care of themselves and their practices so they can, in turn, take better care of their patients.”

CO MPLET E BUS INE S S SO LUT I O N S T H AT W I LL ALWAYS

KEEP YOUR HEAD IN THE CLOUD Central Florida’s ONLY medical practice dedicated entirely to wound care and hyperbaric medicine on a full-time basis.

Front row (L to R): Patrice Muse, ARNP, Maria Soto, ARNP, and Deborah Tedesco, ARNP. Back row (L to R): Dr. Ricardo Ogando, Dr. Walter Conlan, and Dr. Barry Cook.

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1415 GENE ST, WINTER PARK, FL 32789 407.339.4499

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WOUND CARE CENTERS Osceola Regional Wound Care Center 407.518.3565 Kissimmee, FL

Wound Care & Hyperbaric Medicine Center at South Seminole Hospital 407.767.5843 Longwood, FL

Wound Healing & Hyperbaric Medicine Center at Health Central 407.253.2780 Ocoee, FL

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Wound Healing Center at ORMC/Lucerne Annex 321.841.5469 Orlando, FL

Dr. P. Phillips Comprehensive Wound Care Center 321.842.7320 Orlando, FL

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Gateway to the Future When the Need Arises, Florida Hospital Able to Expand Services in Lake Nona Medical City

REDUCING PAIN AND RESTORING FUNCTION

BY JONATHAN SCOTT

Lake Nona Medical City is thriving, and the leaders of Florida Hospital say their medical facility will grow right along with this community’s 650-acre health and life sciences park.

The University of Central Florida College of Medicine and Florida Hospital are partners in Lake Nona. They serve as the primary tenants of Gateway Lake Nona, a 100,000-square-foot medical office building, located at the intersection of Tavistock Lakes Boulevard and Narcoossee Road.

This is a prime location within a community that has already attracted thousands of residents in just a few short years, and Lake Nona, a carefully planned and laid-out city, is expected to be home to tens of thousands of additional families and professionals in the coming years.

Florida Hospital is there now and plans to be there in the future to provide the medical services these residents will need, said Terry Owen, senior executive officer with the healthcare provider that is among the country’s largest not-for-profit medical centers.

“We are excited to bring this care closer to their home,” Owen noted. “We’re there because we saw this as an opportunity to provide the Lake Nona community with the medical services they need, and that they need to have close to where they are.

Medical City is an area that is experiencing a lot of growth so we see a lot of opportunity to serve the people there.”

Gateway is among the first non-hospital patient-care facilities in the Lake Nona Medical City area, but with UCF and Florida Hospital as the anchor tenants in the building, it features some of the most sought-after medical services in the community.

Florida Hospital Medical Group provides imaging and rehabilitation services at Gateway, along with primary and other specialties. Yet under the same roof of Gateway, UCF Health, the faculty practice of the medical school, is also providing primary care services and specialty services.

The primary care and specialty services provided by Florida Hospital Medical Group and UCF Health include: orlandomedicalnews

.com

family medicine, internal medicine, urology, cardiology, endocrinology, orthopedic surgery, sports medicine, gastroenterology, rheumatology, dermatology, obstetrics and gynecology. Florida Hospital’s imaging center will give patients a convenient option for their mammograms, ultrasounds, X-rays, MRIs and CT scans.

At the hospital’s rehabilitation center, patients can receive treatment from physical therapists who specialize in orthopedic and sports medicine, spine and other areas. Patients also have easy access to Florida Hospital’s laboratory when physicians order clinical tests.

Instead of providing competing healthcare services, this medical partnership between UCF and Florida Hospital has been carefully orchestrated to provide patients with complementary services.

“What we have done with the building,” Owen explained, “is that while we have separate business offices set up, we wanted to work together in such a way that we can provide the full spectrum of medical services that the people in this market need and want.”

Gateway Lake Nona contains three floors. The first floor contains UCF Health’s offices, as well as UCF’s 12 exam rooms. Florida Hospital has its imaging and rehab centers on the first floor. On the second floor, Florida Hospital operates 24 exam rooms and a laboratory area.

With their combination of services, Florida Hospital and UCF can offer most patients all the medical services they should need as out-patients.

“All the treatment and diagnosis that do not require an overnight stay or a visit to an emergency room are available at Gateway,” Owen said. “We’re providing the whole spectrum of adult care.”

And as the community grows, Florida Hospital is ready to grow along with it, added Owen, who pointed out that the Gateway building still has some vacant space.

“We have space available in the building so we can add services and build out as the growth of the Lake Nona community continues,” he said. “We intend to make the Gateway building a strong site for medical services for years to come.”

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Telemedicine: A Virtual Compliance Jigsaw Puzzle A Closer Look at the New Wave in Healthcare Delivery

By LyNNE JETER

Telemedicine has quickly become the hottest topic in healthcare delivery, as the industry strives to adapt to its murky waters of compliance. New services, such as Zwivel, a cosmetic surgery consultation service, are coming online with unprecedented frequency, piquing the interest of physicians and administrators about the unknown possibilities of telemedicine.

“Perhaps we shouldn’t be surprised by this trend,” said Michael Sacopulos, JD, CEO of Medical Risk Institute and general counsel for Medical Justice Services, a 4,000-member group with physicians in all 50 states. “High speed internet connections are Michael now the norm. Services Sacopulos like Facetime and Skype are more popular than ever. Under continued pressure to cut costs and cope with declining reimbursements, administrators believe telemedicine offers a tool for in-

creasing efficiency. Patients also like the convenience and increased options that flow from telemedicine. So what’s not to like? Shouldn’t we embrace the ‘new normal’ and sign on to a great, brave new world? Maybe, first let’s proceed with caution.”

Among the state and federal compliance requirements when taking a practice online are licensure, professional liability considerations, standard of care, patient privacy, informed consent, and referrals for emergency surgery.

the medical provider does not accidentally practice in a state without a license.”

Professional Liability Most professional liability insurance policies provide state-specific coverage, meaning that if a provider accidentally practices telemedicine on an out-of-state patient, there may be no coverage, said Sacopulos.

“Providers wanting to expand into the area of telemedicine should check with their insurance carrier,” he suggested. “Another consideration relates to cyber issues.

Traditional medical malpractice policies provide little to no coverage for electronic breaches. The nature of a telemedicine generates exposures to a variety of cyber risks. Any practice moving forward with offering telemedicine should have a comprehensive cyber insurance policy.”

Licensure Medical providers “must be licensed by, or under the jurisdiction of, the Medical Board of the State where the patient is located,” according to the Federation of State Medical Boards’ Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine.

“Unfortunately,” noted Sacopulos, “this requirement imposes traditional state boundaries on the cyber world. Efforts need to be made to identify the residences of prospective telemedicine patients so

Standard of Care It’s imperative to note that telemedicine is the practice of medicine, and not “medicine lite,” Sacopulos pointed out.

“All the duties and obligations that come with in person consultations are owed to the remote telemedicine patient,” he explained.

The American Medical Association (AMA) recently stated there’s a general consensus among AMA members that care provided via telemedicine needs to meet the same standard as care provided in person.”

Also, the Federation of State Medical Boards made clear the position by stating: “In fact, these guidelines support a consistent standard of care and scope of practice notwithstanding the delivery tool or business method in enabling physician(CONTINUED ON PAGE 14)

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Halifax Health – Hospice Offers Innovative Children’s Bereavement Support Children are often thought to be too young to understand and cope with their grief. However, if given the proper support and understanding, they have a natural capacity to grieve and heal.

“First and foremost, grieving children need honesty. They need the truth about their loved one’s death and how it happened in ways that they can understand.

The explanation should be simple, but truthful,” explains Karen Grant, LCSW, children’s program developer for Halifax Health-Hospice BeginAgain Lawrence E. Whelan Children’s Grief Center.

Since 1979, Halifax Health – Hospice has compassionately provided care and services to Central Florida communities, with the non-profit organization’s bereavement program for children recently recognized with a 2015 Award of Excellence for program innovation by the Florida Hospice and Palliative Care Association.

Halifax Health-Hospice’s BeginAgain Lawrence E. Whelan Children’s Grief Center has gained national recognition for its successful programs that allow children the opportunity to process their grief with the assistance of licensed, master’s level counselors who specialize in children’s grief along with a specially trained and supervised team of volunteers.

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One of the center’s most popular programs is Camp BeginAgain, which helps children and teenagers, ages 6-18, heal following the death of a loved one. Held at various times throughout the year, the weekend retreat combines recreational and sharing activities to create common bonds among campers who are experiencing similar emotions. Campers share in grief support groups to learn how others cope with emotions and discover ways to positively express themselves.

“Another one of our signature pro-

grams is Hearts & Hooves which is a retreat for families, young children and teens that involves expression through art and horses,” Grant notes, adding, “During this retreat, trained grief counselors guide participants through artistic activities and allow them healing interaction with horses. These activities give children and teens, who have experienced the death of a loved one, a safe and peaceful outlet for their grief expression. We always conclude the retreat with a healing family ritual to remember loved ones.”

Grant says that although it is difficult to do so when each family member is racked with their own grief, children need to feel included and connected to their family in times of grief. She offers these additional suggestions when dealing with bereaved children: • Children need choices about their participation. Children deal much better with loss when they are given choices, and allowed to participate, or not, in what is happening. For example, (CONTINUED ON PAGE 20)

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Telemedicine: A Virtual Compliance Jigsaw Puzzle, continued from page 12 to-patient communications.”

“Before starting to use telemedicine as a tool to consult with remote patients, a practice should plan how it will meet the standard of care it provides for its in-office patients,” said Sacopulos. “For example, how will it document a dermatological condition? If the condition is normally photographed when a patient is in the office, then the practice should be ready to capture the same quality of image via telemedicine.

Each step of the consultation should be planned in advance to ensure it is equal in quality to an in-office evaluation.”

Patient Privacy Sacopulos said it’s also important to note that any form of electronic communication with a patient should immediately bring to mind HIPAA and HITECH Act obligations.

“Whether the electronic connection with the patient is via email, text messaging, or video conference, the platform should be secure,” he said. “Private and confidential patient information is being transmitted and the patient has a legal right to protect the information in transit.”

The Federation of State and Board Telemedicine (FSMB) Guidelines spe-

cifically state: “Physicians should meet or exceed applicable federal and state requirements of medical/health information privacy, including compliance with HIPAA and state privacy, confidentiality, security, and medical retention rules,” said Sacopulos, adding that FSMB Guidelines suggest maintaining written policies to address: • Privacy; • Healthcare personnel who will be processing messages and patient communications; • Hours of operations; • Types of transactions that will be permitted electronically;

• Required patient information to be included in the communication, such as patient’s name, identification number and type of transaction; • Archival and retrieval; and • Quality oversight mechanisms.

“Finally, telemedicine practitioners are cautioned to periodically evaluate their policies and procedures to insure they remain current and readily accessible,” he said. “FSMB informs us that electronic communications received from patients must be maintained within secured technology password-protected encrypted electronic prescriptions, or other reliable authentication and techniques.”

Sacopulos said it’s reasonable to assume that additional patient privacy requirements will be coming in the near future.

“This well may be in reaction to large scale breaches, such as Anthem Insurance experienced earlier this year,” he said.

“Studies show that medical identity theft grew at an alarming rate in 2014. Government officials, including the FBI and California Attorney General, have specifically cautioned medical providers that their patients’ electronic data is at risk for hacking and theft. All of this should serve as a warning to telemedicine providers to comply with existing state and federal regula(CONTINUED ON PAGE 20)

Physicians’ Telemedicine Checklist

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Physicians interested in electronically interacting with their patients should first work their way through this checklist: • Examine the electronic communication between the practice and its patients. From patients portals to staff testing, a complete picture is needed of the practice’s electronic communications before engaging in telemedicine; • Make sure forms of electronic patient communications are HIPAA-compliant and secure; • The internet may know no bounds, but a medical license does. Be careful not to provide medical services to individuals who live in states in which there’s no license; • Check with the State Board of Medicine to determine state-specific telemedicine limitations; • Develop a specific informed consent document that complies with state requirements and also the Federation of State Medical Board’s suggestions; • Develop a list of disclosures to provide to prospective patients before engaging in telemedicine services; and • ºMake sure there’s adequate insurance coverage. Check with a professional liability carrier and secure a cyber-insurance policy.

“With advanced planning and a little effort, you’ll be able to weave your way through the compliance requirements to practice telemedicine, leaving you and your patients to enjoy the benefits of a telemedicine practice,” said Michael J. Sacopulos, JD, CEO of Medical Risk Institute and general counsel for Medical Justice Services.

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How Telecom Keeps the Heart of Your Business Beating

By SCOTT WILLIAMS

It’s beyond dispute that the playing field of the healthcare industry has changed significantly due to laws such as the Patient Protection and Affordable Care Act (PPACA) and the Health Insurance Portability and Accountability Act (HIPAA).

With rising costs and a shortage of skilled workers, this $2.6 trillion-dollar industry has no shortage of challenges. Despite all of this, they still must provide the best patient care possible.

This massive ecosystem of hospitals, physicians, pharmaceutical companies and insurance providers has been forced to change how business is conducted, adopt a pay-for-performance care mindset, maintain a compliant organization and reduce overhead costs.

So what strategies and tactics can be implemented to help ease the above challenges? Here’s the answer… A modern telecom infrastructure that boasts reliability, scalability, dependable access to data coupled with an IT platform. All of this allows healthcare providers to deliver better patient-care while ensuring regulatory compliance and keeping costs down.

There is no doubt that recent government regulations have changed the old way of doing things. Gone are the days of filling hospital beds or feeding into the pay-for-service mindset. Instead, healthcare providers must focus on patient care and outcomes. A key piece in shifting the patient-care model and supporting advancing medical technologies is the right telecommunication solution.

Imagine for a moment that you are rushed to the nearest hospital. Unfortunately, the hospital you are admitted to cannot offer you the proper care.

But luckily, the ER has videoconferencing equipment connecting it to doctors based in larger hospitals in other cities.

These doctors can not only upload your medical records but can also provide the proper treatment – all from a distance.

Courtesy of the right telecommunication solution.

The industry has to be on alert 24/7/365, and your infrastructure should be too. With the emergence of telemedicine, providers can reach remote patients who live in rural areas or who are homebound and provide expanded access to primary care, specialists, education, research resources and technology.

Through better quality communications, providers can increase their quality of care to patients no matter what time of day and/or distance.

Like it or not, government regulations also demand that healthcare professionals enable their organization to operate under compliance set forth by PPACA and HIPAA. Implementing secure networks is critical in today’s healthcare environment and determines how patient information orlandomedicalnews

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is managed and shared. Administrative staff should have the ability to maximize the company’s infrastructure. Whether “maximizing” includes properly uploading and transferring electronic medical records (EMR) or simply viewing them, staff should conduct their day-to-day responsibilities with confidence and not under a cloud of uncertainty. Should an organization mismanage information or be vulnerable to being hacked, penalties under the current government policies can be hefty.

Hosted VoIP has become more mainstream and is considered to be the future of telecommunications; however, not all hosted VoIP companies are created equal.

Some companies provide Quality of Service (Qos) and some do not.

What exactly is QoS? When bandwidth is low in comparison to the traffic it must handle, some applications need higher priority to avoid impacting their users. Think of VoIP as one of these such applications. If voice traffic on a network is not prioritized (the target of QoS), noticeable quality issues may occur. Data packets being delayed or dropped and resent may result in voice dropouts, static, and dropped calls, which can all impact business productivity.

QOS may also aid in HIPAA compliance. While medical facilities may spend money on protecting their network to protect patient information, Hosted VoIP without proper QOS leaves the network

wide open and unprotected. A suitable telecommunication solution will ensure a compliant environment and help safeguard sensitive information.

Another major role that telecommunications can play is lowering operating costs. A bona-fide telecommunications vendor should be able to seamlessly implement a telecom solution that offers a variety of products and services tailored to the specific needs of each unique healthcare provider, as well as phase out antiquated equipment and duplicative services. With the right products and services your workforce will be more productive and streamlined, cutting costs exponentially.

The healthcare industry must effectively address a growing range of challenges, while focusing on the overriding goal of saving lives. Implementing a reliable telecommunications solution can give you the freedom to focus on what really matters.

For example, hosted VoIP is ideal for multi-location practices. While a multilocation practice may be open at one location one day and a second the next, they must pay for phone lines at both locations.

Because hosted VoIP transmits voice over a broadband connection rather than a traditional public switched telephone network, phones at different locations can

share a number and outgoing calls can be identified by each individual location.

More flexibility, updated technology AND cost savings.

Within hours, an experienced telecom vendor can conduct an onsite analysis of your current infrastructure and identify its strengths and weaknesses. From there, you will have the ability to leverage your provider’s expertise and purchasing power to help raise the bar on healthcare technology standards, maintain a compliance and lower operating costs.

Scott Williams, vice president of sales for TrueChoice Telecom, has over 14 years of telecom experience.

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MGMA Releases Latest Provider Compensation Data

By CINDy SANDERS

In late July, the Medical Group Management Association (MGMA) released findings from the 2015 Provider Compensation Survey Report, an annual analysis of compensation and productivity data illustrating market characteristics across specialties and organizational settings.

“MGMA has been collecting data on medical group management since 1926,” noted Todd B. Evenson, chief operating officer of the national organization for healthcare administration and medical practice man- Todd Evenson agement. “For the last 25 years, we’ve also been specializing in the space of physician compensation and nonphysician compensation.”

Based on 2014 data, this year’s survey found physicians reported salary increases over the past year with primary care physician increases outpacing those of specialists (3.56 percent increase vs. 2.39 percent, respectively). Specialists, however, still report a higher median compensation at $411,852 compared to a median compensation of $241,273 for primary care physicians.

The 2015 benchmarking report included information on nearly 70,000 providers across the United States. In addition to geographic diversity, Evenson

said the data was representative of both large and small practices, various ownership structures including hospital-based providers, and more than 170 specialties.

Evenson said the collected data is important for a number of reasons, not the least of which is that physicians are being recruited on a national level. To remain competitive, he noted, it’s important to look at the compensation methodologies being used by colleagues in various parts of the country.

While primary care physicians enjoyed a 3.5 percent increase in median compensation between 2013 and 2014, the figures are even more interesting when taking a slightly longer view. Evenson noted physicians in this space have seen a 9.2 percent increase in compensation since 2012.

“Will primary care physicians be compensated at the same levels as specialists? Not likely,” Evenson said. However, he continued, “They will continue to play an integral role as care models evolve. Primary care physicians are truly the lynchpin of the new practice model as we move from fee-for-service to fee-for-value.”

Evenson added, “There’s a particular demand for primary care physicians … both because they are the backbone of the referral system and key to a value-based system.”

The latest MGMA survey also showed a continuing shift towards newer models of care. “Historically, it was normal to see 100 percent of compensation plans be pro-

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ductivity based,” explained Evenson. “In 2012, 50 percent of respondents said they were on a 100 percent productivity based compensation plan. In 2013, it was 39 percent; and actually this year, it was 25 percent of respondents.” As he noted, that’s a 25 percent decline in that metric over the past three years.

Evenson said the current data highlights the gradual shift toward rewarding practitioners for improved operational efficiencies, enhanced quality and access to care. While the direct link to quality is still relatively small, it is growing.

Just a few years ago, only 3.4 percent of physician compensation was tied to quality metrics. “Now we’re seeing as high as 10 or 11 percent,” he said. “That value over volume concept that physicians seem to be embracing is really beginning to pay off for them.”

He added, “The behaviors they are trying to promote are tied to that triple aim (of healthcare) … reducing the per capita cost of healthcare, improving the health of populations, and improving the patient experience of care.”

Evenson said those in the behavioral

health sector are also seeing improved compensation as their work complements that of primary care providers in managing a population’s health.

The industry is really recognizing a need to look to behavioral health services to better deliver quality care. The likelihood that someone dealing with a chronic health condition is also dealing with a behavioral health issue is high,” Evenson pointed out.

Recognition of that link has been evident in the MGMA compensation survey over the last few years. “Since 2009, there has been a 21.9 percent increase in compensation for psychiatrists. Now, their median compensation is $244,796,” Evenson said, noting that now puts psychiatrists roughly equivalent to their primary care counterparts.

Economic forces of supply and demand are another issue factoring into physician compensation. A predicted shortage of physician providers in both primary and specialty care could fuel higher compensation rates down the road. Referencing a March 2015 report from the Association of American Medical Colleges (AAMC), Evenson noted the analysis projected a shortfall of between 46,000 and 90,000 physicians by 2025.

In addition to compensation figures, Evenson said MGMA’s annual report also collects information regarding total charges, collections, encounters, RVUs (relative value unit), productivity, benefits, demographics, organizational types, and regional differences all the way down to a state level.

He said drilling down in the data allows those in healthcare to dissect the information in myriad ways, and added it’s critical to learn from one another to adopt best practices that address the triple aim.

“You can take these benchmarks and truly understand what opportunities you have for efficiencies and for providing better care by understanding your colleagues’ activities in the industry,” Evenson concluded.

For more information on the 2015 Provider Compensation Survey Report, go online to mgma.com. Detailed data is available for purchase in two formats – electronically through MGMA DataDive™ or by ordering printed reports.

Compensation and the many other market forces impacting healthcare management will be explored in depth at MGMA’s annual conference scheduled for Oct. 11-14 in Nashville, Tenn.

©2010. Paid for by the United States Army. All rights reserved.

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At the Intersection of Education and Healthcare

By CINDY SANDERS

According to statistics from the Centers for Disease Control and Prevention, one in 68 children falls somewhere on the autism spectrum.

The fastest-growing developmental disorder in the United States, autism spectrum disorder (ASD) is almost five times more common in boys (1 in 42) than girls (1 in 189). Additionally, the CDC estimates it costs at least $17,000 more per year to care for a child with autism, including extra expenditures for healthcare, education and ASD-related therapy.

While there is still no cure for ASD, research has shown early intervention can have a significant impact on a child’s development and ability to more fully interact with peers at school. It’s at this intersection of education and healthcare where Educational Services of America (ESA) offers resources to help these children thrive.

Headquartered in Nashville, Tenn., the company currently provides services in 27 states. “We serve about 17,000 kids a day, and they have a very wide variety of disabilities,” explained ESA President and CEO Mark Claypool, who founded the company in 1999. “We work primarily with public school systems,” he said, noting the company partners with about 250 Mark Claypool different systems. He added ESA also works directly with some state governments and insurance carriers.

“Providing quality services to children and young adults who need them is more important to us than who pays the bill,” Claypool stated.

While ESA, which has about 3,000 employees nationwide, has been in business for more than 15 years, Claypool said many of the programs being used have been around much longer with measurable results. The company has grown significantly through acquisitions and mergers, including the purchase three years ago of South Carolina-based Early Autism Project, Inc. (EAP).

“We had been working with older kids through school systems for a long time, but we wanted to identify a strong provider in the early intervention space,” Claypool explained. “Autism is a very dynamic disability, and the sooner you can intervene, the greater the impact on the child’s life.”

With EAP, he noted, “We acquired this really strong regional brand and put tremendous resources behind them.”

Today, EAP reaches four times the number of children and continues to expand with additional clinics coming online at a rapid pace. Currently, there are clinics and/or in-home services being provided in 11 states including Arkansas, Florida, Georgia, Kentucky, South Carolina and orlandomedicalnews

.com

Tennessee in the Southeast.

“We’re growing very rapidly,” Claypool said. “In fact, we’re in the process of opening 15 new autism clinics in the next year.”

Applied Behavior At the heart of the program is the use of Applied Behavioral Analysis (ABA).

“We know the evidence supports ABA as the most effective treatment, by far,” said Claypool. “It enhances positive behaviors and diminishes negative behaviors.”

According to the Center for Autism and Related Disorders, the effectiveness of this evidence-based therapy has been well documented over the past 40 years. ABA utilizes the principles of learning theory to craft interventions designed to measurably improve ‘socially significant behaviors,’ which include reading, academics, social skills, communication, and adaptive living skills including self-care, toileting, understanding time and money, and honing work skills.

“The same model of behavioral therapy is applied to all of our children across the board but will vary in its intensity,” Claypool explained of addressing individual needs depending on where a child falls on the spectrum.

Finding a way to help these children is critical considering the number of children diagnosed with ASD. “If we don’t do this, the cost will be staggering. These young people will not be able to transition to adulthood and lead normal adult lives,” Claypool pointed out.

With ABA therapy, however, he said the team has seen some remarkable outcomes. “There is no one type of child with autism. There are IQs all over the board, but many do have high IQs and need to have their potential unlocked,” he continued.

That was certainly true for one South Carolina mom. Told it would be best to find her son a residential program because he would never function on his own, she took matters into her own hands and became the co-founder of the Early Autism Project. Today, that son is working on his master’s degree at the University of South Carolina and speaks eight languages.

While certainly not every child with autism will perform at that level, Claypool said all children deserve the chance to reach their own potential.

The Intersection of Healthcare & Education Realizing that ability, however, can be more difficult in some states than in others.

Claypool explained Part C of the Individuals with Disabilities Education Act requires public school systems to identify preschool children with special needs.

However, he added, “It’s very, very loose how to do that. Frankly, it’s not followed through on very often. That issue really drove parents who had children with autism to find another way to have their children identified, diagnosed and treated.”

Of importance, he continued, is the understanding that special education, as it is constructed, is built on civil rights law.

“That’s important because it was built on a minimum set of services defined as ‘free and appropriate.’

“But that’s not enough for parents,” Claypool said. “They want progress, and they want to know their child is going to get the very best treatments.” Therefore, he continued, “More and more, they are looking to healthcare rather than education systems to bridge the gap.”

According to the Autism Health Insurance Project, 39 states plus the District of Columbia have now enacted autism insurance mandates, meaning all fully funded, state-regulated insurance plans must provide the benefits specified by law.

While the specifics vary from state-to-state, each of the mandates requires insurers to provide ABA to young children with autism. Self-funded (employer-sponsored) plans, however, are not legally required to offer autism benefits even in states that have mandates.

As of May 2015, Alabama, Idaho, North Dakota, Oklahoma, Tennessee and Wyoming had no autism insurance mandate. Ohio, Hawaii, Mississippi and North Carolina were in process of enacting a mandate, and Utah had passed legislation, but it won’t go into effect until 2016.

Additionally, the federal government has recently told all states their Medicaid programs must offer ABA therapy for children under 21, but only a handful of states have put this directive into action at this point.

FOR MORE INFO & REFERRALS For more information on autism and other programming by Educational Services of America, go online to esa-education.com. For more information or to refer a child with autism to EAP, go to earlyautismproject.com.

2016 CFMGMA RENEWAL CFMGMA 4TH QUARTER 2015 November 11 - Panel Discussion “Conquering IT Challenges” December 2 - Holiday Party CFMGMA Membership Delivers the best ROI • 6 Educational Meetings • 6 Lunch and Learns • Networking Opportunities, Marketing and Good Friends Visit www.CFMGMA.com for additional information and membership application.

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Telemedicine: A Virtual Compliance Halifax Health, continued from page 13 children should be given a choice about parameters for understanding his or Jigsaw Puzzle, continued from page 14 whether or not they would like to attend her world, which lend to a sense of tions. Telemedicine providers should also anticipate increasing privacy standards.”

Informed Consent Before practicing telemedicine, a medical provider should obtain appropriate patient informed consent. The informed consent document should: Clearly state the patient’s identity; Clearly state the physician’s identity and qualifications; Specify the scope of activities the practice will be using telemedicine technologies to fulfill, such as patient education, prescription refills, and scheduling appointments; The patient must acknowledge that it is within the medical provider’s sole discretion to determine if the available telemedicine technologies are adequate to diagnose and/or treat the patient; The patient should acknowledge the possibility of, and hold harmless the medical provider for, any technology failures and/or interruptions; The practice should, as part of the informed consent process, provide information on the telemedicine technologies privacy and security standards, such as the inscription of data and firewalls; and The informed consent document should specify express patient consent to forward patient information to a third

party if necessary.

Referrals for Emergency Service “The FSMB suggests that telemedicine practitioners have a written protocol in the event that a remote patient needs emergency services,” said Sacopulos.

“This emergency protocol should cover possible scenarios when patients require acute care. How and where referrals are to be made should be covered in this protocol.”

State-Specific Requirements The scope of permissible telemedicine varies significantly by state. Some states specifically require a physician/patient relationship to be established first in person with an exam and diagnosis and treatment plan, including prescriptions. Only then may telemedicine be conducted.

“Telemedicine is receiving much attention at the moment,” said Sacopulos.

“The American Medical Association is in the process of adopting a Code of Ethics for physicians who provide clinical services through telemedicine. Texas has recently issued new telemedicine guidelines to its practitioners. All of this should serve as a warning to those interested in telemedicine to consult with their State Board of Medicine before engaging in telemedicine activities.”

the funeral or memorial service. In order to make that choice, they should be informed about the specifics of the service so they have an understanding of what will happen, what they will see and hear and who will be there. If the child does not attend the service, they will need other means to say “goodbye” to their loved one. Even those who do attend may need other means to say “goodbye” as well that are more ageappropriate and meaningful.

• Children need permission to grieve.

Let children know it is natural to have many feelings and other reactions when someone dies. Give them permission to feel as they do and talk about it if they wish. Tell them that you will be there for them, and are willing to listen, give them a hug, or help them create their own memorials and rituals. Also, be real about your own feelings. Children look to their caregivers for cues about how to behave in a situation.

• Children need consistent limits and rules. The death of a loved one creates chaos in a child’s world. Often, parents and caregivers in their compassion, attempt to compensate for what the child has lost which often results in slacking off on limits and rules. This causes more harm than good. Limits and rules give the child the necessary

security. When all else feels out of control, rules and limits provide a feeling of control and safety for children.

Therefore, it is essential to maintain the same rules and limits that were in place before the death occurred.

At-risk indicators parents and caregivers should look out for that may indicate their child needs help include: personality change; change in school performance; withdrawal; giving away treasured belongings; saying goodbye to loved ones; loss of interest in activities, friends, or things once enjoyed; sleep or appetite disturbance; drug or alcohol use; and sexual acting out.

“It’s important to remember children’s grief looks different from adults,” Grant says. “They may cry one minute and be off playing having fun the next.

This does not mean they are not impacted by loss. It simply means that children can only deal with grief so long, and must take breaks. Also, children do not have the intellectual capacity that adults do and as a result, their grief is often disregarded or overlooked. That’s why grief counseling for children is so important,” she adds.

For more information on Halifax Health-Hospice grief programs for children and teens, visit halifaxhealth.org/hospice

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Finding Your Trusted Partner

By STEVE STRICKER

Several years ago I started my professional journey as a senior staff member at a small Regional Hospital in Kentucky.

Since then I have held a solid place in my heart for the medical field and have sold many different technical solutions within the field of medicine.

In the 80’s it was all about forms, the 90’s were all about inspections and certifications. Then came the millennium, social media, new regulatory requirements, HIPAA and the Affordable Care Act (ACA). Our field was always about patient confidentiality, providing the best care, being sensitive and caring for both the patient and their families.

Today, it’s that and so much more.

The requirements for simply keeping your doors open are endless and changing by the hour. The hard fact is; if you are not 100 percent compliant you can face serious fines, non-pay from the insurance companies and the possible reality of closing your doors. That is why technology plays such an important role in the sustainability of an institution and your practice.

Over the years I have sold technology within all levels of medical care. I remember at the hospital level working with the facilities manager; they were the telephone person and whoever was cheap-

... not everyone is after a quick buck, they are about building a positive reputation. Trusted partners are hard to find, but they are out there.

est won. Today IT staffs can number in the double digits. Their needs, wants and requirements are endless. However; it still can come down to the best price overriding the best solution. What is even a bigger shame; many solution providers will provide a “like solution” by cutting their price in order to gain an impressive logo.

It all comes down to winning the deal and in the end; you end up paying for their win. During the sale cycle; they are always there. After the sale is closed, it’s not their issue; call support hopefully they can help you. Think hard and accept the fact of how many times you have heard that?

Let’s face it, after all of your hard work, due diligence and the endless meetings will you really admit you “may have” made a mistake. Not likely! And they know that! Now it’s up to you to suffer through your thirty six month contract or worse yet your 60 month contract you signed in order to meet your price point.

Remember the old saying, the road to success is paved with great intentions? The questions in the back of your mind should always be; whose success and whose intentions? Success should always be mutual and the intentions should always be transparent and mutually shared.

It is amazing what happens. Many organizations now trust their practice to third party resources. Unfortunately, some present rosy self-designed “cost saving” solutions; that you pay heavily for on the back side because you are 100 percent dependent to their creations.

Fortunately; not everyone is after a quick buck, they are about building a positive reputation. Trusted partners are hard to find, but they are out there.

Who are they? They are people who listen, ask questions and then listen again to your concerns, needs and requirements.

Then they addressed them to your satisfaction. All too often we are told things to placate the question rather than toward providing the correct solution. Smoke and mirrors are still smoke and mirrors.

The bottom line: Find your trusted recommender and provider. Have them earn your trust, and in return trust the fact they are doing the very best for you and your interest. Find that person; use them, refer them and build a true partnership.

Steve Stricker has had a 30 year career in technology. Prior to that, he was an associate administrator for a regional hospital in Kentucky. For the last 25 years he has worked in the IT and Telecommunications field holding senior management, start-up and team lead positions.

He has extensive background in the medical field providing solutions ranging from central dictation to highly complex cloud-based integrated solutions. He can be reached at sstricker@truechoicetel.com

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Visit our newly designed web site … experience its easy navigation and increased functionality. You can read the latest about professional healthcare – Business, Clinical, Regulatory & Compliance, Research, Grand Rounds, Feature Profiles, and a complete line-up of Events and Top Headlines.

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GrandRounds Dr. Seela Ramesh Appointed to Florida Board of Medicine Digestive and Liver Center of Florida is pleased to announce that Seela Ramesh, MD, has been appointed by Governor Rick Scott to the Florida Board of Medicine.

He succeeds George Thomas, MD, and is appointed for the term beginning August 2015 to October 31, 2018.

Ramesh received his master’s degree from Cleveland State University. He did his fellowship in gastroenterology from Virginia Commonwealth University.

Bert Fish Medical Center Foundation Welcomes New Foundation Board Members The Bert Fish Medical Center Foundation Board is pleased to welcome four new board members. The Foundation is comprised of business and community leaders who volunteer their time to the Foundation’s mission of providing philanthropic support for Bert Fish Medical Center by generating ongoing resources dedicated to improving the health of the Southeast Volusia community.

New members include: Sandy Huggard, RPT – physical therapist and owner, Blue Water Therapy Audrey Bellini, marketing representative, Halifax Hospice Patti Kirkman, marketing and retail management (retired) Stan Harrison, insurance agent, Stan Harrison State Farm Agency

Orlando Orthopaedic Center Welcomes 21st Physician To Their Team Orlando Orthopaedic Center officially announced the addition of Aaron M. Burgess, M.D., an orthopaedic surgeon fellowship trained in sports medicine and specializing in shoulder, elbow hip and knee surgery. Dr. Burgess is now accepting patients at the SoDo (downtown), Sand Lake and Lake Nona locations.

Dr. Aaron Burgess was born and raised in Charleston, WV. He attended Ohio University where he earned his Bachelor of Science Degree in Biology with a special focus in Exercise Physiology. He went on to graduate from West Virginia University School of Medicine, where he was president of his

medical school class.

He completed his Orthopaedic Surgery Residency at Orlando Health and decided to pursue additional fellowship training in Sports Medicine at Allegheny General Hospital in Pittsburgh, PA. During his fellowship, Dr. Burgess was an assistant team physician for Major League Baseball’s Pittsburgh Pirates, the United Soccer League’s Pittsburgh Riverhounds, Robert Morris University’s basketball and hockey teams, as well as several local high school football teams. Additionally, Dr. Burgess was a team physician for the United States Men’s rugby team, providing care for the athletes during their 2015 South American Tour.

Dr. Burgess is a board eligible orthopaedic surgeon and is fellowship trained in sports medicine. He is a member of the American Academy of Orthopaedic Surgeons, The Arthroscopy Association of North America, and the American Orthopaedic Society for Sports Medicine.

Thomas R. Kelley, MD Named Chief of Quality and Clinical Transformation at Orlando Health Orlando Health has named Thomas R. Kelley, MD, chief of quality and clinical transformation. His appointment became effective August 1. Dr. Kelley has served as the system’s interim chief of quality and clinical transformation since March 2014.

He has also served as chief quality officer of Orlando Health South Seminole Hospital in Longwood since March 2012 and will continue in that role until a new appointment is made.

Under his leadership, in 2013 South Seminole Hospital became the first Orlando Health facility to install and activate digital quality boards in public areas to provide medical outcomes data directly to patients and families. The hospital was also the first Orlando Health facility to utilize the Xenex germ-fighting robot to keep healthcare associated infection rates low and patients safe. Results from a recently released study show the robot has resulted in nearly a 30 percent facility-wide decrease in infection rates. Both initiatives have since been introduced at all Orlando Health hospitals.

Dr. Kelley graduated from the Medical College of Georgia and completed his internship and residency at St. Vincent’s

Medical Center in Jacksonville. He worked as a faculty physician training residents at Atlanta Medical Center where he developed the first continuous quality improvement council for the residency program.

He also started the only free clinic to serve the uninsured people of South Atlanta and was the founder of the Georgia Free Clinic Network.

Orlando Doctor Receives $50,000 Grant To Further Pediatric Cancer Hyundai Hope on Wheels presented Dr. Susan Kelly of Orlando’s Arnold Palmer Hospital for Children with a $50,000 Hyundai Impact Award to support her continued research as well as her proven track record in providing excellent patient care to families affected by childhood cancer. Since 2011, Arnold Palmer Hospital for Children has received $605,000 in funding from Hope On Wheels.

At the event, Orlando Hyundai dealers, doctor’s from Arnold Palmer Hospital for Children and families of Orlando-area children affected by cancer took part in the event’s signature Handprint Ceremony. Children affected by cancer dipped their hands in colorful paint and placed their handprints on a white Hyundai Santa Fe Sport, the official vehicle of Hope On Wheels, to commemorate their brave battles with cancer.

Hyundai and its dealers joined the fight against pediatric cancer in 1998. Now in its 17th year, Hope On Wheels remains committed to helping children fight this disease through funding life-saving research and innovative treatments. This year, Hope On Wheels will award 22 Hyundai Impact Awards, 36 Hyundai Scholar Hope Grants and 10 Hyundai Scholar Young Investigator Grants totaling over $11 million to institutions across the country. In 2015, Hope On Wheels surpasses $100 million in donations to pediatric cancer institutions nationwide since its inception.

Medical News is pleased to provide space for press releases by providers in our Grand Rounds section.

Content and accuracy of the releases is the sole responsibility of the issuer.

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Arnold Palmer Hospital for Children Nationally Ranked in 7 Pediatric Specialties CARDIOLOGY & HEART SURGERY R RY DIABETES & ENDOCRINOLOGY GASTROENTEROLOGY & GI SURGERY R RY ORTHOPEDICS R RY NEUROLOGY & NEUROSURGERY PULMONOLOGY UROLOGY

Orlando’s Only Nationally Ranked Children’s Hospital

BY U.S. NEWS & WORLD REPORT

We’re honored that U.S. News & Wo W rld Report has recognized Arnold Palmer Hospital for Children’s excellence again in seven pediatric specialties. We thank our outstanding physicians and team members, our patients and their families, our referring physicians and our community for all they do to make this accomplishment possible.

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