Orlando Medical News September 2013

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PHYSICIAN SPOTLIGHT PAGE 3

Tomas Dvorak, MD ON ROUNDS

Breakthrough Procedure for Lymphedema Orlando Health Surgeons Bring VLNT to Florida for Lymphedema Patients

By LyNNE JETER

ORLANDO – Six months ago marked the advent of Florida’s first Vascularized Lymph Node Transfer (VLNT) procedure, which took place at Orlando Health under the direction of Richard Klein, MD. Since then, Klein and his surgical team have assessed 40 patients with lymphedema, a chronic condition that leads to swelling of the arms and legs. They’ve completed a half dozen

Shining a Light on Physician, Industry Relationships Physician Payments Sunshine Act Now in Effect ... 5

New Lines of Research

NCI Data Set Opens Access to CancerRelated Genetic Variations ... 7

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VLNT procedures, with a half dozen on the books. Because the only surgical treatment for lymphedema is so new to the United States, with few surgical teams trained to perform the complex microsurgery, many physicians aren’t yet aware of the new procedure.

“We see many patients suffering from lymphedema and no one had a cure other than conservative efforts such as (CONTINUED ON PAGE 4)

FMA Roundup

Annual meeting nets fresh focus and local representation; survey results announced

By LyNNE JETER

In his installation speech on July 27 as president of the Florida Medical Association, Jacksonville gastroenterologist Alan Harmon, MD, said he sensed a movement of physicians “separating into various interest groups as economic forces” swirl around the state’s healthcare industry.

“We’ve all taken an oath to have loyalty to our patients and to our colleagues,” said Harmon, whose leadership focus is

Dr. Alan Harmon

“Strength and Progress through Unity.” “External and internal forces will try to split our organizations asunder, but we must all resist having the House of Medicine divided. I’ve started a process of contacting the executives of the various county medical societies regarding our need to work together, and I’ve been greatly encouraged by the response.”

Also in July, the FMA

launched the Business of Medicine Quarterly Index Survey to identify hot-button issues concerning Florida physicians. The findings reveal a physician workforce concerned about burdensome regulations, decreasing reimbursement rates, and medical liability issues while practicing medicine in a rapidly evolving healthcare system.

Highlight: What could be done at the state level to help doctors practice medicine?

• Reducing burdensome regulations (30.34 percent); (CONTINUED ON PAGE 6)

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PhysicianSpotlight

Tomas Dvorak, MD MD Anderson Cancer Center Orlando

By JEFF WEBB

ORLANDO - Tomas Dvorak was only 15, so he didn’t really have a say in the event, much less understand it was a turning point in his life. But on that day in 1985, when he, his parents and his younger brother walked out of their home in Prague, Czechoslovakia, Dvorak was taking his first step on the road to freedom.

“My parents told me we were going on a vacation. Back in those days you couldn’t really travel outside communist countries, only inside the Eastern Bloc,” said Dvorak.

“It was a big production and everything had to be done quietly. I was sort of in on it (the possibility they were escaping),” he said, “but not even my parents were sure until we crossed the border.”

The Dvoraks entered Yugoslavia and lived in a United Nations refugee camp for a couple of months before being transferred to another camp in Austria, he said.

“That was actually the ‘true crossing’ from the East to the West, from communist to non-communist. We spent about 4 months there,” he said.

Dvorak’s father, a radiation oncologist, secured a U.S. sponsor who lived in Indiana, so that is where the family headed when they left Europe. “It was quite a culture shock and sent me on a completely different life trajectory from all my friends back home,” said Dvorak.

“In many ways the emigration process was, in retrospect, very challenging,” he said, but also very rewarding.

Dvorak graduated high school in 1988 and enrolled at Northwestern University, where he graduated with a degree in biological sciences in 1992. That gain also was a year of loss for Dvorak. “My father died of kidney cancer when I was 21. When I finished college, I had to go to work to help support my family. I worked for Merck (pharmaceutical company in suburban Philadelphia) for 2 years in vaccine manufacturing operations,” he said. It was during that time Dvorak decided to pursue a medical degree. He moved to New York City and earned his MD at Columbia University. He then completed his internal medicine residency at Harvard University. But he still wasn’t sure which path he would take to find his place in medicine.

“I was really more interested in medicine intellectually at the time. When I went through medical school and my internal medicine residency, it seemed very routine,” he said. The wife of a colleague in medical school persuaded him to work for a healthcare consulting firm in New York. “I found it very interesting, so I left medicine and joined them,” he said, but after a couple of years realized he missed being in a hospital and around patients. “I loved the combination of patient interac-

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tion during a difficult time in their lives, the intellectual challenge of oncology, and the high-tech nature of the radiation treatments,” he explained.

Dvorak returned to Harvard to become a clinical research fellow in radiation oncology, and then spent the next four years as chief resident of the Department of Oncology at Tufts University in Boston and at Brown University in Rhode Island. In 2010, he joined the team at MD Anderson Cancer Center Orlando, where is the chief of breast and gynecologic radiation oncology.

“The cancer center is a really a great place to work. To a great degree it’s because of the affiliation with MD Anderson Houston, which makes it more academic and we are able to attract bright physicians, said Dvorak, 43. “The working environment and my colleagues here are great. By and large, our physicians are fellowship-trained, really smart and stay on top of things. That makes it a pleasure to work with them,” he said.

In addition to seeing patients and designing their treatment plans, Dvorak also is the lead investigator of a trial that, if successful, will significantly shorten the radiation treatments for breast cancer patients, making it more convenient and less costly for them. MD Anderson Orlando is the only place in Florida offering the

“Hypofractionation Trial,” according to the hospital.

Dvorak also has assumed another leadership position at MD Anderson: Director of Clinical Outcomes Analysis and Improvement, which is a longwinded way to say he is overhauling the way patient data is documented. As the Affordable Health Care Act becomes a reality, healthcare providers‘ ability to do that well will be essential in helping patients and profits.

“I’ve always had an interest in data management. Its goes back to my work at Merck,” he said. When he joined MD Anderson Orlando he saw a need for better documentation through electronic medical records, he said. “Lots of physicians dictate their notes, and it is difficult to get good quality data from that. I’m in charge of how we are trying to change our dictations to more of a form-based system that we can data mine,” he explained.

Dvorak said his colleagues “sometimes are resistant to change. Electronic (record-keeping) does take more time … so, there’s definitely some arm-twisting involved. It’s definitely a big change

in how physicians practice.”

“This could be a full-time job,” he said, “but I think it really helps to have someone doing it who also is in the clinic as a physician, so we have the correct correlations about what (data) is important.”

Outside work, Dvorak spends as much time as he can with his family. He also makes time to stay in shape by running four or five times a week. “I have four small children (ages 9 to 2), so spare time is indeed spare,” he said. “I have a very understanding wife,” he said of Cathie, whom he met in the freshman dormitory at Northwestern.

He takes the whole family to Prague once a year to visit his mother, a retired dentist who moved back there after Dvorak’s father died. “They get to see grandma and I try to keep some attachment to the old country, so to speak.”

“The first time I went back was shortly after the (the Berlin Wall came down), he said. “Things were essentially the same then. But now I’ve watched it evolve from a communist country to a western environment.”

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Breakthrough Procedure, continued from page 1 massaging and compressions, so we started aggressively looking for surgical outcomes,” said Klein, who oversees MD Anderson Cancer Center Orlando’s Plastic and Reconstructive Surgery Center for Orlando Health, and received special training in Paris to bring VLNT to Florida. “This procedure has the potential to change the lives of patients affected by lymphedema who, until now, had very little options for treatment.”

Lymphedema prevents lymph fluid from draining from the tissues in the body and as a result, fluid builds up and causes swelling and soreness to one of the extremities and significantly increases the risk of infection in the affected limb. In many cases, lymphedema causes chronic wounds and ulcers and breakdown of the skin.

VLNT moves lymph nodes from one area of the body to another that’s affected by a blockage in the lymphatic vessels, relieving sufferers’ pain and discomfort and allowing them to resume their daily activities. Most insurers have covered the procedure.

Klein learned about VLNT from Corinne Becker, MD, a Paris surgeon who’s performed more than 4,000 lymph node transfers in the treatment of both upperand lower-extremity lymphedema over the last two decades. Two years ago, Becker gave a lecture about the new treatment at a symposium in New York that Klein attended. Last November, he traveled to Paris to train with her for a week. When he returned to Orlando Health, he trained fellow

surgeons Kenneth Lee, MD, and Jeffrey Feiner, MD, on the two-surgeon technique.

“The operation is very demanding because the first step is to go back to the site which nodes were taken from without damaging any nerves,” explained Klein.

“There’s usually a lot of scarring in that area from previous surgeries. You have to find a small artery and vein in the location to transfer and set it into. Then, you have to harvest tissue from another part of the body without causing lymphedema in that location. Those lymph nodes must be attached to a small vein. The artery and the vein measures approximately 8.8 millimeters, so it’s a very tiny vessel. Then you’re operating under a microscope to reattach the artery and veins and sutures to put arteries together. That’s how small they are.”

The first VLNT patient, local breast cancer survivor Jean Hutchinson, is doing remarkably well, said Klein, who led the surgical team to transfer lymph nodes from Hutchinson’s abdomen to her arm pit, and reconnected arteries and veins to provide the transferred lymph nodes oxygen and nutrients to survive and develop new lymphatic tissue. She had developed lymphedema in her right arm following breast surgery and radiation, and had lived with the condition for 18 months.

“Jean is a perfect patient,” he said.

“She was very enthusiastic and motivated to have this procedure done. And, she was prepared for the pre-op and post-op therapy to make it successful. Today, she’s

Lymphedema affects 3-4 million adults and children in the United States and is, unfortunately, not an uncommon side effect of breast cancer treatment in about 15-20 percent of patients, where lymph nodes have been damaged or removed along with breast tissue in combination with radiation.

Other less common causes of lymphedema include cancers where lymph nodes had to be removed as part of treatment or diagnosis, trauma to the lymphatic system, infection, and congenital disorders.

In third-world countries the most common cause is parasitic infection.

so appreciative of how the procedure improved her life.”

Prior to the VLNT procedure, Hutchinson underwent lymphatic therapy to prepare her body for the 3-4 hour surgery. Post-surgery, she continues to undergo additional therapy to gain mobility in her arm. With new vessels and active function of the transferred lymph nodes, she saw improvement within a month or two following the surgery.

“Having the lymphedema therapy team working in tandem with the surgical team is critical. Having the entire team involved is an absolute necessity, because the operation is only one key component for VLNT to be successful,” said Klein.

“Prior to the operation, the affected limb

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must be decongested and massaged without overwhelming the lymph nodes. It takes a trained lymphedema therapist to do this effectively pre-op and post-op. To monitor our patients’ progress, we use volume measurements to track the reduction in swelling. We also provide questionnaires involving daily living and quality of life issues to find out how we’re improving a patient’s quality of life.”

Orlando Health tapped into social media channels to broadcast the first VLNT procedure in Florida on March 11 on Twitter, Instagram and Facebook. The live feed resulted in consumer interest and an uptick in self-referrals, both locally and from out-of-state.

Even though the majority of lymphedema patients are adult females, the youngest person Becker treated with VLNT was six months old.

“You can imagine how technically difficult it is,” said Klein, whose interest in VLNT stems from family members who have had breast cancer, though fortunately none with lymphedema, and an interest in advances in reconstruction techniques.

Klein noted a tremendous need for the new procedure in third-world and developing countries for patients who develop lymphedema from parasitic disease.

“Viral lymphedema of an infectious nature is rare in this country,” he said. “We haven’t scheduled any mission trips so far, but it’s something our practice wants to incorporate down the road.”

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Shining a Light on Physician, Industry Relationships Physician Payments Sunshine Act Now in Effect 12 KEY EXEMPTIONS TO THE REPORTING RULE

By CINDy SANDERS

If you’ve recently enjoyed a golf outing with your friendly pharmaceutical rep or a nice dinner with a device manufacturer, that information will soon be available for all to see.

The Physician Payments Sunshine Act went into effect Aug. 1 of this year and requires applicable manufacturers to report certain interactions with physicians and teaching hospitals that are deemed to have value.

‘Applicable manufacturers’ are defined as pharmaceutical, device, biologic and medical supply manufacturers whose products either require a prescription to be dispensed or for which payment under federal healthcare programs is available.

“The Sunshine Act generally applies when physicians or teaching hospitals receive transfers of value from applicable manufacturers, and the applicable manufacturers receive actual or potential value in return,” explained Tom Baker, a shareholder in the Baker Donelson Health Law group.

Baker, who practices in the firm’s Atlanta office, pointed out the manufacturer doesn’t actually have to receive financial benefit in exchange for the ‘value transfer,’ which can take a wide variety of forms, including donated items, payment to a physician for consulting services or expenditures for entertainment. “It’s enough that it might influence a physician,” he noted.

“The Sunshine Act is about transparency in two different fundamental ways,” he continued. “First, there is the potential interference in medical judgment in clinical trials required for FDA approval of drugs or medical devices. Second, there is potential interference in medical judgment in terms of ordering an item or service for which federal reimbursement is available.”

Baker said the policy is to shine a light on interactions that could be construed to unduly influence a physician or teaching hospital and to ferret out conflicts of interest. “It’s not saying that transfers of value are, per se, illegal but that the public has a right to know when medical judgment might be influenced by the value transfer,” he continued. Relationships between physicians and industry will now be on display for patients, auditors, personal injury lawyers and others to see when the Centers for Medicare and Medicaid Services (CMS) begins publishing the reported data next fall.

The Back Story Championed by Sen. Chuck Grassley (R-Iowa) and Sen. Herb Kohl (D-Wis.), the impetus behind the Sunshine Act came from mounting concern over potential conflicts of interest within the industry.

These conflicts were highlighted by several egregious incidents involving clinical trials

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• Certified and accredited CME. • Buffet meals, snacks, coffee breaks that are provided by a manufacturer at a large-scale conference or event when the items are generally available to all attendees.

• Product samples that are not intended for sale and are for patient use.

• Educational materials that directly benefit patients or are intended for patient use.

• The loan of a medical device for evaluation during a short-term trial period (not to exceed 90 days).

• Items or services provided under a contractual warranty in the purchase or lease agreement for a device.

• The transfer of any item of value to a physician when that physician is a patient and not acting in his or her professional capacity.

• Discounts including rebates.

• In kind items for use in providing charity care.

• A dividend or other profit distribution from, or ownership or investment in, a publicly traded stock or mutual fund.

• Transfer of value to a physician if the transfer is payment solely for the services of the physician with respect to a civil or criminal action or an administrative proceeding.

and devices up for FDA approval where physicians received large payments from the manufacturers of the drugs or devices being studied.

Grassley publicly described a number of academic physicians taking money from the National Institutes of Health when those physician-scientists had direct financial interests in their own research. Among the worst offenders, the former chairman of the Psychiatry Department at Stanford University received an NIH grant to study a drug when he owned $6 million in stock in the company seeking FDA approval. Similarly, the former chair of the Psychiatry Department at Emory failed to report hundreds of thousands of dollars from GlaxoSmithKline while researching the company’s drugs. Harvard also had to discipline three researchers who received almost $1 million

• A transfer of anything with a value of less than $10 unless the aggregate amount transferred to, requested by, or designated on behalf of the physician exceeds $100 in the calendar year.

each in outside income while heading up several NIH grants.

Outside of these flagrant examples, the concern persists that much smaller gifts might also influence medical decisions.

Earlier this year, Pew Charitable Trust published Persuading the Prescribers: Pharmaceutical Industry Marketing and its Influence on Physicians and Patients, which stated the drug industry spent nearly $29 billion marketing their products in 2011 (Source: Cegedim Strategic Data). Of that amount, $25 billion was spent directly marketing to physicians.

After unsuccessfully introducing the

legislation in 2007, the Sunshine Act was incorporated into the Affordable Care Act. A couple of missed rulemaking deadlines by CMS pushed the law’s effective date to Aug. 1, 2013 for the balance of this calendar year and requires annual reporting going forward.

What is a Transfer of Value?

With 12 major exceptions (see box), any direct payment or transfer of value of $10 or more (or an aggregate of $100 or more in a calendar year) to a physician or teaching hospital must be reported. Additionally, indirect transfers through an (CONTINUED ON PAGE 6)

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FMA Roundup, continued from page 1

Physician, Industry Relationships,

• increasing payment for physician services (22.47), and; • bringing increased fairness to the medical liability system (16.85 percent).

“We’re providing them with the resources they need to successfully adapt to the modern healthcare landscape and continuing to fight for policies that allow them to focus on patient care, not regulatory and administrative obstacles,” said FMA Executive Vice President Timothy Stapleton.

“These results will help us further focus our advocacy so that we can do even more to help Florida physicians practice medicine.”

State survey feedback mirrors national industry trends: More Florida practices and physician employers are mulling alternative payment models (40.41 percent). Many have implemented electronic medical records (EMR) technology (69.77 percent). Most respondents are practice owners, partners or associates (57.46 percent); a significant percentage of them now work for hospitals, medical groups or health systems (29.6 percent).

Looking ahead, half of respondents plan to continue working as normal in the next few years. The balance said they would consider reducing work hours (10 percent), retiring (7 percent), changing to a “concierge” practice (2.5 percent), seeking hospital employment (2.25 percent), and reducing their patient load (1.25 percent).

One in four doctors said EMRs have improved the quality of patient care. Another 10 percent said even though the new

continued from page 5

electronic systems hadn’t improved the quality of patient care, they felt confident it would happen.

At the annual meeting of the 139-year-old organization, 201314 FMA councils and committees were announced. Local members include: • Committee on Accreditation and CME: Zachary Wilson, MD (Orlando) • Council on Ethical & Judicial Affairs: Clifford Selsky, MD (Orlando) • Council on Healthy Floridians: Jaime Membreno, MD (Kissimmee) and Kevin Sherin, MD (Orlando) • Council on Legislation: Jason Pirozzolo, DO (Winter Garden) • Council on Medical Education: Melissa Hartman, DO (Orlando) and Leonardo Oliveira, MD (Orlando) • FMA Publications: Shelley Glover, MD, associate editor (Clermont)

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• Treatment Thoracic Outlet Syndrome • Mesenteric Ischemia • Aneurysms

intermediary or third party are also subject to reporting.

There are 14 main reporting categories.

These include consulting fees, compensation for services other than consulting, gifts, entertainment, food, travel, charitable contributions, education, grants, research, royalty or licensing fees, current or prospective ownership or investment interest, direct compensation for serving as faculty or a speaker for a medical education program, honoraria.

Under the new rules, Baker said a physician could accept a ballpoint pen or pad of sticky notes from a manufacturer without it being included in the annual report, but most meals, tickets, or gifts probably will fall under one of the reporting categories considering the $10 threshold.

“The days of the pharmaceutical company taking a group of physicians to the Super Bowl are over … or at least it will be disclosed and expose you to the risk of AntiKickback statute prosecution,” Baker said.

“It’s the entertainment part of it that physicians would probably like to have exposed the least,” he added.

The law also requires applicable manufacturers and GPOs (group purchasing organizations) to report ownership interests by physicians or their immediate family members. It should be noted, however, that purchased industry stocks and mutual funds that are generally available to the public are not reportable. If Dr. Smith buys 50 shares of ABC Pharmaceutical stock, which is publicly traded, it doesn’t have to be reported.

If a representative of ABC Pharmaceutical gives Dr. Smith stock, then it does.

Ultimately, a patient whose doctor recommends a specific device or drug will be able to search the CMS database to see if there is a connection between the physician and the manufacturer. “You’re going to know when your physician has a personal financial interest in your healthcare beyond the physician’s professional services,” Baker pointed out.

Disputing a Report So what happens if your name appears on a report, and you disagree with the data? Baker said CMS is going to notify physicians of all their reported relationships.

Once access is granted to the online portal housing the consolidated report, a physician should have at least 45 days to challenge the data and try to resolve the dispute with the reporting entity.

Those who cannot agree will be given an additional 15 days to come to a resolution before the information is made public.

If no agreement can be reached, the data will be published but flagged as disputed.

Physicians cumulatively have up to two years to dispute reports even after the data is published.

“While physicians aren’t required to track transfers of value, they are encouraged to do so,” said Baker. “How in the world are you going to be able to refute a report if you don’t have evidence to the contrary.”

Baker pointed out you might not think you received an influential ‘gift’ from a device manufacturer by grabbing a bite of

lunch, but even a sandwich, tea, tip and tax is often over the $10 threshold. Short of asking to see the bill, it would be difficult to gauge the cost per person at the table; and without a copy of the receipt, it would be difficult to dispute the reported item.

“As a practical rule, doctors probably aren’t going to be good at refuting the evidence,” Baker said.

However, he added, CMS has created a smartphone app with a version for industry and another for physicians to make it easier to keep track of reportable transfers.

“Open Payments Mobile” is available at no charge through the Apple Store and Google Play Store.

Timeline Data accumulation for 2013 has already begun. Below is a timeline of upcoming key dates in the process.

Jan. 1, 2014: Anticipated launch date for CMS physician portal where doctors can register to receive notice when their individual consolidated report is ready for review. This portal also provides a means for physicians to contact manufacturers and GPOs about disputes in accuracy.

March 31, 2014: Partial year data (August-December 2013) must be turned into CMS. June 2014: Anticipated access to individual consolidated reports from 2013. Physicians have a minimum of 45 days by law to seek corrections or modifications to the information by contacting manufacturers/ GPOs through the portal.

September 2014: Searchable reports are published and open to the public.

Be Prepared “The act itself is vexing,” said Baker.

Adding to the frustrations, he continued, is that CMS is interpreting the Sunshine Act very broadly.

“The applicable manufacturers are not going to take any chances,” Baker continued. He noted, those who accidentally fail to disclose required data will face penalties of not less than $1,000 and not greater than $10,000 per incident up to a cap of $150,000 annually. Those who knowingly withhold reportable information face penalties between $10,000 and $100,000 for each value transfer with an annual cap of $1 million.

“Physicians need to know other people are going to be talking about them,” concluded Baker. “One would hope everything reported is within the legal boundaries … but if you are testing those boundaries, you better stop.”

MORE INFORMATION FOR PHYSICIANS The American Medical Association has put together the “Physician Sunshine Act Tool Kit” with additional information on the new requirements, a webinar and links to the free mobile app. To access the kit, go online to www.amaassn.org/go/sunshine.

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New Lines of Research

NCI Data Set Opens Access to Cancer-Related Genetic Variations

By CINDY SANDERS

How will this breast cancer drug react in patients that are HER2 positive? Will this new lung cancer therapy work in a patient with multiple genetic variations?

Finding answers to those questions just got a bit easier with the rollout of a vast data set of cancer-specific genetic variations by scientists at the National Cancer Institute (NCI). Yves Pommier, MD, PhD, chief of the Laboratory of Molecular Pharmacology at the NCI, was one of three lead researchers on the study, published July 15 in Cancer Research, that pinpointed more than six billion connections between cell lines with mutations in specific genes and the drugs that target those genetic defects.

Paul Meltzer, MD, PhD, chief of the Genetics Branch at the Center for Cancer Research and James Doroshow, MD, director of the Division of Cancer Treatment and Diagnosis, were the other principal investigators.

Pommier explained the new database builds upon the NCI-60 cancer cell line collection, which is comprised of nine different tissues of origin – breast, ovary, prostate, colon, lung, kidney, brain, leukemia and melanoma. In their Cancer Research article, the authors note the NIC-60

panel is the most frequently studied human tumor cell line in cancer research and has generated the most extensive cancer pharmacology database worldwide.

“Most of the cell lines are from cancer tissues that are hard to treat and are usually resistant to therapy,” he said.

“The genomic database is unmatched and enables researchers to mine all the gene expression in relationship to a drug.” Pommier continued, “Each drug has a different profile in the cell line be-

cause they act on different targets.”

In this most recent study, the investigators sequenced the whole exome of the full NCI-60 cell lines to define novel cancer variants and deviant patterns of gene expression in tumor cells. “The whole genome for the cell line has never been done before,” he said. “Many, many genes had never been sequenced.”

The researchers cataloged the genetic coding variations, developing a list of possible cancer-specific gene aberrations.

The group then used the Super Learner algorithm to predict the sensitivity of cells with variants to more than 200 anti-cancer drugs … those approved by the FDA and those still under investigation. By studying the correlation between the gene variants – such as TP53, BRAF, ERBBs, and ATAD5 – and anti-cancer agents including vemurafenib, nutlin and bleomycin, the researchers were able to predict outcomes, showing one of the many ways the data could be used to validate and generate novel hypotheses for future investigation.

Access to the data is freely available through multiple sources including the CellMiner and Ingenuity websites.

By opening up the scalable data on the whole genome sequencing and drug connectivity, Pommier and his colleagues hope to help other researchers connect cancer-specific gene variants with drug response to move the science forward.

“It’s an evolving system,” he said, adding that profiles on drugs in clinical trials will be added to the database as information becomes available to keep the data set current.

In explaining how the system works, Pommier said a researcher interested in a specific agent could plug that drug into the (CONTINUED ON PAGE 10)

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Shifting Patient Behaviors Cause Doctors to Leverage Online Marketing Strategies shift is causing medical practitioners to consider inbound marketing as an effective method for acquiring new patients.

According to The Digital Journey to Wellness report published by Google last year, 77 percent of patients perform Internet searches before booking

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Patients are now giving more weight to internet search results, online reviews, and social media recommendations than traditional marketing methods and word of mouth when choosing a doctor. This

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As a result of the new value given to online search results, inbound marketing has become a focal point of internet marketing and website visibility strategies among

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Unlike traditional marketing methods, like radio, TV and billboards that rely on interruptive tactics designed to gain consumer attention, inbound marketing attracts patients when they’re ready to listen and learn more. Inbound marketing refers to a specific set of internet marketing activities, such as search engine optimization, social media management, and optimized content creation that boost search ranking and website visibility.

Medical professionals are now using this modern and effective marketing method as a way to reach prospective patients who rely on online research prior to booking an appointment.

This marketing approach has been effective in growing medical practices because it impacts the criteria patients consider most when evaluating prospective doctors online.

When a patient searches online for a doctor, they perceive the physicians and practices with the highest organic search engine rankings as being the most qualified and having the best reputation. For many patients, the implications of these (CONTINUED ON PAGE 10)

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Employee Motivation

By JAy A. SHORR AND MARA L. SHORR

Whether you’re hiring a brand new staff or have simply noticed a decrease in employee morale amongst your existing team, know you’re not alone. We often have clients come to us with human resource issues, and one of the most common denominators amongst those practices is an unmotivated staff.

Looking for ways to liven things up and engage your team? We’re more than happy to offer a few tips, but first, it’s necessary to find the root of the problem. There is always an underlying issue, and examining the cause will help a solution stick.

Do your employees feel underappreciated and/or undercompensated?

Anyone who has ever attended ployee, and end up losing 20 percent of any of our lectures knows we have a fathe new hire’s annual salary on training. vorite saying: “When you pay peanuts, Therefore, keeping staff fairly paid, enyou get monkeys.” It’s true; offices are gaged and motivated is key. often willing to pay a new employee Set up sales goals amongst your staff more than they would a former emand offer a bonus when they’re reached.

Foot & Ankle Associates of Florida

Whether the bonus be monetary or something else, like an office tablet, an extra day of paid vacation, a gift certificate to a hot new restaurant, covering their cell phone bill for one month or a prime parking spot in an otherwise hard-to-park neighborhood, think about what your employees are looking for.

In addition, certain vendors offer free product samples, something that your employees would welcome as a reward for good behavior.

We always recommend providing your staff with free in-office procedures, up to a certain price point. (Depending on your specialty, you may want to offer certain procedures at your cost.) This is especially key: show your staff exactly how great your work really is, and let them brag to all of your customers about you… while they feel appreciated. This not only serves double duty as a marketing opportunity AND token of your appreciation, but is the best form of credentialing.

Still, looking for a few more cost-free ways to show your staff you value them?

Give verbal praise at your next staff meeting. (We recommend having anywhere between one per week to one per month.

Another wonderful idea is to host an Employee of the Month program, complete with a sign in your reception area, praise in your enewsletter. Develop a certificate of appreciation for that employee, and present it to them at your next staff meeting. Recognition in front of their peers goes a long way.

Are they being challenged in their jobs, or have they come to believe there’s nowhere for them to excel?

Another great incentive includes additional staff training. Look at bringing in your vendor representatives to offer this at no cost to you; they’re often willing, as guidelines and laws allow, to bring in lunch for the staff. Of course, you should give the vendor face time as well, but know they’re able to assist in the development of the staff. In addition, the meeting time amongst your team builds camaraderie.

If your budget allows, and if your staff shows you they’re meeting sales goals and striving to better your practice, consider taking them to an industry meeting or conference. This serves not only as a motivator and reward, but as a training tool as well. We guarantee your staff will come back more enthused and energized with their new knowledge. The investment in them will positively affect your bottom line.

(CONTINUED ON PAGE 10)

Welcomes Dr. Tara Fussell

Foot & Ankle Associates of Florida is pleased to welcome Tara Fussell, DPM to the practice. Dr. Fussell was born and raised in Central Florida and attended Boone High School and Rollins College. She received her Doctorate of Podiatric Medicine from Temple University College of Podiatric Medicine in Philadelphia, PA and completed her residency program (PM&S-36 Residency Program) as the Chief Resident – Podiatric Medicine and Surgery for the Crozer Keystone Health System. Dr. Fussell treats all areas of foot and ankle pathology, but particularly enjoys sports medicine, pediatrics, and surgery. Dr. Fussell is now accepting new patients in the Altamonte Springs and Sandlake office locations

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Leverage Online Marketing Strategies, continued from page 8 organic search engine rankings are even more influential than doctor referrals.

Having quality content posted on, or associated with, a medical practitioner’s website also plays a key role in the decision making process. In fact, 30 percent of patients who watched an online video, such as a patient testimonial or hospital video, booked an appointment, according to Google’s report.

For this reason, many medical practices are positioning inbound marketing and content creation at the core of their online marketing strategies as a way to attract, and make a positive impression with potential patients.

Inbound marketing strategies create this positive perception because they provide content on relevant health topics patients are searching for. Prospective patients find this content in the search results when doing research online and click through to the doctor’s website.

Once a patient clicks through to a website that they’ve determined as being the most qualified, the quality of the content they find, along with ease of navigation, will determine whether or not they make the transition from website visitor to new patient.

Inbound marketing improves website navigation for patients by including clear calls-to-action that make it easy for prospective patients to find what they’re looking for quickly. This can mean including forms that allow the patient to easily and quickly contact the office or book an appointment.

According to Google’s report, 21 percent of patients prefer to book an appointment through a computer or mobile site.

If patients are confronted with an outdated, confusing website that causes them waste their time looking for the information they desire, they’ll leave the website and move on to the next prospective doctor on their list. However, creating

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actionable forms expedites and simplifies the new patient acquisition process.

Another factor in converting prospective patients into new patients is publishing valuable and helpful content. Doctors can improve a patient’s overall experience with the practice while positioning themselves as industry experts just by answering commonly asked questions and concerns through the creation of relevant, health related content.

Along with positioning these doctors as experts in their local community, this content also instills a sense of trust with patients that makes them want to choose that practice over all of the other options in the area.

However, publishing helpful information to your website will not generate new patients on its own. This content needs to be shared and communicated in order to have the greatest reach and impact. One of the best ways to do this is through social media.

According to Pew Research Center’s Internet & American Life Project, 67 percent of the U.S. population uses social media. Not taking advantage of social networks could mean losing out on a large number of potential patients.

With 77 percent of prospective patients relying on Google searches to research local doctors before booking an appointment, it becomes critical to the business success of your practice to implement a comprehensive internet marketing strategy that utilizes inbound marketing at its core.

Practices that remain stuck in the dark ages of interruptive, traditional marketing tactics are finding it increasingly difficult to attract new patients. Doctors who shift away from these outdated tactics and make a commitment to creating inbound marketing that patients love will benefit from new patient acquisition and business growth.

Caleb Edwards is the Chief Marketing Officer for GreenHouse Agency in Lake Mary, Fla. He specializes in providing medical practices with customized inbound marketing strategies that create an ideal environment for practice business growth. His GreenHouse Effect methodology has lead to the successful acquisition of new patients, as well as measurable business growth for practices across a wide range of specializations. You can reach him at caleb@thegreenhouseagency.com.

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New Lines of Research, continued from page 7

database. “You’ll get the profile activity of the drug, and then you can ask if there is any match to any specific gene mutations,” he said. From there, Pommier continued, the researcher could query, “Are these cells more resistant or receptive to the drug?”

Getting those answers rapidly should help researchers move major lines of oncology drug development toward personalized medicine to achieve optimal outcomes in a safer, more efficient and effective manner. With the added knowledge provided by the data bank, Pommier said researchers might separate patients into groups based on their genetic profile and therefore be able to use specific drugs in a more rational manner.

“Between a targeted drug and a clinical application, you need a verification in the middle,” he stated. That’s just what this new database offers.

Employee Motivation, continued from page 9

Is the job a good fit for their personality and skill set?

If you find the above tactics simply don’t work, or suspect none of the aforementioned issues are the cause, schedule a meeting with the troubled employee. Address the issues openly, honestly, and in a calm objective fashion. Make sure each employee you hire has a set job description; this is the time to pull it out and take a look at how this employee is (or isn’t) meeting the standards you have set. After you’ve done so, give the employee a set, agreed upon period of time to improve, and schedule another meeting in advance to discuss his/her progress.

If you see a positive change in your employee’s motivation… fantastic! However, look at whether that job is truly the perfect fit for the employee, or simply beyond his/ her skill set. Do you have a shy mumbler answering your phones and checking out your patients? Can your patient hear a smile when your phone is answered? Do you have someone who’s not passionate about skincare products selling your newest line to your patients, or someone who’s computer illiterate in charge of keeping your database organized? Consider what the job entails, and do one of two things: either re-work the job description to fit your employee’s strongest assets… or wish them well on their journey to the perfect job.

Jay A. Shorr, MAACS-AH, MBMC, CAC I,II, III, is the founder and managing partner of The Best Medical Business Solutions, assisting medical practices with the operational, financial and administrative health of their business. Mara Shorr, CAC II, III, serves as the vice president of marketing and business development; a national speaker, she is a Level II and III Certified Aesthetic Consultant utilizing knowledge and experience helping clients achieve their potential. They can be contacted at info@thebestmbs.com.

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Female Patients Need More Information about Post-Breast Cancer Options

By JEFFREy HARTOG, MD

While many people think beating breast cancer is the joyous end of a long battle, that’s not always the case. When a mastectomy is performed, it leaves the survivor with deformed breasts. Too many times I’ve seen it lead to depression and low self-esteem, which turns the relief of beating breast cancer into a dreadful experience that can last the rest of the woman’s life. Women want to maintain their womanhood and still look beautiful after having their lives forever changed by cancer.

Breast reconstruction is one of the more obvious choices for a woman’s next step after undergoing breast cancer treatment.

According to a study conducted by the University of Michigan, seven of 10 women are unaware of their breast reconstruction options after a breast cancer diagnosis. It is astounding to know that after completing chemotherapy/radiation there are still many women who do not know the options available to them, particularly given continued improvements in technology and techniques.

Saline and silicone implants are the most common and well-known of the breast reconstruction techniques. Another is the flap procedure. These more traditional implants leave additional scarring and the thought of another hospitalization and being cut open again can be unsettling for many women. Another option that women have available to them is known as autologous fat transfer, a procedure that uses needles similar to those used in liposuction to transfer fat from areas of the body into the breast. Autologous fat transfer is the breast reconstruction technique I use (in my practice). Since I began using the autologous fat transfer technique, I have performed more than 100 such procedures, and about 15 of them include breast cancer reconstruction cases.

In years past, autologous fat transfer

technology was not where it needed to be.

Too much fat was transferred at once and most of the tissue died. After advances in fat tissue research, we now know that fat must be transferred in small amounts to give the body adequate time to provide the vascular structure needed to keep it alive. This has led to exciting new options for autologous fat transfer, but none are more important than breast reconstruction after a mastectomy.

The problems that affect implants are virtually eliminated with autologous

fat transfer. After the procedure, patients’ breasts still look and feel natural. Those who choose the autologous fat transfer technique to reconstruct their breasts, also find that skin and nipple sensation return to the breasts, which is not the norm with traditional implants. Another downfall of artificial implants is that they can interfere with future mammograms. That is also not an issue with breasts that were reconstructed with autologous fat transfer.

Fat is one of the most misunderstood and underappreciated tissues in the body because of its negative impact on the appearance and the general condition of the human body. While there is certainly overwhelming evidence that being overweight has negative effects on one’s health, the positive effects when it is used in other ways are overlooked. Fat contains more stem cells than any other tissue in the body and it’s the only tissue that can expand or constrict as needed. What’s more, there is never a shortage of it, even in thin people. Fat can even be removed and frozen, then used again up to 20 years later. The potential for the autologous fat transfer is almost limitless.

Using the autologous fat transfer technique allows for total or partial breast reconstruction and since the fat comes from the patient’s own body, there is no risk of rejection.

In 2012, we made the decision at (the clinic) to find a creative way to educate women about breast reconstruction op-

tions for National Breast Reconstruction Awareness Day. The concept we ultimately used was created by FEED, a healthcare brand advertising agency. The graphic not only captured the attention of women, but it won a San Diego Marketer of the Year award in the Cause Marketing category at the 2013 San Diego chapter of the American Marketing Association awards ceremony. We are excited to be able to help women decide what the best choice for breast reconstruction is for them.

Beating breast cancer should always be as joyful as possible, given the broader experience. For those who are anything but happy about the condition of their breasts after their mastectomies, breast reconstruction is the way to go. Of all of the options, autologous fat transfer is one of the better ones.

This isn’t just a professional topic for me, it’s personal. My wife, Michelle, found the autologous fat transfer technique the best option for her after her double mastectomy and chemotherapy treatment, and we couldn’t be happier with the results.

Jeffrey Hartog, DMD, MD, is the director of the Bougainvillea Clinique in Winter Park, Fla., and has been a surgeon for more than 20 years and has traveled around the world to receive training and hone his skills. His practice is the first plastic surgery clinic in the United States to have immediate access to the Liquid Gold™ Lipobank, an FDAregistered tissue bank for storing fat removed with liposuction for fat transfer procedures. He can be reached at www. lookandfeelbetter.com.

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Constipation: What Is It And What Do We Do?

By SRINIVAS SEELA, MD

Constipation is one of those topics few like to talk about. If you’ve suffered from this problem, though, you know it can be both painful and frustrating.

Almost everyone gets constipated at some time during his or her life. It affects approximately 2 percent of the population, and in the U.S. women and the elderly are more commonly affected.

Though not usually serious, constipation can be a concern.

What Is Constipation?

Not having a bowel movement every day doesn’t necessarily mean you’re constipated. Constipation occurs when bowel movements become difficult or less frequent. The normal length of time between bowel movements ranges widely from person to person. Some people have bowel movements three times a day; others, only one or two times a week. Going longer than three days without a bowel movement is too long. After three days, the stool or feces becomes harder and more difficult to pass. Normal bowel movements are different for each person. You may not have a bowel movement every day.

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You are considered constipated if you have two or more of the following for at least 3 months: • Straining during a bowel movement more than 25 percent of the time • Hard stools more than 25 percent of the time • Incomplete evacuation more than 25 percent of the time • Two or fewer bowel movements in a week What Causes Constipation?

You may also experience constipation if the muscles you use to move your bowels aren’t properly coordinated. This problem is called pelvic floor dysfunction (anismus), and it causes you to strain with most bowel movements even soft ones.

A number of factors can cause an intestinal slowdown. Constipation is usually caused by a disorder of bowel function rather than a structural problem. Common causes of constipation include: Inadequate water intake; inadequate fiber in the diet; a disruption of regular diet or routine; traveling; inadequate activity or exercise or immobility; eating large amounts of dairy products; stress; resisting the urge to have a bowel movement, which is sometimes the result of pain from hemorrhoids; overuse of laxatives (stool softeners) which, over time, weaken the bowel muscles; hypothyroidism; neurological conditions such as Parkinson’s disease or multiple sclerosis; antacid medicines containing calcium or aluminum; medicines (especially strong pain medicines, such as narcotics, antidepressants, or iron pills); depression; eating disorders; irritable bowel syndrome; pregnancy or colon cancer.

In some cases, lack of good nerve and muscle function in the bowel may also be a cause of constipation. In rare cases, constipation may signal more-serious medical conditions, such as colorectal cancer, hormonal disturbances or autoimmune diseases. In children, constipation might indicate Hirschsprung’s disease, a congenital condition that results from missing nerve cells in the colon.

What Are the Symptoms of Constipation?

Symptoms of constipation can include: infrequent bowel movements and/ or difficulty having bowel movements; swollen abdomen or abdominal pain; pain or vomiting.

Risk Factors You’re more likely to have constipation if you are: an older adult; sedentary; confined to bed; eating a diet that’s low in fiber; not getting adequate fluids; taking certain medications, including sedatives, narcotics or certain medications to lower blood pressure or undergoing chemotherapy.

Women are more frequently affected by constipation, and children more than adults.

NORMAL BOWEL

CONSTIPATED BOWEL

Complications If constipation persists, you may develop certain complications: hemorrhoids or cracks (fissures) in your anus may result when hard stool stretches the sphincter muscle; fecal impaction; rectal; lazy bowel syndrome may occur if you use laxatives frequently.

Tests and Diagnosis If feasible, discontinue medications that can cause constipation before further testing. A careful digital rectal examination that includes assessment of pelvic motion during simulated evacuation is preferable to a cursory examination without these maneuvers and should e performed before referral for anorectal manometry. However, normal digital rectal examination does not exclude defecatory disorders. These include a blockage in your small intestine or colon (intestinal obstruction), a narrowing of the colon, an endocrine condition, such as hypothyroidism, or an electrolyte disturbance, such as excessive calcium in the blood (hypercalcemia).

CBC is the only blood test needed unless other symptoms present. Colonoscopy is not indicated unless alarm symptoms (blood in the stool,anemia, weight loss) or patient due for colon cancer screening. If trial of laxatives at this point fails, order anorectal manometry

and rectal balloon expulsion. If inconclusive, defecography is performed next.

Extensive testing is usually reserved for people with severe symptoms or for older adults with new-onset constipation. You may undergo these diagnostic procedures.

Treatments and drugs After discontinuing medications that can cause constipation and performing blood and other tests as guided by clinical features, therapeutic trial (i.e. fiber supplementation and or osmotic or stimulant laxatives) is recommended before anorectal testing. In most cases, simple changes in your diet and lifestyle can help relieve symptoms and manage constipation.

Less often, you may need medical treatment. A trial of fiber and or osmotic or stimulant laxative recommended before any anorectal testing. Normal and slow transit constipation may be safely managed with long-term laxatives. Defecatory disorders should be treated with pelvic floor restraining by biofeedback therapy.

Subtotal colectomy should be considered for symptomatic slow transit constipation without defecatory disorder.

Diet and Lifestyle Changes The following simple changes can go a long way toward reducing constipation: • A high-fiber diet. A diet with at least 20 to 35 grams of fiber each day helps your body form soft, bulky stool.

• Regular exercise.

• Adequate fluid intake • Take the time for bowel movements.

Laxatives These over-the-counter medications should be considered only when diet and lifestyle changes aren’t effective. Some can become habit-forming.

There are several different types of laxatives: • Fiber supplements • Stimulants: Examples include Correctol, Dulcolax and Senokot.

• Lubricants: Examples include mineral oil and Fleet.

• Stool softeners: Examples include Colace and Surfak.

• Osmotics: Examples include Cephulac, Sorbitol and Miralax.

• Saline laxatives: Examples include milk of magnesia and Haley’s M-O. Other Medications • Chloride channel activators. Lubiprostone (Amitiza) • Linaclotide (Linzess) Srinivas Seela, MD, completed his fellowship in Gastroenterology at Yale University School of Medicine. He is board certified in both Internal Medicine and Gastroenterology.

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GrandRounds Florida Hospital’s Radiation Oncology Program Earns ACR Accreditation Florida Hospital’s Radiation Oncology Program has been awarded accreditation by the American College of Radiology (ACR), the oldest and most prestigious accrediting organization in the United States. The accreditation is for three years, through July 31, 2016. Radiation oncology (radiation therapy) is the careful use of high-energy radiation to treat cancer and other diseases. The rigorous process resulting in full accreditation involved a team of dedicated personnel working tirelessly for more than a year.

To achieve ACR accreditation, our facility’s personnel qualifications, equipment requirements, quality assurance and quality control procedures have gone through a rigorous review process and have met specific qualifications said Dr. Robert Sollaccio, medical director of radiation oncology at the Florida Dr. Robert Sollaccio Hospital Cancer Institute.

The ACR is the nation’s oldest and most widely accepted radiation oncology accrediting body, with over 500 accredited sites, and 25 years of accreditation experience. The ACR seal of accreditation represents the highest level of quality and patient safety. It is awarded only to facilities meeting specific practice guidelines and technical standards developed by ACR after a peerreview evaluation by board-certified radiation oncologists and medical physicists who are experts in the field. Patient care and treatment, patient safety, personnel qualifications, adequacy of facility equipment, quality control procedures, and quality assurance programs are assessed. The findings are reported to the ACR Committee on Radiation Oncology Accreditation, which subsequently provides the practice with a comprehensive report they can use for continuous practice improvement.

The Florida Hospital Radiation Oncology Program treats patients at Florida Hospital Altamonte, Florida Hospital East Orlando, Florida Hospital Kissimmee, Florida Hospital Orlando and Winter Park Memorial Hospital.

Bert Fish Medical Center Signs Letter Of Intent With Health Management Associates The Southeast Volusia Hospital District announced that it has executed a letter of intent with Health Management Associates, Inc. (NYSE: HMA), under which it would enter into a long-term lease with the 112-bed Bert Fish Medical Center in New Smyrna Beach, Florida.

The letter of intent marks the beginning of the due diligence process between Bert Fish Medical Center and Health Management toward a definitive agreement.

The parties expect to execute the definitive agreement by the end of 2013, and to complete the new partnership at the beginning of 2014. During this time, the par-

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Florida Hospital Transplant Institute 40th Anniversary Please join us in celebrating the Florida Hospital Transplant Institute 40th Anniversary.

Proceeds from the dinner will go toward the construction of the Transplant House, where we will provide affordable accommodations and a peaceful healing environment for transplant patients and their families.

ties will seek all necessary state and local government regulatory approvals.

Bert Fish Medical Center would join Health Management’s network in Florida, which currently includes 23 hospitals, and a statewide clinical affiliation with the UF Health Shands Hospital.

Under the lease agreement, Health Management will keep Bert Fish Medical Center’s existing charity care policy, and the hospital will operate under the guidance of a local Board of Trustees consisting of physicians and local community leaders who share a passion for high quality care and service.

Jewett Orthopaedic Clinic’s Electrodiagnostic Lab is First in Central Florida to Receive National Accreditation The American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) recently awarded Jewett Orthopaedic Clinic’s Electrodiagnostic (EDX) Lab “Accreditation with Exemplary Status,” making it one of only five accredited EDX labs in the state and the only one in Central Florida. In order to achieve the AANEM’s peer-reviewed accreditation, a lab must exceed a rigorous set of measures on clinical excellence. Exemplary status is the highest level of accreditation that can be achieved under the AANEM’s program. Jewett’s lab is led by Jewett physical medicine and rehabilitation specialist Colleen Zittel, M.D., who serves patients Dr. Colleen in Jewett’s Winter Park and Zittel Lake Mary offices.

Physicians specializing in electrodiagnostic medicine conduct tests to measure nerve and muscle function, and identify problems associated with the neuromuscular system. The two main tests are a nerve conduction study (NCS), which uses an electrical current to measure the size and speed of the response of the nerves, and a needle electromyography study (EMG), which records the electrical activity of muscles and nerves. Referring physicians typically request these studies to identify causes of radiating pain, weakness, numbness, tingling, fatigue and muscle cramping. Study results can diagnose conditions ranging from carpal tunnel syndrome and sciatica to amyotrophic lateral sclerosis (ALS) and diabetic neuropathy.

After diagnosis, patients return to see their referring physician to begin focused treatment, which may include lifestyle modification, splinting, physical and occupational therapy, medications, injections, or in ex-

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treme cases, surgery.

Dr. Zittel’s lab is the first to receive this commendation in the Central Florida area, said Jewett Orthopaedic Clinic’s President John McCutchen, M.D. who also said that accreditation is a key step to patients receiving outstanding electrodiagnostic care.

Dr. Zittel was especially honored to receive the exemplary status accreditation.

Dr. Zittel graduated from Dartmouth College and went on to receive her medical degree from State University of New York at Buffalo. Following medical school and residency, Dr. Zittel became certified by the American Board of Physical Medicine and Rehabilitation, and the American Board of Electrodiagnostic Medicine.

FCS Lab Awarded CAP Accreditation The Pathology Laboratory at Florida Cancer Specialists & Research Institute is a state-of-the-art facility that is comprised of two specialties: Histology and Flow Cytometry. Both departments have just been accredited by the College of American Pathologists (CAP), an internationally-renowned program that recognizes laboratories that go well beyond regulatory compliance in achieving the highest standards of excellence to positively impact patient care and safety. The pathology laboratory is located in Fort Myers and serves the more than 70 clinical locations in the FCS network throughout the state.

According to the College of American Pathologists, The CAP Laboratory Accreditation program is based on rigorous accreditation standards that are translated into detailed and focused checklist requirements. The checklists, which provide a quality practice blueprint for laboratories to follow, are used by the inspection teams as a guide to assess the overall management and operation of the laboratory. FCS is one of a select few community-based practices in Florida that has achieved CAP accreditation.

Dr. Ryan Olson, FCS hematopathologist, said that following a rigorous initial inspection, the laboratory was not only fully accredited, but passed with a nearly perfect record.

FCS pathologists are in frequent contact with all of the clinicians in the practice, allowing immediate reporting of clinically important information. Because of its commitment to the highest quality standards, the FCS lab is able to provide both the technical analysis and the professional evaluation of all aspects of a comprehensive hematopathology and surgical pathology report.

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