Tampa Bay Medical News April 2013

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PHYSICIAN SPOTLIGHT PAGE 3

Claudia E. Lago Toro, MD ON ROUNDS

Taming Disruptive Behavior

ACPE doctoral-level therapists highlight “bad boy” workplace behavior in new manual on managing healthcare’s troublemakers

... 6

Rock Star

USF medical student selected as national pick for AMA’s GRAF Program the fi rst student to represent USF’s medical school TAMPA - A college track in that capacity, and only coach taught William Pearce a the tenth of a select group valuable lesson: “Put yourself who have served as GRAF in position to succeed and the fellows since the prestigious rest will take care of itself.” program’s inception.

Peace, a second-year stu“I’ve been interested in dent at the University of South this position since I learned Florida (USF) Morsani College of it as a first-year medical of Medicine, and a 2011 NCAA student,” said Pearce, who Student Athlete of the Year, has gained expertise in the William Pearce taken that advice to heart. practical aspects of advocating The American Medical Association for medicine since attending his first AMA (AMA) recently selected him as the only Medical Student Section Interim Meeting student nationwide for the AMA’s 2013last year, and was the primary author of 14 Government Relations Advocacy an AMA resolution aimed at tying further Fellowship (GRAF) Program. Pearce is (CONTINUED ON PAGE 4)

By LyNNE JETER

If I could just inspire a few more students and physicians to (do that) … instead of letting lawyers and politicians decide what’s best for our patients; I think that would be an overwhelming success.

WILLIAM PEARCE

A Major Medical Gift Beating the Odds

Kids Beating Cancer celebrates opening of Central Florida transplant center, founder eyes growing national registry of umbilical cord blood ... 7

Florida Hospital partners with Florida State to boost medical education in Orlando

By LyNNE JETER

ORLANDO — The primaveral announcement by leaders of Florida Hospital and Florida State University (FSU) of a $2 million gift to boost medical training in Central Florida has industry insiders buzzing.

Speculation has swirled that the move further separates Florida Hospital from rival Orlando Health, and the University of Central Florida College of Medicine, which reportedly backed out of a deal with Florida Hospital late last year.

“Although no one’s saying it on the record, it’s true,” said a Florida physician leader, who (CONTINUED ON PAGE 4)

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L-R: Dr. Michael Muszynski, dean of the FSU College of Medicine’s Orlando campus, FSU President Eric Barron, Florida Hospital Vice President Brian Paradis and Dr. John Fogarty, dean of the FSU College of Medicine.

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PhysicianSpotlight

Claudia E. Lago Toro, MD Medical director, St. Joseph’s Women’s Hospital Breast Center

By JEFF WEBB

TAMPA - Growing up as an only child in San Juan, Puerto Rico, Claudia Lago Toro’s four cousins were more like siblings. “It was wonderful,” she said.

“Life was simple, but filled with joy and love from friends and family.”

But when she was 13, one of her cousins was diagnosed with a brain tumor and died of complications from surgery. “It changed my perspective. I had a real curiosity about what was going on,” she said, and “not understanding prompted me to learn more.”

When she got to high school she learned of a two-week medical summer camp in Indiana and persuaded her parents to let her attend. That is where she discovered a mind of her own – literally.

“I was allowed to hold a human brain in my hands. It was truly a fascinating experience. Life as I knew it changed, and I became fascinated with the medical field,” she recalled. “I knew then what I wanted to do. I decided I would finish high school a year early.” That accelerated pace of learning continued in college as Lago Toro completed her undergraduate degree in general science in just three years.

She enrolled at the University of Puerto Rico School of Medicine in San Juan; in 2004 she earned her MD. Lago Toro said she became interested with surgery as a third-year medical student. “With surgery, you are able to intervene and cure in many instances.

(So) I chose the path of general surgery.”

She came to the U.S. to begin her surgical residency at Baystate Medical Center in Springfield, Mass.

The move to New England was a “huge change,” she said. “It’s a big difference when you are used to being with family members and friends daily, and then you move to a place where you don’t know anyone. But you start building relationships and soon it becomes home.”

Springfield was home from 2004 to 2009. “It was a five-year residency program. I was very fortunate to end up being with two exceptional breast surgeons who loved what they were doing,” said Lago Toro. “I saw how they treated their patients, their rapport with the families, and their continuity of care, which was definitely one of the things I was looking forward to for when I entered practice. With breast surgery you definitely have that.

The data is changing constantly, so it’s not like you’re going to be at a standstill.

There are multiple treatment options.”

“That’s when I decided to pursue a fellowship in breast surgical oncology,” she said. The surgery is “very intricate. It may not be as technically complicated as some other surgical specialties, but in terms of

HAEL SMALL, MD

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the knowledge and background,” she said, it’s where she can best apply herself.

Lago Toro said she was very fortunate to undertake her fellowship “in a pristine environment at Bryn Mawr Hospital in suburban Philadelphia, overseen by her mentor, Thomas Frazier, MD, senior surgeon and medical director of the hospital’s Comprehensive Breast Center. “It was the perfect scenario for me because not only did I get the research angle, but I also got an education about how to build a practice.

He had his own breast surgery center. It was one of the best opportunities of my life.

He and his partner, Andrea Barrio, MD, were both my fellowship attendings. I still use them as resources,” said Lago Toro.

The admiration between Lago Toro and Frazier is mutual. “We were extremely lucky to match Claudia in the breast fellowship. She turned out to be a perfect fit for us. She has a great sense of humor, is very enthusiastic and a tireless worker. The patients loved her,” said Frazier. Lago Toro “has a nice way of relating to patients. One of the things Claudia understood is we should treat patients like we, or someone in our family, would like to be treated. Claudia has that upbeat personality that allows her to see someone who is scared and put them at ease.

Not everybody can do that,” said Frazier, 69. “Claudia is a special person and I’m

delighted she has found such a good opportunity in Florida.”

The opportunities Lago Toro found in Florida have been professional and personal. After completing her fellowship she worked for three years for Physicians of Southern New Jersey in Vineland, where she established a comprehensive breast care program, oversaw the tumor board

and the cancer committee. Late last year she relocated to Ormond Beach to care for her mother Magaly, whom she helped recover from three primary cancers she was diagnosed with in the past three years.

“It has been a very challenging time” for she and her father Jose, Lago Toro said.

“It makes you appreciate the simple things in life. Thank God she is now doing well.”

Lago Toro was recruited by HealthPoint Medical Group in Tampa. “I was looking for an opportunity to continue with a breast program ... but I wanted to take it a step further. HealthPoint offered that perfect opportunity,” she said, and it also was within a few hours driving distance of her parents.

Lago Toro is medical director of St. Joseph’s Women’s Hospital Breast Center.

“I can’t say enough about St. Joe’s. What I really love about St. Joe’s and HealthPoint is the sense of community and collaboration about building something great. Ultimately, when you work someplace you want to become part of that community.

That is what I’m striving for. It’s about belonging to something, because when you belong to something that’s when you stand up for it,” she said.

When it comes to caring for patients, Lago Toro’s philosophy is homegrown.

“My upbringing is that you treat everyone (CONTINUED ON PAGE 4)

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A Major Medical Gift, continued from page 1

Rock Star, continued from page 1

declined to be identified. “That said, it’s great for Orlando to have a gift of this magnitude to further medical training right here at home.”

Another local healthcare leader said: “FSU Medical School-Orlando is probably the best kept secret in Central Florida.

The mission statement definitely differentiates from UCF’s College of Medicine.”

The gift will establish the Florida Hospital Endowed Fund for Medical Education to help the College of Medicine support its faculty of nearly 600 Orlando-area physicians.

“A medical school with our unique, community-based curricular design requires outstanding, dedicated clinical partners if excellence in educating the next generation of Florida’s physicians is to be assured,” said Michael Muszynski, MD, dean of the FSU medical school’s Orlando campus.

Florida Hospital CEO Lars Houmann Dr. Michael said the FSU College Muszynski of Medicine teaching model is “an excellent and highly effective approach to growing Florida’s much needed future physician population.”

“From a resource and efficacy standpoint, the community-based Lars Houmann clinical training approach directly aligns with the requirements of a 21st century healthcare model,” he said.

The FSU College of Medicine’s Orlando campus on East Colonial Drive has been in place since state lawmakers approved it in 2002. Florida Hospital supported the creation of the FSU College of Medicine during the legislative process and became one of its affiliates in 2002, just before the Orlando campus welcomed its first group of students.

The premiere class of third-year students began in 2003 and graduated in 2005. The Orlando campus has 20 thirdyear and 20 fourth-year medical students.

“Now that we’re celebrating the 10th anniversary of our Orlando campus, we appreciate this generous gift as an acknowledgement of that relationship, and a great help to us to support and sustain the

advanced directives to driver’s licenses. As 2012-13 vice chair of the Florida Medical Association (FMA) Medical Student Section, he coordinated legislative affairs, served as USF student delegate to the FMA, and led the FMA’s medical student recruiting efforts at USF. Last month, he was among a group of USF students who traveled to Capitol Hill to push for greater funding of graduate medical education. “(The GRAF post) always seemed sort of out-of-reach, so I just made sure to do the best I could at the state level with the FMA,” he said. “Late last year, I was encouraged by a former GRAF (fellow) to apply for the position, so I did – and it worked out!”

Starting this July, Pearce will work full-time for a year in Washington, DC, as a paid member of the AMA’s federal advocacy team. He’ll meet with politicians, AMA leaders and medical students to advance the association’s legislative agenda and policies on behalf of patients, physicians and medical students.

“For me, it means the opportunity to inspire medical students to get involved and take control of our future,” he said.

“If I could just inspire a few more students and physicians to (do that) … instead of letting lawyers and politicians decide what’s best for our patients; I think that would be an overwhelming success.”

A native of Jacksonville, Pearce earned a biology degree from the University of North Florida, where he won a full athletic scholarship and served as UNF track and cross-country team captain for

quality leadership, faculty and programs there in the future,” said John P. Fogarty, MD, dean of the FSU College of Medicine.

Even though students use the Orlando Dr. John P. Fogarty campus as a home base for a longitudinal doctoring course, they spend most of their clinical training in the community. Students work directly with local physicians in a one-on-one apprenticeship-style model to complete clinical rotations in family medicine, pediatrics, internal medicine, obstetrics-gynecology, surgery, emergency medicine, psychiatry or geriatrics and through other electives.

The approach is meant to give students more involvement on the frontlines of the healthcare delivery system. For example, instead of operating a teaching hospital or academic medical center, the FSU College of Medicine partners with hospitals, medical centers, health clinics and physician offices throughout the state to ensure students have an opportunity to work directly with the most experienced physicians in the community and get them more involved in patient care. As a result, of the 81 alumni physicians now practicing in Florida, 70 percent are primary care providers.

“We find the mission of the College of Medicine – to produce physicians who would focus upon primary care and seek to increase access for citizens who live in underserved areas – to be very compatible to our own history and mission,” said Rich Morrison, regional vice president of governRich Morrison ment and public affairs at Florida Hospital.

The FSU College of Medicine operates regional campuses in Daytona Beach, Fort Pierce, Pensacola, Sarasota and Tallahassee, and has rural training sites in Immokalee and Marianna.

Thirteen members of the 113-member FSU College of Medicine Class of 2013 recently matched with residency programs in Orlando, including five at Florida Hospital. Those students are scheduled to graduate next month and begin their residency training in July.

three years.

“Even in college, if I turned on the TV, it was only to check the news,” he admitted. “It’s what I enjoy and what I’ve always done for fun. When I got to medical school, getting involved in organized medicine just made sense. I loved it.

I also believe that organized medicine is the most powerful tool that students and physicians have to shape our future and do what’s best for our patients.”

Managing a hectic schedule of medical school and policy advocacy work “can be a little bit tough,” sometimes, noted Pearce.

“I get way more excited about health policy than I do about biochemistry,” he said. “I’ve been able to balance everything just fine, though. As a student athlete in college, I really learned what it means to budget your time. Compared to that, medical school is easy. I’m honestly not worried about taking a year off at all. I’d head on up to DC tonight if I could.”

The Hillsborough Medical Association recently awarded Pearce an annual scholarship for outstanding service in organized medicine.

“As with everything else in my life, I’m just going to do the very best I possibly can with medicine and policy,” he said. “I’m not 100 percent sure what that’ll bring for me on either front. If we accomplish nothing more than to build strong grassroots student support for taking charge of our future, I don’t think we could be any more successful than that.”

PhysicianSpotlight

Claudia Lago Toro, MD, continued from page 3 the way you would want to be treated – with respect and humility,” she explained.

“Yes, there will be times when the news will not be good, but I want to bring people to a better state or, if necessary, a palliative state. The better you treat people, and the better relationship you have, the better response you get. Give them as much time as they need.”

When she’s not at work, Lago Toro has a host of active pastimes, including tennis, biking, running and in-line skating.

She also loves to cook. “In my culture, ev-

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erything revolves around food and family.

The heart is in the kitchen. I’m not very fancy, but rice and beans and chicken has to be in the mix,” she said.

But when she really wants to impress, Lago Toro pulls out a secret family recipe named after her grandmother: fiodono. It is a baked dessert that melds flan and cheesecake. It’s so popular at family gatherings, she demured, that “I may be asked to bring two or three because one is never enough”

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Taming Disruptive Behavior ACPE doctoral-level therapists highlight “bad boy” workplace behavior in new manual on managing healthcare’s troublemakers

By LyNNE JETER

TAMPA - The medical community took notice when the Indiana Supreme Court ruled in Raess v. Doescher that the hospital had to pay $325,000 in damages resulting from the misconduct of a surgeon in a landmark workplace bullying case.

The state’s highest court acknowledged it as possibly the basis of a claim for intentional infliction of emotional distress arising from a supervisor’s workplace misconduct.

In this case, a hospital room perfusionist claimed a cardiovascular surgeon approached him with “clenched fists, piercing eyes, a beet-red face, and popping veins,” spouting obscenity-laced threats that he “was finished!”

The advent of health reform has perhaps exacerbated disruptive behavior, along with empirical linkage between disruptive behavior and clinical outcomes ranging from medical errors to mortality, prompting healthcare executives to expeditiously mainstream preventive measures and take corrective action quickly.

In the last decade, 21 states have introduced the Healthy Workplace Bill, with 16 bills active in 11 states. The Joint Com-

mission addressed the issue by adopting a new leadership standard concerning “behaviors that undermine a culture of safety,” effective Jan. 1, 2009. The Tampa-based American College of Physician Executives (ACPE) is among national professional organizations that have adopted zero tolerance for abuse policies.

“A measured approach is recommended in defining inappropriate and disruptive behavior,” said Marty Martin, PsyD, co-author of Taming Disruptive Behavior, published by ACPE earlier this year. “The definition shouldn’t be overly inclusive or narrow. If (it’s) too Dr. Marty inclusive, you’ll be wasting Martin organizational resources addressing incidents that later turn out to be ‘false positives.’ On the other hand, if too narrow, you’ll be siphoning off resources to

craft ‘damage control’ strategies when a real case of inappropriate or disruptive behavior ‘falls through the cracks.’”

A few years ago at a spring meeting of the ACPE in Tuscon, Ariz., Martin and Phillip Hemphill, PhD, crossed paths when both doctoral-level therapists were making presentations – Martin on disruptive behavior; Hemphill on managing physician performance.

Hemphill had focused on social work; Martin had pursued clinical psychology.

One was a researcher and published author of disruptive behavior Dr. Phillip and workplace bullying Hemphill issues; the other was a lead clinician in an assessment and treatment program with a national reputation for treating disruptive behavior.

“We were familiar with each other’s work … and came to the same conclusion: the field needed a manual to assist physician leaders and other leaders on how to address disruptive behavior and where to send individuals who engage in such behavior,” recalled Martin. After noting a marketplace void for such manuals and guides, the two embarked on the collaborative book.

The 126-page, fact-rich manual is organized by a series of questions that are explored in detail: • What is disruptive behavior and how common is it?

• What are the impact, costs and risks of disruptive behavior?

• How can you prevent disruptive behavior?

• How can you address disruptive behavior from a leadership and organizational perspective?

• What are special considerations when working with physicians?

• What are special considerations when dealing with nurses and other members of the care team?

• What are special considerations when addressing disruptive behavior of (CONTINUED ON PAGE 8)

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Beating the Odds

The National Scope

Kids Beating Cancer celebrates opening of Central Florida transplant center, founder eyes growing national registry of umbilical cord blood

By LYNNE JETER

Most folks in Central Florida know about Margaret Guedes, the mother of a 9-year-old son who lost his fight with leukemia more than 20 years ago.

Yet it may be surprising to many Florida healthcare professionals to learn the impact her non-profit organization, Kids Beating Cancer, has had in medical circles around the globe.

Since Guedes established Kids Beating Cancer Inc. on Aug. 13, 1992, in memory of her firstborn, John Robert Voight, it’s served nearly 6,000 children and families fighting pediatric cancer, and maintains its mission to providing 96.5 percent of all income to those families, while also increasing access to treatment for children with cancer and life threatening diseases in need of a bone marrow or umbilical cord blood transplant.

Guedes’ non-profit organization funds the cost to identify compatible donors, funding uninsured medical expenses and providing support for families facing the challenging journey toward a cure.

For example, Guedes said a national bone marrow search costs about $4,000, which is an uncovered expense. Total, each transplant costs roughly $40,000 to $50,000 per patient.

The non-profit organization hosts fundraising events throughout the year, through its online sales of pediatric patient-

created artwork, planned workplace giving, golf tournaments, and signature annual events: A Spoon Full of Sugar High Tea and Fashion Show every spring, and the Hats & Heroes Ball in the fall. This year, the Sept.

28 ball is Golden Age-themed at the Waldorf Astoria in Orlando. Last October’s ball marked Kids Beating Cancer’s single-largest fundraising event.

Kids Beating Cancer has gone a step further than the dozen or so similar organizations across the United States, also established by parents of children with cancer. It was the first non-profit organization of its kind to make a $1 million pledge to establish a transplant center. Earlier this year, Guedes cut the ribbon at the grand opening of the Kids Beating Cancer Pediatric Transplant Center, named in memory of Voight, at the Walt Disney Pavilion at Florida Hospital for Children in Orlando.

Guedes’ organization began as a recruitment center for the National Marrow Donor Program® and its registry for unrelated donors.

(CONTINUED ON PAGE 8)

The federal government selected the National Marrow Donor Program (NMDP) to operate the nation’s Cord Blood Coordinating Center, as mandated by the Stem Cell Therapeutic and Research Act of 2005 and amended by the Stem Cell Therapeutic Reauthorization Act of 2010.

In this role, the NMDP works with doctors and researchers to continually improve cord blood transplantation and to educate medical providers. The NMDP also operates Be The Match® to encourage expectant mothers to donate umbilical cord blood to the Be The Match Registry®.

“By growing the cord blood registry nationwide with all ethnicities, it will solve a huge crisis when identifying a donor, especially minority populations, who are underserved,” said Margaret Guedes, founder and CEO of Kids Beating Cancer Inc. “Transplants are a cure for not only leukemia and cancer, but also 72 malignant and non-malignant life-threatening diseases.”

Save the Date Kids Beating Cancer’s Hats & Heroes Ball, the non-profit organization’s largest fund-raising event of the year, will be held Saturday, Sept. 28, at the Waldorf Astoria Orlando. Sponsorship information is available via Dyan@KidsBeatingCancer.com or (407) 894-2888.

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Taming Disruptive Behavior, continued from page 6 board members and senior leaders?

• What are special considerations when dealing with sexual misconduct at work?

• What’s the role of human resources, the legal department, patient safety, quality management, risk management and medical staff?

• What if I’m perceived to be disruptive?

Me, really?

• How may I use multi-source feedback in the management of individuals with disruptive behavior?

The book ends with resources of programs across the United States focusing on disruptive professional behavior.

“As the medical director of the Physician Health Program for our state, I encounter physicians with problems related to disruptive behavior on a daily basis,” said Scott Hambleton, MD, FASAM. “The negative impact that an organizational leader with these behaviors will have on the organization can be tremendous, with a trickle-down effect that can damage the entire institution. Intervention and treatment are very effective, and can turn even the most seemingly hopeless situations into positive experiences. This book provides a

framework that clearly describes the problem and the solution.”

The authors leave readers with 10 tips in the development of a monitoring program: 1. Develop a positive culture.

2. Be clear about the purpose.

3. Clearly express any desired behaviors.

4. Keep the number of items to be scored few.

5. Keep the scale simple and fit-forpurpose.

6. Use six to 10 raters.

7. Compare results with self-assessment.

8. Train those giving feedback.

9. Involve the ratee.

10. Incorporate development.

“If individuals with disruptive behavior are provided with the expectations and goals of your organization, you’re offering directionality, effort, persistence and strategic development,” said Hemphill. “Remember, the more difficult, specific, yet realistic your goal setting, the higher the level of performance you can expect. Avoid non-specific, easy, and/or do-your-best goal setting. Giving and receiving feedback regarding goals in progress is an important factor in goal accomplishment.”

Beating the Odds, continued from page 7 “For the first 20 years, that’s what we were contracted to do,” said Guedes, wife of Ben Guedes, MD, medical director of the Pediatric Intensive Care Unit at Florida Hospital for Children, a Florida physician since 1983. “Many people don’t know this, but about 75 percent of the time, family members’ bone marrow doesn’t match. Over the course of 20 years, we’ve added more than 37,000 potential donors to the registry.”

After the non-profit organization’s 20-year anniversary, Guedes moved in a broader direction. “We’d been focused so heavily on the recruitment of donors and traveling throughout the state and southeast promoting awareness and testing potential donors,” she explained. “For the first part of the 20 years, potential bone marrows had to give blood samples. Now, we just need inner cheek swabs.”

When the National Marrow Donor Program (NMDP) topped 10 million registrants, Guedes downsized the outreach and recruitment component of Kids Beating Cancer, and focused on the transplant

side of the procedure.

“Before, we were removing the barriers to transplant, which involved securing potential donors,” she said. “Today, we’re removing the barriers to transplant, which are financial. It’s the same longrange goal: getting every child a transplant that needs one.”

In addition to assisting pediatric cancer patients’ families with financial and moral support and collaborating with industry partners such as the Ronald McDonald House, Guedes has become a staunch supporter of the national Be The Match® program that connects patients with their donor match for a life-saving marrow or umbilical cord blood transplant.

“Now, umbilical cords have become another option, and there’s been an increase in mothers donating their baby’s umbilical cords,” she said. “However, we still need help from the medical community – obstetricians and labor and delivery staff, for example – to make expectant mothers aware of this important option.”

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From Intervention to Prevention

By JEFFREY L. COHEN

“Healthcare Reform,” “PPACA” and “ACOs” all have one certain thing in common: cost-saving change. Though debate swirls about politics, timing and the particulars of change, it seems clear that the changing demographics of our country (aging baby boomers) in our economic climate is not sustainable as is. And it’s no surprise that a compensation system based on how much is done and how much it costs leads to greater expense. An economic reward system that drives costs up as more and more people are set to join the ranks of the insured (through mandated health insurance and expanded Medicaid) simply underscores the timing of the change. What does that mean for physicians? Physicians are asking three key questions: 1. Is there a future for small or solo practices?

2. Is fee for service really gonna change?

3. What can I do right now to adapt?

The Future of the Small Practice

The only solid answer is “less.” It really depends on complex things like the demographics of where the doctor practices and the number of competitors close by. That said, as change happens, the hardest hit will likely be the smaller practices, since they lack the personnel and financial resources to weather the change and to invest in adaptation. Many small practices will likely experience change in such a way that the best they can hope for is to survive, rather than thrive. Even worse, solo practitioners already know what it’s like to handle all the duties as a physician, keep track of business operations and keep the patients flowing into the practice. Exhausting. Without substantial support and resources, it’s just not realistic for most solos to expect to keep up.

Even larger practices are not often run like a business. The professionals that generate the revenue often manage as well.

Moreover, most practices do not market or do any serious “back office” magic (revenue cycle management). As such, change hits small practices especially hard. Implementing even new EHR requirements can be consuming for a small practice. How will it be as changes are made to reduce cost and improve quality? How will it be when practices begin to see there is opportunity in change, that they may actually make more money in a prevention-based, risk-based compensation environment?

Rougher. Like a herd of buffalo when attacked, circling together is a good strategy.

That said, the vision has to be clear.

Why circle together? Most practices are combining and growing to guard market

share, not to manage costs or measure and demonstrate quality. This is probably the biggest reason why we see larger practices in single specialties, not multi-specialty or primary/specialty based practices. Most physicians that are adapting by joining larger practices are doing so for the same reason why buffalos circle together—the threat of change. Though size alone is no panacea, larger practices are definitely in a better position to adapt.

Let’s face it: few are running after change in healthcare right now. Few see the opportunity and are leading the charge. Most are waiting or are just setting the stage. And most large practices are, at best, good platforms where change can be implemented and costs can be shared and spread among a larger pool.

Will There be a Change to Fee for Service Payment?

Yep. Simple as that. It’s already happening. Bundled payments are in place, even in Florida. Capitation is old hat for many now.

When? Over time… Not right away.

Even ACO aspirants are selecting just one sided risk, testing the water as they see how well they do to reduce costs, improve quality and “earn” their right to bonus money.

Physicians that think fee for service will thrive for decades are kidding themselves, at least in the insured market. Is there a basis for it in a “second tier” or concierge sort of environment? Probably.

What Can I Do Right Now?

First, accept that we are approaching a

new paradigm of healthcare delivery. The current model of disease/injury crisis management has prepared no one for the move from intervention to prevention. And yet, systems that are solidly based in wellness and prevention stand to profit most from the change we all face.

Second, look to shore up your business model. That means: • Look to join a larger practice that is committed to thriving in the future prevention-based, risk-based compensation scenario. If the practice is there just to thrive in a fee for service environment and has no commitment to thriving in a risk based compensation model, keep looking; • Market. Most practices do not market at all, and yet consumers are selecting healthcare in the most unlikely environment—the Internet; • Look at anything concierge-like. Most of the public conversation centers around the insured market, mostly the Medicare Shared Savings Program (which has spawned the ACO concept). What about the rest of the consumers? As the insured market gets squeezed (remember that consumers are feeling the pressure too with heightened copays, deductibles and benefit limits), you can expect growth of the “second tier,” those who want more and are willing to pay for it; • Build in wellness and prevention. Not all practices lend themselves to wellness related services that can reduce healthcare costs, but those that do must look at ways to offer cost-saving,

wellness and prevention-oriented services. Smart patients may welcome the message that “prevention saves (money and lives)”; • Enlist the patients. The concept of “partnering” with patients is strange, but consider the amount of savings and the enhancement of outcomes if physicians could incentivize healthy patient behavior. Though absent from the public policy conversation, healthcare businesses that build in patient accountability stand to win big in a payment system that rewards clinical outcomes and cost savings.

Change is frightening. Even “good” change is frightening. Just look at all the upset stomach meds sold at airport kiosk counters. Physicians have a terrific burden at this time. They not only hold our health in their hands, they are expected to have skills and time to help create a new environment in which care will be delivered.

Denying change in the healthcare sector is a waste of time and energy. Looking for ways to thrive in it and even drive it is wise.

With over 24 years of healthcare law experience following his experience as legal counsel for the Florida Medical Association, Mr. Cohen is board certified

by The Florida Bar as a specialist in healthcare law. With a strong background and expertise in transactional healthcare and corporate matters, particularly as they relate to physicians, including chiropractic physicians, the Florida Healthcare Law Firm is immersed in regulatory, contract, corporate, compliance and employment related matters of practices, surgery centers and other healthcare businesses. He can be reached at www. floridahealthcarelawfirm.com

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GrandRounds St. Joseph’s Hospital Expands Robotic Surgery Program with First Surgery at St. Joseph’s Hospital-North

Women’s Hospital and now, St. Joseph’s Hospital-North.

New Advanced HighField Short-Bore MRI at Bloomingdale Radiology

The most comprehensive robotic surgery program in the Tampa Bay area now offers the latest in minimally-invasive procedures at its newest hospital just north of Tampa. Obstetrician and gynecologist Pamela Dale Twitty, M.D., performed the first robotic hysterectomy at St. Joseph’s Hospital-North on March 13.

Today, some patients even leave the hospital the day after their procedure.

With nearly 30 physicians who together offer more than 40 different robotic procedures for patients, the diversity of Advanced Center for Robotic Surgery at St. Joseph’s is unlike any other in the country.

St. Joseph’s offers robotic-assisted colorectal surgery, general surgery, gynecological surgery, gynecological/oncology surgery, pediatric urological surgery, and urological surgery as well as single site gallbladder surgery, which takes cholecystectomy to a whole new level.

St. Joseph’s Hospital in Tampa was the first in hospital in Florida to use the da Vinci®surgery system for general surgery. Now all of St. Joseph’s Hospitals are performing robotic surgery with da Vinci®robots located at St. Joseph’s Hospital in Tampa, St. Joseph’s

Bloomingdale Radiology is proud to announce the arrival of our new 1.5T MRI scanner. This upgrade will significantly benefit both our patients and medical community due to its 1.5T field strength which allows us to deliver outstanding image quality that supports a complete range of clinical applications. These applications include neurology, orthopedics, body imaging, angiography, breast imaging, oncology and pediatric imaging.

The Tim™ (Total imaging matrix) technology, increases throughput with the combination of up to four matrix coils which makes patient repositioning virtually unnecessary. This advancement results in workflow improvements that can lead to reduced exam times. Additionally, the system’s ultra-short bore will alleviate concerns of claustrophobia since many patients can be imaged with their head outside of the bore. Additionally, Bloomingdale Radiology will now be able provide patients with benefits such as: breast MRI exams, faster more comfortable exams with ultra-lightweight coils, more “head-out” exams thanks to the ultra-short magnet design, exams

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with flexible combinations of up to four different coils and improved diagnostic confidence with 1.5t image quality.

Eighth Annual PNC Bank Miles For Moffitt Race On May 11 WHO: PNC Bank Miles for Moffitt and Moffitt Cancer Center, the only NCI-designated comprehensive cancer center based in Florida.

WHAT: The 2013 PNC Bank Miles for Moffitt - offers five-mile, 5K and one-mile races. With 7,000 participants expected in 2013, the PNC Bank Miles for Moffitt race offers everyone a chance to be on the team to fight cancer. One hundred percent of all registration fees go to benefit Moffitt Cancer Research. Online registration closes May 5, 2013 at midnight. After May 5, participants must register in person at one of the packet pick up locations. Participants who register on race morning will not be chip timed. Increased entry fees will apply to all registrations effective Monday, May 6, 2013. The cost of the eight training sessions is $85, which includes the PNC Bank Miles for Moffitt entry fee for the 5K or 5-mile race.

Please contact Lynn Gray at 813-4537885 or LGray88@yahoo.com to register or for further details. WHEN: 2013 PNC Bank Miles For Moffitt: Saturday, May 11, 2013. WHERE: University of South Florida - Tampa Campus 4202 E. Fowler Ave., Tampa, FL 33620 For more information, visit www.milesformoffitt.com, or follow on Facebook atwww.facebook.com/MilesForMoffitt

St. Joseph’s Hospitals Enrolling Bay Area Residents in Nationwide Cancer Study St. Joseph’s Hospitals are helping the American Cancer Society find “cancer fighters” in the Tampa Bay area who want to join a historic nationwide study about how genetic, environmental and lifestyle factors may cause or prevent cancer.

Men and women ages 30-65 who have never been diagnosed with cancer are encouraged to enroll in Cancer Prevention Study-3 (CPS-3), and can do so during a registration event hosted by St. Joseph’s Hospitals on May 2, 10 a.m. – 4 p.m. in the Medical Arts Building.

During the May 2 enrollment event at St. Joseph’s Hospital, research participants will complete a questionnaire and give a small blood sample, along with height, weight and blood pressure information. Participants don’t have to know all of the answers to the questionnaire at the time of the enrollment event – there will be a timeframe for participants to go back and research health history, if needed. The most important things to do are explore the CPS-3 website, get answers to any questions and consider registering for the study. Your health information can help researchers save lives.

The study will follow participants for

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GrandRounds at least 20 years. St. Joseph’s Hospitals Cancer Institute hopes that folks in the community will honor their friends and family members who have been touched by cancer by joining in this landmark research study.

So far, 100,000 people across the United States have enrolled in CPS-3 in the past two years, but this is the final year of enrollment and Hillsborough County has a goal of 900 participants for 2013. Last year St. Joseph’s Hospitals alone enrolled 240 participants.

For more information about the study, visit www.cancer.org/cps3florida.

Tampa General Hospital Opens New Primary Care Center In Carrollwood Tampa General Hospital has opened its new Tampa General Medical Group (TGMG) Family Care Center in Carrollwood. It is the hospital’s fifth primary care facility and the third to open since May. The center, located at 13860 N. Dale Mabry Highway, is open weekdays. Sameday appointments are also available, and all major health plans are accepted.

Board-certified family practice physician Antonio Farrales, MD, provides primary care and chronic disease management for all age groups at the new center. Services include routine exams, EKGs, minor procedures, well-child and

well-woman checkups, and school and sports exams by appointment. TGMG nephrologist Denise Alveranga, MD, also relocated her medical practice to the new Carrollwood location, and is accepting new patients.

TGH Foundation announces 16th Annual Gala: License to Thrill - Which Bond Are You?

You only live twice, so why not indulge in Tampa General Hospital Foundation’s 16th Annual Gala on Saturday, May 4, beginning at 7:30pm at the Hilton Tampa Downtown?!

Embrace your inner agent and discover the secrets of an evening full of thrills.

Try your hand at the Casino Royale tables, place your bid on a silent auction item or test your spy skills with challenging interactive activities. Indulge in a special Bond (shaken, not stirred) and enjoy cuisine fit for 007.

Enter our infamous “high stakes” Chance Drawing Contest and you could take home a cool $10,000.

All sponsors at the $1,500 level and above are invited to the exclusive PreGala Patron’s Party at 6:30pm. The Gala is presented by SKANSKA and the media sponsor is the Tampa Bay Times.

The Gala benefits Tampa General Hospital’s Fund for the Future, helping TGH achieve its vision of being the

leading medical center in West Central Florida. Your generous contributions ensure that our dedicated physicians and patient care staff have all the tools necessary to provide excellent medical care and advance teaching, research and service to our community.

The Gala is Co-Chaired by McIver Grim and Wayne Lewis.

Attire: Secret agents, Bond girls and villains, come dressed to kill.

For more information, call: (813) 844-8217…or www.tgh.org/foundation_ events.htm

Tampa General Among Nation’s Best Heart Programs Tampa General has been named one of the nation’s “100 Hospitals With Great Heart Programs” by Becker’s Hospital Review, a national healthcare publication.

The publication’s editorial staff selected hospitals based on clinical accolades, recognition for quality care and contributions to the fields of cardiology and cardiovascular surgery, according to its website.

In addition, the hospitals were chosen for their excellence in heart care and research by reputable healthcare rating resources, including U.S. News & World Report, HealthGrades, Thomson Reuters, and the American Nurses Credentialing Center.

SHEN YUN RETURNS TO THE TAMPA BAY AREA

Tampa General is the only Hillsborough County hospital, and one of only two Tampa Bay area hospitals to make the list. Eleven Florida hospitals were named.

Tampa General’s Cardiovascular Center has six cardiac catheterization laboratories and six interventional radiology suites. It nine cardiovascular operating rooms, including a state-ofthe-art hybrid operating room where the most complex cardiac surgeries, such as Transcatheter Aortic Valve Replacement (TAVR) procedures, are performed. Complex arrhythmia procedures, including atrial fibrillation ablation and ventricular tachycardia ablation, are also performed at the hospital.

Physicians with the hospital’s heart transplant program have performed more than 1,000 transplants, which is the fifth busiest heart transplant program in the country with one of the highest survival rates. In 2012, Tampa General began offering an investigational treatment for people battling treatment-resistant hypertension.

Since 2008, U.S. News & World Report has rated Tampa General as one of the nation’s Top-50 hospitals in cardiology and cardiac surgery. In 2012 U.S. News also ranked Tampa General the number one hospital in Florida.

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