Tampa Bay Medical News June 2015 by FW Publishing

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June 2015 >> $5

PHYSICIAN SPOTLIGHT PAGE 3

Kay Shawchuck, MD ON ROUNDS

HIT: Optimization Through Integration

You can love it, hate it, fear it or revere it … but technology has become an integral part of healthcare processes ... 5

Blake Medical Opens Only Burn Center between Tampa and Miami Comprehensive burn services complement HCA hospital’s trauma center By JULIE PARKER

BRADENTON—When Blake Medical Center opened its new $3 million burn center last month – to complement its status as the trauma care provider for Sarasota, Manatee and DeSoto counties for the most severe injuries – it came with the designation as the only one of its kind located between Tampa and Miami. Previously, Blake Medical Center burn patients were transferred to Tampa General Hospital, located 50 miles north of Bradenton. “Last June, we started taking a very hard look at the need for a complement (CONTINUED ON PAGE 5)

Benefitting from Return on Engagement

Helping Men Get Healthy

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

American men live sicker and die younger than their female counterparts ... 6

By JULIE PARKER

When Tampa Bay Medical News’ website is re-launched soon, it will feature arguably the most advanced business-to-business (B2B) platform in the industry. “I’m not aware of any other platform that has quite the breadth of capability,” said Eric Kammerzelt, vice president of technology at SouthComm, parent company of Medical News Inc. “We’re creating a 360-degree profile around our audience, and it will totally revolutionize how editorial content is generated.” Kammerzelt, listed among Folio magazine’s annual Top 40 (CONTINUED ON PAGE 4)

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PhysicianSpotlight

North Winds Bring Transplant Kay Shawchuck, MD, Extraordinary Physician and Mother ST. PETERSBURG - When Kay Shawchuck moved to St. Petersburg last fall, she marveled at how many people were paddle-boarding on the Tampa Bay waterfront. “It looked like a blast,” said the energetic 55-year-old, so she took the plunge – literally. “It took me several weeks before I could stand and actually travel anywhere on the water, but I love it now,” said Shawchuck, who soon made it a daily routine. But what about the winter months, when the water temperature dipped into 50s and the air temperature was even colder? “Ha! I wore a wetsuit for a while, but I haven’t experienced ‘cold’ yet in St. Pete,” scoffed Shawchuck, whose perspective is that of a native of rural Mott, N.D. who later spent almost two decades working in Fargo. The water is just one advantage of relocating to “the most beautiful place I’ve ever lived, for both the climate and the people” said Shawchuck, a specialist in breast surgery, breast disease, breast cancer and oncoplastic surgery. Shawchuck works for Women’s Care Florida, but she also is deeply involved at St. Petersburg General Hospital’s Center of Excellence for Women’s Health, where she serves as the community cancer liaison physician with the American College of Surgeons and the American Cancer Society. “This is a great group to work with,” she said. The team at the hospital is “the most amazing, dedicated group. The women who work in the Breast Center have been there for years and this is their life’s work. They are so supportive of me and my practice, and the patients (by providing) personal, one-on-one attention,” said Shawchuck. “The nurses, the OR staff, and the administration have been so supportive. They really are wanting to grow women’s care and are putting a lot of effort and resources into that.” “We have become aligned with the National Cancer Institute to offer patients enrollment in clinical trials,” she said, and “we realize the importance of research and clinical trials in the advancement of care in breast cancer.” “Combined with living in a warmweather climate for the first time, I feel like I’ve been given such a gift and opportunity,” she said. Like most talented physicians, Shawchuck worked very hard to develop her gifts and create her opportunities. She grew up the youngest of three daughters born to Verna and Lee Shawchuck. Her father was a Methodist minister who “placed great importance on education and serving others,” said Shawchuck. She remembers “the thrill and awe of learning about human cells” in high school. “A whole new realm of life was opened to me and I recall thinking what an amazing ta m pa b ay m e d i c a l n e w s

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thing the human body was,” she said. In college she studied biology and it was then she decided she would become a physician. But her choice to become a surgeon had a less-scientific influence. After seeing the Academy Awardwinning movie M*A*S*H, Shawchuck said, “I thought what the surgeons did to save lives during trauma surgery was the most remarkable thing I’d ever seen.” Later, her rotations at Indiana University School of Medicine reinforced that choice. Shawchuck went to the University of Texas Medical Branch Hospitals in Galveston for her internship and residency in general surgery. It was there she met Courtney Townsend, MD, the department chair who became her mentor and motivation for specializing in breast surgery. “I spent months working closely with plastic surgeons, medical oncologists, radiation oncologists, pathologists and radiologists, discussing breast cancer patients, and learning how important it is to work together across multiple specialties to make a best plan of treatment for each patient,” she said. “The physician most responsible for this training was Dr. Townsend, an expert educator, researcher, and author of many books on breast disease, including a textbook of breast surgery,” she recalled. “At the end of my residency, he encouraged me to do only breast surgery. At the time

there were very few surgeons who focused solely on breast surgery, and I wondered why I would do that, considering I had just spent years doing all types of surgery. But several years out of training I recognized his wisdom,” said Shawchuck, who since has done that exclusively. Townsend is still in touch with Shawchuck, who he said sometimes calls him to discuss a patient or a technique. “She’s al-

ways been very bright and dedicated to excellence,” said Townsend, who at 71 years old is still teaching in Galveston. “She has a great sense of empathy for her patients. Since breast cancer probably is the most devastating thing a woman could face, I thought Kay handled (that part of her job) quite well. As the field was evolving, and more women were entering medicine, more and more women were seeking female surgical oncologists to be in charge of amputating their breasts and taking care of them as a whole person. I always thought she would be outstanding at that,” said Townsend. “It’s been a perfect fit for me,” said Shawchuck. “Each individual has a special set of needs for the best treatment options, and I love working closely with other specialties to make best treatment plans for the individual.” Shawchuck said she is in the OR two days a week and sees patients at her office on 5th Avenue North other days. But when she’s not working, she is enjoying living on the waterfront and exploring downtown St. Petersburg with her Maltese sibling puppies, Beasley and Benson. “I even bought one of those silly doggy strollers,” she laughed. Shawchuck resides with two other siblings, too: Her 20-year-old twin sons, whom she home-schooled from kinder(CONTINUED ON PAGE 5)

BayCare Medical Group Welcomes Kenneth Essig, MD, FACS | Urological Surgery

BayCare Medical Group welcomes Dr. Kenneth Essig, who specializes in urology. His clinical interests include overactive bladder issues, pelvic health and prostate health. Dr. Essig is a member of the American Medical Association and the Florida Medical Association. Education ■ Doctor of Medicine – University of Cincinnati, College of Medicine; Cincinnati, Ohio Internship ■ Urology – Jewish Hospital Medical Center; Cincinnati, Ohio Residency ■ Urology – State University of New York Health Sciences Center; Syracuse, New York BC1501028_0515

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Benefitting from Return on Engagement, continued from page 1 list in recent years, joined SouthComm via Cygnus Business Media Inc., an international B2B media company. SouthComm, niche publisher of consumer and B2B weeklies, monthlies, and regional magazines primarily in the South and Midwest, acquired Cygnus’ 11-magazine and 7-trade show public safety group last November, chiefly for the industry’s most sought-after technologies – BASE. BASE is a content management system hosting thousands of market-specific articles. This need-driven platform was built with open source tools and technologies for a comprehensive solution for editorial and design publishing teams. A leading content strategy serves as a cornerstone in sales-lead generation, and was developed by a small WI team. The Listening Phase “Back in 2007, we began asking the editorial team at Cygnus: what are your challenges? What are your needs? How can technology help? At that time, print editors were being asked to also manage content online, in addition to managing social media and newsletters. We heard overwhelmingly they needed an easy way to share and organize content,” said Kammerzelt, who joined Cygnus in 1998 as network administrator, and was promoted to corporate IT director in 2006, the same year Twitter was launched. “We looked around and weren’t happy with what we were finding in the industry, so we built our own system. We met with editors weekly to advance to their needs. The system has grown and evolved, and has become quite popular.” The platform intuitively maximizes use of responsive design and compelling content. “The way we organize our content allows us to be smarter about the content we provide,” he explained. “Our analytics platforms helps us understand our audience – what’s being consumed, read or simply grazed, and insights into how read-

ers are navigating the site. It’s been very enlightening to many editors who may think the audience is interested in particular content but instead are interested in something different that editors may not have thought would hold their interest.” Historically, editors and sales have been distinctively separate departments. In the digital age, the entire team – editorial, production and sales – has become more collaborative with its partners, yet remaining so in ethical fashion. “The bottom line is to maximize impact,” pointed out Kammerzelt. Industry’s Dirty Little Secret The platform has received accolades for the way optimized in-view impressions are measured. “The dirty little secret of many websites is that ad impressions further down the web page are still counted as having value to advertisers when clearly they have no value if no one ever sees it,” he said. “That’s how sites were designed for years. About a year ago, we implemented technology that allows us to fire the ad only when it’s on the screen and the user has the ability to actually view it. A big conversation among ad agencies is that advertisers are catching on and don’t want to pay for impressions not seen. They want effective ads.” For example, Cygnus approached Caterpillar about advertising in its B2B construction industry publication. “Their content wasn’t generating as much industry interest and exposure as they’d planned,” he said. “We brought data to them that showed readers were hungry for the information but there was a wrinkle: either it wasn’t marketed well, found easily, or consumed well. Caterpillar asked for our help, and we created a section of the site built around a specific type of legitimate content, combined with content they already had, and it resulted in a very successful sales program for Caterpillar.”

Another example: Cygnus built a buyer’s guide platform, a collection of product and company data, and infused content in the database for users to easily find. “We gathered information on the people who were interested in that approach, and then built a buying capacity to show advertisers and potential advertisers a group with potential buying propensity for particular products,” he said. Return on Engagement Success stories resulting from the innovative platform spurred Kammerzelt’s invention of the Return on Engagement (ROE) report. “The engagement report is built specifically for advertisers and potential advertisers to show content consumption trends to better reach their target audience, compared to competitors in the same category with the same audience while answering the question: how can we better pinpoint the target audience? Sometimes it’s content; sometimes it’s advertising,” said Kammerzelt. “We crafted the engagement report as a way to educate advertisers and give them more transparency and visibility on the popularity of their content. We keep hearing: what have you done for me lately? Have you run articles relevant to me, my needs and my market? Finding specific examples used to be laborious. Now it’s instantaneous.” The revised Tampa Bay Medical News website will have opportunities for rapidresponse polls and surveys to learn more about reader engagement, and will feature tools for article response and possibly access to white papers and other readerdirected information. Once the website is re-launched, Kammerzelt estimates 90 days for data collection to be absorbed. “The platform will allow us to response rapidly to reader trends,” he said. “For example, the systems may not show a void in editorial content, but data ana-

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Design Features & Improved Ad Performance The Tampa Bay Medical News platform has a responsive design optimized for mobile and tablet sites, each laid out differently for an advanced viewing experience. Audience and content segmentation will route through half a dozen “channels” for better content organization. “Let’s say ‘education’ falls under ‘business,’ but data show that ‘education’ is popular and could be its own channel or maybe even a separate site. That’s data analytics driving change.” Other features include related content for deeper site engagement; advanced techniques and best practices for optimizing online readability and engagement; and social media integration including sharing, social sign-on, and user comments. Improved advertiser offerings: all impressions are “in-view,” data analytics provides the ability to target within segments and “own” a channel; ad placement is more integrated with content; placement is variable; click-through rates and total clicks provide higher overall clicks; ad impressions are optimized on mobile and tablet devices; and the platform generates availability for page peels, billboards and other rich media ad capabilities. Backend highlights include a unified workflow for print and digital products; real-time editorial control, allowing for more frequent updates; automated image and media handling; and rich taxonomy and organization/relation of content. “We’re very excited about re-launching our Medical News markets,” said Kammerzelt. “The more thrilling part will occur when we have enough data to drive changes to truly make a difference to those who support us.”

REPRINTS: Want a reprint

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lytics will make it easier to discern specific editorial needs.” If advertising support warrants it via data feedback, the system will allow Medical News to quickly add new markets, such as Jacksonville, Fla., Columbia, SC, or Portland, Ore., and revitalize existing ones, such as Charlotte, NC, and Research Triangle, NC, including Raleigh, Durham and Chapel Hill. The sites could quickly evolve into separate yet connected markets. It will also allow Medical News to easily and inexpensively test the waters on other ideas, such as potential awards programs or niche market sections, perhaps one targeted to medical students. “No longer do you need to wait months for a site,” he emphasized. “It’s much more fluid now.”

of a Medical News article to frame? A PDF to enhance your marketing materials? Email subscribe@medicalnewsinc.com for information.

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HIT: Optimization Through Integration By CINDY SANDERS

You can love it, hate it, fear it or revere it … but technology has become an integral part of healthcare processes on both a clinical and operational level. Therefore, you might as well learn to optimize it. That was a key part of the message Chris Miller, principal with Nashvillebased Cumberland Consulting Group, and Deb Dulac, director of PRISM and business systems for the University of Vermont Medical Center, shared with audiences at the recent HIMSS15 Annual Conference & Exhibition. More than 38,000 professionals flocked to Chicago last month to attend the premier health information technology conference, which included more than 300 peer-reviewed education sessions, vendor exhibits touting the latest technology options, updates on government regulations impacting the industry and keynote speakers ranging from Bruce Broussard, president and CEO of Humana, to George W. Bush, 43rd president of the United States of America. “Over the past five years, there has been a huge shift towards technology largely because of the HITECH Act of 2009 and government programs like Meaningful Use that have helped drive the technology in healthcare,” Miller said. Although slower to adopt technology into daily operations – particularly in a clinical setting – than many other industries, healthcare has increasingly been pressed to take an ‘all in’ stance. Miller noted that over the last few years, technology has fundamentally changed the way providers … both large and small … operate. He added the challenge is balancing the adoption of technology with everything that brings.

“Today anything a healthcare organization wants to change in a business or clinical process requires a change in their technology, and likewise, any change in their technology has an impact on the care they provide or their revenue,” he said. “I think healthcare entities were used to thinking of technology as a separate entity, but now it’s so intertwined,” added the Atlanta-based HIT expert. In their HIMSS presentation, Miller said he and Dulac focused on how to manage and optimize technology now that it has become so pervasive, while at the same time accounting for all the other changes happening in healthcare including a switchover to ICD-10, meeting ongoing and new Meaningful Use requirements, actively engaging patients, supporting accountable care models, and the myriad other programs that require attention. The bottom line is that thinking of each of these mandates or initiatives as individual tasks to conquer leads to madness

… or at least extreme frustration. Instead, Miller said the question should be, “How can organizations effectively manage all of those together with a higher degree of efficiency and lower overall cost?” He continued, “When I think implementation, somewhere between 25-30 percent of the time spent on these changes is spent on testing so if you can group – effectively overlap testing on these programs – you can significantly save time.” More than just testing, though, Miller said very deliberately grouping initiatives under a single governance project structure helps with a range of other issues from interoperability to simplification for end users. “Being able to group things together almost makes it irrelevant as to what changes were made,” he said of the finished product in the minds of those actually using the technology. The ‘ripping off the bandage’ approach means one educational update for those end users as opposed to having to

Blake Medical Opens, continued from page 1 to our trauma center not only in our immediate community, but also South Florida,” said Dan Friedrich, CEO of Blake Medical Center, a 383-bed HCA hospital (NYSE: HCA) in Bra- Dan Friedrich denton. “Just looking at the map of Florida and seeing how much was uncovered or not in close proximity to a burn center, we saw the need to help people in this way. It made sense for us to open a comprehensive burn center.” Burn care services will be provided on an inpatient basis for all burn patients that come through the emergency department or are transferred from another facility. The outpatient clinic will be done in collaboration with Burn Centers of Florida Inc., to treat burn patients not requiring hospitalization and those previously hospitalized. Friedrich is enthusiastic about “the

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talent” hired for the burn center. Fred Mullins, MD, a nationally recognized leader in burn research and treatment, and president and medical director of the internationally known Joseph M. Still Burn Centers Inc. in Augusta, Ga., will lead a multidisciplinary team of highly trained specialists with extensive burn experience. Mullins, who will travel from the Georgia practice to Blake Medical Center part-time as the burn program is being built, recruited two burn surgeons – Michael VanVliet, MD, and Laura Velcu, MD – to the Bradenton hospital to treat burn patients from initial evaluation through the entire process of reconstructive surgery. VanVliet was recruited from Memphis Medical Center’s Firefighters Regional Burn Center in Tennessee, where he specialized in acute burn surgery and burn reconstruction. Velcu is a critical care specialist from Augusta, Ga. Also, physicians in the outpatient

create an educational module for each individual initiative. Not only does a rolling schedule of changes often feel more overwhelming, but also the time away from desks learning the new processes would typically be less under a grouping structure than to have 10 separate trainings for 10 separate initiatives. Miller was quick to admit that creating overarching technology structures could be difficult without staff or contracted expertise, which makes it more problematic for small practices. “Whether you see it as a good or bad thing, there’s certainly a lot of consolidation in the market. Small private practices are becoming more and more rare,’ he said. “I think one of the reasons is it’s becoming increasingly difficult for groups like that to manage all these changes.” Miller added larger practices or health systems enjoy the economies of scale that make it easier to incorporate the rapid number of changes taking place. However, he added that in addition to HIT consultants, software vendors typically also offer at least some assistance in helping clients assimilate new processes into their workflow. “Managing technology is only getting more complex,” he concluded. “Organizations need to be intentional and strategic in how they do that … whether that’s implementing analytics platforms, system upgrades, system optimization, Meaningful Use programs, or ICD-10. They need to be looking at ways they can consolidate those initiatives to be more effective with their resources and increase the return on their technology investment.”

PhysicianSpotlight clinic will provide consultation and management of acute and chronic wounds, skin and soft tissue disorders. “We’ve had to add some ICU staff,” said Friedrich. “As it gets busier, we may need to add OR staff. However, for the most part, the burn center will have its own separate staff.” Friedrich said the burn center will continue to develop with the addition of pediatrics. “We’re proud to add this vital service for our community,” he said. “The program will provide the full complement of services to burn victims, with high quality and patient safety being our utmost priority.” Blake Medical Center’s level II trauma center is one of only two trauma centers in Florida to receive the American College of Surgeons’ official verification.

Kay Shawchuck, MD, continued from page 3 garten to 8th grade. “I did it primarily to give us freedom to travel, and to give them a less conventional form of learning,” said Shawchuck. Both already have earned undergraduate degrees in Chinese language. One is going to China, where the family has traveled extensively, to earn his MBA. The other has his sights set on medical school at the University of South Florida. “I’m so proud of them,” she said. Shawchuck still visits her mother and sisters (one is a registered nurse and one is a pediatric clinical psychologist) in Fargo. But even though she remains unfazed by the occasionally chilly waters of Tampa Bay, she has set limits about when she will travel to the icy Great Plains. “Only during the summer months. I’m not going back up there in the winter – ever!”

JUNE 2015

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Helping Men Get Healthy

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American men live sicker and die younger than their female counterparts. However, Men’s Health Network is working to change the status quo by reaching out to men where they work, live, play and pray. “We want to make sure we are every place where men can be reached,” stated Ana N. Fadich, MPH, CHES, vice president of Men’s Health Network (MHN). It’s mission critical, she noted, given some of the sobering statistics about men and their well-being. Men have lower

rates of health insurance coverage, a higher prevalence of death rates for nine of the 10 leading causes of death, fewer physician visits and cultural barriers to seeking help. “A lot of times, men feel they are invincible,” Fadich said. She added phrases like ‘man up,’ or ‘big boys don’t cry,’ or ‘walk it off’ are deeply engrained in the American experience. A lack of awareness and education coupled with persisting cultural behaviors have had a sustained, negative impact on men’s health in the United States. To reverse (CONTINUED ON PAGE 8)

Help on The Hill In April, Rep. Markwayne Mullin (R-Okla.) and Rep. Donald Payne, Jr. (D-N.J.) were announced as co-chairs of the newly re-authorized Congressional Men’s Health Caucus of the American Public Health Association. The Caucus is dedicated to raising awareness of male health issues, encouraging men and boys to take an active role in their personal health, and promoting legislation that has a positive impact on the health of American men, boys and their families. The bipartisan Caucus, which was formed in 2010, works closely with Men’s Health Network to ensure issues affecting men and boys have a place in government healthcare priorities. “After witnessing my father lose his battle to colorectal cancer, it became my mission to raise awareness about the importance of preventive care and to help reduce health disparities across diseases from cancer to diabetes,” said Payne. Co-chair Mullin added, “I consider fitness a necessity to a good life so I’m proud to help lead the Men’s Health Caucus in its mission to promote healthy living across the country. It’s incredibly important that our nation’s youth understand how to exercise and eat right so that they can live healthy, productive lives.” The Caucus has established a Prostate Cancer Task Force, which is charged with increasing awareness of the disease. The group is also conducting outreach to three groups with especially high risk of developing prostate cancer – African-Americans, veterans exposed to Agent Orange, and individuals with a family history of the disease. Additionally, the Caucus, in conjunction with Men’s Health Network, has led briefings on a number of topics impacting men’s health and will continue these efforts to educate Congress and the general public.

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

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value-based payment. “There are elements of the Affordable Care Act that have some pretty significant unknowns attached such as the Cadillac tax,” he continued. The chief unknown, he continued, is “Does the Cadillac plan tax survive and get implemented as it stands today?” That question, he added, probably won’t be answered until after the presidential election. The 40 percent excise tax, which is currently scheduled to go into effect in 2018, is levied on healthcare benefits that exceed certain pre-set limits. Despite the name of the tax, Sheidy said its impact would be felt far beyond affluent circles. In fact, the thought is that a significant number of employers could wind up incurring the tax. “This cuts across po-

litical parties when it comes to the impact of this,” he said, noting teachers, labor unions and public officials often have strong healthcare benefit packages. “You’re talking about having an excise tax that indirectly impacts a significant amount of the population through employer-provided benefits.” He continued, “If this Cadillac tax survives, employers are going to be faced with having to change benefits, maintain benefit levels under a different cost structure, or pay the tax.” Sheidy added that since there doesn’t seem to be much enthusiasm for paying the tax, employers are going to look at how to bend plan design or the cost curve and will be more willing to consider value-based network designs. “The government … through state-

BayCare Medical Group Welcomes

Juan M. Valdivia-Valdivia, MD | Neurological Surgery Dr. Juan Valdivia-Valdivia, board certified in neurological surgery, has joined the practice of Dr. Gabriel Gonzales-Portillo. He completed a surgical internship at the University of Illinois at Chicago, as well as a complex and reconstructive spine surgery fellowship at the University of Michigan in Ann Arbor. Dr. Valdivia-Valdivia’s clinical interests include complex and reconstructive spine surgeries such as adult spinal deformity surgery and adult scoliosis surgery. Education ■ Doctor of Medicine – Universidad Peruana Cayetano Heredia; Lima, Peru Residency ■ University of Arizona; Tucson, Arizona

BC1503320_0515

First the good news … providers are generally excited about the idea of moving to more holistic, integrated care with a focus on prevention, quality and outcomes. Now the not-so-good news … we have to figure out how to pay for it. “Providers are on board for the potential benefits from changes to the way we provide care, which is different from the way we pay for care,” noted Dion P. Sheidy, a partner in KPMG’s Health Care Advisory Practice. “This is a little bit of the Dion Sheidy elephant in the room.” Nashville-based Sheidy said the Centers for Medicare and Medicaid Services have stated their plans to significantly increase value-based payments to providers over the next few years. In a fact sheet released in late January, CMS noted improving quality and affordability of healthcare was as much a pillar of the Affordable Care Act as expanding access. The goal, the memo continued, is to reward value (measured by quality of outcomes) and care coordination and efficiency rather than volume and duplication. To that end, the Department of Health and Human Services has adopted a framework of four categories of payment: • category 1: fee-for-service with no link of payment to quality, • category 2: fee-for-service with a link of payment to quality, • category 3: alternative payment models built on fee-for-service architecture, and • category 4: population-based payment. Value-based purchasing includes payments in categories two through four. The stated goal is to have 30 percent of Medicare payments in alternative payment models (categories three and four) by the end of 2016 and 50 percent by the end of 2018. Additionally, HHS hopes to have 85 percent of Medicare fee-for-service payments in categories two through four by the end of 2016 and 90 percent by 2018. “Although they have put that out there, they have yet to put out guidance about how they expect to achieve it,” noted Sheidy. “These are huge jumps. We’re going to go from less than 10 percent in fiscal year 2015 to 90 percent with some link to quality in fiscal year 2018.” Sheidy added there is some ambiguity as to what CMS calls ‘alternative fee arrangements’ and that at this point there are a lot more questions than answers. While he doubts normal market forces would push payment reform fast enough to hit the HHS targets in the next three years, he said regulatory changes could be the driver to hasten the transition to

ments around the move to the 80 percent (value-based purchasing) along with the continuing lingering effects of the Affordable Care Act … has really set the industry up for the opportunity for some significant impact on payment reform over a fairly short time frame,” he noted. “On the payer side, CMS is looking to change the payment mechanism. On the commercial side, we’re looking at the Cadillac tax and how to get costs under control. And all of those things share the potential to come into play over the next several years. It’s almost like the perfect storm.” It’s not that the industry hasn’t taken any steps to prepare for a move to a different type of payment mechanism. Sheidy said the industry is already involved in demonstration projects, quality reporting and capturing data points. However, he pointed out, the true impact on payment of all that collection and monitoring is still pretty narrow. “People confuse population health with risk and payment,” he said. Now, we’re at the intersection of how to more effectively, efficiently manage the health of a population while simultaneously figuring out how to link payment to these new practice models. While the industry has floated along with a foot in both the fee-for-service and value-based worlds for quite a while, Sheidy said the drivers are now in place, barring any changes, to force the movement to a more outcomes-based payment methodology in a very short window of time.

Other Languages ■ Spanish, Portuguese, French Now accepting new patients. Most major insurance plans are accepted. 10141 Big Bend Road, Suite 103 Riverview, FL 33578

To schedule an appointment: (813) 397-1274

BayCareMedicalGroup.org JUNE 2015

Practical Advice for a HIPAACompliant Organization By GAIL BLOUNT, VISHAL DAVE

History can be useful in guiding our future actions, and it’s generally considered wise to learn from past mistakes. Healthcare providers have an advantage here, because we can learn from the HIPAA violations of others to avoid similar pitfalls and penalties. This article explores the most common violations reported in 2014 and provides insight for preventing them in your own organization. Electronic Records Last year in the healthcare industry, nearly five million records were affected by 75 data breaches, according the Privacy Rights Clearinghouse, which has collected such information since 2005. Thanks to the widespread adoption of electronic health records, 93 percent of those five million records were in electronic form. Healthcare is right on trend with other U.S. industries, including financial, education and retail, who reported that 99 percent of their affected records were electronic. In the same way that customers, depositors, investors and other individuals trust organizations to safeguard their personal information, patients trust their healthcare providers to do the same. In addition to electronic protected health information, or ePHI, the data they trust us with often includes credit card and personal information. Clearly, it is vital to effectively secure and protect ePHI as well as other sensitive information you collect in the course of managing your practice and providing healthcare services. Unintentional Disclosure Of the 75 breaches of healthcare data in 2014, the unintentional disclosure of PHI or other personal information accounted for 23 percent – the lion’s share

of last year’s data breaches. Unintentional disclosure of PHI can occur in a number of ways, as we’ll see, and there are two HIPAA Privacy Rule regulations that bear strongly on such disclosure. One is 45 CFR 164.502(a)(1)(iii), which covers ‘Incidental Uses and Disclosures.’ It allows certain incidental uses (of PHI) that occur as a by-product of another permissible or required use or disclosure (of PHI) as long as the covered entity has applied reasonable safeguards and implemented the ‘Minimum Necessary’ standard. The Minimum Necessary Standard, described in 45 CFR 164.502(b) and 164.514(d), requires covered entities to take reasonable steps to limit the use or disclosure of PHI to the minimum disclosure necessary to accomplish the intended purpose. How Unintended Disclosure Occurs and How to Avoid It Following are examples of unintentional disclosure covered by the HIPAA Security Rule. As you read, consider which of them may be occurring in your organization. • Patient information can be accessed or viewed by staff who, based on their job or title, have no valid reason to view that information (i.e., they do not ‘need to know’). • Computer screens can be viewed from common or public areas, and/ or do not use screensavers, screen protectors or time-outs. • Staff conversations can be overheard by patients or other staff who do not ‘need to know.’ • Patient bills or information have been accidentally mailed to the wrong patient or address, or prescriptions have been mistakenly faxed or emailed to an address other than the pharmacy. • Employees are able to visit unsecured websites, which can install malware on computers to siphon off patient data for sale on the black market.

• Employees are unaware of the danger of clicking links in emails they receive from unknown or non-professional sources, which includes allowing hackers to gain entry to your systems or malware to be installed. • Multiple office staff use the same password to access the computer or EHR system. Have you put reasonable safeguards in place to prevent these types of unintentional disclosure? And have you implemented the Minimum Necessary standard throughout your organization? If not, these findings will be called out in your next annual HIPAA Security Risk Assessment, and it is unlikely that you will pass an audit until they are resolved. Actions you can take to prevent the above vulnerabilities include: • Assign levels of access to systems and PHI based on each employee’s role and resultant need to know • Establish system access based on login credentials unique to each user (this will also enable you to track user access to PHI) • Move computer screens and other visible sources of PHI away from public and common view • Activate screensavers and screen time-outs • Restrict access to external websites. It is also mandatory to train, and regularly remind/retrain, all staff on privacy and security measures they must observe for HIPAA compliance and patient protection. Loss or Theft of Portable Devices Close behind Unintentional Disclosure as the cause of most healthcare data breaches in 2014, the loss or theft of portable computing devices was responsible for 21 percent of breaches reported to the Privacy Rights Clearinghouse. These devices include smartphones, tablets and laptops as well as portable data

storage and transfer devices such as CDs and thumb-drives. They can be inadvertently left behind somewhere or misplaced and never found. Or they can be spotted by someone who can’t resist the temptation to lift an easy target. The PHI or other data that resides on any of these devices is vulnerable if it has not been properly safeguarded, as is the case with any of the following: • Missing password-protection or missing encryption • Security protections that are out-ofdate or have not been turned on • Security measures that are residential-grade rather than designed for commercial or enterprise use • Devices that do not permit data to be wiped remotely in case of loss or theft. • Devices that regularly auto-connect to an unsecured public Wi-Fi hot spot, such as a coffee shop or restaurant, are also vulnerable to opportunistic data thieves. Beyond HIPAA Compliance HIPAA Privacy and Security Rules were enacted, and are vigorously enforced, for a multitude of good reasons. The fact is, however, that your organization needs to secure its ePHI and associated computing and storage devices not only for HIPAA compliance purposes – but also to preserve your patients’ trust, avoid fines and unwanted publicity, and enjoy some much-needed peace of mind. Gail Blount is communications manager for JDL Technologies (www.jdltech.com), and has worked in the information technology industry for eight years, including five in cybersecurity. She created an awardwinning eBook explaining the Florida Information Protection Act of 2014 and its impact on healthcare IT. Contact Gail at gblount@jdltech.com. Vishal Dave, MHSA, is a HIPAA Security Analyst with JDL HealthTech (www.jdlhealthtech.com), a division of JDL Technologies. He joined JDL from an 11year career with Family Physicians Group. As HIPAA Privacy Officer he performed compliance monitoring, audits, security risk assessments and training for the 500-employee organization and their ACO. Email Vishal at vdave@jdltech.com.

Helping Men Get Healthy, continued from page 6 this trend, MHN is employing a number of strategies in an effort to impact health in five key areas: • Reducing premature mortality of men and boys, Ana N. Fadich • Enhancing physical and mental health of men for happier, fuller, healthier lives, • Reducing cycles of violence and addiction, • Energizing government involvement in men’s health issues, and • Encouraging women to expand on their traditional role as the family’s healthcare leader to promote 8

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healthcare services and healthy choices. The Weaker Sex While males might celebrate their physical prowess, the reality is men are statistically the weaker sex. Fadich said men start out at a slight advantage with 105 boys being born for every 100 girls. However, she continued, “Once they hit (age) 34, the numbers for men begin to decline. At retirement age, there are about 80 men to every 100 women.” In general, men’s life expectancy tends to be five years less than that of women – 76.3 vs. 81.1 years, according to the latest data from the National Vital Statistics System. For non-Hispanic black males, life expectancy is

even lower at 71.6 years. Additionally, the gender gap widens during teenage years and early 20s when more men than women are lost to accident, violence and suicide. In fact, suicide across all age groups is more prevalent in men. In 2013, men had a suicide rate of 20.2 vs. a rate of 5.5 for women. That year, death by suicide was 77.9 percent male compared to 22.1 percent female, according to the 2013 CDC Fatal Injury Report. A December 2013 report from the U.S. Department of Justice noted the nation’s homicide rate fell to 4.7 homicides per 100,000 residents in 2011, the lowest level since 1963. Even so, of the 14,610 homicides in 2011, men accounted for

11,370 victims. From 2002 to 2011, the average homicide rate for males was 3.6 times higher than that of females, and young adults ages 18 to 24 had the highest homicide rate of any age group. Changing Trends Fadich said strategies including national awareness and educational campaigns, partnering with providers and organizations nationwide, and conducting screenings at events where men gather all enhance MHN’s efforts to change those trends. From experience, Fadich noted, when a man is asked why he hasn’t gone to the doctor, the answer more often (CONTINUED ON PAGE 9)

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Bending the Cost Curve with Telehealth By CINDy SANDERS

Richard S. Bakalar, MD, who has two decades of experience in telemedicine following a decade of clinical practice, has witnessed an evolution in the field that has moved distance medicine from being deployed almost exclusively to address exceptions to care to being employed to reach a much broader audience. Denver-based Bakalar, a managing director for KPMG, spent 25 years in nuclear medicine and internal medicine practice in the U.S. Navy. “I was asked by the Navy Surgeon General to set up a Navy telemedicine program,” he recalled, adding the goal was to provide continuity of care across 30 ships, 23 clinics and hospitals and four medical centers around the world … including the South Pole. “We had underserved populations on ships without access to specialty care,” he explained. With the telemedicine initiative, he continued, “They got the same kind of care as if they were in a major U.S. medical center.” The Navy’s use of the program mirrored what most telemedicine programs looked like 20 years ago, but Bakalar said the field is expanding beyond its traditional uses. “Today, telemedicine initiatives are around not only access to care but also quality of care and reducing costs,” he said. Telemedicine allows smaller facilities and those in rural areas to maintain the quality typically found in major academic medical centers. With shortages in a number of specialties, Bakalar pointed out, telemedicine offers a unique solution to allow more patients access to specialty care. Cost and reimbursement were initially a concern for payers. However,

The Virtuous Cycle Everyone’s heard of a vicious cycle … why not a virtuous one? As individuals become more conscious of their health, they engage in healthy habits and activities more frequently … the more they engage in activities to get healthier, the more they change their behaviors and become more conscious of their health. Richard Bakalar, MD, said telehealth applications have the ability to expand beyond care provision to increase this type of health promotion. “Where we really want to start impacting people is before they become sick so we can reduce consumption of health resources,” he said. Telehealth – which encompasses all the mobile health application devices plus personal computers – has a range of decision support tools and data to help individuals make more informed choices. “Both tools and information allow people to become more engaged and more proactive in changing behaviors,” Bakalar noted.

Bakalar said time has allayed those fears. “The concern for the payers was this would become something that would be overused and abused and wouldn’t be affordable,” he said. Dr. Richard S. “The evidence hasn’t Bakalar borne that out.” In fact, it has shown the opposite. For example, Bakalar said, a family with a child who becomes sick with an infection could utilize a virtual visit for a cost to the system of about $50, to a clinic for a cost in excess of $100, or to an Emergency Department for a bill typically in the neighborhood of $1000. Now, he continued, “Utilization is being driven by payers who are seeing the savings that can be accrued by these alternative models of care.” The difference in ‘telemedicine’ and ‘telehealth’ Bakalar explained is initiation

by the consumer. Where telemedicine is a provider-to-provider interaction, telehealth is driven by consumers, who go online to see a virtual doctor licensed in their state. “That’s a newer, more modern approach of using technology to give patients the control and the ability to engage with their health providers in a way that’s more timely and convenient,” he noted. Obviously, Bakalar continued, remote care doesn’t work in every instance. “If you have chest pains, you are still going to go to the ER,” he said. Bakalar added virtual visits are a great option, however, for complaints that are relatively minor or chronic in nature that could be addressed without emergency intervention. Despite the promises of the technology, there are still issues to be addressed. “One of the challenges with telehealth or telemedicine is to keep the network of providers connected,” Bakalar said. The technology is there. “The cloud has made mobile health very effective,” he noted.

However, the biggest hurdles are issues with governance, regulation, reimbursement and licensing … which are more programmatic in nature … that need to be resolved before telehealth reaches its full potential. Increasingly, the reimbursement piece is being addressed as states adopt parity laws that mandate reimbursement for telemedicine and telehealth. The technology also plays into the Affordable Care Act’s emphasis on prevention and can help ACOs more easily address health promotion. Additionally, it has the opportunity to engage patients in a way that healthcare hasn’t before. “People are having choices they didn’t have before,” Bakalar said of the bottom line. “As we get into quality-based or value-based purchasing, we believe telehealth will become more prevalent and more widely accepted and more widely desired,” he concluded.

Helping Men Get Healthy, continued from page 8 than not is because he can’t afford the time away from work. The answer, she continued, is to bring the ‘doctor’s office’ to the workplace. Fadich said MHN has been to worksites from John Deere to Harley Davidson. “We bring the information to them,” she said. “Sometimes we do screenings – cholesterol, glucose, blood pressure, body fat and grip assessment.” Fadich added MHN also works with partners nationwide to provide information and brochures for those planning health fairs or lunch and learn series at workplaces throughout the country. The organization and its partners also have a strong presence at sporting events and in churches. “That’s where we ta m pa b ay m e d i c a l n e w s

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do a lot of screenings and events – in the ‘play and pray’ portion of our mission,” Fadich said. She noted they have worked with the National Football League, National Basketball Association, and Major League Baseball in an attempt to reach men and boys. Churches also play a key role in getting the message across. “A lot of the folks we reach are underserved and minority populations, and they are very connected to their churches,” she explained. Fadich added, “We always recommend they speak to their healthcare provider, but we get the conversation started.” Provider Push Fadich said physician visits really

drop off for men after they age out of a pediatrician’s office. After that, she noted, “Women get called all the time for their pap smear or mammogram. Men aren’t getting those kinds of calls.” Knowing that physician encounters aren’t as frequent, the hope is that providers will start deeper conversations with men about family history, diet, prostate and testicular cancer, and other health concerns any time an opportunity presents … whether it’s after a sports injury, work accident or a collegiate STD scare. “We want men to start thinking about health at a younger age and recognize what they are doing now will affect health in their 50s and 60s,” Fadich said.

Men’s Health Month Fadich noted Men’s Health Week – the week leading up to Father’s Day – started in 1994 and was signed into law by President Bill Clinton. “We encourage men to wear blue during that week in recognition of men’s health,” said Fadich, who added the number of events has grown so significantly over the years that one week is no longer sufficient. “Now we use the entire month of June to raise awareness about men’s health.” To request materials and resources or to learn how to partner with MHN, go online to menshealthnetwork.org or call (202) 543-MHN1 (6461).

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GrandRounds Local Pediatrician Offering Free Online Pediatric Symptom Checker Dr. Robert Weiss has joined an elite group of physicians around the country offering free online access to pediatric specific, peer-reviewed health information designed specifically for parents and other caregivers. All parents deserve to have a go-to source for trusted information - in the middle of the night, when physicians’ offices are closed, or whenever they are concerned and want to learn more said Sarasota Pediatrician Dr. Robert Weiss. Configured in a first-of-its-kind pediatric symptom checker, the Is Your Child Sick? function located atwww.weisscare. com provides advice for over 100 symptoms and illnesses common in kids, along with a medicine dosage guide, and an easy-to-use resource for a variety of medical conditions. Unlike general search engines that may have misleading, unverifiable, or inaccurate information, Is Your Child Sick?provides health care advice via nationally recognized pediatric protocols written by Barton Schmitt, MD, Professor of Pediatrics at the University of Colorado School of Medicine, Medical Director of the After-Hours Call Center at The Children’s Hospital of Denver, and author of parent triage and telephone protocol materials utilized in nearly 20,000 physician practices. A peer review process ensures that parents can trust that all articles and acute care information are up-to-date, accurate and reliable. When Nicole Coggin, whose son is a Weiss Pediatric Care patient, learned

about the symptom checker during a recent office, she had no idea how quickly it would be a source of guidance and comfort. That evening her son’s asthma symptoms began to worry her so she went online to review the symptom checker. Is Your Child Sick? describes signs and symptoms of specific illnesses, offers at home care advice, and provides guidelines for when to call the doctor and when to seek emergency care. The information, offered by Weiss Pediatric Care as a community service, is for educational purposes only. It is not intended to be a substitute for professional medical advice.

Three HCA West Florida Hospitals Earn an “A” Patient Safety Score Medical Center of Trinity, Oak Hill Hospital and Regional Medical Center Bayonet Point have been recognized with an “A” safety score by The Leapfrog Group, an independent non-profit run by employers and other large purchasers of health benefits. The score was awarded in the latest update to the Hospital Safety ScoreSM, the ABCD or F scores assigned to U.S. hospitals based on preventable medical errors, injuries, accidents, and infections. The Hospital Safety Score was compiled under the guidance of the nation’s leading experts on patients’ safety. “Earning an ‘A’ on the Hospital Safety Score demonstrates that our hospital continues to strive for excellence,” said Leigh Massengill, CEO, Medical Center of Trinity. “This demonstrates that the three hospitals in our Pasco-Hernando Area value patient safety. This is one

more indication that we are ‘walking the walk’ in fulfilling its mission, vision and values,” she added. Several HCA hospitals received an “A” rating demonstrating that Tampa Bay’s largest health system focuses on making hospitals safe for its patients. To see the hospitals’ scores as they compare nationally, visit the Hospital Safety Score website atwww.HospitalSafetyScore.org, which provides information on how the public can protect themselves and loved ones during the hospital stay. Scores were awarded to for-profit hospitals, not-for-profits and public hospitals throughout the nation. Not all hospitals earned an “A.” The Hospital Safety Score exclusively measures safety – meaning errors, accidents and infections.

Florida Blue and Tampa Bay Integrated Healthcare Network Form Accountable Care Program Florida Blue and Tampa Bay Integrated Healthcare Network (TBIH) have announced the launch of an accountable care program to improve the quality and efficiency of patient care in the Tampa Bay area. An accountable care program allows an insurer to collaborate with a network of providers, sharing in the medical and financial responsibility for a group of patients. The coordination of care helps ensure that patients get the right care at the right time, and focuses on improving the health care experience. The partnership between Florida Blue and TBIH provides care to (CONTINUED ON PAGE 11)

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GrandRounds patients with the goal of improving their health status, and eliminating unnecessary spending by seamlessly sharing information and meeting quality targets. This type of physician-centric arrangement that does not include a hospital as part of the agreement is the first of its kind for a Florida Blue accountable care program. Launching in April, this Tampa-focused program serves as another example of Florida Blue’s innovative approach to transforming the way patients receive their medical care. To date, Florida Blue has established 19 commercial accountable care partnerships with leading health systems and physician groups in Florida - more than any other insurer.

Medical Center of Trinity Plans for Citrus Park Free Standing ER Medical Center of Trinity announces its plans to open the Citrus Park ER, a free standing emergency department of Medical Center of Trinity. Citrus Park ER is a 24 hour, seven day a week emergency room for adults and kids. Planned opening is this month. The Citrus Park ER will offer easy, convenient access to emergency care 24 hours a day with all the resources needed for acute care of a serious illness or injury. The free standing ER will provide even more advanced emergency services than an urgent care center. This full service ER will also accept patients via ambulance and have on site CT scan, ultrasound, x-ray and laboratory services. The Citrus Park ER will be staffed by physicians Board Certified in Emergency Care and nurses with emergency care experience and certifications. The free standing emergency department will be located at 12922 Sheldon Road.

Chairman and CEO of AutoNation Joins Moffitt Cancer Center’s National Board of Advisors Moffitt Cancer Center announces the appointment of Mike Jackson to its national Board of Advisors, a group of prominent individuals from throughout the nation who serve as Moffitt ambassadors and offer their expertise and counsel on issues relating to the cancer center. Jackson is Chairman, CEO and President of AutoNation, the largest automotive retailer in the United States, in June of 2015 AutoNation will sell its ten millionth vehicle. Previously, Jackson served as President and CEO of Mercedes-Benz USA, overseeing the German automaker’s U.S. sales operation and 311 franchised dealerships. In that role, he helped create the vision and direction that led to the luxury vehicle brand’s rejuvenation in the U.S. He also has served as chairman of the Mercedes-Benz National Dealer Council. It was at a Mercedes-Benz deal-

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St. Joseph’s Hospital Heart Institute Physician Presents at Heart Rhythm Society Electrophysiologist Kevin Makati, M.D. with St. Joseph’s Hospital’s Heart Institute recently traveled to Boston, MA to speak about the Convergent procedure at the 2015 Heart Rhythm Society conference. These scientific sessions drew more than 1,200 experts together to focus on the ideas, people and technology that propel their specialty forward. Convergent is a hybrid, minimally invasive cardiac operation that combines the expertise of electrophysiologists (heart rhythm specialists) and cardiovascular surgeons in a single pro-

ership that Jackson began his automotive career, starting as a technician. Jackson has received a wide range of honors for his achievements, including being named one of the top 50 Global Business Leaders by Fortune Magazine in 2011. In addition to a wide variety of industry honors, Jackson is vice chair of the Atlanta Federal Reserve Board of Directors for the U.S. Southeast region.

Blake Medical Center Earned an ‘A’ Grade for Patient Safety in Leapfrog’s Spring 2015 Hospital Safety Score Blake Medical Center has been recognized for its dedication to patient safety by being awarded an A grade in the Spring 2015Hospital Safety Score, which rates how well hospitals protect patients from preventable medical errors, injuries and infections within the hospital. This A grade is one of the most meaningful honors a hospital can achieve, and one of the most valuable indicators for patients looking for a safe place to receive care. The Hospital Safety Score is the gold standard rating for patient safety, compiled under the guidance of the nation’s leading patient safety ex-

cedure to treat -- and hopefully even cure – Atrial Fibrillation. Since becoming the only hospital in Hillsborough County to offer Convergent in 2012, St. Joseph’s Hospital has grown to be one of busiest of 10 Convergent sites in the world. In late 2014, nContact, Inc. selected St. Joseph’s Hospital as the first Convergent training center in Florida. Physicians travel from all over the world to learn the procedure from electrophysiologist Kevin Makati, MD, and cardiothoracic surgeon Andrew Sherman, MD.

perts and administered by The Leapfrog Group, a national, nonprofit hospital safety watchdog. The first and only hospital safety rating to be peer-reviewed in the Journal of Patient Safety, the Score is free to the public and designed to give consumers information they can use to protect themselves and their families when facing a hospital stay.

The American Board of Physician Specialties Announces Development of Physician Board Certification in Administrative Medicine The American Board of Physician Specialties® (ABPS) has announced an innovative board of certification for physician leaders involved in healthcare management and administration, or physicians that have administrative responsibilities in clinical practice. The American Board of Administrative Medicine® (ABAM), a newly formed Member Board of ABPS, is in the final stages of development. It’s anticipated that the board will begin accepting applications in the fourth quarter of 2015. Healthcare reform is creating new opportunities for physician leaders with

business management qualifications, and this type of program is a perfect match for those physicians. Qualified physician leaders wishing to distinguish themselves as experts in administrative medicine should consider becoming board certified. Eligibility requirements to be certified by ABAM are available online. Administrative medicine is when physicians practice in leadership and management roles, not only in their physician office or group, but also within other areas of health care explains Judy L. Smith, MD, MS, CPE, FACS. The board certification process through the ABAM standardizes the skills and abilities that are needed for physicians to be strong leaders and effective managers of large healthcare organizations. This creates an environment that stimulates innovation and forward thinking, while keeping the organization grounded to its roots. Medical News is pleased to provide space for press releases by providers in our Grand Rounds section. Content and accuracy of the releases is the sole responsibility of the issuer.

JUNE 2015

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