Tampa Bay Medical News November 2015

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PHYSICIAN SPOTLIGHT PAGE 3

Vilma Vega, MD ON ROUNDS

Detecting Pancreatic Cancer Earlier

Researchers Developing Blood Test to Identify and Characterize Precursor Lesions

Largo Medical Center Forges New Palliative Care Partnership For David Weiland, MD, chief medical officer at Largo Medical Center, palliative care has come a long way in general acceptance in the medical community.

In fact, palliative care was not even a term in the early 2000s. Today, it’s a bona fide recognized specialty with widespread acceptance ... 4

Mercy Launches World’s First Virtual Care Center ST. LOUIS, MO — Last month, Mercy unveiled the world’s first Virtual Care Center in the heartland of America ... 8

By DANIEL CASCIATO

Pancreatic cancer is one of the deadliest cancers worldwide - currently the fourth leading cause of cancer-related deaths in the United States. It is predicted to become the second leading cause by 2020. Today, there are no accurate methods to diagnose pancreatic cancer early when a patient may be eligible for surgery to remove the tumor and hopefully survive longer.

In a recent ‘proof of principle’ study published in Aug. 27 issue of Cancer Prevention Research, Moffitt Cancer Center researchers hope to improve pancreatic cancer survival rates by identifying markers in the blood that can pinpoint patients with premalignant pancreatic lesions called intraductal papillary mucinous neoplasms (IPMNs).

“To beat this disease, early detection is key, and our team has dedicated efforts to studying pancreatic cancer in its precancerous state because we believe that the identification and treatment of precancerous pancreatic lesions offers a promising strategy to reduce the number of people losing their lives to this disease,” said Jennifer Permuth, PhD, assistant member in the Departments of Cancer Epidemiology and Gastrointestinal Oncology at Moffitt (CONTINUED ON PAGE 4) Cancer Center.

Florida Telehealth Summit Slated for Orlando Dec. 2-4 Event Will Take Place at The Alfond Inn

By LyNNE JETER

Editor’s Note: “Accelerating Telehealth” is the second of a two-part series about the upcoming Florida TeleHealth Summit. In this edition, Medical News highlights the agenda lineup.

Pushing telehealth to the forefront of Florida politics will top the agenda at the second annual Florida TeleHealth Summit, slated Dec. 2-4 at The Alfond Inn in Winter Park. The Southeastern Telehealth Resource Center, Florida State University (FSU) College of Medicine, and Florida Partnership for Telehealth are sponsoring the statewide event.

(CONTINUED ON PAGE 6)

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PhysicianSpotlight

Balancing Act Sarasota Physician Taps Spirituality for Solace, Success

By JEFF WEBB

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worked with the best of the best,” Vega said.

Her job search led her to Sarasota and a position at Infectious Disease Associates, where she spent the next 20 years and also served 10 years as medical director for the Community AIDS Network.

Soon, Vega said, she will be working fulltime at the Comprehensive Care Clinic in

health choices,” she said.

The career choice was to divest her partnership at Infectious Disease Associates and not work so many hours in clinic.

“It was the best growth decision I’ve ever made. Financially it seemed crazy, but from a quality-of-life standpoint it was like the MasterCard commercial – priceless!” she said.

But Vega’s choice about her health was the opposite of growth; she shed 65 pounds. “It changed my life. Now I am able to help people all around the world by providing medical and spiritual support for the underserved. I also am able to promote a more preventive method of practicing medicine for my patients, as well as myself, which brings me to my new career,” said Vega.

That new career is “Blueprint to a Balanced Life,” a curriculum-based program she conceived to help others make “transforming changes in their lives … and by giving them principles and methods which will help balance their lives,” said Vega, who is presenting it as a final project as she nears completion of her bachelor’s degree in ministry. Balanced Life Blueprint centers, she said, “will address all aspects of wellness, not just physical health. They also will focus on spiritual, mental, social and financial health.”

The centers will be manned by (CONTINUED ON PAGE 9)

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SARASOTA - When Vilma Vega talks about balancing, it is not an act; it’s an avocation. And if things go as planned, that avocation may morph into another full-fledged vocation.

After two-decades of caring for mostly HIV-afflicted patients in private practice, Vega is making her mark as a mentor who is motivating colleagues to free themselves of conventional expectations and pursue a lifestyle that is both professionally and personally holistic. That effort has manifested itself in Vega Consulting, where the 50-year-old has developed two self-help programs: “Transition MD” and “Blueprint to a Balanced Life.”

Both concepts are outgrowths of Vega’s love of medicine, humanitarianism and a desire to meld her experience and faith to inspire others.

Vega’s journey to medicine and mission work began when she was a little girl growing up in Chicago, the oldest of four children born to Peruvian emigrants.

“When I was 5 my mother was diagnosed with a brain tumor. That changed my whole destiny. I watched her go through surgery. … I wasn’t sure whether my mom was going to live or die. When she came home she had a lot of bandages on her head. That very day I told my dad I wanted to be a doctor so that I could take care of my mommy. I wanted to help people like my mom. That was a turning point in my life,” said Vega.

And that was just the first of a trio of childhood epiphanies. “At 7, I was watching TV shows about the Greenpeace and the Peace Corps. I remember saying I wanted to serve in other countries. I remember thinking you had to be a nun to be a missionary, but my father said no (and) guided me toward being a doctor,” she remembered. By the time she was about 13, Vega said she “knew for sure that someday I would be a missionary doctor.”

She excelled at science in high school, which earned her a four-year scholarship to Loyola University, where she completed a bachelor’s degree in biology, with a minor in theology and philosophy. She enrolled at the University of Illinois College of Medicine in Rockford, graduating in 1990. It was there she developed an interest in her specialty. “These doctors were my mentors. They took me under their wings and I realized that infectious disease specialists were the brainiacs of medicine,” she said.

For her internship and residency in internal medicine, Vega went to Jackson Memorial Hospital at the University of Miami, and stayed there for a fellowship in infectious disease. “I got involved full blast in the HIV/AIDS program. I started my HIV clinical research at that time. I

North Port. That move will “allow me to do exactly what I love, which is to practice prevention in an outpatient clinic setting to help HIV patients, which is what I am very well known for,” said Vega. “I’ll be an independent contractor.”

Vega doesn’t just cherish the freedom to command her own schedule, she needs it because she is involved in so many ventures.

In 2005, she co-founded Hearts Afire, a not-for-profit group that has grown from three people to “about 2,000 in our database now,” said Vega. Hearts Afire has taken trips all over the world to provide humanitarian relief – medical, ministerial and other types – to areas that are in need because of natural disasters and poverty.

She remains active as president emeritus and a board member, and regards helping that group to become financially sustainable as one of the biggest challenges of her life.

The second-biggest challenge went “hand-in-hand with Hearts Afire,” Vega said. Her life was “out of synch” seeing patients day-in and day-out and working up to 80 hours a week. “I was leading an unhealthy life at 207 pounds, with a variety of other disease patterns creeping in, including high blood pressure, blood sugar elevation and sleep apnea. I knew I had to completely balance my life, which meant making tough career choices and difficult

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Largo Medical Center Forges New Palliative Care Partnership

By DANIEL CASCIATO

For David Weiland, MD, chief medical officer at Largo Medical Center, palliative care has come a long way in general acceptance in the medical community. In fact, palliative care was not even a term in the early 2000s. Today, it’s a bona fide recognized specialty with widespread Dr. David acceptance.

Weiland “We all need to get better at helping people cope with the aftermath of a serious illness,” Weiland said.

To back up this statement, late this past summer, Largo Medical Center, in partnership with the non-profit hospice provider Empath Health, began providing patients inpatient palliative care services focusing on relieving the pain, symptoms and stress that result from serious illnesses.

Comprised of board-certified physicians, licensed counselors and chaplains, Largo and Empath’s palliative care team coordinates care with doctors while offering emotional and spiritual support to patients and

their family members.

“We have become more family-focused than ever and palliative care’s focus puts the patients and the families in the middle,” said Weiland. “Our goal is to understand our patient’s wishes and work toward the goal of how we can improve the patient’s quality of life while they are coping oftentimes with debilitating symptoms – and to do this in a team-based format.

This service can be well-integrated into our typical care in most acute care hospitals.”

During his six-year tenure as medical director for Suncoast Hospice, now known as Empath Health, Weiland was responsible for creating and working with palliative care teams in the community. After joining HCA Healthcare, which owns and operates Largo Medical Center, he reached out to his former Empath colleagues so HCA could expand palliative care into Largo.

“It was a real opportunity for us to leverage our community partnership between Empath, our sole provider of hospice services, and Largo Medical Center,” explained Weiland. “As healthcare systems continue down the path toward the model of integrated care, palliative care is something that should be integrated into the care

treatment of patients with any chronic, debilitating illness.”

Through these inpatient palliative care services, the palliative care team can: • Treat pain and symptoms such as fatigue, nausea, anxiety and depression • Help patients maintain the most comfortable, independent and active lifestyle possible • Coordinate care and treatment with a patient’s doctors and care team • Provide guidance, emotional and spiritual support to patients and their family members when they are facing difficult medical decisions • Identify support services to help patients From its customer satisfaction assessments, Largo Medical Center has long discovered that what dissatisfies families the most during a hospital visit or stay is when they feel they have not been communicated with effectively. A palliative care physician can act as a bridge in that circumstance to try to meet a patient’s level of understanding and ensure they understand what was explained to them about their situation.

With the assistance of Empath Health, Largo Medical Center educated its physi-

cians on the role of a palliative care physician, added Weiland. “These physicians will be working with families in ICU and will have earnest conversations with families. We’re not talking about end-of-life decisions, but rather, hard choices one needs to make, such as should a loved one have or not have a feeding tube. These are conversations that families need to sit down and have with specialists to help them make informed decisions on difficult choices. This is a role palliative care does well.”

According to Weiland, palliative care is best if it’s introduced early, alongside curative treatment and helps during all stages of serious illness.

“Patients should always feel empowered to ask for other forms of therapy or treatment that may help them in their journey with their illness or disease,” he said.

“Palliative care is just another tool in the toolbox. It doesn’t replace the oncologist, cardiologist, or general practitioner. Palliative care can help manage that debilitating pain that is really affecting a patient’s quality of life. So we’re really focusing on making lives comfortable and more livable, truly, and not just fighting the disease state as much as acute care does.”

Detecting Pancreatic Cancer Earlier, continued from page 1 Similar to how colon polyps can progress into colon cancer, Permuth said they now know certain types of pancreatic cystic lesions can progress into pancreatic cancer. IPMNs account for nearly onehalf of the estimated 150,000 asymptomatic pancreatic cysts detected as ‘incidental findings’ on computed tomography (CT) scans or magnetic resonance imaging (MRI) scans each year during the clinical work-up for an unrelated condition.

Imaging alone cannot reliably distinguish between benign, pre-cancerous, and cancerous cysts, and cannot differentiate low-risk IPMNs (defined as low- or moderate-grade disease) that can be monitored from high-risk IPMNs (defined as high-grade or invasive disease) that should be surgically removed. According to Permuth, the decision to undergo pancreatic surgery is not trivial for the patient and medical team since pancreatic surgery can be associated with an estimated 40 percent chance of complications and a chance of death. Noninvasive tests are needed to accurately detect precancerous lesions of the pancreas so that personalized risk assessment and care can be provided.

“One of our goals is to develop a blood test that can be used to help predict whether an individual has a highrisk IPMN that should be removed,” said Permuth. “Our blood test is based on measuring substances in the blood called microRNAs (miR- Dr. Jennifer Permuth NAs). These are small 4

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molecules that act as ‘master-regulators’ of cancer-related processes in the body.”

Permuth and her team previously conducted a study in which miRNAs were measured in surgical tissue that was removed from patients with IPMNs, and they were able to measure the levels of miRNAs in the tissue and differentiate between high-risk and low-risk tumors.

“We felt that a natural extension of this tissue-based research was to evaluate the levels of miRNAs in blood, as a blood test could serve as a less risky and more costeffective approach to inform medical management at the time of diagnosis,” she said.

One of the main purposes of their ‘proof of principle’ study was to measure miRNAs in the blood and determine whether a set of miRNAs could distinguish patients with IPMNs from healthy individuals. The team then sought to determine whether a set of miRNAs could distinguish patients known to have low-risk IPMNs from those with high-risk IPMNs. “We show that new, relatively inexpensive digital technology could reliably measure miRNAs in blood plasma from individuals newly-diagnosed with pancreatic cancer precursors( IPMNs), and healthy individuals,” she said. “Thirty miRNAs out of 800 tested showed higher levels in IPMN patients compared to healthy individuals, providing a preliminary miRNA signature that may be found only in people with early pancreatic disease, suggesting it could serve as an early diagnostic tool.”

Furthermore, added Permuth, they also provide preliminary data to suggest

that a 5-miRNA signature can partially distinguish high-risk IPMNs that warrant resection from low-risk IPMNs that can be watched. This is important clinically because it would be opportune to personalize care such that high-risk IPMNs that warrant resection are properly identified while individuals with low-risk IPMNs are spared the substantial risks of mortality and morbidity associated with over treatment from unnecessary surgery.

Permuth noted there are several challenges involved when trying to develop a blood test to help in early detection efforts.

To name a few, it is important to have blood and other pertinent information donated from a large number of people affected with the condition of interest as well as people not affected by the condition. It is also critical that numerous steps are taken to make sure that the blood test captures important biological information that can be used to predict disease severity rather than noise. Funding from federal and non-federal agencies and groups is critical to the success of this research.

Looking ahead, Permuth said findings from this proof of principle study support further development of a miRNA-based blood test to detect precancerous lesions in the pancreas. Large-scale studies with rigorous designs are needed to further explore the potential for miRNAs to be utilized clinically as markers for the early detection of pancreatic cancer.

Through recently-obtained funding from the State of Florida and the newly established Florida Academic Cancer Center Alliance, her team at Moffitt Cancer Center plans to further its research on IPMNs by partnering with researchers from the University of Florida Health Cancer Center and the University of Miami/ Sylvester Comprehensive Cancer Center. This new partnership, called the Florida Pancreas Collaborative, represents the first state-wide multi-cancer center collaboration they are aware of that is dedicated to conducting research on IPMNs with the ultimate goal of promoting the prevention and early detection of pancreatic cancer.

“This is promising news and could someday lead to a noninvasive test for early detection of this disease,” Permuth added. “This could translate into earlier diagnoses and lives saved. However, it is important to note that the results presented in this study are preliminary.”

Additional research is needed to determine if such a miRNA-based blood test could help diagnose pancreatic cancer earlier or more effectively than current methods. These results need to be verified in a larger prospective, or forward-looking, study before being available for use in the clinical setting.

“This could take several years and will involve pancreatic cancer researchers working together with patients and families affected by this disease,” she said.

November is Pancreatic Cancer Awareness month.

For more information on this study, visit www.moffitt.org.

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Florida Telehealth Summit Slated for Orlando, continued from page 1 “This summit is the event to attend if you’re interested in being part of the movement to advance telehealth in Florida,” said Rena Brewer, CEO of Global Partnership for Telehealth Inc., and principal investigator (PI) of the Southeastern Telehealth Resource Center (SETRC). “Come to meet, and network with those who are using technology to profoundly impact how healthcare is being delivered in Florida.”

For the keynote luncheon on Dec. 3, Curtis Lowery, MD, director of MaternalFetal Medicine at the University of Arkansas Medical Sciences (UAMS), and medical director of the ANGELS Telehealth Program at UAMS, will share his story about how the university’s telehealth has transformed healthcare delivery to many underserved and previously unreached residents in rural communities nationwide.

Conference registration begins late afternoon Dec. 2, and continues the following morning, as exhibits, sponsors and poster presentations are unveiled. Brewer and SETRC director Lloyd Sirmons will open the summit before introducing Mike Smith, MA, program director for the Center for Strategic Public Health Preparedness and PI for the Center for Universal Research to Eradicate Disease at FSU, to provide an update on Florida Telehealth Policy.

In August, the Florida TeleHealth Workgroup – an all-volunteer, multi-disciplinary group of industry leaders tasked with providing insight and direction concerning the advancement of telehealth in Florida and encouraging collaboration

among existing telehealth networks and programs – developed a priority list of 2016 telehealth policy priorities and guiding principles.

Highlights include: • No legislation is preferred to poorlydrafted legislation that would curtail good telehealth practice or create unnecessary restrictions.

• At minimum, telehealth legislation is worthwhile to provide standard of care and recordkeeping clarity to clinicians and protections to patients.

• While reimbursement remains a top priority for the majority of telehealth providers, even if state lawmakers don’t seek a mandate, having simple foundational legislation in place will facilitate reimbursement discussions with payers.

• Telehealth, the broader use of telecommunication for the provision of healthrelated services, shouldn’t be confused with the practice of medicine; clarifying language is needed.

Ann Burdick, MD, MPH, associate dean of telemedicine and clinical outreach at the University of Miami Miller School of Medicine, will moderate a Telehealth Outcomes Panel on telehealth initiatives in Florida. The discussion – designed to provide perspectives from the patient, provider, rural community and urban health system – will highlight TeleGenetics, provider of specialist services to underserved areas in Florida, and Robert Zori, MD, professor and chief of the University of Florida’s Division of Pediatric Genetics &

Metabolism.

After lunch, the first afternoon session will focus on telehealth payment models in Florida, moderated by Ken Peach, executive director of the Health Council of East Central Florida. In the second one, the Florida Medical Association and Florida TaxWatch will address telehealth’s “State of the State.”

A mid-afternoon session, “Telehealth: Let the Data Speak,” will be moderated by Leslee Gross, MHCA, RN, assistant vice president of operations for Baptist Health South Florida. The discussion will feature William Freeman, MD, a neurologist with the Mayo Clinic, and Michael Pizzi, MD. In the last Day 1 afternoon session, Lauren Faison, telehealth administrator for Tallahassee Memorial Healthcare, will moderate a panel discussion on “Telehealth Best Practices.”

Day 2 will begin will a panel discussion focusing on mobile telehealth technology, moderated by Wayne Hodges, RN, PMD, telemedicine clinical manager of UF Health in Jacksonville.

Paloma Costa, manager of customer service and outreach for the University Service Administration Company (USAC), will moderate a discussion on “Telecom and Broadband Funding via the Rural Health Care Program.” A discussion on telehealth’s legal landscape will be moderated by telehealth consultant Deborah Randall, JD, and featuring Nathaniel Lacktman, JD, of Foley & Lardner LLP in Tampa, and Justin Stone, JD.

To address the financial aspect of telehealth delivery, Sirmons will moderate a panel discussion, “ROI: The Business Case.” The panel will include Jeff Robbins, director of telemedicine at Tift Regional Medical Center in Tifton, Ga.; Joseph Ebberwein, principal of Longitudinal Health; and Donna Jennings, RRT, MBA, of Telemedicine Programming Solutions, as they discuss how telehealth can positively impact the financial and social bottom line of providers and health systems.

Late morning, a 30-minute session on how telehealth is impacting the treatment of tuberculosis in Florida will be presented by the Florida Department of Health in Orange County. The final half-hour session will focus on understanding the direct-to-consumer telehealth model and its implications for patients and healthcare organizations.

“The exciting lineup of speakers includes policy makers, physician telehealth practitioners, payers, implementers of successful programs, legal experts, and many others who have a telehealth story to tell,” said Brewer.

Immediately following the summit: a free hands-on lab for registrants who wish to experience the clinical side of telehealth.

“This lab will allow an opportunity for attendees to interact with telehealth experts who are implementing programs across the region,” Brewer said, “as well as to evaluate and become familiar with a variety of telehealth devices and services.”

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Early Stage Breast Cancer Patients Can Now Choose Single Dose Radiotherapy Clinical Trials Promising for this Highly Efficient Treatment

By OLGA IVANOV

The statistics are alarming. Up to one in three women fail to complete their postlumpectomy standard radiation treatment.

Why? Traditional radiotherapy is time consuming and stressful; requiring daily radiation to the whole breast for a total of three to six weeks. Consequently, thirty-five to forty percent of patients who did not follow through on their treatment experienced a reoccurrence of breast cancer.

Today, a more efficient option is available to women with early stage breast cancer. Intraoperative Radiation Therapy (IORT) is a single dose of radiation that is administered directly into the tumor bed immediately following a lumpectomy.

Who is a Potential Candidate?

To be eligible for IORT at the Comprehensive Breast Health Center at Celebration Health, women must be 45 or older with a new diagnosis of early stage breast cancer (a tumor size less than or equal to 3 cm and no positive lymph nodes).

Is IORT the Better Option?

Promising Clinical Trials: The TARGIT clinical trial showed a similar risk of cancer recurrence within the breast among women treated with IORT compared to standard breast radiotherapy.

A TARGIT summary is included below.

Less Stress and Travel Time: When compared to three to six weeks

Targit-A Trial Summary 3,451 women ages 45 or older diagnosed with early stage breast cancer (Size: < 3.5 cm) were randomly assigned to have either intraoperative radiation therapy or whole-breast external beam radiation therapy: • 1,721 women got intraoperative radiation therapy (15.2 percent of these women had to have additional whole-breast external beam radiation therapy after surgery because their pathology report showed the cancer had more advanced characteristics than originally thought.)

• 1,730 women got whole-breast external beam radiation therapy After 5 years of follow-up, researchers found that both radiation techniques had about the same breast cancer survival rates: • 97.4 percent for intraoperative radiation therapy • 98.1 percent for whole-breast external beam radiation therapy

of traditional radiation therapy, IORT offers patients reduced stress and less travel time.

In addition, all radiation side effects are confined to the tumor bed.

Minimizes Exposure to Health Tissue: With the standard treatment, radiation must first pass through the breast skin before reaching the inside. IORT minimizes exposure to healthy tissue and critical organs (including the skin, ribs and heart) by delivering less radiation and allowing for the skin to be pulled away during the procedure.

The Five-Step IORT Procedure IORT is relatively fast and straightforward. The first step is a biopsy of the lymph nodes to ensure there is no involvement with cancer. Next, the surgeon performs a lumpectomy, leaving a cavity

where the tumor was located. In the third step, the radiation oncologist places the Xoft® ballon applicator into lumpectomy cavity to administer the one-time dose of radiation intraoperatively. Retention sutures secure the Xoft® balloon applicator.

Radiation is delivered to the surrounding tissue for 9-15 minutes. Lastly, the Xoft® balloon applicator is removed and the surgeon closes the incision.

Clinical Results Are Consistently Positive Studies suggest that the new technique offers about the same overall survival rates as whole-breast traditional radiation therapy for women diagnosed with early stage breast cancer. In an article published in the Lancet in February of 2014, researchers calculated that the five-year risk of cancer recurrence was 3.3 percent for the women who had IORT, compared with 1.3 percent for the control group—a margin that was within the trial’s predetermined definition of “noninferiority.” There was no difference in the long term survival between recipients of IORT or standard radiotherapy. The study also revealed that women who had IORT had fewer severe skin problems.

Olga Ivanov, MD, FACS, is a leader in the field of breast health and specialized breast surgery. A board-certified and fellowship-trained breast surgeon, Dr. Ivanov serves as the Medical Director of the Comprehensive Breast Health Center at Celebration Health. She received her medical degree from the Medical College of Ohio, completed her residency in general surgery at Loyola and, in 2005, completed her breast surgery fellowship training at Northwestern Memorial Hospital. Dr. Olga Ivanov is one of a few breast surgeons in the United States to lead the clinical trials into Intraoperative Radiation Therapy (IORT).

Gary Wilson Joins Tampa Bay Medical News Gary Wilson recently joined Tampa Bay Medical News as account executive, and will collaborate with healthcare industry partners in the Tampa Bay market area, including also Sarasota, Manatee and Charlotte counties, to expand coverage of the area’s only monthly B2B publication dedicated to medical professionals.

Wilson may be a fa- Gary Wilson miliar face to local healthcare industry partners. He was part of Medical News from 2006 to 2008, working with the publishing group’s flagship publication, Nashville Medical News, directing special publications in various Medical News markets, and launching Tampa Bay Medical News in 2007.

Wilson’s strong bass voice may also be familiar. An award-winning broadcaster, Wilson debuted his syndicated radio show – the Top 20 Gospel Music Countdown –in 1987. It’s broadcast on nearly 100 affiliates in the United States and Canada,

and On Demand at www.sgusa.com. A non-commercial version is aired weekly on XM Radio, and worldwide on the American Forces Radio Network (AFRN). The AFRN show is dedicated to the memory of his dad, Tech Sergeant Charles G. Wilson, a decorated World War II veteran who died in 2001. A native of Rocky Mount, NC, Wilson was inducted into the Mount Olive Hall of Fame for singing and broadcasting accomplishments.

Wilson also now produces a new syndicated show – Flashbacks – featuring norepeat music from the 1980s and beyond (www.southerngospelusa.com).

“Gary returns to Medical News after some time away pursuing his radio syndication passion,” said Dennis Triola, group publisher for Medical News. “Gary’s awardwinning radio program will continue on weekends. He brings to Medical News a wealth of background in print and broadcast media.”

Wilson may be reached in his Sarasota office via (615) 584-1005 or gwilson@tampabaymedicalnews.com.

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Mercy Launches World’s First Virtual Care Center

By LYNNE JETER

ST. LOUIS, MO — Last month, Mercy unveiled the world’s first Virtual Care Center in the heartland of America.

Bishop Edward Rice of the St. Louis Archdiocese officially blessed the nonprofit Catholic health system’s newest facility Oct. 6 in Chesterfield, Mo., a suburb located 15 miles west of St. Louis.

The new $54 million building on a 38-acre campus houses the nation’s largest single-hub electronic intensive care unit (ICU/Mercy SafeWatch), and also provides a center for telemedicine innovation and a testing ground for new healthcare products and services. More than 300 physicians, nurses, specialists, researchers and support staff at the four-story, 125,000-square-foot center are tapping into technology to deliver care to patients around the clock via audio, video and data connections to locations across Mercy and around the country through partnerships with other health care providers and large employers.

“This is a huge and impactful step forward for telehealth and I appreciate that Mercy leadership had the vision and determination to demonstrate to their community and the world how telehealth is one powerful and effective solution to the issue of diminished access to healthcare that many citizens in America and across the globe are experiencing,” said Rena Brewer, CEO of Global Partner-

ship for Telehealth Inc., and director of the Southeastern Telehealth Resource Center.

Randall Moore, MD, MBA, Mercy Virtual president, spoke with Medical News exclusively about establishing the Virtual Care Center and the positive impact it’s already making on practices, clinics and hospitals across the United States.

How did the idea of Mercy creating a Virtual Care Center originate?

It was an evolutionary process. We launched our first virtual program – Mercy SafeWatch, our electronic ICU– in 2006, and we’ve experienced great success. As the team continued to build programs and saw the importance of virtual care becoming a transformational pathway for our health system, a light bulb went on.

It made sense to create a Virtual Care Center that worked like a hospital to bring

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together teams, resources and infrastructure to care for patients in a much more coordinated manner and to offer a care continuum that extends 24/7/365. We needed a facility for this conduit of care, just as we’d need one for a particular service like cancer care.

How did the concept evolve into the world’s first-of-its-kind telehealth center?

The Virtual Care Center evolves from the culture and charism of Mercy.

The Sisters of Mercy who founded our health system were famously known as ‘the walking sisters.’ That goes back 187 years, when nuns were mostly cloistered and did good deeds from their convent for people in need. The walking sisters, who were quite independent, didn’t want to wait for people to find them. Instead, they searched for people in need and addressed those needs on the spot. They were an anomaly for their time.

When you think about hospitals in general, we wait for people to come to us, and we give them exceptional care.

The idea permeating our culture was to seek those needing medical care by taking virtual care teams from our clinics and hospitals and proactively identifying their healthcare needs, intervening with them earlier and more completely. It translates to a lower cost, high impact option to keep a person from deteriorating.

At the board level and leadership level, (Mercy president and CEO) Lynn Britton and (Mercy CFO) Shannon Sock were the primary drivers of this project, understanding the Virtual Care Center is 100 percent consistent with our organizational mission – and also a model for us to progressively replace our hospital-based care with care when and where people need it. If we do this well, we’ll be able to realign our contracts to be rewarded for keeping people well.

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First, it’s important to know we didn’t go into the Virtual Care Center thinking that a fee-for-service equivalent would make it a sustainable business model.

We weren’t expecting, though we’d have welcomed it, very much direct reimbursement as has panned out. In Missouri, our parity laws have helped.

We’re broadening it to enable us to move our teams and our patient centricity from our facilities, which are somewhat limiting, to virtual care anytime, anywhere. If we did that with something like performance-based, population health contracts, we could intervene earlier and more effectively, and then it would pay for itself.

For example, here’s how it works in today’s environment in the hospital ICU vs. the floor. In the hospital ICU, the hospital is paid a lump sum for a patient with a given condition and it’s a fixed amount of money.

The ICU is more expensive, and the patient usually doesn’t have as good an outcome. One result of our Mercy SafeWatch program shows the actual v. predicted mortality for the last few quarters in our Joplin (Mo.) hospital has been running around 50 to 55 percent. In other words, 45 to 50 percent of the patients who ‘should’ve’ died didn’t. That statistic doesn’t help much with finances, right? It should help us with market differentiation; by having Mercy SafeWatch in place, we can do a better job taking care of people. But here’s another example: Looking at the risk-predicted length of stay, both in the hospital and the ICU, our length of stay is running 20 to 30 percent less than predicted in the ICU, and 30 to 35 percent less than predicted on the whole hospitalization. If we can get a sick person well faster, that’s less time for the patient in the ICU. Looking at it financially, the direct variable ICU costs us about of $900 a day. If it costs us $650 a day to use Mercy SafeWatch, then we’re getting 100 percent return on our investment of virtual care without being paid directly for it.

But the most important aspect is that a third of the ICU patients predicted to die aren’t dying. That’s just the tip of the iceberg, and it implies that patients accessing the Virtual Care Center are doing better.

We expect to deliver more efficient, effective, and higher impact care as we integrate virtual into bedside and clinic care.

What’s Mercy’s longer-term goal for the Virtual Care Center?

One of our key growth areas for our mission is to create the Virtual Care Center as a conduit of care anyone, anywhere can access. We’ve been on a 10-year, several hundred million dollar journey to get where we are. We’ve learned many positive things, and we continue to learn from missteps.

We’re proposing that instead of selling our services, or having an entity trying to replicate the same services without us being able to provide much support, we’d like to build a national consortium of interdependent partners. We’d continue packaging our offerings and building our infrastructure with our partners’ support. They could buy into our entity, we could capitalize it together and replicate what we’ve learned with a fraction of time and money, and also do it in an interdependent way so we could then go to GM, Boeing, CMS, United Healthcare to offer it to people they’re covering throughout the 50 states. ta m pa b ay m e d i c a l n e w s

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GrandRounds

WHO’S TENDING OUR DOCTORS?

World’s First Virtual Care Center Tailored to Improve Physicians’ Quality of Life, Too

By LYNNE JETER

ST. LOUIS, MO — Internist Randall Moore, MD, MBA, recalls countless nights of sleep interrupted by on-call requests.

Moore, now president of Mercy Virtual, is doing his part to make sure more doctors enjoy their private lives when they clock out of their practice, clinic or hospital.

“Instead of getting a 2 a.m. call to come in, they can sleep,” said Moore, who helped open the world’s first-of-its-kind Virtual Care Center last month near St. Louis, Mo. “It’ll enable them to be more productive, have less chance of burnout, and improve their quality of life while we enable better, more responsive care for their patients.”

When Mercy’s electronic intensive care unit (ICU), also known as Mercy SafeWatch, was established in 2006, Mercy had one “full” intensivist group in one site. Now, Mercy has intensivist groups at multiple sites, said Moore.

“One reason why, aside from our overarching mission of care, is to improve the quality of life for our doctors,” explained Moore. “For example, if a doctor goes into a community with no virtual care and he’s the only intensivist, he’s on call all the time. It’s tough and doctors burn out. With the virtual team, the doctor can go home and have a life. We do that increasingly across the board, not just Mercy SafeWatch. Using a nurse-on-call feature, which is housed inside the Virtual Care Center, 70 percent of the calls our doctors were getting a couple of years ago are now handled without them being bothered.”

Moore said Mercy will take another step to making it easier for doctors by bringing more physicians into the Virtual Care Center.

“Hopefully, we’ll approach 100 percent of the calls at night no longer going to our doctors,” he said. “By not taking calls at night, doctors can be more productive.”

Physicians have shared concerns about Virtual Care Center operations and how it will impact their practices, Moore shared.

“The Virtual Care Center isn’t a call center,” he emphasized. “It should be progressively integrated into the doctor’s practice. We’ve designed it specifically the way the doctor would want it done.

You might say it’s somewhat of a mass customization … supporting our doctors and other healthcare professionals via the Virtual Care Center.”

In one-on-one conversations with ta m pa b ay m e d i c a l n e w s

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President of Mercy Virtual, Dr. Randy Moore, addresses a group of visitors. This room, like many areas of the Virtual Care Center, has the latest in audiovisual technology.

doctors, Moore is often asked how the Virtual Care Center “can be better than what I can do?” Bolder ones ask: “Is it a threat to my practice?”

“The Virtual Care Center is another resource for a doctor or hospital to have in the care of their patient when they don’t have the time, resources or infrastructure to do it on their own,” he said. “It’s very complementary to what they do.”

One telehealth success story involves Mercy’s early warning system for sepsis.

To identify patients at risk for sepsis and alert doctors to these risks for early intervention, Mercy’s Early Warning & Identification System (EWIS) monitors multiple patient variables in real-time.

“We look at building programs as ways to partner with doctors to create a seamless integration for the patient,” explained Moore. “We look at how we can improve the value of that entity – practice, clinic or hospital – in the local marketplace so they can show first and foremost, they can deliver better care with documented outcomes for the patients they serve. Secondly, we show how they’ll be financially and operationally rewarded instead of having their revenue adversely affected.

I’ve had doctors say, ‘I don’t know how to sustain my practice if that happens.’

Instead, we’re helping them build a financially sustainable and professionally more rewarding offering in the community.”

Moore recalled a primary care physician sharing his experience after working with the Virtual Care Center. “He told me that after 35 years of the practice of medicine (without telehealth),” said Moore, “it was the most rewarding time of his professional life. That’s what we strive for, to allow doctors to get back to the basics of practicing medicine.”

Moffitt Senior Member, Geriatric Oncology Gets Recognized at Assembly in Basel, Switzerland

Jim Burkhart Elected as Vice Chair/Chairman-Elect to Florida Hospital Association’s Board of Trustees

Dr. Martine Extermann, senior member of Moffitt’s Senior Adult Oncology Program, has been honored with the Geriatric Oncology Lifetime Achievement Award, originally known as the “Preis geriatrische Onkologie für das Lebenswerk 2015,” at this year’s German, Austrian and Swiss Congress of the Societies for Hematology and Oncology. She was recognized at a ceremony in Basel, Switzerland.

Extermann’s main interests are to understand how the health of older patients affects their cancer’s behavior, which can be used to guide treatment choices. Among her many accomplishments, Extermann has established an index to assess an individual’s risk of severe toxicity from chemotherapy: the Chemotherapy Risk Assessment Scale for High-age patients, or CRASH, score.

In July, the Kay Yow Cancer Fund, in partnership with The V Foundation for Cancer Research, awarded a $1.25 million ovarian cancer research grant to Extermann. The grant will support research focused on how to personalize care for aging women with ovarian cancer.

Extermann has received numerous awards for her work in geriatric oncology including the ASCO B.J. Kennedy Award for Scientific Excellence in Geriatric Oncology in 2009 and the Paul Calabresi Award in 2014 presented by the International Society of Geriatric Oncology. She has also served as president of the International Society of Geriatric Oncology, of which she is a founding board member.

Extermann received her M.D. and Ph.D. in Geneva, Switzerland, and later came to the University of South Florida College of Medicine for a fellowship in medical oncology/senior adult oncology. She has been at Moffitt since 1997.

Along with receiving this lifetime achievement award, Extermann also is one of the 35 experts presenting at the congress. She discussed the “Development of Geriatric Oncology in the USA” on Oct. 11.

Jim Burkhart, president and CEO of Tampa General Hospital was named vice chair/chairman-elect of the Florida Hospital Association (FHA).

Burkhart spent two years as an FHA trustee and this past year served as treasurer. FHA officers Jim Burkhart and trustees are nominated by the executive committee, which includes past board chairmen. They were then elected by their peers.

The FHA has 214 member hospitals and health systems across the state. It supports the mission of its members to provide the highest quality of patient care through advocacy, education and informational services.

Burkhart came to TGH in 2013 after serving as president and CEO of UF&Shands Jacksonville Medical Center, now known as UF Health Jacksonville. He holds a Doctorate of Science, Administration-Health Services degree, and a Master’s of Hospital and Healthcare Administration from the University of Alabama Birmingham.

Tampa General Wins Consumer Choice Award for 10 Straight Years For the 10th straight year, Tampa General Hospital was named the Consumer Choice winner by National Research Corporation. The annual award identifies hospitals across the United States that healthcare consumers choose as having the highest quality, best reputation, and best doctors and nurses.

TGH is the only hospital in the Tampa-St. Petersburg-Clearwater market, and one of just 19 in the state, to receive this recognition. The winning hospitals are listed in the Oct. issue of Modern Healthcare.

Winners are determined by consumer perceptions on multiple quality and image ratings collected in the company’s Market Insights survey, the largest online consumer healthcare survey in the country.

Balancing Act, continued from page 3 medical directors, whom Vega is training through another program she created, “Transition MD.” “It is for physicians who want to truly practice preventive medicine and make a transformational movement in healthcare. They will want to practice for the love of their profession, in an environment where they also can practice their faith, their desire to help people in a more proactive or preventive fashion,” she said. She currently has eight enrollees, she said.

If that seems like a lot of plates to keep spinning, Vega is undaunted. She also travels to public speaking engagements on

behalf of several pharmaceutical companies, as well as motivational speaking gigs for an array of educational and ministerial organizations.

And when Vega finds time to relax, it usually means working out at the gym, cooking all her own meals, playing piano, ballroom dancing (she used to compete), or working on the outlines for two books.

Vega acknowledges she still is shoehorning an awful lot into her schedule, but “the difference now is I am creating and doing things I love. Down the road, it’s all going to pan out as it should,” she said. “It can only be done through the power of God.” NOVEMBER 2015

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GrandRounds Moffitt Cancer Center Researchers Seek Bilingual Smokers For New Study Researchers at Moffitt Cancer Center are actively recruiting Hispanic smokers that speak and read both English and Spanish for a study testing cessation education materials.

The Moffitt study will incorporate focus groups of smokers who speak both Spanish and English.

Researchers are currently recruiting for the bilingual focus group and to be considered for the study, participants must be 18-years-old or older, speak English and Spanish, been a smoker for at least and year and smoke at least five cigarettes a week.

Each focus group will take 90 minutes and participants will be compensated for their time.

Physician Board Certification in Administrative Medicine Offered The American Board of Administrative Medicine® (ABAM) is proud to announce that applications are now being accepted for its inaugural administrative medicine examination for physicians who serve in management and leadership capacities of healthcare organizations. The initial exam will be administered in October 2016 at testing centers throughout the United States, Puerto

Rico and Canada.

While many physicians pursue board certification in their medical specialty, the ABAM offers an opportunity for certification in the administrative side of medicine. This allows our Diplomates to further demonstrate their strong business acumen to employers, hospital CEOs, boards of trustees, and other stakeholders.

The ABAM credential is designed to recognize physician leaders who hold a Master’s degree in a related field or have significantly relevant and practical administrative experience. There are multiple pathways to apply for, and earn, the credential.

As the healthcare industry continues to evolve, physician leadership and business expertise is more important than ever before.

In order to be considered for board certification through the ABAM, the physician must: • Hold a master’s degree in business administration, medical management, or healthcare administration, or have at least five years of cumulative experience in an administrative position • Currently hold, or previously have held, board certification through the ABPS, ABMS, AOA, or a RCPSC board • Have a valid and unrestricted license to practice medicine • Complete eligibility requirements

Keep your finger on the pulse of Tampa Bay’s healthcare industry.

SUBSCRIBE TODAY to begin receiving Tampa Bay Medical News in print or on your tablet or smartphone www.TampaBayMedicalNews.com

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and application are available online at http://www.abamus.org.

Moffitt Cancer Center Hosts Award-Winning Cancer Drug Developer and Researcher Moffitt Cancer Center is hosting its 17th-annual Ted Couch Cancer Research Lecture on Wednesday, Nov. 18 at 4 p.m. at the Vincent A. Stabile Research Building, 12902 Magnolia Drive. Charles L. Sawyers, M.D., who serves as the Chair of the Human Oncology and Pathogenesis Program at Memorial Sloan Kettering Cancer Center, will give a free public lecture on his studies of mechanisms of drug resistance in cancer and his work in developing new drugs for cancer treatment.

Sawyers is a co-developer of Gleevec®, a drug that treats certain types of leukemia, and he co-discovered the anti-androgen drug Enzalutamide, which is used to treat prostate cancer.

His research has significantly contributed to understanding the progression of cancer, and his findings in drug resistance and work in developing new targeted anti-cancer drugs has made him a leader in his field.

Sawyers is a member of the National Academy of Sciences, and of the Institute of Medicine. He received the 2013 Breakthrough Prize in Life Sciences, the 2013 Taubman Prize for Excellence in Translational Medical Science and the 2015 BBVA Knowledge Award in Biomedicine. He is a past President of the American Association for Cancer Research and was appointed to the National Cancer Advisory Board by President Barack Obama.

A cocktail reception will follow the presentation. Please RSVP to 1-888-MOFFITT (1-888-663-3488).

Moffitt Cancer Center names Christine Chung as a New Chair Moffitt Cancer Center announced that Dr. Christine Chung has been appointed as the new Chair and as Senior Member in the Department of Head and Neck, and Endocrine Oncology.

Dr. Chung comes to Moffitt from Johns Hopkins University, where she was Director of the Head and Neck Cancer Therapeutics Program in the Department of Oncology and Otolaryngology. Prior to her time at Johns Hopkins, Chung was an assistant professor in the Division of Hematology and Oncology at Vanderbilt University Medical Center from 2003 to 2010.

She also hopes to advance the understanding of the clinical and biological differences between human papillomavirus (HPV) and tobacco-related head and neck cancers, as well as providing personalized care specific to the patient, building on Moffitt’s experience in these areas.

Dr. Chung will facilitate the growth and development on the recently formed Department of Head and Neck, and Endocrine Oncology.

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