Tampa Bay Medical News February 2013

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PHYSICIAN SPOTLIGHT PAGE 5

James ‘Jim’ Norman, MD

Melanoma: Closer to Answers Researchers find blockade of myeloid-derived suppressor cells after induction of lymphopenia improves adoptive T-cell therapy

ON ROUNDS

Moving Up

By LyNNE JETER Dr. Shari Pilon-Thomas in the lab.

More effective immunotherapy for melanoma, a leading cause of cancer mortality, hinges on blocking suppressive factors, say researchers at the H. Lee Moffitt Cancer Center in Tampa.

A study that appeared in the December edition of The Journal of Immunology showed how delayed tumor growth and enhanced survival of mice with melanoma were possible by blocking the reconstitution of myeloid-derived suppressor cells and regulatory T-cells (Tregs),

HORNE’s salary survey trends paint promising outlook for 2013; shows increased pay for pharmacists, technicians and IT specialists, lower pay for managers ... 6

Employers Weigh ACA Coverage Options, Requirements

It’s here.

Somehow between years of political pontificating and awaiting court decisions, implementation of major components of the Affordable Care Act (ACA) seemed to be somewhere off in the distant future. ... 4

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suppressors of anti-tumor activity, after total body irradiation had eliminated them.

Blocking myeloid-derived suppressor cells and regulatory T-cell reconstitution improved adoptive T-cell therapy, an immunotherapy designed to suppress tumor activity, said Shari Pilon-Thomas, PhD, assistant member of Moffitt’s Immunology Program.

“With few nonsurgical options for treating melanoma, immunotherapy, which focuses on the induction of immunity against cancer cells, (CONTINUED ON PAGE 3)

A New Tack Florida Hospital joins with insurer to provide affordable health plan to community residents

By LyNNE JETER

In the wake of health reform and insurance mandates, hospital systems have begun forming their own health insurance plans.

In November, Fountain Valley, Calif.based MemorialCare Health System announced intentions to launch its own Seaside Health Plan, pending a license application from the California Department of Managed Health Care. A month later, leaders of two Georgia health systems – Pied-

mont Healthcare in Atlanta and WellStar Health System in Marietta – revealed they’re collaborating on the creation of a health insurance plan.

Industry trends indicate the new marriage between hospitals and insurers will significantly strengthen this year. A 2011 survey of 100 hospital leaders

by The Advisory Board Co., a Washingtonbased consulting firm, showed that 1 in 5

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Melanoma: Closer to Answers,

A New Tack, continued from page 1

is a promising approach,” she explained.

“However, a major hurdle in developing effective immunotherapies is tumor-induced suppression that can limit the effectiveness of tumor-specific T-cells used in immunotherapy.”

Chemotherapy or radiation can induce lymphopenia, the condition of having an abnormally low level of white blood cells.

“Moffitt is one of few centers in the country that offers patients with metastatic melanoma an immunotherapy called adaptive transfer of T-cells,” PilonThomas explained. “That’s the model we’re working on with mice. Patients that have melanoma have an immune response against their melanoma, so they’re able to generate immune cells to potentially fight off their own melanoma. However, they can’t fight it off because the melanoma itself is suppressive in the immune system.

So basically the disease itself outweighs the ability of the immune system to be active.”

In melanoma patients, the team finds immune responses against patients’ tumors.

“But the tumors grow too fast and overtake the immune system until it’s inefficient,” she pointed out. “We can find immune cells that are reactive to the tumor, so those T-cells can’t do anything.”

The team’s strategy: a patient’s tumor is surgically resected and their immune cells are grown in a laboratory to billions of cells. (In the mouse model, the team grows immune cells specific to melanoma.)

“The idea is, because the patient’s internal immune system is inefficient at rejecting the tumor, we’re going to give them back their own cells to kill the tumor,” she said. “To put the cells back into the body, you have to make space for them. So we give them chemotherapy or radiation to wipe out their current immune system. It becomes a very dangerous state when the white blood cell count

anticipate marketing an insurance plan.

Florida Hospital has joined the grass roots movement. Next January, its Volusia/Flagler hospitals will begin providing health insurance through Health First Health Plans to residents in Volusia and Flagler counties.

“We believe the healthcare system should be managed locally by providers,” said Daryl Tol, CEO of the Volusia/Flagler division of Florida Hospital, also noting “we have to be able to Daryl Tol provide a cradle-to-grave option for our community that allows them to have access to wellness and prevention.”

Five Florida Hospitals in Volusia and Flagler counties – Daytona Beach, Ormond Beach, Orange City, DeLand and Palm Coast – are collaborating with Rockledge-based Health First Health Plans to develop the infrastructure for the plan. In addition, Florida Hospital’s providers in Orlando will be available in-network for more specialized care, emphasized Tol. “Health First Health Plans is extremely excited to be working with a premier leader in health,” said Margaret Haney, president of Health First Health Plans, an insurance provider established in 1996 with a 4.5 Star Medicare Advantage Rating and more than 60,000 members. “We’re always working to inspire the health of our community by providing a high quality customer experience and we believe Florida Hospital shares in our vision.”

Much work is left to be done to launch the new health insurance option in 11 months, said Tol, such as filing of legal and government documents, finalizing a physician network, and building the plan infrastructure.

“This process isn’t easy,” he said.

“The ACA is a complex and demanding law. Numerous ‘hurdles’ are required of health insurers and healthcare providers.

The exact requirements vary by type of insurance offering. It’s not possible to specify them all here, but we’re working diligently

continued from page 1

becomes very low. But we give back new immune cells specific to the tumor. It’s a way of rescuing them.”

In a small clinical trial, a combination of chemotherapy and immunotherapy appears to be a labor-intensive but feasible treatment for persons with metastatic melanoma.

The 19 clinical trial participants with metastatic melanoma underwent nonmyeloablative chemotherapy, along with immunotherapy consisting of ACT TIL. In this process, tumor tissues were surgically removed from each patient, minced, and grown in culture to expand the number of antitumor T lymphocytes. The cells were then reinfused into the patient, accompanied by interleukin-2, which boosts the immune system in cancer therapy.

Over a median follow-up time of 10 months, the overall response rate among the 13 persons who finished treatment was 26 percent of the original 19, and 38 percent when considering only those 13 patients. Specifically, two patients had complete responses; three patients had partial responses.

Four other patients had stablized their disease for a period ranging from more than two months to more than two years.

Three members of this group had disease control without additional therapy, including one at more than 24 months, by the time researchers reported the results in The Journal of Immunotherapy.

“Although our clinical study successfully met its goal of demonstrating that ACT TIL therapy could be offered to advanced melanoma patients, strategies to improve on its feasibility and efficacy are underway,” explained Pilon-Thomas.

“Combination therapies that enhance the proliferation and function of TIL are being explored.”

Moffitt Researcher 4-1-1 A native of Michigan, study investigator Shari Pilon-Thomas, PhD, completed her higher education close to home – undergraduate studies at the University of Michigan, where she returned for post-doctoral work, and doctoral studies at Wayne State University in Detroit.

When the laboratory at the University of Michigan was relocated to Moffitt Cancer Center, Pilon-Thomas moved to Tampa to complete her post-doctoral work. Her family welcomed the warmer climate change, and the mother of two daughters, ages 4 and 13, stayed. She’s served as an assistant professor in the Department of Oncologic Sciences at the University Of South Florida’s Morsani College of Medicine for nearly three years.

“My research interest lies in using the immune system to attack and kill cancers, and melanoma is one disease that has a very strong immune component to it,” she said. “That interest led me to try my strategies in mice that have melanoma.”

As a translational scientist, Pilon-Thomas identifies issues in clinical trials and returns to the laboratory and the mouse model to address and improve those strategies via research. Specifically, the team investigates experimentally the mechanisms of immune regulation induced after lymphopenia; examines the efficacy of DCbased vaccination in the setting of lymphopenia by transfer of T-cells enriched in CD8+ memory T-cells; and determines the efficacy of dendritic cell vaccination and CpG adjuvant therapy in combination with irradiation and adoptive T-cell transfer in a murine melanoma model.

“We’re starting with melanoma,” she said, “and we’re hoping the knowledge we gain from our melanoma patients may potentially be adapted to other types of cancers, such as neuroblastoma, a pediatric cancer.”

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to meet all standards and deadlines.”

The move will help Florida Hospital offset an estimated reduction of roughly $30 million in government revenue for its hospitals in Volusia and Flagler.

Altamonte Springs-based Adventist Health System (AHS), parent company of Florida Hospital, introduced commercial group health insurance through Concert Health Plan (CHP) in 2010 in response to the changing healthcare market. CHP president Peter Weiss, MD, led the initiative to expand insurance presence in cooperation with Florida Hospital Volusia/ Flagler and community physicians.

“Healthcare is local, yet providers and patients often face mandates from insurance companies who aren’t local,” said Tol, adding the expansion should further engage the local physician community. “This initiative will help us keep healthcare decisions in our community.

I’m happy to be working with Dr. Weiss on this exciting opportunity. ” Weiss said the Affordable Care Act (ACA) continues to add pressure for healthcare providers to deliver better value.

“Through payment changes, the ACA is creating incentives for provider systems to manage the entire process of care,” he said. “This is easier when the provider system is also the insurer and can align the incentives of all parties around the health of the member. Our goal is better care and better health for our members.”

Hospital and insurance company leaders are discussing the exact insurance products and their timing to the market, said Tol. “Our intention is to provide those products which will most directly meet the health and healthcare needs of our Central Florida community,” he said.

Through the Florida Memorial Health Network (FMHN), an association of nearly 600 providers established in 1974, Florida Hospital already has a strong local provider presence.

“We’re just beginning the process of working with FMHN and other community physicians to explain our initiative,” said Tol.

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Employers Weigh ACA Coverage Options, Requirements

By CINDY SANDERS

It’s here.

Somehow between years of political pontificating and awaiting court decisions, implementation of major components of the Affordable Care Act (ACA) seemed to be somewhere off in the distant future. But that distant future has drawn near … 2014 is just around the corner, and ACA stands as the law of the land.

Last month, the American Health Lawyers Association hosted “Inquiring Minds Want to Know — How to Plan Now for Healthcare Reform in 2014,” a webinar focused on employers’ options and requirements for their health benefits plan. A trio of health law experts — including Carolyn E. Smith, counsel in the Washington, D.C. office of Alston & Bird, LLP— focused on employer pay-or-play penalties, the advent of Carolyn Exchanges and premium Smith subsidies, and reform requirements for employer plans effective next year.

As Smith noted, “A year is not much … and the way the timeline is set up, it’s really October for the start of the Exchanges and the enrollment process so it’s really less than a year.” Of course, she noted, most employers have tried to look ahead and make plans. “It’s game-changing rules,” she said of ACA. “It definitely changes the things employers need to consider in making their decision as to the health benefits they provide employees.”

Prior to joining Alston & Bird, Smith was associate deputy chief of staff of the Congressional Joint Committee on Taxation and served as counsel to the members

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of the staff of the House Ways and Means and Senate Finance Committees for more than two decades. She now focuses her practice on regulatory, compliance and legislative issues related to healthcare, pensions, executive compensation and tax.

Heading into 2014, she said the key issues facing employers are how to structure their benefit plans, who they will cover and what contribution the employer will make toward the cost of that coverage. “Those questions have always been there,” she pointed out. However, Smith continued, “What healthcare reform does is two main things that change the decision-making metrics for employers – 1) the existence of the Exchange and federal subsidies and 2) employer pay-or-play penalties.”

Prior to ACA, the individual health market had not been very well developed so there were limited options for coverage outside of employer-sponsored benefits.

Now that the option will exist for employees to be able to purchase coverage, will employers opt out?

Smith said there were originally a lot of predictions that everyone would simply drop coverage and pay penalties. While there is clearly a financial tipping point that employers have to consider, more goes into the decision. Some companies see offering coverage as a competitive advantage to attract high-value employees, many already offer coverage that meets federal requirements and will continue with little change, and coverage decisions may vary for different groups of employees.

“There are pros and cons to any of this, but these are the kinds of things employers are thinking about,” Smith said.

She added that the punitive side of the equation became a little clearer when the proposed rule for employer penalties was released on Dec. 28, 2012 and published in the Federal Register on Jan. 2, 2013 (www.gpo.gov/fdsys/pkg/FR-2013-0102/pdf/2012-31269.pdf). Additional information on the penalties is also found on the IRS’ ACA site under the heading “Employer Shared Responsibility Payment” (www.irs.gov/uac/Affordable-Care-ActTax-Provisions).

“Not all questions are answered, but we do have far more comprehensive guidance than we had previously,” she noted.

The first consideration for any employer is whether or not they will face penalties if they don’t offer coverage. Smith said the law exempts employers with fewer than 50 full-time equivalent employees from the penalty structure. She added the statutory definition of FTE has been set as 30 hours per week. However, Smith noted how that plays out in the real world raises a lot of questions, particularly for companies that have heavy seasonal employees.

One pleasant surprise for large employers is how the penalties will be calculated when a company consists of a number of related companies, a controlled

group. In determining whether or not an employer has at least 50 full-time employees, the company is viewed as a whole … a single entity. However, when it comes time to calculate penalties, each controlled group member is viewed separately. The benefit is that a large parent company with a number of subsidiaries would only be assessed penalties on the parts of the business that are not in compliance with ACA as opposed to paying the penalty rate times the total number of employees under the corporate umbrella, Smith explained.

Another concern for companies was that penalties might be imposed across the board if a full-time employee or dependent was inadvertently missed. “The proposed rules have a 5 percent leeway,” said Smith.

“If you offer coverage to 95 percent, then no penalty is imposed.”

So what exactly are the penalties?

Smith said there are actually two penalties, sometimes referred to as the “A” or “no coverage offered” penalty and the “B” or “non-qualified coverage” penalty. The B penalty is when coverage is offered, but it doesn’t meet minimum standards. “These penalties are mutually exclusive. You’ll never be hit with both for the same employee,” she said.

The first is the $2,000 per all full-time employees assessed to companies required to offer coverage that opt not to do so and is triggered even if one full-time employee receives a subsidy on the Exchange. The B penalty, which is generally lower, is calculated as $3,000 times the number of employees who get a subsidy to purchase insurance on the Exchange, and it cannot exceed what a company would have paid had they been assessed the A penalty. “Even if you offer coverage, you can be subject to this B penalty if coverage doesn’t meet the minimum value or isn’t affordable,” said Smith. She added that at a minimum, plans must pay 60 percent of benefits.

One possible corporate strategy might be to offer coverage but at a higher premium to minimize penalty exposure. In this case the company would pay B penalties for those who would qualify for

subsidies. Another consideration in this strategy, of course, would be how many employees fall at or below the 400 percent of the federal poverty level threshold that qualifies for subsidies. If a company has a small percentage in this category, this strategy could be financially appealing.

Interestingly, Smith said one factor that might drive employers away from offering corporate coverage is how efficient the state and federal Exchange program turns out to be. “If it works well, then over time employers may shift to Exchange coverage,” she said.

While many are aware of major tenets of the 2014 reforms — no exclusions based on pre-existing conditions, guaranteed renewability, modified community ratings — one added cost has flown under the radar for many. “One of the things we’ve found that has been a sleeper for employers, particularly those with self-funded plans, is this fee called the ‘reinsurance contribution,’” said Smith. Many employers assumed it was only tied to the Exchange. In fact, it applies to almost every health plan.

For three years beginning in 2014, employers will be assessed approximately $63 per member in the health plan. “The money is collected and paid out to insurers covering the individual market. It redistributes risk … paid for by this reinsurance contribution … to help stabilize the individual market,” Smith said. Although employers have submitted comments to HHS opposing the fee, the expectation is that it will remain a requirement.

With the clock ticking, employers must make some quick decisions about benefit packages. Smith noted very small employers would be exempted from the task since they aren’t subject to ACA penalties for failing to provide coverage, and large employers already have many consultants with whom they regularly work to help guide them through the next few months. “The middle-sized employers are going to be the ones who are going to need a little more help now making these financial decisions and running the numbers.”

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PhysicianSpotlight

James ‘Jim’ Norman, MD Founder, Norman Parathyroid Center

By JEFF WEBB

TAMPA - Lightning struck Jim Norman the day before Thanksgiving 1990.

He was in his chief surgical resident year at the University of South Florida College of Medicine. Having already “fallen in love with endocrine surgery,” he recalled, that night he was assisting in a parathyroid operation and had plans to drive to Winter Park to spend the holiday with his family. But his trip was delayed.

“We wound up being in the operating room for six hours. I said to myself ‘This is ridiculous.’ I knew then I was going to change parathyroid surgery because operating for six hours to remove a tumor the size of an almond was simply stupid,” he said. “I figured there had to be a better way.”

As he discussed it the next day with his father, Norman said, it was his “lightning bolt moment. ... Dad told me ‘Jim, I’ve never seen you so passionate about anything. Maybe this is your calling.’” As it turned out, he was right, and it echoed advice his father had passed on years earlier: Build a better mousetrap and the world will beat a path to your door. “I said ‘There’s my opportunity.’ So, from that day forward, my entire career has been dedicated to parathyroid surgery,” Norman said.

And that career has been wildly fulfilling from both a medical and business perspective. Today, the Norman Parathyroid Center “does far more parathyroid surgeries than anyone else in the world, like 20 times more,” said Norman. “We average more than 50 operations a week and people come from all over the world” to avail themselves of his surgical techniques, which have shortened the procedure from several hours to an average of 18 minutes, he said.

“I am regarded as the father of minimally invasive parathyroid surgery and developed most of the techniques used. I have over 250 peer-reviewed publications and seven patents,” Norman said. “For nearly 20 years my practice has been limited to parathyroid surgery only. We don’t even do thyroid surgery — just parathyroid. This comprises about 77 percent of all the parathyroid operations in Florida, and about 10 percent of all parathyroid operations in the U.S. About 55 percent of our patients are from out of the state of Florida, with about 160 per year from other countries. Only about 12 percent of our patients come from the greater Tampa Bay area,” he said. “Our group performs more than 15 times the number of parathyroid operations than any other hospital in the world.

Norman said he has implemented another bit of seminal advice from his father in building his practice: “If you want to be successful, surround yourself with sucmedicalnews

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cessful people.” Norman has done that by recruiting three “great partners who are remarkable surgeons and compassionate MDs.” Doug Politz, Jose Lopez and Rafael Toro. “We have a great working relationship and enjoy working together.”

Most of that work does not happen at the Norman Parathyroid Center in Wesley Chapel. Rather, “we work out of a great facility that Tampa General Hospital has built for us which is state of the art, including our own dedicated operating rooms, nuclear medicine, recovery room and pre-op areas – with an amazing view of the bay,” Norman said.

“Tampa General has been forwardthinking and very supportive of us for a decade. Several aspects of our practice are very attractive to them. It’s partly because we are very good at what we do, but also because we bring patients from all over the world. We’re not competing against local hospitals. We’re taking patients from the Mayo Clinic and from MD Anderson ...

We play our role in helping TGH achieve those accolades of being one of the top hospitals in endocrinology and head and neck surgery,” he said.

“But it’s a two-way street,” said Norman. “They have given us a facility that is better than any other in the world. There is no other hospital anywhere that has a dedicated parathyroid surgery center.

They get a lot of credit for our success,” he said.

Norman said the key to his practice is “We are very boutique. We do one thing and we do it better than anyone else in the world. It’s as simple as that. The expertise of doing ‘just one thing’ has been very good for us from a business standpoint.

The word “just” has great power for us and for patients” dealing with hyperparathyroidism.

But Norman’s vision of patient care is central to his business success. “We are very cognizant of the fact that we are in a service industry and we have to treat people better. We not only have to be better surgeons, we have to be better at all other aspects of our practice,” he said.

For instance, he said, “We don’t have an answering service. Every patient gets all four of our cell and home phone numbers. They can call, text or email us at any time. That has really helped us build a reputation that we’re not just great surgeons, we are going to love ‘em, hug ‘em and respect ‘em.”

A recent patient verified the bedside manner and abilities of Norman and his staff.

William Sloan, a 71-year-old urological surgeon from Los Angeles, had “not been feeling myself for several years,” he said. His daughter, an endocrinologist

who practices in Albuquerque, diagnosed his symptoms of muscular weakness, joint and muscle pain, and narcolepsy as hyperparathyroidism. After extensive research, she brought her dad to see Norman.

Sloan said “I was in the hospital at 10 a.m. and out at noon. ... (The surgery) was exactly as advertised. I don’t remember a thing and I woke up feeling much, much better,” he said. “And it only took eight minutes! .. I feel better than I have in five years.”

“I was blown away,” said his daughter, Anita Sloan-Garcia, MD. “It’s quite remarkable,” she said. “It’s so good to have dad back.”

Norman also is a bit of a technological entrepreneur. “We were big into the Internet way back in 1996,” he said. “Now (CONTINUED ON PAGE 9)

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5

Moving Up

HORNE’s salary survey trends paint promising outlook for 2013; shows increased pay for pharmacists, technicians and IT specialists, lower pay for managers

By LYNNE JETER

Salary changes in clinical and clerical positions, staff turnover rates, and changes in benefits were notable trends in the 2012 HORNE LLP Medical Office Staff Salary Survey.

“Overall compensation levels have grown over the past year, the turnover rate at the general and administrative levels are lower than in prior years, with an overall reduction in turnover levels by 2 percent from 2011 to 2012,” said Sharon Walden, CPC, director of the anSharon nual HORNE Salary Walden Survey. “Additionally, our participation levels were up from last year.”

Even though HORNE’s Salary Survey doesn’t include medical doctors, it reflects intriguing statistics on non-physician providers such as nurse practitioners (NPs) and physician’s assistants (PAs).

For example, an analysis of turnover percentages for nurse practitioners (NPs) was 8.7 percent in 2011; in 2012, it rose to 12.7 percent. For physician assistants

(PAs), the turnover rate was 11.5 percent in 2011, and dropped to 8 percent in 2012.

More specifically, NPs specializing in orthopedics enjoyed the highest annual compensation packages (75th percentile), specifically in physician practices with 11-20 providers ($114,500). The median annual compensation packages for NPs were highest for cardiology specialties ($97,321), followed by orthopedics ($95,667). Regionally, NPs were better compensated in the Midwest ($91,427), compared to the Southeast ($84,351). In the Southeast, NPs found more money in Louisiana ($86,150), followed by Mississippi, Virginia, and Tennessee.

The trend for PA pay was similar to that of NPs with notable differences. For example, PAs specializing in orthopedics commanded the highest annual compensation (75th percentile) in physician practices with 1-5 providers ($110,475). The median annual compensation packages for PAs were highest in orthopedics ($93,835), followed by internal medicine ($87,780), multi-specialty ($87,153) and family practice ($82,000).

Total annual compensation differences between the Midwest and Southeast weren’t as sharp, with PAs in the Midwest garner-

ing a median rate of $87,922, compared to $85,808 in the Southeast. Higher-paying positions were also found in Louisiana for PAs ($90,938), with similar trends for southern states as NPs. NPs and PAs found similar salaries with hospital-only positions, with a median income of $90,000, and $85,369, respectively.

NPs and PAs reported 2012 bonuses based on incentives: personal production (70 percent), overall practice profits (12 percent), and quality (11 percent). Nonmonetary benefits reflected continuing education (85 percent), professional association dues (79 percent), communications equipment (43 percent), additional insurance benefits (27 percent), and retirement contributions (15 percent).

Experienced pharmacists enjoyed increased clout last year. In 2011, pharmacists with more than five years’ experience reported a median hourly income of $42.

In 2012, the rate jumped to $51.06. Coincidentally, pharmacy technicians’ median income dropped from $15.50 in 2011, to $14 in 2012.

Other clinical positions changed slightly, with technicians gaining the most ground salary-wise in the specialties of bone

Just In: Physicians’ Compensation The 2012 Physician Compensation Survey from Physicians Practice magazine has just been released. It can be viewed online at this address: http://www.physicianspractice.com/ physician-compensation-survey/2012physician-compensation-survey-data

density, cardiovascular/EKG, mammography, MRI, nuclear medicine, orthopedic, surgery, ultrasound and x-ray. Audiologists, physical therapy assistants, and registered nurses in supervisory and research roles saw their median income increase.

Certified athletic trainers saw the biggest median income drop in clinical posts, from $26.92 in 2011, to $20.81 in 2012.

A quick look at general and administrative position salary changes includes slightly increased pay for entry- and mid-level accountants, and decreased pay for CPAs. Billing services supervisors saw a median bump from $18.60 to $21 per hour, and (CONTINUED ON PAGE 9)

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Florida’s New ACOs

Who is Kirk Clove?

In the newly released list of ACOs, Kirk Clove is listed as the ACO executive for Accountable Care Coalition of North Central Florida LLC, along with 14 other ACOs across the nation covering Alabama, District of Columbia, Florida, Georgia, Maryland, New Mexico, South Carolina, Texas and Virginia.

Seventeen cover Florida; South Florida ACO steps outside the box

By LYNNE JETER

Of the third wave of new Accountable Care Organizations (ACOs) formally announced by the Centers for Medicare & Medicaid Services (CMS) last month, 17 cover Florida.

An innovative new ACO participating in the 2013 Medicare Shared Savings Program (MSSP) cycle includes 75 doctors and the Walgreens drug store chain in Miami-Dade (South Florida ACO).

CMS also announced that 15 of the new ACOs qualified to participate in the Advance Payment ACO Model, bringing the total of MSSP ACOs to more

than 250; 215 are in the traditional MSSP and 35 participate in the Advance Payment program. Approximately one in five ACOs includes community health centers, rural health centers, and critical access hospitals that service low-income and rural communities.

CMS announced the first wave of 27 ACOs last April, and a second wave of 89 last July. Also, CMS is working with 32 ACOs in its Pioneer ACO model. When asked for feedback on the new program, CMS acting principal deputy administrator Jonathan Blum said it’s too soon to release results from Medicare ACOs launched in 2012.

• Accountable Care Coalition of Central Georgia LLC • Accountable Care Coalition of DeKalb LLC • Accountable Care Coalition of Georgia LLC • Accountable Care Coalition of Greater Athens Georgia II LLC • Accountable Care Coalition of Greater Augusta & Statesboro LLC • Accountable Care Coalition of New Mexico LLC • Accountable Care Coalition of North Central Florida LLC • Accountable Care Coalition of North Texas LLC • Accountable Care Coalition of Southern Georgia LLC • Accountable Care Coalition of Western Georgia LLC • Essential Care Partners II LLC • Maryland Collaborative Care LLC • Northern Maryland Collaborative Care LLC • Southern Maryland Collaborative Care LLC • Virginia Collaborative Care LLC

In the first batch of ACOs that CMS announced last April, Kirk Clove’s colleague, Jim Korry, was attached to nine of 27 ACOs covering Connecticut, Georgia, Mississippi, New York, North Carolina, South Carolina, Texas, Wisconsin.

• Accountable Care Coalition of Caldwell County LLC • Accountable Care Coalition of Coastal Georgia LLC • Accountable Care Coalition of Eastern North Carolina LLC

(CONTINUED ON PAGE 8)

• Accountable Care Coalition of Greater Athens Georgia LLC • Accountable Care Coalition of Mount Kisco LLC • Accountable Care Coalition of Southeast Wisconsin LLC • Accountable Care Coalition of Texas Inc. • Accountable Care Coalition of the Mississippi Gulf Coast LLC • Accountable Care Coalition of the North Country LLC

How have 24 ACOs, ranging from close-knit medical groups to loose-knit rural collaborations, been accepted to the Medicare Shared Savings Program (MSSP) affiliated with Collaborative Health Systems (CHS), a Houston, Texas subsidiary of Rye Brook, NY-based Universal American?

“Unlike other payers, we have a long history of working with providers,” explained Clove, president of CHS, a pioneer participant in the Medicare Part D Program.

Logistics was the greatest challenge forming ACOs, said Tony Wolk, senior vice president and general counsel for CHS, which has offered subsidies for doctors to get started with electronic health records (EHRs) on the NextGen platform.

CHS is fronting the stimulus money to doctors, who then reimburse CHS when they achieve meaningful use mandates.

“A lot of people sat on the sidelines because of the ambiguity in the process,” Wolk told Healthcare IT News. “But we began to act immediately. We felt comfortable enough, having been through the experience before. You can’t sit and wait for it to be perfect.”

CHS doesn’t appear to have affiliations with the new ACOs announced last July, according to CMS data.

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Florida’s New ACOs, continued from page 7 The next application cycle for the MSSP will begin next January, with applications due this summer.

New Florida Medicare Shared Savings Program ACOs, effective Jan. 1, 2013, with ACO executives listed: Accountable Care Coalition of North Central Florida LLC Kirk Clove • (713) 770-1148 kclove@UniversalAmerican.com American Health Alliance LLC Jayanti Panchal, MD • (352) 854-7444 Drjaypanchal1@gmail.com BAROMA Health Partners Scott J. Backer • (888) 315-4490, ext. 222 sbacker@baromahc.com Central Florida Physicians Trust Kimberly Schneider, ACO executive (407) 960-5583 kschneider@cflphysiciantrust.org Collaborative Care of Florida LLC Jennifer Endicott • (321) 841-3727 Jennnifer.endicott@orlandohealth.com

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Diagnostic Clinic Walgreens Well Network Jeff Kang, MD, MPH • (847) 315-3585 Jeff.kang@walgreens.com Integral Healthcare LLC Pariksith Singh, MD • (352) 799-0049 psingh@accesshealthcarellc.net MCM Accountable Care Organization LLC Raul Puente • (561) 502-3139 rpuente@mcmaco.org Nature Coast ACO LLC Bhadresh Patel • (352) 634-2027 bpatel992000@yahoo.com Northeast Florida Accountable Care Howard Buff • (763) 458-9348 howard.g.buff@gmail.com Paradigm ACO LLC Dinesh Khanna • (352) 516-3972 sk@pmacare.com Physicians Collaborative Trust ACO LLC Larry Jones • (407) 475-3213, ext. 204 ljones@pct-aco.com Primary Care Alliance LLC Sandi Zeljko • (215) 796-5021 ceo@primarycareaco.com ProCare Med LLC Ray Fusco • (941) 812-0894 rfusco@procaremedfl.com South Florida ACO LLC Kelly A. Conroy • (561) 385-7566 kconroy@pbaco.org Primary Partners Sheila H. Fuse • (352) 394-5219 Sheila.fuse@primarypartners.org ProCare Med LLC Ray Fusco • (941) 812-0894 rfusco@procaremedfl.com medicalnews

.com

Revved up

Moving Up, continued from page 6

Surgeon makes rounds on race tracks, too

By JEFF WEBB

TAMPA - For the past four years Jim Norman, MD, has been racing Porsche and Audi race cars in NASCAR’s GrandAm series and American Le Mans series.

This includes races such as the 24 Hours of Daytona, the 12 Hours of Sebring, and The Montreal Grand Prix among others.

He races about 14 times a year.

“I race on a large team (I do not own the cars I race), and I have raced (and won) at almost every track in North America. Last year I drove for Audi, driving one of the most advanced GT race cars in the world, the Audi R8 LMS,” Norman said. “This year I am back with Porsche, a move that I am very happy about.”

Most of the races Norman drives in are televised, usually on the SPEED channel or ESPN2. He has a standing profile on the website www.grand-am.com. “We have the team and car to win a championship this year, and this is my goal, in addition to winning the big races, like Daytona and Le Mans,” he said.

When he was interviewed for this article, Norman was preparing for the 24 Hours of Daytona. He was optimistic about how the team would finish in its

Porsche Cayman GX. “I am in the car that is the favorite to win its class,” he said.

In team racing, Norman explained, “You have to have at least two drivers per car, per race.” The shorter races are three hours and the longer ones, like Sebring and Daytona, require four drivers. Two of the more successful drivers on his team are David Donahue and Shane Lewis.

Norman said that even when he is racing, he also is keeping up with his surgical practice, Norman Parathyroid Center in Tampa. At the track, he practices driving “for two hours and then I sit on my butt for four hours. So, I use that time to email, make calls, work on my mobile apps” and otherwise carry on business from afar.

His son Josh, a freshman at the University of Florida in Gainesville, is a premed student, and also shares his dad’s need for speed.

“He started racing when he was 16,” Norman said. “We’ve used racing as a carrot for him. If he earned A’s, we rewarded him by putting him in the (race) car. He’s been over 180 mph at Daytona and he’s won amateur races,” Norman said. “It’s incredible what hand-eye coordination these kids develop,” he said.

Congratulations Dr. Norman!!

Just as we were going to press, Jim Norman added to his 2012 Grand Am Rookie of the Year honors by winning the 2013 Rolex 24 Hours of Daytona as a member of the driving team for Napleton Racing. It was the inaugural victory of the GRANDAM Rolex Sports Car Series’ new GX class. Norman joined the team of Shane Lewis, David Donohue and Nelson Canache in leading nearly the entire 24 hours aboard the team’s debuting No. 16 Napleton Racing Porsche Cayman S.

systems analysts’ pay increased from $24.46 to $29.81, while HIPAA officers’ median hourly pay dropped from $31 to $21.41, operations managers’ pay dropped from $35 to $24.23, and practice managers’ pay dropped from $28.50 to $25.99.

Upper management bonuses were based on overall practice profits (30 percent), personal production incentives (28 percent), and quality incentives (16 percent). Non-monetary benefits included professional association dues (82 percent), continuing education (54 percent), communications equipment (52 percent), and additional insurance benefits (28 percent) and retirement contributions (14 percent).

“As healthcare changes, so does the HORNE Salary Survey,” said Walden.

“Changes to this year’s survey from last year’s include the addition of a new management position, 10 new clinical positions, addition of a new report on top EMR vendors used by participants, and the addition of a new part time employee analysis report, which contains information on benefits.”

Electronic Medical Records (EMR) statistics showed that physician practices and hospital systems are lagging on the transition from paper to electronic records, more so than anticipated.

A recap of findings reflects: • 71 percent use an EMR package.

• 60 percent acquired a new practice management package with EMR integrated.

medicalnews

.com

He did it as an amateur when he was a teenager in Winter Park, inspired by his father, a former diesel mechanic who eventually owned five automobile dealerships in the Orlando area. Now “I race professionally at the highest level of sports car racing in the U.S. (See sidebar) But long before then, Norman was seeking thrills of a different kind as he roamed the 30-story hospital at Oral Roberts University School of Medicine in Tulsa, racing after a fellow medical school student. “She was the prettiest girl in the hospital and I chased her until I caught her,” he said. The couple has been married 27 years and he and Gail, who retired after 18 years as a family physician in Tampa and is now an internationally competitive triathlete, raised two children. Ali is a senior at Savannah College of Art and Design, and Josh is a freshman at the University of Florida.

“I have a fantastic family and a very understanding wife,” he said.

For more information on the 2012 HORNE LLP Medical Office Staff Salary Survey, visit www.horne-llp.com.

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PhysicianSpotlight, John Ferlita, MD, continued from page 5 I am developing mobile apps (for which he said he has two patents) that deal with calcium and osteoporosis and bone density.” This venture is not only going to cement “our place as the 800-pound gorilla, it’s going to help us take better care of our patients as we are able to see their information and statistically analyze it in huge databases,” he said.

That software feeds into his vision for expansion. “Our apps will be in multiple languages, so we will know where there are opportunities to open up other parathyroid centers. The bigger picture is to open up more centers around the world in places like Hong Kong, Rio de Janeiro and Dubai,” he said.

Norman’s penchant for risk-taking has extended far beyond his expertise as a ground-breaking surgeon.

He raced airplanes, but after a close friend died in a crash a day after Norman had flown with him, he deemed it too dangerous. Looking for a new hobby, he returned to an old one: racing sports cars.

• Nearly half (48.8 percent) invested more than $12,000 per provider for the EMR package.

• 85 percent of respondents budget up to $20,000 annually for EMR maintenance cost per provider.

• 70 percent use EMR via handheld or tablet input devices.

• 97 percent who have EMR also have the capability to e-prescribe.

• 94 percent of those with EMR actively use the e-prescribing program.

• Of 158 respondents with EMR, the leading vendors were Allscripts (12.7 percent), Greenway Medical (10.1 percent), and NextGen (10.1 percent).

• 64 percent outsources IT functions.

• 81 percent of medical staff has Internet access.

• 54 percent participate in the Physician Quality Reporting System (PQRS).

“We’re looking into new types of reports for the upcoming year, which include producing surveys at state levels if the minimum participation threshold is met; including additional information based on practice ownership (physician or hospital),” said Walden. “We sincerely appreciate participation in our survey this year, and welcome feedback and suggestions for changes to future reports.”

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GrandRounds FOCUS ON CANCER RESEARCH, TREATMENT UPDATES, SCREENING AND DIAGNOSIS MOFFITT CANCER CENTER WILL PRESENT SEVERAL CONFERENCES IN 2013 FOR A VARIETY OF HEALTHCARE PROFESSIONALS.

FEBRUARY 28 – MARCH 1, 2013

13th Annual Current Perspectives in Oncology Nursing Conference Moffitt Cancer Center, Tampa The goal of this annual nursing conference is to provide information pertinent to the practice of oncology nurses at all stages of their careers. Topics are chosen to educate the novice, update the proficient and challenge the expert oncology nurse. Call for abstract is available and nursing continuing education contact hours are offered. Special Event included: 9th Annual Rhinehart Reception and Lecture on February 27, 2013.

For more information visit the conference website at: www.MOFFITT.org/Nursing2013 or contact Chrystyna Pospolyta at 813-745-4918.

ACPE Survey Finds Most Physician Leaders Skeptical of Online Ratings Google a physician’s name and you’re likely to come up with a dozen consumer websites that claim to rate doctors. But a new survey found that physician leaders view online physician ratings as inaccurate, unreliable and not widely used among patients.

The survey found that physicians much prefer internal organizational ratings based on actual performance, as opposed to the consumer websites that many physicians consider to be nothing more than “popularity contests.”

The survey, conducted by the American College of Physician Executives (ACPE) was sent to 5,624 ACPE members and 730 responded.

Results showed most physician leaders are frustrated with consumer online ratings. They complained the sites contain sampling bias and invalid measurements of competency.

Only 12 percent of respondents believe patient online reviews are helpful.

A far greater number (29 percent) said they are not used very much by patients and don’t affect their organization; 26 percent called them a nuisance.

Most of the survey respondents (69 percent) admitted they checked their profile on an online consumer website, but 55 percent believed few of their patients have used an online physician rating site.

Of the physicians who checked their online profiles, 39 percent said they agreed with their ratings and 42 percent said they partially agreed. Nineteen percent didn’t agree.

The survey also revealed skepticism about ratings conducted by health care organizations such as the National Committee for Quality Assurance (NCQA), The Joint Commission and Press Ganey, too, although they are viewed more favorably than online consumer sites. Most (41 percent) described their feelings about them as neutral. Another 29 percent said the systems were helpful, while 14 percent said they were a waste of time.

For complete survey results and re-

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FEBRUARY 2013

MARCH 9, 2013

State-of-The-Art NeuroOncology Conference Sheraton Sand Key, Clearwater Beach This conference will present the most recent diagnostic and treatment information and advances in neuro-oncology and neurosurgery. A variety of topics on neurological abnormalities will be presented.

Moffitt is the only brain cancer center in Florida and one of only 15 in the U.S. recognized by the National Cancer Institute as a founding and active member of the Adult Brain Tumor Consortium, which aims to develop more effective therapies for these tumors.

For more information visit the conference website at: www.MOFFITT.org/NeuroOncology2013 or contact Melissa Pearson at 813-745-1247.

lated articles, go to acpe.org/measures.

Joanna Conley Named CEO for Poinciana Medical Center Joanna J. Conley, FACHE, has been promoted to Chief Executive Officer of Poinciana Medical Center, according to Peter A. Marmerstein, FACHE, President of HCA West Florida, effective January 1, 2013. She has served as the hospital’s Chief Operating Officer since 2012, responsible for coordinating the construction of the new hospital and medical office building, recruiting the inaugural medical staff, and working with the Poinciana community and businesses to enhance the availability of medical services.

The $65 million Poinciana Medical Center will open in the summer of 2013 with 30 beds including a 6-bed intensive care unit. The two-story, approximately 110,000 square foot hospital was initially approved in 2007 and has been designed for future expansion to meet the needs of this growing community. Once fully operational, the hospital will employ 200 full time staff members and attract new physicians to the community.

The hospital will offer a broad range of services including 24-hour emergency care, cardiac catheterization, and inpatient and outpatient surgery.

Conley initially joined Osceola Regional Medical Center, a sister HCA facility in Kissimmee, in 2009 as the Associate Chief Operating Officer and Ethics and Compliance Officer. She has more than nine years of healthcare leadership experience including hospital strategic planning at Mission Hospitals in Asheville, North Carolina.

Board certified in healthcare management, Conley is a Fellow of the American College of Healthcare Executives (FACHE) and was awarded the North Carolina ACHE Early Careerist of the Year Award in 2007. She received a Master of Business Administration from the Owen Graduate School of Management at Vanderbilt University, a Bachelor of Science degree with Distinction in Public Health, Health Policy and Admin-

istration with Honors and a Bachelor of Arts degree with Distinction in Psychology from the University of North Carolina at Chapel Hill.

Her community involvement includes serving on the Poinciana Area Council, Rotary Club of Kissimmee South/Poinciana, Junior League of Greater Orlando, and Poinciana YMCA. She was recognized as an Osceola Woman Magazine 40 under 40 Honoree and is a graduate of Leadership Osceola County.

TGH Names New CEO James R. Burkhart has become the president and CEO of Tampa General Hospital. He will start March 4 and replace the retiring CEO Jim Burkhart Ron Hytoff.

Burkhart, 58, has been president and CEO of Shands Jacksonville Medical Center, a private, not-for-profit teaching hospital affiliated with the University of Florida Health Science Center–Jacksonville. Burkhart has held the position since 2010.

David A. Straz Jr., chairman of the Florida Health Sciences Center Inc, the governing board for Tampa General Hospital, said Burkhart was the choice of the board’s search committee, consisting of members of the hospital board, and representatives of the TGH medical staff, and the USF Health Morsani College of Medicine.

Burkhart is familiar with Tampa General since both hospitals are members of the Safety Net Alliance of Florida. Safety net hospitals like TGH and Shands Jacksonville provide a significant level of care to low-income, uninsured, and vulnerable patients compared to other hospitals.

Burkhart holds a Doctorate of Science, Administration–Health Services, and a Master of Hospital and Healthcare Administration from the University of Alabama at Birmingham. Burkhart is a fellow of the American College of Healthcare Executives.

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