interview with surgical oncologist
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FROM THE EDITOR Dear Entrepreneurs Anchor readers, I’m inspired by your voice. First and foremost, I am thankful for your loyalty, your voice and your emails. As you know, Entrepreneurs Anchor has gone through a lot of changes in its design, content and layout within the previous three issues. Over the past year, the magazine’s editorial and management staff has also been in transition. It is for the best! It’s now been two years and four months since the launch of our inaugural issue. The magazine’s content and layout inspires our readers and engenders more fans towards Entrepreneurs Anchor. Our anchor is that we know and understand what you, our readers, want and expect from us. You want us to take the lead role in developing a compelling and instructive business
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Entrepreneurs Anchor Magazine | entrepreneursanchor.com â€˘ 5
Volume 3 | Issue 3
Cover Feature 08
Dr. Hill Hank – Medical Passion
Focus Feature 31
Paws & Effect
MCCI Jacksonville, FL
An Ounce of Prevention
Healthcare & Wellness 18
The Game is not Over
Hands on Healing
ffer diabetic40 cooking classes to improve Anti-virus Software something 37 that isHealthcare not done nationTechnology wide. Information es do not have the ability to do that. Financekitchen in addition to fully functional 22 Roth 401K lists that come in and show you some iendly cooking. Marketing provide free 44 transportation Medical Marketing for their sits.
MCCI Medical Centers in Jacksonville
Mind Body & Soul
Passion into Practice tally, we 20 advisePutting exercise, a healthy 39 Did You Know? d proper medical care to help patients 24 On-Site Insite tting diabetes. Copyright © 2012 by Entrepreneurs Anchor TM.
All rights reserved. Contents be you find about MCCI asmayanot medical reproduced without written consent of the publisher. on and its medical care motto how is Disclaimer: t from other medical groups around 2/3 E n t re p re n e u r s A n c h o r p ro v i d e s g e n e r a l 7 information about business topics. It does not your knowledge? 12 provide legal business advice. Views and opinions expressed herein by all articles and advertisements of a patient centered approach. It takes in 17 are solely those of the authors and advertisers; 21 they do not necessarily represent those of affected. the ct of a patient’s life that might be 23 magazine, nor its parent organization, Brain Media . Therefore, neither entity accepts any Group e in-patient nurses that follow them. We 23 liability with respect to any incorrect, incomplete, or 23 statements contained within. nurses ephonic caseunacceptable managers. We have the home as well as home visit doctors 6 • Entrepreneurs Anchor Magazine | entrepreneursanchor.com y. Our motto focuses on prevention and, our centers are very large with a lot of TM
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assion in Action
an interview with surgical oncologist, Dr. Hank Hill The national firm, 21st Century Oncology, with a local office in Jacksonville on Baymeadows Road, has brought together some of the best talent in the medical field, anywhere. In its over 20 years of operation, 21st Century Oncology has developed an operating model which enables its centers to deliver high quality, cost-effective patient care. Its doctors come from some of the most prestigious and recognized medical training centers and universities in the world. It continuously looks for those who excel in their field to join it’s evergrowing team of professionals so that it can provide its patients with the best oncologic care available. One of the premier doctors working at the Jacksonville location is Dr. Hank C. Hill; Entrepreneurs Anchor had the opportunity to meet with this passionate professional. Entrepreneurs Anchor (EA): Please tell us about yourself.
the academics, but to be a scholar athlete helped sustain my drive and motivated me to seek excellence in both areas of my undergraduate years. After completing the undergraduate degree, I matriculated at Morehouse School of Medicine in Atlanta, Georgia, and obtained my M.D. degree in 1991. After completing that, I sought out surgical residency and was matched at Harlem Hospital, Columbia/Presbyterian Medical Center in New York City. General surgery residency lasts 5 years, however in order to pursue a career in surgical oncology, I interrupted that training after the third year and spent two years at M.D. Anderson Cancer Center in Houston, Texas as a surgical oncology research fellow. This was encouraged by one of my mentors, Dr. Harold Freeman, who is a Breast Fellowship-Trained Surgical Oncologist and was the Chairman and Director of Department of Surgery at that time. He continues to be a reliable mentor.
“Our purpose … is to serve each other as humans on this planet.”
Dr. Hill: I am currently a Surgical Oncologist in Jacksonville, Florida at the 21st Century Oncology Cancer Care Center here in Jacksonville. I’m part off multidisciplinary group that includes surgical oncologists, medical oncologists, and radiation oncologists. However, I was an ambitious young AfricanAmerican who grew up in Queens, NY encouraged and motivated by Guyanese immigrants. EA: And your educational background?
Dr. Hill I was born in Brooklyn, raised in Queens, and attended Long Island University, Brooklyn Campus as a Biology/Pre-Med major. My athletic abilities earned me a tuition-free scholarship allowing me to play for L.I.U Blackbirds Men’s Tennis Team (a team that does not exist today). That was great experience for me, not only for
After completing the two years of the research fellowship at M.D. Anderson, I returned to Harlem Hospital Center, completed my surgical training, and stayed at Harlem Hospital another year as an endoscopy and critical care fellow. After completing that, I went on to complete my fellowship in surgical oncology in the Roswell Park Cancer Institute in Buffalo, New York. This included an additional year of research, followed by two years of clinical fellowship. EA: How did Dr. Freeman impact your surgical training? Dr. Hill: I would like to believe that Dr. Freeman saw something special about me as a resident and when sharing with him a personal experience regarding my Entrepreneurs Anchor Magazine | entrepreneursanchor.com • 9
late father’s diagnosis of stage IV sigmoid (colon) cancer. I shared with him that I would like to be able to be in a position to make a difference in a cancer patient’s life and to have an impact on reducing cancer disparities. I felt that after witnessing what my father endured, and asked the question why the colon cancer couldn’t have been diagnosed at an earlier stage and perhaps become a cancer survivor today. I wanted to put my energies and efforts in becoming a surgical oncologist. Not only for the surgical aspects of treatment, but also in education, prevention, and managing cancer in the global community. Many families know a relative or have a friend who is dealing or dealt with cancer. Today considering cancer rates, and recognizing the influence of environment, and lifestyles choices, we’re still going to be dealing with cancer for a long time. EA: Are you still passionate about what you do? Dr. Hill: Yes. As I matured over the years, I began to realize what’s important as it relates to what a surgical oncologist offers a cancer patient. Certainly the greatest joy is having that ability to physically remove solid organ tumors (for example; esophageal, stomach, liver, pancreas or colorectal tumors) from patients I treat. And to provide them with some comfort, first of all, some relief from their cancer, but to assist these patients to become long term cancer survivors. One of the things that is really gratifying about my training, because of the specialty, it allows myself and others who are in this field to actually perform procedures that most surgeons would shy away from. The training allows me to review studies (for example CT scans and PET/CT scans) that are used to evaluate my cancer patient and educate the patient about their chances for removal of the tumor. Additionally, we can perform operations that are quite complex at times and may require more than one surgical specialist. I take responsibility in recruiting a team to provide the best surgical outcome for cancer patients. Sometimes a patient may go to a location that says, “We may not be able to operate on you,” then if they seek us out for a second opinion, I can reeducate the patient on what surgical options are available…providing some hope, and coordinating a surgical plan. A clinical trial may be an option. This is why the multidisciplinary approach is so critical for cancer patients.
Dr. Hill: I agree. I believe there’s a calling for each of us. If you don’t listen to that calling or perhaps don’t tap into what our faith is about, realizing that God is in control of a lot of things that we do and experience, we miss out on what our true purpose is. This is why education is so critical. It allows us to eventually tap into our calling and become whom we are destined to be. Our purpose―overall among anything else we do—is to serve each other as humans (with common decency and respect) on this planet. I just happened to find that my service to humankind is through surgical oncology. I enjoy interacting with people. My patients deserve the highest quality of whatever surgical oncology there is today. And I strive to be, if not perfect, then excellent. It is a tough time for a patient, to think about their diagnosis with cancer. Questions such as whether or not they’re going to live or die from the disease and the impact their diagnosis is going to have. The cancer patient is connected to many other individuals, especially when they have family― spouse, children, parents, or even grandchildren―that they may have to take care of. And that’s where my passion and drive come in. I’ve accepted that responsibility as being a surgical oncologist. And I’m always willing to offer them something. The reality discussion sometimes is hard to initiate but I find that when patients are well informed they want to hear what the inevitable may be. Whether it’s a procedure, or whether information on alternatives in management, or perhaps preparing them for the end of life, it relates to how we look at the big picture in the treatment of the patient. It’s not only just the disease itself; it’s the spiritual aspect, it’s the psychological aspect, it’s the emotional aspect … And really, when I’ve adopted these patients, I’ve adopted the whole family.
“Oncology research has opened doors to a lot more questions.”
EA: I often say passion is what allows you to have longterm success; because if you find your root, if you find the thing that God has created you to do, that’s when things become easier because that is your innate talent.
10 • Entrepreneurs Anchor Magazine | entrepreneursanchor.com
EA: How does being a surgical oncologist differ from other medical specialties? Dr. Hill: Oncology is an area that still has a lot of questions. When I talk about questions it’s not just really what we understand today, but what we now understand is the uniqueness of the cancer cell and its unique mechanism for immortality. It is very complex and there are millions of research dollars gone into trying to figure out this thing. What is more apparent is just how genetics relates to cancer. Oncology research has opened doors to a lot more questions. There’s so much that’s unknown and that’s why research is so important in this field. We still don’t know everything about cancer. What we do know is that if we can get the cancer out (at an early stage), then we give the patient the best chance
for survival. Additionally, we know that technology has been able to interface with this disease in a way that we can recognize the complexity of the cancer cell itself. It behaves completely different from a normal (non-cancer) cell. You have to appreciate that more and more. We’re going to be able to open up a whole new concept as to how we treat cancer patients with a customized approached. It gets down to the molecular and genetic levels, and for a surgical oncologist, learning how to implement those applications in the future. We’re going to be the specialists who’ll be the vehicle for the delivery of that new technology. Furthermore, how to identify the patients who potentially may have a familial inheritance for cancer is another area that is so critical today. When we are dealing with these patients who have cancer, we have to appreciate the patient’s family cancer history as well. Because, that’s a signal. Then we can come in and educate about what is genetic testing and why it is important in dictating their overall care. Today we can test our patients with a very simple test using a mouth rinse, send it off to the laboratory, and it can identify if the patient has a genetic mutation.
“I think it’s critical people listen to their bodies.”
This changes the whole dynamics as to what that patient and their family is about. If they carry the genetic mutation, they can pass it down to the next generation. Then we have to educate that next generation about how we customize their cancer screening and how to offer prophylactic surgery. EA: How has technology played a role in surgical oncology? Dr. Hill: Great question. You’ve heard of nanotechnology? There are now nanoparticles that are carrying agents and compounds that can help destroy tumor cells. We are at the cusp—not so much here at 21st Century Oncology— but at the big cancer centers, such as Sloan-Kettering in New York City, M.D. Anderson in Houston, and University of Pittsburgh in Pittsburgh. These major, tertiary cancers centers are looking at how nanotechnology can actually introduce cancer-killing agents. There have been some noteworthy successes and clinical trials are underway. There’s also microwave technology that’s available. There are nanogold particles that can carry tumor killing agents, which has been shown in research to specifically go to only where the cancer cells are and kill them off, essentially. There is going to be some very interesting progress that will come about in the near future. EA: You talked about genealogy; what other exposures or activities can cause cancer? Dr. Hill: Another great question. The simple fact of being a living organism is that we are walking biochemistry sets, if you will. There are some things that go on in our systems that go on from birth, which can put us at risk of developing a cancer cell. The healthiest parts of lives
Entrepreneurs Anchor Magazine | entrepreneursanchor.com • 11
are when we are children and our systems are growing, constantly being influenced by proteins and hormones in our bodies. The thing is; our bodies already have a checkand-balance system for whenever there’s a cell that changes genetically to transform into a cancer cell, we have certain enzymes and corrective mechanism in place to stop that cell from moving in that direction. That process is called apoptosis. Now the problem is that we don’t get to really appreciate—especially if we’re undereducated—we abuse the body and overtax these corrective processes. Most people do not understand that if you consume too much alcohol, it can really affect their body in negative ways. If you’re a tobacco smoker ... tobacco smoke contains over 50 known cancercausing agents. The industry knows it. Those who are study this know it. Messages are out there that talk about smoking and its dangerous consequences. Yet we still have people who ignore the messages. Nicotine is addictive. Some people have to understand that because of their own physiology of who they are in terms of being melanin challenged, with very light complexion, oftentimes with red or light blonde hair, we’ve identified these individuals who are at higher risk for developing melanoma; they can’t be sunbathers. These are things we understand today. So the preventative tact is to reduce one’s exposure. I think it’s critical people listen to their bodies. A lot of the things that we deal with have to do with physical stress. Among many of the things we deal with, in America, is that we’re living a very fast-paced world. It’s not only what’s going on in the U.S. but it’s a global issue as we are all connected. Countries that were once considered underdeveloped have now become industrialized. And we’re missing out. Or especially stateside, there’s a lot of misconception about what
the rest of the world is about. There are a lot of things we don’t understand in the corporate world that affects our financial well-being and concurrently our health and wellness. We’re so knowledgeable in so many areas, but we are left out of the most important things. Approaching our lives in selfish view, promotes an imbalance in our world system of natural order. You know, we talked about surgical oncology, technological breakthroughs, proper screening, etc. But there’s a mental health issue that is significant in this country, which really doesn’t get sufficient attention the way it should. Depression and other mental illnesses are plaguing our communities. And that disease plays havoc on all the physiology within our systems. Another issue is health care disparities. Lower socialeconomic populations, and especially African Americans have a greater risk of presenting with stage IV disease because of lower education and not having the financial resources for healthier options, such as healthier foods, the opportunity to engage in exercise or sporting activities, as well as reduced access to physicians. They don’t have adequate health insurance; therefore they don’t see a physician regularly and seek medical care through emergency room services. Ultimately that leads to and propagates an unhealthy lifestyle. So the behavior is one that condones eventually, after many years, a cancer if not diabetes, hypertension, and obesity. Not just that, but heart, lung, liver and pancreas disease, along with other life-threatening or debilitating (chronic) illnesses. If you would like to refer a cancer patient to Dr. Hill, or if you have a question related to cancer, you may contact his office at 904-562-4360.
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An Ounce of
Prevention By Robert Kaye
Even with the Supreme Court’s recent upholding of President Obama’s “The Affordable Care Act,” or what has commonly been called “Obamacare,” many health care pundits still feel the law didn’t go far enough to significantly change our country’s health care system, which many have described as being dysfunctional. In other words, we’re still in “condition critical.” That’s just what the innovative, Jacksonville-based firm, U.S. Preventive Medicine, is all about. Based in south Jacksonville, U.S. Preventive Medicine is accredited in Wellness and Health promotion by The National Committee for Quality Assurance (NCQA) as well as disease management by URAC. The company has developed a collection of prevention, early detection and chronic condition management products and services, which help improve health outcomes while reducing health care costs. Frederic Goldstein serves as President for U.S. Preventive Medicine, which features a comprehensive suite of proprietary, technology-based products and services to the marketplace to meet the prevention needs of 300 million consumers. Mr. Goldstein is also chair-elect of the Care Continuum Alliance, an organization that advances strategies to improve care quality and outcomes, and reduce preventable health care costs. Entrepreneurs Anchor (EA): Even with all the technological, pharmacological, ongoing research, and other advances in medicine and surgery, many who study the health care field—including doctors themselves— state that the best way to cut health care costs in the U.S. is by instigating serious, actionable preventive health care programs in the workplace and for the private sector. Frederic Goldstein (FG): I’d most certainly agree with that. Studies from the CDC [Centers for Disease Control & Prevention] have shown that up to 80% of Type 2 diabetes and heart disease, and up to 40% of cancers are preventable. And those statistics are based on if people would just do four consistent things: Don’t smoke, exercise, watch your weight, and eat nutritiously.
EA: How do you define preventative health care and/or preventative medicine?
FG: There’s actually a clinical specialization, a specific board certification for doctors in Preventive Medicine. It has three components—Primary, Secondary and Tertiary prevention. Primary prevention is keeping the healthy people healthy. Doing all those things to keep yourself well such as eating right, getting regular exercise, watching your weight … all of activities you’d do, or not do in the case of not smoking or drinking excessive alcohol, not using recreational or misusing prescription drugs, and the like, to maintain optimal health. Secondary prevention is the early detection of individuals who or are at-risk or have a condition they’re unaware of.
There are over 70 million people today who have pre-diabetes and a huge number of those individuals even don’t know it. EA: And that includes getting regular check-ups, etc.? FG: Right. Screenings, as appropriate, supported by evidence-based guidelines according to your age gender, evaluating possible risk factors and knowing your family’s health history, where that’s allowed. Studies have shown that some tests aren’t necessarily ‘carte blanche’ per se. It comes down to what’s appropriate for a particular individual. That’s something worth discussing with your physician and also understanding yourself. For example, we know today there are over 70 million people today who have pre-diabetes and a huge number of those individuals don’t even know it. That’s why getting a screening test to determine if you might be a prediabetic is very important. Similarly, there are millions of Americans who don’t even know that they actually do
Entrepreneurs Anchor Magazine | entrepreneursanchor.com • 13
have diabetes. The earlier you can intervene, the better. That’s why getting appropriate screenings for your particular situation is important. Tertiary Prevention, then, is evidence-based medical management for individuals who already have a specific condition. For instance, if they have diabetes, make sure that they’re getting treated appropriately, the patient understands their treatment plan, and they’re following through with the recommendations for their particular ailment. Those, in essence, are the three components of Preventive Medicine that really need to be integrated in to a program for individuals to help them better manage their own health.
We actually have a “Sick Care System.”
not as functional when they’re at work. There are conditions, particular diseases or genetic precursors that can lead individuals to experience debilitating conditions that are not lifestyle related. So then the key becomes a Tertiary Prevention issue. “How do we effectively help that individual deal with their sudden onset condition or malady?” EA: Expanding our perspective one step further, why is preventive health so important to our country’s somewhat discombobulated and still politically contentious health care policies? FG: We have a system today that’s set up … in some ways it’s backwards. In order to access our health care system, for the most part but not completely, you have to have a medical condition. Providers get paid to deal with somebody who is sick. We actually have a “Sick Care System.” Providers don’t get paid, in the majority of cases, but in not totally, to keep people healthy. The question then becomes how to change that system? Clearly Ben Franklin had it right 200 years ago when he
EA: The next three questions will be in tiers, so to speak. First, why is preventative health important to the individual? FG: Obviously, the better you do at maintaining your own health, the more vitality you have. The better your life can be. If you can keep yourself healthy by doing appropriate things such as living a healthy lifestyle, watching your weight, not smoking, etc., then you have a better chance of enjoying your life in general and especially in your older years being healthier overall. You’re better able to do things, live independently, enjoy your life more, versus suffer from some disability or multiple medical conditions that may seriously hinder your ability to do things by yourself , or at all, in some cases. EA: Moving up a notch, why is preventative health so important for an employer? FG: Two key reasons here. One of them is, in our country’s present health care model, employers tend to cover a majority or a fair amount of the health care costs for the individual. We tend to be an employerbased health solution, with many employers paying the health care costs for their employees. Even more importantly today, studies have now shown that the full cost of employees’ poor health to their employer is even greater than the insurance costs. For every dollar a company typically spends on the health care cost for each employee, they’re losing two to three dollars in productivity losses if that employee becomes ill. It’s a fact: the employee who suffers from certain conditions or who has higher health risks or other health-related conditions is absent from work more often. Or they have what’s called “presenteeism,” which means they’re
14 • Entrepreneurs Anchor Magazine | entrepreneursanchor.com
said, “An ounce of prevention is worth a pound of cure.” And that’s what certain organizations are striving to change the system to do. Not only our company, but I think around the country, prevention as a concept and practice is beginning to take hold. There are also groups like The Partnership to Fight Chronic Disease, The Partnership for Prevention, the Care Continuum Alliance, and certain medical groups such as the American College for Preventive Medicine. And there are many advocacy organizations such as the American Diabetes Association and the American Heart Association. These types of groups are all working to get policy makers to recognize that if we invest upfront, if we all take some proactive role and responsibility to help keep ourselves healthy, as well as change the system, then we can create a much less expensive health care system in the U.S. Because then we won’t need as many of the expensive medical services that are now being provided to people who
are becoming sick. In other words, if we can be more proactive and preventative, we’ll have fewer people suffering from heart disease, diabetes, some cancers and other avertable conditions. EA: This is all particularly germane given the statistics we’re now seeing around the country about childhood obesity and its negative ramifications. Some are even calling it an epidemic; children and teenagers showing evidence of being pre-diabetic … FG: Or even contracting diabetes. What we have is a situation where Type 2 diabetes, not Type I, but Type 2, which used be called “Adult Onset Diabetes” is showing up in younger and younger individuals. It definitely is related to lifestyle factors, which is why we no longer refer to it as “Adult” but Type 2 because we now have kids with it. It’s a dichotomy, really. Because one of the saddest things is it is a snapshot, and not a very attractive one at that, of the current state of our nation’s health. But the other side of the coin, which is encouraging, is that Type 2 diabetes is preventable.
Type 2 diabetes now accounts for approximately 85 to 90 percent of all the diabetics in the country. One of the big tragedies is that we’re seeing children being afflicted with Type 2 diabetes due to them becoming overweight at earlier and earlier ages. The other important thing that needs to be said is that Type 2 diabetes is associated with heart disease, and that's why it’s so important to not only treat the glucose levels, but also to attack blood pressure and cholesterol levels as well. As one physician I once heard said, “We ought to recognize and call it ‘Adult Onset Diabetes’ again because every time it happens to a child, we ought to think of it as our failure,” because we know we can prevent Type 2 diabetes if we recognize it at an early stage. EA: In some instances the challenge is compounded, as certain school systems have cut back on physical
education programs, or don’t teach students about the importance good nutrition and portion control. Even the controversy that made national headlines last year, where Congress declared that a slice of pizza should be counted as a vegetable, when fed to school children. FG: It’s a cultural issue that we all need to work with. And you’re beginning to see some unique solutions. For example, when I was a kid growing up in California, I used to ride my bike to school. Today, for whatever reasons—the transportation system itself, or there aren’t safe roads, or just parental fear—kids don’t ride their bikes to school as much anymore. A community in Oregon came up with a cool program called “The Walking Bus.” They got seniors to volunteer to help walk students a couple of blocks to the next senior, who’d walk the kids a couple of blocks to the next senior and so on to the school grounds. So the kids walk to and from school, and get some exercise. Those are the kind of things that communities can kind of look to as a model. And there are probably hundreds, if not thousands of examples all across different communities where there are creative solutions, to look broader, to create those opportunities for kids to get adequate exercise and appropriate nutrition. Another example is the “Let’s Move” program from the White House, where you see First Lady Michelle Obama leading that effort [www.letsmove.gov]. It’s going to take individuals and communities working together to really solve this issue. It’s not just one thing. It’s going to take a lot of sandbags to stop the flood, so to speak. You can’t just put up one sandbag and hope, “We’ll change the school lunch program and that will fix it.” It will be part of the solution, but there’s much more to it. EA: We have another major health issue on the opposite side of the age fence, as you might say. And that is the massive number of “Baby Boomers” now approaching their mid-50s and early 60s, who are going to require greater access to health care and medical resources. But nationally, medical schools haven’t been graduating enough primary care doctors to serve this burgeoning population. So the quandary becomes, who’s going to provide the first line of health care defense for this everenlarging, aging population? FG: It’s a major issue that’s going to require serious rethinking … there are several things we can do to solve it. For example, enabling Physician Assistants, Nurse Practitioners/Advance Practice Registered Nurses [APRNs] to step up and become those primary care providers, giving them more authority regarding writing prescriptions and what procedures they’re allowed to do. There are clearly ways to change the current health care system and make it more efficient. That’s one of them, using extenders and others like that to broaden the range of primary care. EA: What are some others?
Entrepreneurs Anchor Magazine | entrepreneursanchor.com • 15
FG: We’re now seeing this move towards a patientcentered medical home, where each individual has their own “medical center.” It tends to be a little bit broader, as there are several health care specialists versus just one physician in this one locale. It’s essentially a clinic set up more around a team approach, where you might see a nutritionist, a dietician, an exercise physiologist, a social worker, and nurses to help better manage patients with diabetes, or pre-diabetics or other conditions. And you may see other types of therapists in there as well. So they’re looking at the client/patient more holistically, versus a “they’re in here for this illness or that medical condition” type of mindset. We’re beginning to see some companies try to focus on more of those preventive approaches.
with a doctor and then receive referrals to other service providers to help them, if necessary. Again, it may be a nutritionist, exercise physiologist, social worker, or whatever is appropriate for that patient’s needs.
EA: So one would go to one of these patient-centered medical homes versus seeing their “regular” primary care doctor?
FG: I think we could do a better job about nutritional education in general, and clearly provide better access to food that’s good and healthy for you. Some of this we’ve known, such as eating more fresh fruits and vegetables in our diets every day, drinking adequate quantities of water, those kinds of things. It’s also a matter of making individuals aware, and then providing them with opportunities to get those healthier foods more readily, versus the so-called fast foods that are pre-processed and that we may know, or not even know, whether they’re harmful or not. One thing we do know is that if you stick to the basics, and eat that way regularly, you tend to do better.
FG: Yes, and the idea, too, would be to change the [insurance] reimbursement structure so it’s not necessarily that they would get reimbursed for each service as it’s structured now, where the more services or procedures a doctor does, they more they get paid. But maybe they have a population of patients, and therefore part of their reimbursement is based on the overall health on that population. For instance, if their clients received appropriate screenings, how many patients had better results and those types of parameters? Now it becomes more of an outcomebased payment versus a service delivery payment. Those are the kinds of models you’re beginning to see more often. That is, patients going to medical homes and the new groups of accountable care organizations that are broader structures than hospitals, physicians and services, which are now looking more holistically at the population of individuals they serve. Their focus being, “How do we maximize the health of this population versus just treating their diseases?” Then instigate particular payment structures to reward those accountable care organizations or providers for delivering higher quality of preventive care. Instead of getting paid every time you get a patient visit, you may get a flat rate for a given population, and if you keep that population healthier overall, you may get bonuses, or things like that. Those are some of the things that are being explored right now, like these different types of health care delivery models. I don’t think policy makers have gone far enough to recognize how important it is to work with individuals to keep them healthy and employing those services to facilitate doing that. But they’re getting there. You can see Medicare now has “The Annual Wellness Visit” to establish a personalized health care plan. Essentially it includes a health risk appraisal, some lab work, maybe a few other tests. The provider gives the individual their report, explains what their risks are, and what they need to do to get healthier and/or keep themselves healthy. They meet
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EA: Another challenge we face, as a consumer-based marketplace, is that we’re bombarded by companies and products whose nutritional value or overall impact on one’s health can be decidedly negative. I’m talking about canned and processed foods with too much refined sodium and sugar and laden with trans fats, and, of course, all the junk and unhealthy fast-food products such as “supersized” double cheeseburgers, with an extra large order of fries, and a mega-sized, sugar-laden carbonated beverage and so on.
EA: However, there are so many readily available—and heavily marketed—products that are chocked full of ingredients that aren’t healthful, such as high fructose corn syrup, refined grains, monosodium glutamate, aspartame, hydrogenated oils … FG: Right. I think what we also need to do, at the end of the day, is to have studies to show whether an ingredient is harmful or not. And when the studies do show that particular ingredients are harmful, we should ensure those are not included in our foods, or their levels are lowered or whatever. But you’re certainly correct. I remember a health coach once telling me, “When you read the food labels, if there’s anything on there that you don’t understand, or don’t know what it is, or the name is a super long-sounding chemical ingredient, or you can’t even pronounce it, then you probably want to stay away from that product.” [Laughs.] U.S. Preventive Medicine is accredited in Wellness and Health promotion by The National Committee for Quality Assurance (NCQA) as well as disease management by URAC. For more information visit: www. uspreventivemedicine.com, www.thepreventionplan. com, and/or http://macawapp.com.
Nurse Practitioner Student
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Entrepreneurs Anchor Magazine | entrepreneursanchor.com • 17
By Brian Klep
Like most health law watchers, I was surprised by the Supreme Court’s decision to uphold President Obama’s Affordable Care Act. I’m sure that on this issue, as with everything else, zealous responses rationalize the result and split the country down the middle. I expected the Court to be purely partisan, but apparently Chief Justice John Roberts, acknowledging the gravity of his role, saw his way clear to support the law with some constraints. Here’s the comment from Supreme Court of the United States (SCOTUS) Blog: “Salvaging the idea that Congress did have the power to try to expand health care to virtually all Americans, the Supreme Court on Monday upheld the constitutionality of the crucial—and most controversial—feature of the Affordable Care Act. By a vote of 5-4, however, the Court did not sustain it as a command for Americans to buy insurance, but as a tax if they don't. That is the way Chief Justice John G. Roberts Jr., was willing to vote for it, and his view prevailed. The other Justices split 4-4, with four wanting to uphold it as a mandate, and four opposed to it in any form.”
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It undoubtedly weighed on Chief Justice Roberts that his decision could mollify or exacerbate a Washington freefor-all that affects nearly one-fifth of the US economy. He may also have wanted to gently rebuke Congress for pushing the Commerce Clause too far, though he let it slide as a tax. Even so and important as it is, the Fat Lady hasn't sung yet. It’s important to place this ruling in context. Virtually every DC health care and party-aligned organization was poised to spin the result, no matter what that result looked like. Today and into the foreseeable future, the parties are far apart and not likely to compromise. The same organizations that, in 2009, contributed $1.2 billion to Congress in exchange for influence over the law's formulation remain unrelentingly engaged. Princeton Professor of Public Affairs Julian Zelizer, observing the quid pro quo exchanges in the ferocious lobbying environment then quipped, “They cut it. They chopped it. They reconstructed it. They didn't bury it. I don't think they wanted to.”
While the individual mandate will allow us to spread risk more broadly and make access more available, especially to lower income Americans, it isn't perfect. The dire problems of extravagant health care utilization, unit pricing and cost remain largely untouched by the law in its current form. Half or more of all U.S. health care spending provides no value by design, meaning that Americans pay double for health care compared to citizens in other developed nations, and our quality is spottier. The requirement to keep up with this excess through the mandate will be onerous for many Americans. As analyst health care analyst Bob Laszewski points out, a $60,000 annual income household will need to find 9.5%, or $5,700, in its tight budget, for the premium. But the threat of health care costs extends beyond individual households to our national economic security. A recent RAND study showed that, in the decade leading up to 2009, 79% of all growth in U.S. household income was siphoned off by health care. That leaves only one in five new dollars available for other purposes, like education and infrastructure replacement, a frightening prospect. This is the direct result of Congress’ embrace of money for influence, the embodiment of regulatory capture. In the face of this national paralysis, pragmatists’ solutions will be found in the marketplace rather than in policy. Meaningful approaches (e.g., empowered primary care, data collaboratives, large case management, medical destinations, incentive programs, collaborative benefit design, paying for management rather than volume) do dramatically drive down costs while improving quality, though of course some are more powerful than others and some vendors execute better than others.
It is as though there is an awakening in the health care marketplace, as the pressures intensify for purchasers and, now, health care vendors. Many purchasers are finding that they can gain a competitive edge by exploiting health care’s egregious market vacuums, and if it is at the expense of the brokers, the health plans, the hospitals, the specialists or the suppliers who have driven excess in the past, so be it. Some vendors are realizing that they can win by changing course and by delivering more efficiency in exchange for greater market share. The rancor preceding and surrounding the Supreme Court decision is, to some degree, a reflection of our national dysfunction: our inability to have fact-based discussions and our unwillingness to directly confront dire problems that threaten the public interest. We swim in a media-rich, content-poor environment fueled by lobbying, where buzzwords, sound bites and the special interest trump thoughtful discourse and the public interest. It has become impossible to fix our health system through law and statute. The decision is a fascinating and, to some degree, heartening study in national legal process, but the game isn’t nearly over. The tug-of-war will continue and become more ferocious. Nothing in the larger game has changed, an election is around the corner, and, literally, trillions of dollars are at stake. But for those who are watching, the real game for health care now is in the market, which cares only about value. This article originally appeared on Medscape Connect (medscape.com) on June 29, 2012. It is used by permission of its author.
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Putting Passion into Practice
There comes a time in everyone’s life when passion screams to be released, demonstrated or put towards active use. There’s a sense that “something’s missing” and it must be discovered. Becoming cognizant of your passion may require inquisitive actions, but doing so will be well worth your quest. Once unleashed, passion can bring the most fulfillment to your life. So what is passion? (We’re not talking about the romantic version here, but what fuels your very being.) Passion is what brings you the most satisfaction. Your zeal personified. An intense interest. It is what makes you shine and stand out like the brightest crayon in the box. Passion is what you are willing to do with a smile on your face in the absence of being paid to do it. It is directly linked to your purpose, and oftentimes, success in life. Passion helps to complete you; however, it is not to be confused with your own gifts, talents, skills or abilities.
Think back to your earliest memories as a child growing up. What thoughts immediately come to mind? Were you the adventuresome kid that one day wanted to become a firefighter or a policeman? Ladies, did you line your dolls up and teach them math or English? What did you want to become when you grew up? What could you be found doing on rainy or snowy days? These questions may provide clues to tapping in to your passion. Day in and day out, countless numbers of women and men faithfully go to work to support themselves (and their families). If they’re lucky, their gifts, talents, skills and abilities are used in support of their companies’ vision. Unfortunately, passion, for many, is put on hold as the primary focus becomes just working for a living. While working to meet fundamental expenses is necessary to keep food on the table and a roof overhead, not to mention being honorable and responsible, again the question is worth repeating: What about your passion?
Unveil your passion through the process of reflection, acknowledgement and execution. 20 • Entrepreneurs Anchor Magazine | entrepreneursanchor.com
Is it possible to ignore it, as if it doesn’t exist? In answering this question, keep in mind that your passion is resilient. No matter how hard you or others may try to snuff it out, your passion always resurfaces anew. Why? Because it defines who are. It is directly connected to your purpose in life. It cannot be ignored forever. Left unaddressed, there will be times when the flames of passion will be fanned, renewing the zeal within. It may lie dormant for a season or more, but it does not disappear. There are those who have already identified their passions. They can be found operating in one aspect or another of their fondest interests. For others, passion has to be rediscovered and identified. Unveiling your own passion is achievable by going through this three-fold, introspective process: •Reflection: While it may not be the easiest thing to do, seek quiet times and places to spend quality time thinking and reflecting on your personal interests. Revisit those childhood dreams. This is a good time to do some journaling, affording you the opportunity to capture your thoughts on paper. List activities you enjoy doing―which ones bring a smile to your face, as well as a sense of pleasure and satisfaction. Ask yourself the question, “If money was not an issue, what would I like to be doing?” Soliciting the help of family, friends and co-workers may be beneficial in composing your list. Once complete, narrow your list down by drawing a line through items of less personal significance until you are able to determine with confidence, what your passion is.
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•Acknowledge: Once identified, acknowledge and research your passion. Keep up your journal entries as you continue this process of self-discovery. Brainstorm ways of implementing your passion in to your life. Draw mind-maps, pouring all your ideas around your rediscovered passion on to paper. •Execute: By now you have discovered and acknowledged your passion. What’s next? Follow through. Set a course of action in place to make room for your passion in your life. Spend time in prayer and meditation for your next steps. Set goals with a series of actions steps in place. You didn’t stop journaling, did you? Write down your goals and success plan on paper. You may want to consider partnering with a life coach or mentor. A good mentor will impart wisdom and direction. We’re all hard-wired with our own passion(s). Identifying what it is and furthermore, allowing it to flow through you, can lead to a sense of completeness and satisfaction. Unveil your passion through the process of reflection, acknowledgement and execution. Then be ready to shine forth as the brightest crayon in the box.
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Entrepreneurs Anchor Magazine | entrepreneursanchor.com • 21
Roth 401 ( k )
Additio na l O pport uni t y fo r t h e S m al l B us in e s s Ow n er By Michelle Ash Nearly everyone’s heard of a 401(k), and some have heard of the Roth IRA. Now there’s a new retirement plan available that you might not have heard about. As its name implies, the Roth 401(k) is an employer retirement plan combining features of the classic 401(k) with opportunities for post-tax contributions that grow tax-free for the future. If tax-free retirement income is something of interest to you, read on. The Roth 401(k) has been around since January 1st of 2006, but wasn’t made permanent in legislation until the Pension Protection Act of 2006, which was passed in August of that year. Like anything new, it can take some time to learn its benefits and uses. The Roth 401(k) has some particularly attractive features for proprietors of the Owner-only small business (commonly referred to as a sole proprietorship) since owners serve as both a working employee and the owner/employer in such an operation. The contribution limits of the Roth 401(k) are the same as a standard 401(k). As the company’s employee, the owner/worker could start contributing up to $17,000 of his or her salary in 2012. Individuals age 50 and older were allowed to contribute a “catch-up” contribution of an additional $5,500 in 2012 as well, totaling a $22,500 maximum contribution. And, as the company’s employer, the owner/worker can make a tax-deductible contribution of the lesser of 25% of the owner’s W-2 salary, or $33,000, to the employee (that is, him or herself). The real power of the Roth 401(k) plan occurs for the Owner-only business proprietor who is taking home high levels of income. (Congratulations, BTW, on your success!) Let’s compare the contribution limits of the Owner-only Roth 401(k) with the Simplified Employee Pension IRA, or SEP-IRA, using a 45-year old proprietor of the Owner-only S-Corporation business with $100,000 of W-2 income. Both plans allow the same level of employer contributions: up to 25% of the Annual Gross Income (AGI) equaling $25,000. However, with the Owner-only 401(k), he or she is also allowed to contribute $17,000 as an employee salary deferral (Roth or pre-tax). The result? Total contributions to the Owner-only 401(k) equal $42,000, while the SEP-IRA only allows maximum contributions of $25,000. The contribution limits, and overall contribution comparisons to the SEP-IRA are actually the same whether you use a standard 401(k) or the Roth 401(k). Where the Roth 401(k) sets itself apart is that it has no income limitations to determine investor eligibility. This can be an important benefit, since many high-income 22 • Entrepreneurs Anchor Magazine | entrepreneursanchor.com
individuals who would like the opportunity to put away dollars for tax-free future income make too much money to utilize a Roth IRA. In 2012, Roth IRA eligibility phases out for a single taxpayer beginning at $110,000, and at $183,000 for a taxpayer filing married and jointly. If an individual is eligible for a Roth IRA, however, it may be used in addition to the opportunity presented by the Roth 401(k). Not bad! The Owner-only Roth 401(k) plan is the only type that allows both Roth plans (after-tax) and pre-tax contributions, in any combination of amounts the account holder desires. Contributions are discretionary in any given year, offering maximum flexibility as business income fluctuates. The Roth 401(k), similar to a standard 401(k), also offers the opportunity for business owners to take tax- and penalty-free loans from the account: up to the lesser of $50,000 or 50% of their account balance. Another opportunity is that an Owner-only 401(k) may be used in conjunction with a SEP-IRA or defined benefit plan. So, a business owner can make the employee deferral to the Roth 401(k) account while continuing to make the employer’s tax-deductible contribution to the SEP-IRA or defined benefit plan. As with everything in life, there’s a give and take to consider when choosing whether The Roth 401(k) the Roth 401(k) is right for you. A combines features of business owner the classic 401(k) with must choose opportunities for postbetween getting a tax deduction tax contributions. today in a standard 401(k), or paying taxes today on the Roth dollars and getting tax-free income in the future. A qualified financial professional can assist a business owner in determining which plan makes better sense in the short- and long-term, given a business owner’s individual circumstances. Other items to consider when determining feasibility of the Roth 401(k) include noting that Roth contributions are irrevocable. Once contributions have been allocated to a Roth 401(k) account, they cannot be shifted to a pretax account. Also, “qualified,” or tax-free distributions from the Roth account will be allowed only in the cases of death, disability, or attainment of age 59-and-a-half, as long as it has been at least five years since the initial Roth 401(k) contribution was made. As with any tax situation, consult with your CPA to determine the tax ramifications to your individual situation.
OM is a .C E T O U Q JAXROOF based company local web connecting n focused o le Metro Area il Jacksonv with with rs consume -Licensed e local Stat ofessionals. r Roofing P
Phone: (904) 554-2838 Entrepreneurs Anchor Magazine | entrepreneursanchor.com â€˘ 23
On-Site Insights By Troy Peck
My name is Troy L. Peck, and I’m a college entrepreneur. Currently, I’m a junior at Florida State College at Jacksonville, pursuing a Bachelor’s degree in Supervision and Management. I’m the former 2010-2011 Vice President of the Student Government Association, FSCJGA Legislative Liaison for District 4, and Student Community Volunteer of the year. I have also been honored as a recipient of the 2012 “Herbert W. Scheidel Community Leadership in Action Award.” The Scheidel scholarship recognizes students whose volunteer work has expanded the opportunities of those who are less fortunate, and who have the passion to continue their community work. I’m also the owner/President of River City Safety Solutions, Inc., (RCSS). My business partner and I started RCSS in April of 2012. Our mission is to help companies develop and train a safe and healthy workforce. RCSS offers such services as OSHA 10- and 30-hour construction safety training, consultation and private inspection for storm water erosion and sediment control, customized two- and four-hour construction safety awareness workshops, site-specific safety inspections, and job training consultation services. Due to the diverse demographic of our community, we offer all of our services in English and Spanish. Companies also benefit by having their employees obtain certification in either the 10- or 30- hour OSHA Safety Training course. It’s a proven fact that when employees receive standardized in-service safety training, the number of on-the-job injuries decrease dramatically. OSHA safety training is beneficial to the employee because it enhances the employee’s overall job safety performance and can lower the number of workers compensation claims that are filed. From the employer’s perspective, aworkforce that has received certified OSHA Safety and Health training can help lower the insurance rates that a company can be charged. I have faith that RCSS will make a difference in our immediate community. While the job market has come to a stand still for many Americans, this is the perfect opportunity for many job seekers to receive additional job training that will enable them to become more employable in the future; especially considering that
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most companies are far more likely to hire individuals who have received OSHA training than not. RCSS is also poised to dive right into the information workshop consortium. We want to offer individuals and employers the opportunity to receive training about sitespecific personal protection equipment. I say site-specific, because each job site is a little different from the next, requiring particular personal protective equipment and having its supervisors and workers be aware of the regulations pertaining to each specific site. Work hazards can vary from one site to the next. We can assess the natural environment in which a company conducts its operations by evaluating soil types, landscape, and conditions at the worksite, then develop a work plan and site-specific safety manual for a particular contract. My education, job experience and specific training make me uniquely qualified to operate a business that focuses on safety training. I’ve recently been employed part-time as a Student Assistant in the Brownfields Job Training Program at the MPSS division of Florida State College at its Jacksonville Downtown Campus. While working in the Brownfields Job Training Program, I received 40-hour HAZWOPER training, lead worker and lead renovator training, confined space entry, EPA’s 40-hour health and safety training, asbestos and mold awareness, deconstruction, environmental math, CPR and First Aid certification, along with soil sampling and analysis training.
The mission of River City Safe Solutions, Inc., is to help companies developandtrainasafe andhealthyworkforce.
I’ve spent the past year assisting the Brownfields Program Coordinator with EPA reporting, student tracking, weekly reports, quarterly reports, and job placement. My primary responsibility has been assisting the students with résumé building, interview etiquette and job placement.
My advice to anyone student who wishes to start a business is to find a service that you can perform or product that you can actually produce. Make sure to do your research so you can ascertain if there’s actually a need for what you’re offering. Every service provider has to have a market or niche.
The EPA Brownfields Job Training Program is a grant that focuses on restoring our local community by offering job training and job placement for low income, displaced workers.
As a business owner, your most important asset is your word. Whatever you promise your clients, make sure that you can deliver and provide them with even more services. The more you can exceed someone’s expectations, the better. Also, never ignore the benefits of bartering, as many business services are simply traded between B2B and B2C.
I’ve developed a strong desire to serve my community by offering job training, creating job opportunities, and creating safety awareness in the work place. My active involvement in community empowerment, environmental certifications, and my own certification as an OSHA Authorized Construction Safety Trainer have given me the expertise and to offer my services to the private sector. I have always had an entrepreneurial spirit. I co-owned and operated a print publication called “NtoU Magazine” in the Jacksonville area from 2004 to 2008. Although” NtoU” was primarily an advertising and marketing entity, the experience I gained from that venture has proven to be invaluable as I embark on my new projects. My reputation as a respectable business owner has already been established through my previous clients and business contacts.
Other essential recommendations: • Develop a solid business plan; it’s your roadmap to success. • You will eventually need a website. Many potential and current clients perceive that a company with a well-designed, functional website is a valid firm, because not many companies will take the time to put up a high-quality website. • Make sure to research special programs that offer government and state aid to small businesses and especially businesses under minority ownership. • Ensure all your paperwork and licensing is in order so you can operate legally.
F I NA N C
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Dr. David Priscal MCCI Jacksonville, FL
What kind of medicine do you practice and how long? Family Practitioner for about 11 years. How long have you been working for MCCI? What is so great about working with MCCI? I’ve been working for MCCI for 10 years. There are physicians who have been working for MCCI for 20+ years, which speaks volumes for an organization. MCCI gives me the opportunity to just practice medicine; that is why I have stayed here. They tell me “Whatever it takes; you know your patients better than we do. We trust you know what to do.” I chose this company because I was able to practice what I was taught and and I am given no limitation of my opinion toward medical care for my patient. How long has MCCI been around? Close to 25 years. We have been present in Jacksonville for around four and a half years and opened 5 new centers in the last year. We have two business models: independent doctors in larger groups in the city that have previously been well established and wholly owned centers where we employ all the doctors. How is the market in Jacksonville different from the market in Miami as far as caring for their patients and culture? There are cultural differences between cities that we evidently have to acknowledge but we do not treat anybody differently. The medical problems are usually the same no matter the location: COPD, diabetes, congestive heart failure, heart disease and any variation of it. We practice medicine the way it should be: focusing on preventive care.
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We take the time to understand and know our patients not only from a medical standpoint but also personally. This gives us the opportunity to be able to aid them if they cannot access health care appropriately. Diabetes diagnoses have been increasing over the passed years. What do you think about that? I think the FDA does a poor job of policing our food supply. If one is diagnosed with diabetes, what medical problems can develop? It can absolutely affect your body. Symptoms include: vascular disease, losing vision, higher chances of heart attack and/or stroke, foot amputation, to name a few. Does exercising help regulate diabetes symptoms? If so, what are the best exercises? Yes, exercise definitely helps. There are no prescriptions that any physician can give that will do as good to your body as regular exercising will do. Before a diabetes patient starts any exercise regimen, though, they should follow up with their primary care physician to evaluate if they can tolerate a strenuous exercise. Especially if they haven’t exercised in a while. What does MCCI do to advise your patients of prevention of diabetes? We currently have a program for diabetes that includes diabetic teaching classes from our nurses. These classes explain why medications are taken at certain times, side affects associated with medications, dangers
We also offer diabetic cooking classes to improve lifestyles- something that is not done nation wide. Most offices do not have the ability to do that. We have a fully functional kitchen in addition to our specialists that come in and show you some diabetes-friendly cooking. We also provide free transportation for their medical visits.
MCCI Medical Centers in Jacksonville
Fundamentally, we advise exercise, a healthy lifestyle and proper medical care to help patients prevent getting diabetes. What do you find about MCCI as a medical corporation and its medical care motto how is it different from other medical groups around Florida to your knowledge? It is more of a patient centered approach. It takes in every aspect of a patient’s life that might be affected. We provide in-patient nurses that follow them. We provide telephonic case managers. We have nurses go out to the home as well as home visit doctors if necessary. Our motto focuses on prevention and, although our centers are very large with a lot of patient traffic, we strive to have each patient feel and know that they are most important.
11744 Beach Blvd, Jacksonville, FL 32216
4496211 US Highway 301, Ste 110, Callahan, FL 32011
3450 Dunn Ave, Ste 210, Jacksonville, FL 32218
5238-16 Norwood Ave, Jacksonville, FL 32208
A lot of medical organizations mandate what medications doctors can and can’t use. The 10 years I have been here they have never told me what medications to use. Whatever is necessary for the patient is what is needed.
MCCI Provides All the Medical Services You Need Under One Roof. Primary Care Physicians Lab Drawing Stations Transportation
Normandy 8225 Normandy Blvd Jacksonville, FL 32221
Group Wellness & Education Programs Convenient Locations
Entrepreneurs Anchor Magazine | entrepreneursanchor.com • 27
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28 â€˘ Entrepreneurs Anchor Magazine | entrepreneursanchor.com
Hands on Healing by Edna Wade
Every year, large and small companies spend thousands of dollars providing medical health coverage to their employees. However, many of their employee health issues—particularly neuromuscular, postural and some skeletal ailments—could be averted by making sometimes simple changes to the physical work environment, such as adjusting a worker’s desk and chair height, realigning the position of the computer monitor, utilizing more ergonomically friendly equipment, etc. A large percentage of work-related health issues are caused by repetitive motion injuries (RMI). Surprise, surprise: medical science has discovered over the past few decades that we humans were not designed to sit in chairs all day, glued to our PC/workstations, spending hours upon hours typing, texting, using a mouse or track ball, and executing other modern office environment tasks. Even seemingly benign actions such as holding a phone receiver between one’s ear and shoulder can, over time, cause neuromuscular problems. Particularly if one isn’t using well-designed equipment and/or employing proper ergonomics on a regular basis, RMIs are almost bound to occur.
other activities they may be engaged in (exercise, playing a musical instrument, etc.). Many people are under the impression that deep, specific bodywork can be painful; as it’s different than a pleasant, relaxing and often less invasive, Swedish massage. Trained neuromuscular therapists don’t ascribe to the motto, “more pain more gain.” Their work is largely based on physiological laws, among them, the Arndt Shultz Law that states, “… weak stimuli activate physiological processes; strong stimuli inhibit them.” In other words, if too much pressure is applied on an already over-stimulated tight muscle, doing so will inhibit the muscle’s ability to release and relax. Furthermore, excessive pressure can cause more intense pain for the patient, to which s/he reacts with even more tension and resistance. Not an ideal scenario. A very common, but often debilitating work-related injury is Carpal Tunnel Syndrome (CTS). This condition can painfully affect the neck, arm, and wrist; with extremely uncomfortable pain, tingling and numbness in the hand and consequently, loss of functionality. If CTS is left untreated, or even worse, if treated incorrectly, it can easily lead to an employee requiring surgery in an attempt to fix the lingering, debilitating condition. Along with surgery, of course, is time off from work; usually four to eight weeks of recovery. And, often after surgery the patient requires several weeks of physical therapy, which can also interfere with one’s work schedule. For obvious reasons, treating this all-too-common modern workplace malady with non-invasive modalities is preferable to the alternative, “going under the knife” procedure.
Neuromuscular massage therapists focus on treating sports and post-traumatic injuries soft tissue (traffic accidents, falls, etc.), and also specialize in treating work-related injuries, including vexatious RMIs. They regularly and successfully treat people who are suffering with both new and/or chronic pain issues that accrued over time from their place of work or from Entrepreneurs Anchor Magazine | entrepreneursanchor.com • 29
Well-trained neuromuscular massage therapists focus on the structure of the entire body; their philosophy is to identify the cause of the problem, not to just treat the symptoms. There are over 600 muscles in the human body; all of them have different functions to perform. For example, one set of muscles and tendons contracts the fingers, another set extends the fingers. The muscle belly forms into a tendon that attaches to the bone. When a particular muscle contracts, it can potentially realign the bone from its original position. In turn, this creates postural distortion and perhaps nerve entrapment. This starts a continuous decline and change to one’s skeletal structure, which can lead to an ongoing progression of joint (and even disc deterioration when talking about spinal imbalances), thus causing pain and loss of function. Especially regarding CTS, there are several muscles in the upper body and neck, which, when held in a compromised or non-ergonomic position over a period of time, can become contracted. This causes the trigger point within the muscle to develop to an active state. When it occurs, these particular muscles begin to fire from within the neck and upper torso, causing the classic CTS sensations of tingling and numbness in the arms, wrists and hands. A group of muscles known as the scalenes, which emerge from the lateral or side of the neck from the skull, and traverse down underneath the collarbone and then attach to the first and second rib bones, are huge players in this increasingly growing modern malady. The scalene group consists of three separate muscles that also surround the brachial plexus, the main nerve supply to the arm, which begins in the lateral side of the neck and weaves its way through the scalene muscles, finally emerging under the collarbone alongside the scalenes and courses down in to the arm, wrist and hand. Many who have been diagnosed with CTS respond remarkably well after skilled neuromuscular treatment is applied specifically to the scalene muscle group, as well as receiving more localized bodywork in their upper extremities. Oftentimes, continuous soft tissue therapy can completely arrest the symptoms, or at the very least, reduce the level of discomfort to make the condition much easier to tolerate. Properly applied neuromuscular massage can postpone or even eliminate the need for surgery. Usually, in addition to receiving successful neuromuscular treatment, the patient/worker will need to be educated about correct workstation posture, proper office ergonomics, efficient motion, the importance of periodic stretching, taking rest breaks, etc. To reach the point of an official diagnosis of CTS, an individual has usually been suffering for a while. One does not wake up one morning and suddenly experience this debilitating condition. It devolves over time. For example, let’s take Suzi Q. Ms. Q obtained an
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administrative position that required her to be sitting at a computer for most of the work day. Everything was fine the first year, but eventually she noticed she was frequently experiencing headaches towards the end of her shift. A few months later, the headaches increased and then Ms. Q began to experience a noticeable degree of discomfort and stiffness in her neck. It increasingly became more difficult for Ms. Q to function at work and accomplish all her responsibilities in a timely, efficient manner. Of course this situation now caused a great deal of psychological stress to Ms. Q, which only added to the intensity of the pain she was already experiencing. However, Ms. Q continued to carry on, doing the best she could, until a few weeks later she started to notice a numbing, tingling sensation running down her arms into her hands. She became really concerned and scheduled a doctor’s appointment. Of course, this necessitated her having to take time off work to make her appointment. Her physician prescribed physical therapy for Ms. Q for three times a week. So far, Ms. Q’s employer had been very understanding of her taking time off; after all, as a good leader who empowers her employees, she wanted to see Ms. Q healthy and productive again. After four weeks of physical therapy, Ms. Q noticed a little improvement in her condition, but it was still not enough for her to have a pain-free day. Back at the office, Ms. Q’s employer was beginning to see a trend developing: she had six employees complaining about the same type of symptoms and pain that Ms. Q had been experiencing. The boss saw a definite decline in overall productivity due to health-related issues and began to do some research on the issue. She happened to see an article on workplace ergonomics and, over the weekend, decided to go to the office and implement some of the recommendations and suggestions the article outlined. When the employees returned on Monday morning, they were surprised to see new desks and chairs, the monitors had been rewired so that they could be viewed straight on, without any tilting of one’s neck and upper body. After the employees were properly fitted at their ergonomically correct workstations, the work day proceeded. At the end of the day, all were elated with the way they felt—much less pain! Today, more companies are discovering the benefits of their workforce having properly functioning, ergonomically designed workstations, as well as the therapeutic advantages of intelligently applied structural bodywork. Combing the two can make an incredible difference in the health, well-being and productivity of their employees, which in turn, positively affects any firms’ bottom line.
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Here’s something to wag your tail about: a family started charity organization that is making miracles happen for wounded veterans around the country. K9s For Warriors is a small organization nestled in picturesque Ponte Vedra Beach, Florida. It is making a huge difference in the lives of our veterans who are suffering from Post Traumatic Stress Disorder, commonly known as PTSD. Its unique program is profoundly helping those who volunteered to fight for our country and protect our preciously held freedoms, especially during the prolonged and difficult engagements in Iraq and Afghanistan. This small-staffed, nonprofit organization in PVB has set for itself a big mission: to help our wounded American warriors return to civilian life with the dignity and independence he or she deserves. Since 9/11 and as the result of our nation’s conflicts in Iraq and Afghanistan, there are now over 500,000 disabled military warriors (men and women). One in five suffers from PTSD, an invisible but potentially destructive psychological wound from war; it’s especially prevalent in those who re-enlisted to serve in multiple missions in the various combat theaters abroad.
sometimes it’s commonplace, everyday, even seemingly benign events that can trigger these negative feelings over and over again. You never get to rest or feel at ease. And if or when you do sleep, often aided by a lot of medication, our haunting nightmares return again and again.” These complex symptoms often lead our combat veterans to further isolate themselves, withdrawing from public life. Perhaps the saddest PTSD statistic of all: One in six soldiers returning home from combat attempts or commits suicide. And especially given their knowledge of firearms, they often succeed. Front Lines of Defense However, there is hope for men and women combatants suffering from PTSD from a variety of demonstrated resources, even when medications and traditional psychotherapy fail. For example, Transcendental Meditation has proven effective . Yet, there’s an even warmer, fuzzier and highly documented method of treatment success: the use of service canines as a medically proven recovery aid for our suffering warriors.
K9s For Warriors provides a service canine, its veterinarian care; specialized training, certification,
Hence the creation of K9s For Warriors Academy, founded in 2011 by Shari and Bob Duval (Bob is a retired professional golfer). Their son, a veteran K9 police officer, had worked as a contractor for the Department of the Army as a bomb dog handler and served two tours in Iraq. Returning home with PTSD affected the Duval family in many distressful ways. “So after two years of research on canine assistance for PTSD,” explains Shari, “we decided the best way we could help these deserving combat veterans was to start a nonprofit organization to specifically train and provide special service canines to assist our warriors to return to their civilian lives feeling and being healthier, with dignity and independence. It is our hope and prayer that we can help as many wounded warriors with the assistance of, what we like to call, ‘a forever partner.’” The Duval’s original goal was to assist 12 wounded warriors their opening year; but they actually exceeded, training and graduating 28 combat veterans and their respective new service dogs, which the veterans have affectionately deemed as their “battle buddies.”
equipment, most meals, and housing—free of charge to soldiers.
What is PTSD? The distressing symptoms and injurious consequences of PTSD are numerous. There are some that manifest physically; but most are detrimental mental changes, including, but not limited to: hyper-vigilance, hostility, aggression, depression, paranoia, acrophobia, delusional thinking, recurring nightmares, panic attacks, poor coping skills, memory loss, and lack of trust. PTSD affects not only these gallant warriors who bravely served our country but concurrently, their families, personal relationships, in the workplace, and society-at-large.
Sophisticated brain imaging studies have definitively proven there are actual physical changes that occurred in specific areas of veterans’ brains, particularly in the hippocampus and prefrontal cortex, caused by the horrific war experiences these warriors now suffer from. One former soldier described it aptly. “You know the feeling you get when you’re almost in a car crash? Your heart races, your adrenaline glands fire on overload, you’re hyper-alert. Most people recover from these psychological and physiological effects in seconds. However, soldiers suffering from PTSD do not or cannot. We feel this way many times each day. Even worse,
Service canines are considered legitimate medical equipment, recognized by the U. S. Department of Justice Civil Rights Division, and the American Disability Act (ADA) of 1990. A “service dog” is defined and protected by law as a dog that is individually trained to
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perform tasks to mitigate the disability of its owner. A service dog requires a great deal of specialized training, is considered an assistive device by the ADA, and is permitted to accompany its disabled owner anywhere the public is permitted. Service dogs fall under the broader category of Assistance Dogs, which also includes Guide Dogs for the Blind, and Hearing Dogs for the Deaf. The Veteran’s Administration is currently investigating whether it should provide specific funding or projects such as K9s For Warriors. Currently it does not. The sad reality today is that currently, there is no governmental fiduciary assistance provided to such programs as the Duval’s K9s For Warriors. To date, they’ve relied upon kind-hearted corporate and private donations. It costs approximately $10,000 to train and provide each wounded warrior with his or her service canine. Funds provided entirely by K9s For Warriors are imperative for: • Veterinarian care for the service dogs •
retired veterans,” explains Shari. “If or when a dog is no longer fit for service duty, K9s For Warriors trains and provides our previous graduate warrior with another trained service dog. This includes additional visits to our academy for the combat soldier to train and work directly with their new service canine.” The good news, Shari points out, is that sometimes, PTSD “becomes more manageable” over time. “Therefore the soldier no longer needs a service dog. Unfortunately, some soldiers’ post-combat neurophysiological condition remains a life-long affliction. So these veterans will need
Initial training of the dogs
• Dog chews, toys, treats (especially peanut butter), dog beds, carrying crates • Grooming supplies (shampoo, conditioner, brushes, nail clippers, etc.) • Travel, evaluation and personal acquisition of potential service dogs • The dogs’ equipment (special hands-free leashes, martingale collars, service vests, collapsible water bowls) • 120 hours of individual training for each wounded warrior and his/her service dog • Room and board for three to four wounded warriors each month while they’re in training in PVB • $600 to $1,000 for meals for the injured warriors while in they’re in training, on-campus • Laundry costs and acquisition of bedding, blankets, pillows, etc., for the combat veterans while in training • Utility costs for the dormitory house where the wounded warriors live for three weeks and kennel upkeep for the service dogs •
General maintenance for the training facility
• Marketing expenses, staff salaries, general office supplies, etc. Presently, K9s For Warriors assumes all of the above expenses (and then some). Of every dollar that is donated to the organization, 83.25% goes directly in to its core training program. The remaining percentage goes to staffs’ salaries, office expenses, postage, marketing materials, fundraising, special events, etc. “K9s For Warriors serves both active duty troops and
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service dogs for the rest of their lives. If that’s the case, a particular soldier may end up needing two to four, or even conceivably more, specially trained service dogs, throughout their lifetime,” explains Shari. “It is entirely possible a veteran may have to return to our academy several times throughout their lives to retrain with a new dog.” Of course, there will be similar costs accrued if this is the case, putting additional financial burdens on K9s For Warriors. Building a Hand-to-Paw Relationship K9s For Warriors philosophy and methodology is to actively involve the soldier in the final training phases with their new service canine partner, allowing them the opportunity to be part of the solution to their own recovery—working directly with their service-canineto-be. K9s For Warriors’ Academy is staffed by skilled, certified canine handlers and teachers who train the
canines prior to the warriors’ arrival. Once the soldier arrives, more specific training methods, individualized for each warrior’s condition and his or her specifically chosen service dog, are designed and instigated. K9s For Warriors obtains its dogs from rescue organizations and private donors. Ninety-five percent of the canines used in the K9s For Warriors’ program come from rescue shelters. Through real-life experience, the program has learned that Labrador and Golden Retrievers, both pure and mixed breeds, generally have the best temperament and ability to please their veteran owners for PTSD service dog work. A special mixed
breed, “Labradoodles,” are sometimes required when a veteran—or perhaps one of their family members— have allergies to certain breeds of dogs. That’s because Labradoodles are specifically bred to be hypoallergenic, and are of appropriate size for service dog work. Each training course is three weeks long, where warriors suffering from PTSD come from around the country to PVB to train at the academy to learn the specific skills needed to finish the training of their very own service dogs. K9s For Warriors provides a service canine, its veterinarian care, and necessary supplies; as well as the specialized training, certification, equipment, most meals, and housing—free of charge to the soldiers. Classes are limited to three to four warriors per each training session per month. During an average year, K9s For Warriors ends up training about 40 soldiers and his or her respective service dog.
Each soldier is responsible for his or her own transportation costs to and back home from the facility in St. Johns County. In some instances, particularly with a wounded Marine, The Semper Fi Fund (a private, nonprofit, organization; not an official military unit), pays for the Marine’s travel costs from all around the U.S., including as far away as Hawaii. Partners in Prevention At K9s For Warriors, its service dogs are trained to perform work or tasks to alleviate the symptoms of PTSD and help afflicted warriors return to a normal civilian life, gain independence, and ideally are able to return to the workplace as a contributing employee. Whereas a “normal” pet may be able to tell if its warrior is in distress, a service dog is trained to become aware of and respond to its owner’s anguish by performing specific tasks to alleviate or lessen his or her symptoms. The dogs are trained to “block” a command, which places the dog between their warrior and the public, giving the soldiers the space they need to feel comfortable in crowds. They are trained to “cover” a command in which the dog will face backwards, literally covering the warriors’ backs, allowing them to stand in a line at a bank, or visit an ATM, without worrying if someone will come up behind them without warning. Amazingly, these highly trained service canines can also sense when a warrior is about to have a panic attack and will actively respond to and with their warrior, helping alleviating the attack before it can take place or reducing its severity or length. Examples include: licking, pawing or bringing a toy to help break a disturbing episode or panic attack; performing a sit/stay facing away from the warrior to “watch their back”; blocking an unwanted person from advancing too close by performing a stand/stay sideways in front of the warrior; forging ahead around a corner in front of the warrior; reminding the warrior to take his or her medicine; safety checking a room before the warrior enters; or nudging the warrior awake if they’re thrashing due to a disturbing nightmare. Each warrior exhibits PTSD symptoms differently, so his or her service dog is specifically trained to respond to his or her owner’s individual disabilities and/or triggers. This unique bond forged between the warrior and his or her service dog becomes as strong as an aircraft carrier, since the returning warrior and his or her dog are together 24/7, 365 days a year. Medical Mystics? Two of the service dogs that graduated from the K9s For Warriors program were able to sense on-coming seizures in their respective warriors, and alerted them before they began. Another dog, Sierra, a beautiful Golden Retriever and former shelter dog, remarkably saved her warrior companion’s life. Sierra and her wounded warrior came home from his job one afternoon. He wasn’t feeling well and just wanted to lie down and go to sleep. But Sierra protested; she acted agitated, was restless and would not let him rest. So he walked her
Entrepreneurs Anchor Magazine | entrepreneursanchor.com • 35
around the neighborhood, but upon re-entering their abode, she still wouldn’t let him settle down. The warrior started to get annoyed with her, but in a flash of insight, he remembered a key phrase that was emphasized during his training at K9s For Warriors, “always listen to your dog.” He called his girlfriend and told her what was happening. So she came over and drove him to the hospital. Two hours later he was in emergency surgery. He was suffering from a blood clot in one of his cardiac arteries and was experiencing the precursor symptoms of a heart attack but didn’t realize it. That’s why Sierra was behaving so anxiously—she sensed something was, in fact, physiologically wrong with her owner. After his life-saving surgery, the hospital staff allowed Sierra to reunite with him in the recovery room. When the hospital staff proceeded to hook up all the requisite monitors, electrodes and cables to him, he simply told them, “There’s no need. Sierra is here. She’ll let you know if I need you.”
“Our warriors fought for our tomorrows, we are fighting for theirs.”— Shari Duval, President and Co-Founder, K9s For Warriors A Happy Tail of Success Service dogs can and do heal our warriors in so many ways. That is the message of hope that Shari and Bob want people to know. “We have seen amazing results with our program, which continually motivates us to expand it, so that we can help as many combat soldiers suffering from PTSD as possible,” Shari emphasizes. “Our warriors fought for our tomorrows, we are fighting for theirs. Many of our soldiers return from the wars physically and/or psychologically broken, they arrive at our training campus on two legs. They’re hurting and are in real need of help. Three weeks later, they leave our facility ‘with six legs,’ with their very own service canine, back on the path to recovery, returning home and in to the arms of their loved ones more healed and whole. And hopefully moving onwards towards a productive life again, which may include going on to college and/or obtaining a job,” says Shari.
If you have questions regarding real estate, Have no fear Mary is HERE !
Call me for confidential and personalized assistance if you need a Realtor to: Discuss First Time Homebuyers Programs Sell your home as a short sale Relocate, downsize or up-grade
Mary McPherson, Realtor® Tel: 904– 228-9047
4194 San Juan Avenue Jacksonville, FL 32210 Email: MaryMcPherson@ WatsonRealtyCorp.com Website: www.MaryMcPherson.WatsonRealtyCorp.com
To learn more about K9s For Warriors, visit www. K9sForWarriors.org or “Like” on Facebook.
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How Health Care Information Technology Will Affect Small Businesses By Dr. Michael R. Jones and Abigail Slentz
The cost of employee health care insurance has long been a challenge for all employers, particularly for smaller businesses and those just starting up. Fortunately, advances in health care information technology hold the promise of better health care results and better control of health care costs. Current Issues The Patient Protection and Affordable Care Act shone a political spotlight on health care. But the issues have been with us for decades. Discoveries in medical science and other technology-based disciplines have brought the world many lifesaving breakthroughs that have saved millions of lives, and enabled millions of others to live productive lives. Fifty years ago, most of these advances would have not only been impossible, but also unimaginable. These medical miracles did not come cheap, however. The cost of health care technology and delivery has risen faster than almost any other sector of the U.S.â€™s national economy.
our economy relies upon. It was a difficult enough proposition when competition was only domestic, but now that U.S. small businesses have to compete in the global marketplace, the implications of any significant cost increases must be considered in a broader, world view. Small business employers encounter health care insurance expenses much differently than large corporations and governments. Smaller-sized firms do not have the same ability to leverage their size to get the best health care insurance rates. While they can rely on competitive vendors to supply their offices, buildings, vehicles and equipment, the entrepreneurs and startups find that there is little ability to negotiate lower
Now, the same medical technology that brought the breakthroughs between life and death, or infirmity and activity, is helping the health care industry provide additional benefits derived from information technology and data management. This ability resides in the hands of IT professionals, in cooperation with doctors and nurses, and it will help all those who rely on health care servicesâ€”which, of course, means most of the working population. Our social and economic model of financing health care through insurance benefits provided by employers was not preordained. It arose only in the last 75 years. Today, employer health care insurance, along with Medicare, Medicaid and other government-led initiatives, provide the framework for financing the U.S. medical system. The health care insurance provided by large employers covers their employees and oftentimes the families of their workforce. Millions of employees, though, rely on small businesses, startup enterprises, and entrepreneurs. The burden of employer-provided health care insurance weighs heavily on these organizations. It is not only a problem for these businesses; it is also a problem for workers and job-seekers because these are generally the very organizations that provide the new jobs, which
costs in health care insurance for its employees. Health insurance, then, frequently becomes a big cost for small businesses, and one they cannot control. In addition Entrepreneurs Anchor Magazine | entrepreneursanchor.com â€˘ 37
to cost, of course, companies with fewer employees are more vulnerable to the impact that is felt when key worker become unavailable for an extended period due to accidents or health-related issues. For these reasons, health care results and costs are more important to small businesses, start-ups, and entrepreneurs than to any other group served by the health care marketplace. Health care issues can be a problem for every organization, but they can easily become a critical care issue for smaller-sized businesses. Health Care Information Technology Health Care Information Technology (HIT) addresses the issues that affect small employers to improve health care results, and to better control health care costs. From the clinical perspective, the key benefit of electronic medical records (EMR) is for the right electronic information to be presented at the right time to the right people. This can be done through advanced reporting, evidence-based medicine, and electronic ordering, often referred to as Computerized Physician Order Entry (CPOE). EMRs permit doctors and hospitals to share critical clinical data among providers that deliver patient care for a specific population. Reports can be generated to find non-patient specific data for statistical purposes, such as the median age for the onset of diabetes, or percentage of patients over age 70 diagnosed with dementia. As a result, medical providers know better what to look for when treating patients. The direct advantage to the small business owner is there an increased likelihood the correct medical intervention will result in their employee getting well and is better able return to work sooner. This also allows health care insurers to better predict the cost of providing insurance. In turn, enhanced cost information, enables more competition among health care providers, leading to lower health care insurance costs for employers. The incorporation of evidence-based medicine within EMRs is another way the health care landscape is changing. Many medical professional associations, including primary and specialty care providers, have diagnostic treatment protocols based on research. Among these professional associations are the American College of Endocrinology, American Academy of Pediatrics, and American College of Surgeons. Recommendations can be integrated in to the clinical systems that can guide providers on what these professional associations advocate for certain diagnoses when creating a treatment plan and determining a prognosis. These IT changes enable shared data among physicians as well as hospitals, which makes it possible to share data regionally and eventually nationally. This Health Information Exchange (HIE) will reduce costs of health care by not having duplicate tests performed, having more accurate and detailed patient history, and allowing associated providers and/or specialists to have immediate access to invaluable patient records.
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The Positive Effect on Small Business Employers Health care IT also improves real-time interaction between patients and their providers via an online portal. Patient portals permit real-time appointment scheduling, non-complex consultation with physicians’ offices, and prescription refill management. EMRs, in conjunction with patient portals, allow for health visit sharing such as laboratory and image results. This creates the opportunity for patients to have access to portions of their own records, subject to some restrictions arising out of HIPAA and other legislation and regulation. These communication tools benefit time management and allow employees to perform administrative functions that don’t require often time-consuming, face-to-face interactions with patients or their family members. Now, these can be accessed via the web or even from smartphones/ devices either from the comfort of their own home, or while on break at the workplace. This also means that communication and scheduling can occur outside of business hours, affording patients the ability to not have to take time away from their work schedules to contact their providers for appointments, test results, and referrals. An emerging benefit is the ability to use blinded (anonymous) health data of their employees, where small business can assess their employee’s health outcomes and quality measures. Again, these are subject to some privacy restrictions, but they are not insurmountable. This type of data may help small business owners find ways to facilitate their employees to embrace and practice healthier lifestyles. Additionally, EMRs permit the employers to review blinded employee statistics to assess overall employee wellness and health status within the limitations of HIPAA privacy laws. Businesses can then partner with health coach professionals to review healthier lifestyles with their employees. This may include lifestyle coaching such as proper workstation ergonomics, instigating an exercise program, dietician consultation and stress reduction. One of the greatest assets of any small business is its employees. Having a greater number of healthy employees covered by a company’s health insurance plan has proven to reduce the cost of that small business’ health insurance premiums. This helps the productivity and hence, the bottom line of any business. Finally, and very significantly, health care IT can help close the gap that exists between the small business employers and the large corporations and government entities. The economies of scale and the pricing leverage enjoyed by big employers will still be there, but now smaller employers will have greater access and can benefit from them as well.
KNOW By: Darrell Locket
The Benefits of Regular Exercise to Relieve Work Related Stress Did you know On-the-job stress can contribute to shifts in corporate structure, stall company growth, even large projects and the daily competitiveness within a company? Did you know Physical threats such as carpal tunnel syndrome, fatigue, the common cold and other illnesses can be easily contracted in your work environment? Did you know research has shown that regular exercise such as cardiovascular conditioning and weight training performed at less 3 times per week an hour before or after work will decrease work related stress levels, absenteeism, and back problems while decreasing health care costs?
Things to know Regular exercise improves overall health while decrease work related stress in the following ways: •
Helps control bodyweight
Helps build and maintain healthy bones, muscles, and joints
elps reduce blood pressure in people who H already have high blood pressure
elps older people become stronger and better H able to move about without falling
educes the risk of developing diabetes/helps R control blood glucose
Reduces the risk of dying prematurely
Reduces the risk of developing colon cancer
Promotes psychological well-being
Enhanced productivity and greater appreciation
mproved health care costs
Decreased illness, injuries and absenteeism
Increased stamina and decrease stress levels
Increased well-being, self-image, and selfesteem
I ncreased employee retention and improved employee morale
I ncrease in problem-solving aptitude and heightened morale
Reduce headaches, back strain and fatigue
Decline in turnover rates
It's clear to see why the leading Fortune 500 companies offer gym memberships as part of their employee benefit program. Regular exercise has been shown time and again to alleviate work-related stress and build immunity against many illnesses, and companies that offer gym membership benefits to their employees not only have happier employees but healthier employees who feel appreciated, and in turn excel in their jobs.
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by John Perry Nowadays every business knows that having some form of anti-virus protection in the office is a must. It can be the first line of defense when protecting your staff against cyber-attacks like data theft, malicious intent or down-time. The reality is that anti-virus software should be considered the first line of defense only. While this is necessary, offices can still fall victim to other security threats that sometimes pass under the radar. Hackers and other malicious technologies’ goal is to either steal your data or bring your systems to a stop. Your goal is to protect that data, which can include valuable intellectual property, and to prevent down-time. Desktop Protection the Smart Way If your office has more than two computers, chances are you will want a smarter way to manage your desktop security. Imagine going to each computer, every day, and/or every time a new security threat is discovered, and manually updating your anti-virus programs on each PC. You probably don’t have the time, or the patience. Off-tasking this to your IT Manager will also just slow him/her down or take him/her away from more important business-critical functions. Using centrally managed anti-virus solutions can cut out all the manual labor involved in managing your desktop security. Since everything is managed from one centralized system, you can easily update all your office’s PCs and instantly contain threats inside any of your office locations. Your Network Should Have Eyes and Ears Security threats can still infiltrate your computer and office networks in the presence of anti-virus software and become embedded into your systems, without being detected. Don’t just think about desktops. Think about your network and any other device that transmits sensitive company information such as scanners, copiers or servers. Your desktops may function fine, but security threats have evolved to the point where they can reside outside your desktops at the front or end point of your networks, sending or transmitting your desktops’ information to would be data thieves without ever touching it.
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Not all office Internet routers are made the same. Some routers just provide your office Internet access with no additional protection. Using smart devices like firewalls means your network can monitor itself for common security intrusions from the inside and out. The firewall’s main job is to allow or block traffic coming in or out. This means you can control what data comes and goes, at what times, and to where. Firewalls can also give you comprehensive reports including where your data is going, what systems are being accessed, and usage statistics. The Human Element Human error also accounts for the majority of security threats. The most commonly made mistakes are by staff inserting USB or CD media into the computer or network systems, or by downloading risky software from completely legitimate websites that don’t know that they have been compromised. USB and CD access on computer and server systems can be the easiest access point to your networks. Consider locking these features down or implementing a server-based environment where you can control what files, folders and computers your staff have access to. Let’s face it: your finance department may need access to your sales teams’ data, but not the other way around. Disgruntled employees who have access to sensitive information can put the company in to a tailspin, by either stealing or deleting important data. All the while, you’ve put a lot of time and energy towards safeguarding against cyber-attacks from the outside. Sometimes, little effort is sometimes placed on defining company policies and procedures on how to regulate employees’ access to sensitive information. These policies and procedures are sometimes non-existent in some companies. Your priority should be to dictate who has access to what and why.
HaveeasyaccesstoEntrepreneursAnchor Encryption Isn’t Just For Spies Even if you have budget constraints (and who doesn’t?), when it comes to securing your office desktops, server and networks, the good news is data and software encryption is probably available in your office. Even if you don’t have encryption options there are many free options out there. Encryption helps protect your data and prevents anyone other than yourself from reading it. Only you or those you trust would have access to this data by way of a secure encryption key. Vendors and Consultants Outside vendors and even internal staff such as data base administrators, Helpdesk or web masters would have clearance to your business information. When it comes to dealing with this kind of scenario, make it a point to research these companies or individuals’ track records and references. If your business is subject to strict compliance regulations then you don’t want an additional liability. Include in your vendor, consultant and employee contracts the appropriate legal clauses that hold these people liable and legally responsible for any mismanagement of the company’s intellectual property or data. You can also train your staff on these policies and how to handle security situations when they occur. Industry Compliance Legal requirements that conform to your industry are one of the biggest challenges for any office. Translating that into internal technology compliance is even more challenging. Governing regulations such as Sarbanes-Oxley, Graham-Leach, ITIL, HIPAA, etc., provide general security guidelines and recommendations for your office desktop security.
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Trust but Verify Monitoring your employees’ computer habits also protects your business. By collecting security logs that will document computer logins and times, web traffic usage and downloads, you’ll know exactly what is going on when a red flag is raised. Make sure you or a designated security manager are the only ones who have access to these security logs and make it a point to review the logs periodically. Desktop security is not just about having the right kind of anti-virus software, but making sure all aspects of your data are protected. Protecting your Intellectual property and customer data can also mean the difference between keeping your doors open, or a lengthy and expensive lawsuit.
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By Judith Rodriquez, Ph.D., R.D. According to the U.S. Department of Labor, the Bureau of Labor Statistics, “Dietitians and nutritionists are experts in food and nutrition. They advise people on what to eat in order to lead a healthy lifestyle or achieve a specific health-related goal.” For the remainder of this decade, jobs for dietitians are projected to grow about 20 percent, which is faster than average, according to the Bureau of Labor Statistics. Given the global challenges we currently face of rising obesity rates as well as malnutrition (seemingly a paradox, but the two are related—one only need take a look at a “Happy Meal” to understand why), career opportunities in nutrition and dietetics should increase in both popularity and demand. Traditional major categories of practice in nutrition and dietetics are found in clinical, food systems, public health, education and research. However, over the past few decades, several areas of practice have been emerging that promise to be ideal opportunities for nutritional entrepreneurs.
Career opportunities in nutrition and dietetics are bound to increase in both popularity and
The Educational Route A traditional educational route for a Registered Dietitian is completion of a baccalaureate level, accredited didactic program (commonly referred to as a B.S./D.P.D.), then an accredited, supervised practice program (commonly referred to as an internship), and passing of the National Registration Exam. This qualifies the individual to be a Registered Dietitian (R.D.). This credential is important in that for many of the states where the practice is licensed, the R.D. is an entry credential for eligibility for a license. For those who go on to pursue higher degrees such as masters or doctorates, teaching opportunities in collegiate institutions becomes a greater option.
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Entrepreneurial Opportunities Cultural Brokers The increasingly multicultural U.S. population, the continued popularity of cultural foods, and globalization of food habits, has caused a demand for experts on cultural food practices. As a result, some R.D.s have become entrepreneurs by creating consulting practices as nutrition and cultural brokers. A leader in this area is Hebni Consultants, which emphasizes working with culturally diverse populations. Hebni Consultants is known for its Soul Food Pyramid and has a business that includes a Nutrition Resource Center where classes are provided. Malena Perdomo, “The Latin Voice of Nutrition,” is a consultant who specializes in serving the Latino population for a variety of companies, including serving as narrator for Spanish eLearning courses for inTEAM. Lauren Swann has also bridged several of these categories as a cultural specialist who has become an expert in food labeling, marketing and communications. Food Systems and Industry Consultants Some nutritional entrepreneurs serve as consultants to industry, trade associations or products. This may include quick-service or sit-down restaurants; trade associations for dairy, beef, pork, fruits and vegetables, nuts, along with many other products. Nutritionist may assist with the development of educational materials, serving on committees and policy panels, conducting presentations to target populations such as health professionals, and a providing a variety of other services. Life Span Consultants Life span consultants offer services and specialize in nutritional care for older adults through the dissemination of information, education and resources. Becky Dorner, a pioneer in the consulting area, owns two companies related to nutritional care for older adults. One employs R.D.s and Dietetic Technicians Registered (D.T.R.s) to provide nutritional expertise in health care facilities and communities, while the other is a continuing education/ publication business. On the opposite side of the age spectrum, the increased prevalence of overweight children has provided opportunities for nutritional
entrepreneurs to work with parents and caregivers. This may involve direct counseling, creation of educational materials, menu development for childcare centers and schools, and an array of other services. Management Specialists Some R.D. entrepreneurs have started management, consulting and clinical service companies, and have well-established, financially successful companies that subcontract or hire other R.D.s. Nutritious Lifestyles offers “nutrition and food service consulting and educational services to healthcare companies, hospitals, skilled nursing centers, assisted living facilities and developmental centers throughout the Southeast.” Erica M. Weitz of Nutritious Lifestyles states she became an entrepreneur for the “flexibility, ability to be creative, and the power to make the R.D. a true professional.” Some entrepreneurs, such as Lucille Beseler, have started their own nutrition clinics. In 1991, Beseler founded the Family Nutrition Center of South Florida, a comprehensive practice providing in-office consultations that focus on the nutritional health of families and children. It is one of three companies she now owns. Her Family Nutrition Communications firm is an event staffing company that specializes in health- and nutrition- related events. Nutrition and Physical Activity or Sports Consultants Nancy Clark, R.D., was a leader and entrepreneur in the area of nutrition and physical activity. Newer entrepreneurs have taken this specialization a step further, opening up their own studios and fitness facilities. Jim White, who has a Fitness & Nutrition Studio in Virginia, has created a successful career combining nutrition and physical fitness. Retail Industry Consultants Entrepreneurial R.D.s work in supermarkets or large retail outlets in a variety of consulting capacities. This may involve developing promotional materials, conducting shopping tours, analyzing menus for calorie or nutriental content, and other services. Some eventually create fulltime consulting positions or go on to become full-time employees for the actual companies. Social Media and Media Specialists Some R.D.s specialize in communicating with blogs, tweets, and a variety of other social media mechanisms. Carolyn O’Neill was one of the first R.D.s to have a regular segment on TV and Kathleen Zelman was of the first R.D.s to have a presence online at WebMD.com. David Grotto, Marie Spano, Cheryl Forberg and many other R.D.s regularly tweet an array of messages, tips and updates that support their private practices, and serve as marketing instruments for their consulting nutrition services. Susan Mitchell, R.D., helps food companies, PR firms and the media communicate nutrition messages to the public.
This decade jobs for dietitians are projected to grow about 20%. The entrepreneurial opportunities in nutrition and dietetics are only limited by our imaginations. However, as with any entrepreneurial venture, one has to know the business, the opportunities and the potential pitfalls. It requires a calculated risk-taker who is strategic, a careful planner, tenacious and persistent. According to Dr. Susan Mitchell, R.D., the advantage is that she can “drive the direction of (her) career and business and make the final decisions on business branding and strategy.” On the negative side, she must “network constantly and always be thinking about the next business opportunity.” Wellness Coaches and Corporate Wellness Consultants Coaching and motivational interviewing have become increasingly important skills for counseling and behavior change strategies. Entrepreneurial practitioners are incorporating these skills in their private counseling and wellness initiatives. This may also take the form of corporate wellness promotion through small group education, lunchtime seminars and individual counseling. Nutrition Entrepreneurs Practice Group The Academy of Nutrition and Dietetics has a specialty practice group, Nutrition Entrepreneurs, which interested members may join. It provides a forum for networking, mentoring, and skill development for R.D.s and D.T.R.s who want to become entrepreneurs. According to Becky Dorner, the biggest challenges for the service business are collections and staffing balance (having enough or too much qualified staff in certain geographic areas). “The product business has the positive of up-front payment,” she says, “but the challenges are the need to constantly develop new products and expand (the) customer base.” With the proper training, knowledge, and skills, as well as initiative and strategic planning, a successful private practice in the field of nutrition and dietetics can be achieved.
Entrepreneurs Anchor Magazine | entrepreneursanchor.com • 43
Marketing Your Practice: Of MediaMedicine
By Priscilla Goudreau-Santos
Visit most any doctor’s office or clinic today. Gone are the days of the the 8-track cassettes, hold-it-under-yourtongue for-five-minutes mercury thermometers. Medical Marketing is a Must And from a marketing perspective, gone, too, are the once tried and true word-of-mouth referrals based on physicians or your satisfied patients. Or even relying on a newspaper or magazine clip that interviewed the doctor about a new procedure or breakthrough s/he recently incorporated in her/his practice. Not so anymore.As medical technology has advanced and evolved, so, too, must today’s doctors’ marketing strategies. Like nearly every other type of business professional today— doctors must proactively advertise their practice and specialty— from cosmetic surgeons, to OB/GYNs, to endocrinologists, to bariatric surgeons, to dermatologists, to dentists and including primary care physicians. With so many avenues for announcing and creating interest in your practice, it can seem confusing to choose even a handful of media campaigns as your plan of action or mode of operations. Prognoses for Success When physicians first began to proactively advertise their practices, they traditionally used print media and direct mail to announce themselves or new doctors joining their firms, services/procedures, special prices, or certain procedures/ tests exams and locations. The Internet has forwarded your physicians’ marketing strategies market into a whole new universe. Now, print and electronic media campaigns are being combined synergistically with combining internet marketing to cross-forward advertising across a wide range of potentially interactive media campaigns. Partnering with radio and TV stations to create and generate online awareness is a perfect strategy for health care delivery doctors professionals because of the pressure on TV stations to make their numbers achieve high ratings. Therefore, placing your ads during a TV or radio station’s compelling, relevant health care programming is a great way for stations to retain viewers/listeners and is also a sensible, logical avenue for generating and keeping viewers and a great way for physicians to inform audiences about their own practice or specialty. 44 • Entrepreneurs Anchor Magazine | entrepreneursanchor.com
Network TV has changed dramatically because there are now many other competitive—and sometimes less expensive—venues for medical practices to advertise, including cable and satellite channels. And, because of the economic slowdown, some traditional advertisers are drifting away from using TV for reaching potential clients. So take advantage of this less expensive airtime by educating and informing consumers about your practice; it’s a creative, and more economical way for physicians to connect with viewers on a more personal level. Partnering involves working together with TV and radio stations to present information about your practice to your potential customer base. You can use commercials, become a guest and/or expert commentator about health-related issue(s) for a station, and/or have a link to your practice’s website on that station’s own web page, which may then direct customers towards your own practice’s website. Having video streams on stations’ websites allow doctors to become more visible as experts on certain subjects, and it also creates valuable backlinks, especially if that same video is also posted on www.youtube.com, which is owned by the supreme ubiquitous and trend-setting search engine, Google. And it’s certainly less expensive than placing a 10- and 20-second advertisement on prime time network TV. So now, instead of a sizeable portion your marketing resources being spent on TV advertising, you’re working collaboratively and proactively to get your message out. TV stations’ websites, usually used for branding and positioning, now offers doctors the opportunity to tell their story 24/7, whenever the consumer wants it, not just during the prime time programming blocks. Invest Your Marketing $$ Wisely When you develop a relationship with TV or radio stations, select a segment that airs on a regular basis, such as a show sponsorship. It should run at the same time or position so that people will recognize it. He became “the -face” of the client’s product, engendering a loyal and trusting audience who were the practice’s targeted demographics (women ages 34 to 64). The DJ was also on-hand at events where consumers could see and speak with him about the product itself, as well as the medical office’s practitioners who were selling the product to potential clients/patients.
The reality is that in today’s economy, proactive, carefully planned out, cross-platform medical marketing is a necessity. Most of the tools that apply to advertising a commercial business apply to one’s medical practice. And, although specialists tend to depend upon referring physicians, most people (your potential patients) generally prefer to make their own decisions about whom they’re going to choose—especially as a specialist. So get your name and/or your practice’s name out there. And do it often. Use media that your marketing consultant advises and what is financially feasible for your practice. Unfortunately, solo practitioners don’t have the luxury of spreading what can become exorbitant advertising costs among a group of physicians; it all comes out of their own sole proprietorship costs. First, decide what you want for your practice because marketing dollars do add up. As a new doctor (or practicing group) in town, you need to let people know you’re here, that you have good academic and medical credentials (i.e., a high rating on such websites as www.healthgrades.com, have obtained key fellowships and/or awards) and built a loyal patient referral base. Once established, you need to stay visible; it’s all about reaching people and providing the best service and care to each and every patient. One bad referral can wreak havoc across dozens of previously favorable ones. For one physician’s practice, the marketing program began with a new website and it’s now building on this foundation. What this practice found is that many more patients than originally thought were using the Internet to find the site, especially older ones. Patients are more involved in the decision process of choosing a doctor now more than ever before. They’re asking: Who is the best physician I can find?” “Why do I need this procedure?” “How much is it going to cost?” “Are there
alternatives to surgery or having to take expensive drugs with potentially dangerous side effects?” Therefore, make certain your website addresses these questions and invites them to ask for more information. Here’s where having a thorough “FAQs” page on your website is important, as well as perhaps having instant virtual access to a consultant. As in the days of yesteryear, before doctors began to actively advertise across various media, word-of-mouth referrals is still one of the best ways to obtain new patients. But in today’s reality, if you want become more visible, take it to the next level with a healthy marketing plan and choose the right media platform(s) best suited to your practice. Establish Your Marketing Campaign’s “Vitals” A good way to begin a marketing program is by writing a mission statement for your practice. Then, carefully evaluate all the materials that are usually handed out to your patients,, such as: brochures, business cards, stationery, and how you communicate with referring (usually primary care) doctors, etc. Making your practice more visible may also include your taking the initiative to speak to various interest groups and increasing your community involvement (have a booth set up at a popular sporting or health-oriented or charity events.) Start with a medical marketing consultant who knows the business and the area, finds the appropriate advertising venues and speaking engagements, coordinates with the right firms to produce your materials and website, and who will do a professional job with each element of your campaign. It’s not just about spending large sums of money on advertising in general; here you want to become a medical marketing specialist, utilizing effective, Floridplaced, a Hardest-Hitprofessional strategically communications and Fund state-of-the-art expertise.
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