Contents
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The issue of being constantly plugged in has expanded from just personal use. Work is no longer restricted to the office, it is carried with you to your home or anywhere you are through emails and text messages and phone calls.
Digital Detox The ultimate guide to switching off.
HIPAA Violations: What are the Risks? 2
Unplugged
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From the Publisher
8
Physician Spotlight Dr. Deepa Verma, MD
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Feature Unplugged
12
Wealth Management Unlocking the Science of Behavioral Finance
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Organic Acids Test Ask the Expert with Dr. Kurt Woeller
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Feature Digital Detox
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Legal Corner HIPAA Violations: What are the Risks?
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Selling Your Practice
Advertisers
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Unlocking the Science of Behavioral Finance Doctor’s Life Tampa Bay
BioSpine Institute 4 Burr & Forman 21 Jarred Bunch 7 PNC Bank 24 Publix 3 Suncoast Advisory Group 23 Tampa Bay Radiation Oncology 9 The Florida Orchestra 19 The Great Plains Laboratory, Inc. 15
Issue 5, 2015
{ } “ With help, my patients can do better. They want to
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REVOLUTIONIZING HOW SPINAL SURGERY IS PERFORMED! With over 30,000 patients treated and 13,000 surgeries performed, BioSpine founders Dr. James J. Ronzo and Dr. Frank S. Bono wouldn’t have it any other way. They’re skill and relentless passion for perfection will make the experience as comfortable as possible. An extension of Gulfcoast Spine, The BioSpine Institute provides the latest breakthroughs in minimally invasive technology with an emphasis on strategies that encourage the body’s natural healing responses.
5 KEY FACTORS WHEN CHOOSING A SPINE SURGEON 1
Surgeon’s Experience • Dr. Ronzo and Dr. Bono have over 23 years of combined experience. • Dr. Ronzo and Dr. Bono have successfully treated over 35,000 patients for spine-related disorders. • Dr. Ronzo and Dr. Bono have performed over 14,000 successful minimally invasive spinal surgeries. • Dr. Ronzo and Dr. Bono are among the top spinal surgeons in the nation as documented by Consumer Reports, Newsweek, ProPublica & Health Grades.
2
Minimally Invasive Approach
• Minimally invasive spinal surgery requires an incision that is only 3/4” in length. That’s the same as the diameter of a United States penny. • In minimally invasive spinal surgery, muscles are gently separated and not cut. • Smaller incisions and less invasion into surrounding tissue and muscles means quicker recover times.
3
Nationally Ranked Outcomes
• Dr. Ronzo and Dr. Bono have been rated in the top 5 in the nation for back surgery results. • After more than 14,000 surgeries, Dr. Ronzo and Dr. Bono’s infection rate is almost non-existent and is dramatically less than the national average.
4
Length of Surgery
• Drs. Bono & Ronzo's minimally invasive spinal surgery averages 45 minutes in length. By comparison, traditional spinal surgery can last several hours.
5
Recovery Time
• All patients receiving minimally invasive spinal surgery are able to return home on the same day of the surgical procedure. • Recovery time for BioSpine patients is consistently half of that for patients who have received traditional spinal surgery.
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From the Publisher
I
www.doctorslifetampabay.com
n the world where every single second is consumed with some sort of technology, in which we as a society use for communication, collaboration, education and to just explore… how can one unplug? Will I miss an important email, post or update? Is it possible to stay focused when there are some many forms of technological distractions that keep us informed? Great questions and I can say with utter honesty, I have no clue. I know in just the five minutes I spent thinking about what and how to write this section, I was distracted three times from various forms of technology. This issue of DLM explores the unspoiled islands of St. Vincent and the Grenadines. We go through a step by step how to guide to digital-detox in the Caribbean courtesy of the St Vincent and Grenadines Tourism Authority. I revealed my research and sat down with Dr. Greg Savel to discuss the struggles and importance of unplugging. The one sure takeaway I got from researching this topic, unplugging is difficult and baby steps are your best choice. Try unplugging 15 minutes or longer before bed to start and see how that affects your life. Cold turkey can be rough. Our wealth management section reveals the science behind behavioral finance. This was one of my favorite articles from Scott Jarred. It made me really look at why we make financial decisions and how most of our decisions are made from experiences. The legal corner talks the five letter bad word, HIPAA. Okay, it is actually an acronym. However, it is always better to be well-informed and proactive than non-informed and reactive. Finally, we had the pleasure to meet with Dr. Deepa Verma for this issue’s Physician Spotlight. Extremely interesting and we hope to explore more with Dr. Verma in the future in regard to integrative medicine. Ironically, we had the pleasure of interviewing Dr. Kurt Woeller in this issue as well and got his expert opinion on Organic Acids Test (OAT). As always, we hope you enjoy this issue of Doctor’s Life and always welcome your feedback and comments. Until the next issue…
TAMPA BAY
Tampa Headquarters 1208 East Kennedy Blvd. Tampa Fl, 33602 813-419-7788 Group Publisher Edd Suyak publisher@doctorslifetampabay.com Creative Director Rob Stainback Editorial Director Danielle Topper Associate Publisher CJ Cooper Advertising Account Executive Ryan O’Neil Editorial Advisory Board Scott Jarred Robert V. Williams
Be well,
-Edd Edd Suyak Group Publisher publisher@doctorslifetampabay.com
™
Contributing Writers Scott Jarred Robert Williams Rick O. Helbing A Special Thank You to the St. Vincent and The Grenadines Tourism Authority Doctor’s Life Magazine, Tampa Bay is always seeking events, stories and remarkable physicians. Please email the publisher if you have an event, an editorial idea or you know of a doctor or dentist who may have done something extraordinary. We want your suggestions and feedback. publisher@doctorslifetampabay.com Doctor’s Life Magazine, Tampa Bay does not assume responsibility for the advertisements, nor any representation made therein, nor the quality or deliverability of the products themselves. Reproduction of articles and photographs, in whole or in part, contained herein is prohibited without expressed written consent of the publisher, with the exception of reprinting for news media use. Printed in the United States of America.
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Doctor’s Life Tampa Bay
Issue 5, 2015
Physician Spotlight
Dr. Deepa Verma, MD 1. How long have you lived in the Tampa Bay area? I was born in Queens, NY and lived most of my life in Jersey. I moved to Miami in 2006 and settled in Clearwater, FL in 2007. 2. What is your favorite Tampa Bay restaurant? I love how this area is represented by Clearwater, St Pete and Tampa. I think Pinellas County is unique because it is basically a peninsula with the Tampa Bay on the east and the Gulf of Mexico on the west. I have been exploring Safety Harbor, and I love the quaint vibe. Green Springs Bistro and Floribbean and Tapping the Vine are eclectic. In the Clearwater area, Positano and Mystic Fish are fun. In St Pete I enjoy Castille and Sea Salt. And in Tampa, I am just beginning to venture out, but Ulele and Haven appeal to me. I am a foodie….but in a very healthy way. 3. Where is your favorite place in Tampa Bay to relax? Believe it or not, my backyard is a sanctuary. I also love going to my beach place on St Pete beach, Gulf Blvd. The beach to me is my escape from reality. It reenergizes me and grounds me. 4. How important is it for physicians to be involved with their communities and how important is it to you personally? I have always valued being involved with the community. During medical school and residency, I was very active in going out into the community and doing lectures and workshops. It is important for physicians to educate the general public outside of seeing them as patients. We don’t get enough time to fully educate patients during their medical visit with the constraints of insurance and time. 5. What is integrative medicine? Integrative medicine and its principles are based a lot on holistic wellness and Ayurvedic medicine, which is arguably the most ancient and intricate medicinal system in the world, dating back over 10,000 years. Integrative medicine is healing-oriented medicine and an approach to health care that puts the patient at the center and addresses the full range of physical, emotional, mental, social, spiritual and environmental influences that affect a person’s health. It neither rejects conventional medicine nor accepts alternative therapies uncritically. 6. In your opinion, are more people today seeking out this type of medicine? What I have been seeing is a general frustration with people who are sick and tired of feeling tired and sick. While there is always a place for traditional Westernized medicine, the philosophies of Eastern medicine and integrative medicine are firmly planting its 8
roots. The emphasis of being preventative is allowing people to take control of their health and chronic disease states. In conjunction with lifestyle modification such as diet and exercise and taking natural supplements, mindfulness about one’s genetics and environmental exposures plays a big part in determining the course of health, aging, longevity and so much more. 7. What are the major benefits of integrative medicine? It is disturbing that America has some of the highest rates of cancer, obesity, diabetes and heart disease, just to name a few…and what integrative medicine allows for is the utilization and optimization of the synergy with mindbody-spirit. This is different from traditional medicine which tends to dissect the body into different systems while treating the disease and not the patient as a whole. This unfortunately dismisses the fact that the body thrives in harmony. For example, poor gut health and micronutrient deficiencies influence brain health which influences inflammation and hormonal imbalance etc. 8. What have been your greatest challenges? I think some of my challenges were breaking out of the mold of being a traditional MD and having other traditional doctors really embrace what I am doing. That being said, with my traditional medical background and training, patients and doctors trust me and the credibility factor is there, so overall the challenges have transformed into great awareness amongst everyone in a very positive manner. 9. What services do you offer that differ from what you did as a traditional MD? A major difference from what I did in my previous life as the traditional MD to being an integrative MD now is the type of in-depth testing I offer. Aside from specialized tests like food intolerance or neuroadrenal or micronutrient or immunity tests, my initial bloodwork delves much deeper into genetic and inflammatory markers. I offer IV nutrient therapy and have a very cutting edge piece of equipment called the CVAC pod. For more info on that, go to www. drdeepaverma.com, because there is a lot to explain about that. I prescribe bioidentical hormones and supplements. I can pretty much address any medical issue, but I also know what is out of my scope and when I need to refer to a conventional specialist, I do so without hesitation. Remember, integrative medicine is a marriage of conventional and holistic therapies. 10. Where do you see the future of healthcare going in this country as people start to take more control over their health and wellness? Doctor’s Life Tampa Bay
Dr. Verma is double board certified in family medicine and integrative holistic medicine. She graduated magna cum laude from The College of NJ and is a graduate of Rutgers Medical School in NJ (formerly known as Robert Wood Johnson Medical School). Dr. Verma completed her family medicine residency at Somerset Medical Center and was elected chief resident. When she is not busy raising and playing with her three boys, she enjoys music, the beach, healthy cooking, reading, exercising and hopes to travel the world one day. She is an accomplished dancer and tennis player and enjoys being competitive in any sports or games.
I can only hope that preventative medicine is something that the health care industry and insurance companies recognizes and helps patients with. Insurance should not only reimburse and cover for illnesses and diseases, but should offer incentives for people to get integrative services while promoting people to be proactive about their wellness. 11. Should primary care physicians refer or offer integrative medicine as an alternative or in some cases as a primary and why? It would be nice if primary care doctors can be open to offering more of an integrative approach, because after all, we are the front-line physicians, gate-keepers and jack-of-all-trades. And if they cannot do it as a traditional primary care doctor, then they should offer the option to patients to seek out an integrative doctor. 12. Knowing yourself, if you could go back in time and provide your younger self advice, what would it be? I always say…have no regrets, because at one time, it was exactly what you wanted. But if I were to offer advice to a younger version of myself, or to my three amazing boys…it would be to always stay true to yourself, and though we want to have control over things, sometimes just letting go and having faith can take you far. I had my life planned out by the time I was age 10, and though it eerily played out almost how I planned it, I would have never guessed in a million years how unpredictable life could be. Major life changes allowed me to evolve and be who I am today. It is always a perpetual evolution and self-growth. Radiate positive energy out to the universe and it will come back to you a thousand fold. And then anything is possible! Issue 5, 2015
Unplugged Have you ever panicked when you forgot your phone after leaving your home or checked your messages in the middle of dinner? Have you ever left a social event to find you’ve spent more time looking on your phone than actually conversing with people at the event? Do you answer texts or e-mails on the way home from work, during your dinner hour at home, or conversations with family?
Dr. Greg Savel
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Do you go on vacation and find it impossible to be without your phone, internet connections or wake up in the middle of the night and have the urge to text, phone, email someone, or check the status of your social media sites? Doctor’s Life Tampa Bay
If any of these sound familiar, you may be dependent or even addicted to the digital world. The issue of being constantly plugged in has expanded from just personal use. Work is no longer restricted to the office, it is carried with you to your home or anywhere you are through emails and text messages and phone calls. We recently sat down with Dr. Greg Savel, owner and a pediatrician with Myrtle Avenue Pediatrics. We had a discussion on the struggles and importance of unplugging. Dr. Savel stated, when asked how often he felt he spent time on some sort of communication device in a 24 hour period, “sadly, I imagine that I’m on some sort of device almost every waking hour. As most know, our devices are both a blessing and a curse as physicians. If I disconnect from my patients in my practice, I’ll lose my business. However, if I continue to remain connected 24/7, I’m going to lose my future.” Like almost all of us today, unplugging completely is just not an option. Our busy personal and work schedules rely entirely too much on technology for us to completely unplug. No one is saying technology does not serve a purpose especially in modern medicine. We can all agree, technology allows us to operate, communicate and educate in a robust and timely fashion. Would it be bad to unplug for one hour a day? Would you miss something important or might you come up with a better creative sense? Jonathan Spira, author of Overload: How Too Much Information is Hazardous to Your Organization, contends that information overload costs the U.S. economy almost $1 trillion in 2010; that reading and processing just 100 emails a day can occupy over 50 percent of a knowledge worker’s day, because it takes 5 minutes for the brain to get back on track after a 30 second interruption. Four years ago, Facebook had 100 million Issue 5, 2015
users, today it has 1 billion. Jonathan Harris, writing in the blog Big Think, says that social networking on the Internet and telephones is constraining our identities and communication through: • Compression; we’ve moved from letter writing to phone calls to email to texts, compressing both time and language • Disposability; information overload leads to a sense that ideas don’t need to last • Curation; the focus is more on the storage of information online than its creation •S elf-promotion; the encouragement of social competition and self-advertising more than collaboration and interconnecting
Benefits of Unplugging Frees up time; we spend a lot of time checking emails, replying to emails, checking updates, tweeting, texting, commenting and liking Reduction of stress; stress plays a major role in promoting diseases and shortens your life span. So if you want to stress less – just unplug, even if it is for a little while. The constant flow of information, even if it is bad or good, causes stress Rebooting; recharging your battery provides you more drive and focus on getting things done that you have been putting off. Rebooting allows you to step back from your day to day and gives a new perspective on life Deeper real connections; Unplugging will ultimately push you to adapt to primarily looking forward into people’s eyes during conversations, rather than downward into your screen. You will appear much more approachable. Better eye contact encourages people to connect on a deeper level Increases creative thinking; reduction of constant distraction will allow you to become more creative. Scientists suggest that emails and cell phone calls take up important space in working memory that could be freed up for contemplation and deep thought. The related idea was that the constant multi-tasking associated with being plugged-in is a brain drain on both attention and memory. In multitasking, the brain is in a constant state of focused attention, with attention switching rapidly between or among multiple goals “I’d like to install pods where myself and employees could have a place to relax throughout the day. However, I’m pretty sure we would be out of business and all living in a van by the river,” says Dr. Savel. This portion of Dr. Savel’s statement came from a question we asked him about how some of the largest tech companies make it mandatory for their employees to unplug a percentage of the day and did he feel it should be part of his practice. Like most of us, we don’t work for Google Issue 5, 2015
or Facebook and smaller businesses don’t have the time or resources to allow employee downtime during work hours. It is our responsibility to manage the task of unplugging on our time and allowing ourselves our own reboot. Dr. Savel went on to say, “I believe that physicians need to unplug to recharge the batteries and to clear the mind so the mind is sharper when it comes time to making diagnostic and critical decisions. As physicians, we need to be resilient to sleep and always be able to function in a stressful and sleepless environment.” The takeaway from this is we now live in a world that is connected much closer through the use of technology. Whether you embrace it or not it is how a large portion of our society communicates, educates and explores. I don’t think anyone can say technology is going anywhere but in the direction of more and faster. Embracing the positive uses, withholding from the negative aspects and taking a small break, even if it is only five minutes a day should make for a better experience. Can two people spend one week together with no connectivity or devices? Can a family spend one day with no devices? We asked Dr. Savel the same questions. Dr. Savel has been heading up a yearly event titled, Playing Unplugged. The event draws between 16,000 and 20,000 each year and promotes one full day of kids playing unplugged in a park. “I have to say, I’m guilty of not unplugging often enough, says Dr. Savel. My dream is to see Playing Unplugged further spread around the country and throughout school systems. We are actively pursuing to spread throughout other communities and I’ll continue to make the right thing happen.” In regard to the question of two people spending a week together with no devices, “I don’t know how many books I would have to read to come up with enough subject matter for my wife and me to have one weeks’ worth of conversations in the absence of connective media. I think most would feel the same if they were being honest.”
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Social media has changed our society both for better and worse, says Dr. Savel. It seems we live in a much smaller place and we are able to share across cultures ideas and thoughts in ways it whenever possibly in the attempt to make this world a better place to live in the long run. On the other hand because we can plug into so much on a 24-hour basis, we often find ourselves connected until the very moment before we lie down for sleep. Logic dictates that we need to turn our brains off one hour prior to sleeping so our sleep is more fulfilling and successful.” Give yourself what your brain deserves. I know the thought of not being in the know can bring anxiety but imagine being in a state of mind where knowing nothing is all you have to accomplish. Only worried of the very breath you are breathing in and blowing out. Try it for five minutes a day or even five minutes a week.
Doctor’s Life Tampa Bay
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Wealth Management
Medicine and investing: Two games which are extremely tricky to navigate. Two games that leave physicians and investors at the mercy of vast information processing hubs: The human body and the market. While medicine has been perfected over the years, practice hasn’t always made perfect for investors. Unlike medicine, investing appears to have no standardized science behind it. And don’t forget every investor’s kryptonite: Volatility. Why? Volatility can drive irrational investment behavior.
UNLOCKING THE SCIENCE
OF BEHAVIORAL FINANCE By Scott Jarred, CFP®, CEO of Jarred Bunch Consulting
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Doctor’s Life Tampa Bay
Issue 5, 2015
Money is Emotional Successful marketers understand that the most effective messages stimulate consumers emotionally. This gives us a unique look at the human psyche: Emotions drive behaviors. One would be hard pressed to prove that money isn’t emotional, or even the field of medicine for that matter. Think about it: Expanding medicine into uncharted territory; crafting revolutionary surgical methods; reigning victorious over deadly diseases. This emotional feast is why physicians continuously push the limits of modern medicine. For investors, volatility is the predator that feeds on our emotions; enter irrational investment behavior. Prompted by spikes in volatility, emotions drive investors to endlessly try and craft the winning formula for market performance. Science provides answers in medicine and grounds physicians in their emotional pursuits. It’s proven, tangible and unchanging. But what science is there for investing? Unlike science, everyone has an answer for what works and what doesn’t. This is precisely why investors fail at consistently crushing it in the market.
Just How Vulnerable Are We? If financial behavior has taught us one thing, it’s that we’re more vulnerable than we know. This is because we have a hard time realizing when we’re being manipulated, especially when it comes to investing. Interestingly enough, we’re just as easily manipulated by others (noise) as we are by ourselves (emotions). To overcome this financially lethal combination, we have to understand the emotions that drive detrimental behaviors. Then, we can formulate a science behind investing that overcomes these.
Information Overload “Dow Plummets 331, Oil Drops Below $50.” “Stocks Slide on Oil, Economic Fears.” “Dow’s Charge Turns the Year Positive.” “Dow Soars 323 Points, Erases 2015 Losses.”* All of these statements were headlines that ran in the Wall Street Journal and USA Today in January, 2015. When the catastrophic headlines dropped in investors’ laps stomachs churned. Losses were Issue 5, 2015
immediately assessed. Feelings of defeat were rampant. But, you don’t surrender to defeat when a surgery begins to go awry; you stand your ground. The booming headlines followed the catastrophic ones by only two days. Those who were driven by the fear of what may come next and acted rashly were now tending new wounds. Volatile times in the market are magnified by the noise surrounding investors. Too often, noise effectively manipulates us into thinking we’re acting with the best intentions. Remember this: Disasters have been the result of the best intentions.
Track Records & Forecasting Investing is a means of preserving our future. Investing also carries risk. What a conundrum; no wonder we will listen to every source of information we can. The fact is that financial loss is felt much deeper than financial gain, similar to how the patients you lose can stick with you longer than the ones you save. Hence, why we go to great lengths to avoid risks more so than finding the right times to capitalize. Triggering these emotions, volatility entices us to seek the advice of market forecasters. Many endure arduous journeys of investment selection based on past performance. However, no one can tell you when earnings will explode or chaos will ensue. Past performance has little to no impact on tomorrow. Everyone has a solution: From talking heads in the media, to your friends, to your advisor. But, attempting to time the market or forecast its behavior can cause you to get burned by huge losses. As Warren Buffet says, “Market forecasters will fill your ear but never your wallet.”
Active Trading Holistic versus western medicine, active versus passive management: Battles that have raged on for decades. While hybrid medicinal practices have progressed, investors would also do well to recognize that elements of both are beneficial. Unfortunately, volatility screams for us to act when positive spikes occur and to question why we’re holding when drawdowns happen. This is the exact moment where optimism and confidence Doctor’s Life Tampa Bay
can enact irrational behavior. While these are essential personality traits for happy human functioning, volatility can quickly blur the lines between optimism and realism, confidence and cocky. You’re king in the operating room, so you’re king of the market too, right? Regularly trading stocks in order to beat the market only guarantees one thing: A high friction portfolio with large fees coming out of your pocket. History has proven that fund managers regularly trail the market. Instances of outperforming are rare, and even harder to duplicate. Time IN the market should be your first priority (passive), adjusting for risk tolerance, time frame and tax impacts along the way (active).
Unlocking the Science: Your Personal Investment Philosophy The majority of us would say our goal is this: to make our money last forever. Now, where’s the plan? Remember, a goal without a plan is simply a wish. Finding your “why” is a critical first step in discovering the science behind investing. Why is money important to you? Why are you investing? Why do you value certain principles over others? Putting many things into perspective, this helps us understand three vital points in formulating a sound reasoning behind our actions: 1. Where your money is. 2. What your money is doing. 3. Why your money is where it is and doing what it is doing. This ensures that your investing behavior aligns with your personal philosophy and no one else’s. And when we understand the “why” behind our actions, the self-destructive impact of emotionally driven impulse can be overcome. We can’t say when or how volatility will strike. But, I can tell you this: Storms will happen. It’s how you weather the storms that separate success from failure. And our clients are well prepared to stand on the side of success. Disclosure: *Headlines found in the online archives for the Wall Street Journal and USA Today newspapers. 13
ORGANIC ACIDS TEST ASK THE EXPERT WITH DR. KURT WOELLER 1. What is the mission of The Great Plains Laboratory? The mission of The Great Plains Laboratory is to offer cutting edge diagnostic testing that can help a practitioner uncover various hidden sources of metabolic imbalances. They are also actively involved in educating health practitioners about the benefits of integrative medicine for a wide variety of chronic health disorders such as autoimmune disease, asthma, autism spectrum spectrums, chronic fatigue, neurological conditions, and mental health disorders. 2. Can you explain what the Organic Acids Test (OAT) is and how it can help physicians in diagnosing chronic illnesses? The Organic Acids Test is a urine test from The Great Plains Laboratory that evaluates various metabolic markers of biochemical imbalances, as well as biotoxins from yeast and bacteria. This test is comprehensive in that it can detect certain vitamin deficiencies, mitochondrial problems, essential fatty acid issues, neurochemical imbalances, yeast and bacteria toxicity, oxidative stress, and high oxalate levels, which are all known to create physical and neuropsychiatric problems. For example, the Organic Acids Test measures two biotoxins from clostridia bacteria called HPHPA and 4-cresol. These two toxins are known to inhibit a dopamine converting enzyme which when adversely affected, leads to excess dopamine production. This causes oxidative stress in the nervous system and can lead to mental health and neurological problems. In my practice, I often find these clostridia toxins elevated in my patients and treatment of the clostridia bacteria with either antibiotic and/or natural remedies shows great improvement in patients’ clinical problems. In my opinion, the Organic Acids Test from The Great Plains Laboratory is an essential test to perform for any integrative health practitioner. 3. How is (OAT) testing different than regular blood and urinalysis testing? Many organic acids cannot be measured effectively and cost-efficiently through the blood. There really isn’t a blood equivalent to the Great Plains Laboratory Organic Acids Test (OAT). There are other OAT tests on the market, but they don’t measure specific markers that Great Plains Laboratory is known for, and that are needed to practice integrative medicine effectively. 4. What are some of the chronic illnesses (OAT) can help diagnose? The OAT evaluates for various metabolic imbalances such as mitochondrial dysfunction, nutrient deficiencies, oxalate toxicity, and the 14
presence of various pathogen toxins from bacteria such as clostridia and candida. The OAT also measures quinolinic acid, which has been linked to neurodegenerative diseases such as Alzheimer’s, Huntington’s, and Parkinson’s disease. All information gathered from the test is then applied clinically to the patient’s health history and symptom complaints. It doesn’t diagnose a specific illness per se, but assists a practitioner in deepening their understanding of imbalances that can cause or exacerbate a specific health condition. For example, a patient with chronic fatigue syndrome may have a chronic candida issue manifesting with elevated yeast metabolites that are directly impacting mitochondria activity. 5. So the OAT can help to diagnose mental illnesses as well as physical ones? The OAT cannot diagnose a mental illness. This needs to be done clinically by a licensed physician. What the OAT can do is identify toxins that are known medically to be associated with mental illnesses. This information helps a practitioner to understand the potential problems for their patients and to treat them accordingly. The OAT provides biochemical assessment for myriad imbalances. There are compounds that help to identify in-born errors of metabolism seen in metabolic diseases in children. Most commonly, the information from the OAT can be used in a wide variety of clinical situations, whether it is an individual suffering from chronic fatigue, autoimmune disorders, mental health problems, autism, etc. In reality, there isn’t any clinical scenario that I can think of where the OAT cannot be useful. What has to happen is a practitioner needs to become proficient at implementing the OAT into their clinical practice. Once they do this, they will find it is an extremely useful diagnostic tool. 6. Is your training specifically targeted Doctor’s Life Tampa Bay
towards integrative healthcare practitioners or can more traditional medical practitioners and their patients also benefit from it? The OAT seminars are open for any health care practitioner interested in learning how to apply this test in their practice. The seminar is full of practical information rooted in science, biochemistry, and clinical practice. A practitioner who has some integrative medicine training may already understand some of the concepts of organic acids testing more than a conventional doctor, but everyone can gain useful knowledge from the OAT seminar. 7. Can you explain what the Integrative Medicine Academy is and who it is for? Integrative Medicine Academy (IMA) is an online educational training system for health practitioners interested in learning how to become proficient at various topics in integrative medicine. I am the medical director of IMA and am actively involved in course development and teaching. We have courses on autism, gastrointestinal disorders, practice marketing strategies, and we have upcoming courses for adrenal and hormone testing and treatment. The main website for IMA is www. IntegrativeMedicineAcademy.com. 8. How have the changing attitudes of patients toward their care impacted the kinds of tests physicians need to perform nowadays? Patients are much more active in their own education regarding their health now. Much of this has come about with open access to online information and the free distribution of health information. Because of this, doctors have to become more aware of different ways of assessing patients, particularly when it comes to chronic health disorders. Also, because of advancing science, sophisticated lab testing, and clinical experience from different types of practitioners, we now know different ways of helping people with their health challenges than ever before. 9. What kinds of treatment options might a physician prescribe based on the results of an OAT? There are many different treatment options available based on OAT results. For example, dietary changes may be necessary if a certain compound called oxalate is high, often seen in people with kidney stones. Elevated candida and clostridia toxins often times warrant prescription antifungals and antibiotics, respectively. Most commonly though, there are many natural supplement remedies that can be employed for various biochemical and nutritional imbalances. 10. Where can physicians learn more about the Organic Acids Test if they are interested in offering it to their patients? The Great Plains Laboratory sponsors oneday OAT training seminars at various locations around the country. Practitioners can check the main website at www.greatplainslaboratory. com or the workshop website, www. organicacidworkshop.com for more information and upcoming seminar dates and locations. Issue 5, 2015
Organic Acids Workshop Tampa Bay January 30, 2016 Doubletree by Hilton Tampa Airport
Early Bird Price Ends: December 20, 2015
$199
Regular Price
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Presented by:
Digital Deto THE ULTIMATE GUIDE TO SWITCHING OFF… St. Vincent and The Grenadines has 32 blissful islands waiting for you. Unwind, switch off, and de-tech. Unspoiled islands set within the beguiling blues of the Carribean Sea.
D
e-tech? That’s right, step away from the technology, log off and disconnect. A detech is like a health detox but for your mind, a complete digital detox. It means unplugging from the world, turning off all the distracting devices that battle for your attention in our modern world and living in the here and now. Just for a while at least. De-tech is the occasional prescription you need to write to yourself to get you back up a running and ready to face the rest of the year anew. For the ultimate digital detox trip, there is no better place on earth that St. Vincent and the Grenadines (SVG) to get rid of all the technological trappings. Close your
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eyes for a second (no cheating now), and imagine a chain of unspoiled islands set within the beguiling blues of the Caribbean Sea, uncluttered by visitors where deserted islands are fringed by bleached out sands gently lapped by clear waters. When it comes to tranquility and total escapism nowhere beats the paradisiacal islands of St. Vincent and the Grenadines. We’ve teamed up with Life Coach Louise Gillespie-Smith to create the definitive guide to managing time out from a fast paced existence. This experience covers that before, during and after, arming you with tips and practices that will enable you live life in the movement. So go on, give yourself a little me time, slide the power off, de-tech and slip into
Doctor’s Life Tampa Bay
the Caribbean way of life. This is your guide to de-tech, a digital detox… hit the off button, NOW! Unlike your typical holiday guide, we won’t be advising on what to pack but what not to pack. By that we mean stepping away from the mac book/ tablet (yes, we know it’s slim and fits in your suitcase but put it down), the iPhone and all other devices. De-tech is not just about switching off when you get there, it’s about achieving the right state of mind before you go. When it comes to switching off, be prepared- don’t go cold turkey now. Life Coach, Louise Gillespie-Smith provides some tips… This is your guide to de-tech, a digital detox.
Issue 5, 2015
ox Before You Go: • Push all work deadlines back and arrange an extension if worried • Fire up Hoot Suite and get your auto-tweets on the go • Set the TV to record your favorite shows so you’re not stressing you’ve missed the finale • Think you’ll miss someone back home? Then ask them craft you an old fashioned letter you can open half way through the de-tech to keep you going • Write a plan, not for your vacation… but for your first day back. Ease yourself in with no meetings first thing allowing time for jet lag recovery • Set up out of office replies and voicemails so people now you are away • Let people know you will be noncontactable- as opposed to, I’m picking up urgent emails. • Turn off and place all devices in a bag that you will not be taking with you (that should be all of them with the exception of one emergency mobile phone)
Issue 5, 2015
Relaxation is the key. Our minds are so often in the past or in the future, being present is where we get our sense of peace, it is worry and guilt free. Tips to help you stay in the moment: CREATE; get lost in a drawing or painting. (on the beach of course) READ; a good book does wonders, we recommend a few. YOGA; great for you physical and mental self, it helps you to switch off and calms your mind. Doctor’s Life Tampa Bay
MEDITATE; Sit on the beach and just focus on the sound of the waves. If thoughts arise, observe them but do not give them any in-depth attention. SUBMERGE; snorkel or dive in the clear Caribbean Sea. The sea has a fantastic calming effect and it often seems easier to disconnect when you are near it. In the shadow of something so vast, it helps get life in perspective. EXPLORE; go for a walk amid the lush vegetation and palm trees, and pay attention to nature all around you. WRITE; remember the things that you’re grateful for in your life every day and jot them down. DANCE; lose yourself in the rhythm. (continued on page 18) 17
Digital Detox (continued from page 17)
Touchdown in St. Vincent and the Grenadines (SVG) we’ll whisk you off for the ultimate island experience to help detox from all that is digital. When dropping a pin on the map to find a truly authentic digital detox, the ultimate place to escape to is the archipelago of St. Vincent and the Grenadines. Encompassing 32 paradisiacal islands and cays, and covering 150 square miles of gleaming sea, SVG is an untainted and remote part of the Caribbean- free from crowds, mass tourism and the technological trappings of the modern digital world. Here, life continues on as it has for generations, unhurried and laid back with a strong sense of family, food and the simple life. Feel liberated of technology and soak up the sound of lapping waves and chirping birds in the lush verdant rainforest. Each of the nine inhabited islands has its own distinct character, so hopping from one to another you’ll find a different experience each time. Kick back on the platinum-sand coastline of the Grenadines, flip alongside turtles amongst the seagrass and colorful reef in the Tobago Cays, climb St. Vincent’s La Soufriere mighty volcano, and feel the calming effects of the ocean with some of the best sailing on earth. SVG is an incredibly diverse island nation with a landscape and environment sure to cure the modern day ills of the digital revolution. So kick back, set your phone to voicemail and enjoy the present. There is a lot to see and do around St Vincent and the Grenadines, particularly on the ‘mainland’ as the island of St Vincent itself is known. Here you can explore both coastlines, where there are simple local villages (also ports on the Caribbean side) and waterfalls, mountains and incredibly fertile forest inland. In the Grenadines, tours tend to be by sea, of course. St. Vincent and the Grenadines has a very rich culture, which includes unique festivities and sports. In SVG the history of the country has produced a marvelous heritage of Amerindian strength of spirit, fused with European governance, to which we add African inventiveness, complemented by Asia’s resilience philosophy. Much of our culture, as you might expect, is strongly linked to the sea, and to the boats which brought African slaves, Portuguese laborers, and 18
French and British settlers together with indigenous Caribs to give St. Vincent and the Grenadines its vibrant, multi-ethnic community, that is both proud and unified. Virtually everything you eat in St. Vincent & The Grenadines will have been grown or reared locally. The furthest many ingredients will travel is from a small farm on St. Vincent to a plate at a restaurant on the Grenadine islands. The fish will have been pulled out of the waters surrounding the island by a local fisherman and sold straight to the chef just a couple of hours before it is cooked. Be sure to sample the local dishes jackfish and breadfruit, and wash it all down with a cool Hairoun Beer or a Sunset Rum. Young Island and Palm Island should be on your list to visit during your trip. Young Island, just off the coast of St. Vincent, nestles with all the Caribbean tranquility and seclusion that you need after months rushing through the rat race. Unlike its glamorous star studded neighbor Mustique, Young Island Resort is all about barefoot chic, just what the doctor ordered. With a dazzling white sandy beach flanking the island, it’s the perfect place to indulge in a little much needed R and R with only a good book as company. Then off to a secluded piece of bliss, Palm Island Resort. Nestled between Union Island and Petit St. Vincent, Palm Island occupies its own private 135-acre island hideaway. This is Doctor’s Life Tampa Bay
the place to live out those wildest Robinson Crusoe dreams, all in blissful isolation of course. Enjoy the simple pleasures of nature and the starling beauty of the Caribbean. The island is a mecca for various types of water sports above and below the water. Grab some scuba gear and a kayak and head out to find your own secret bay to explore. The private villas on Palm Island are also the perfect place to take a step back and soak up the natural beauty of the island. With no TV or internet in the rooms you’re in a perfect spot to focus on your digital detox.
When You Return Home Just before you leave, write down what you have learnt from your experience and try not to forget it. Ask yourself what, if anything, would you like to continue to do in your everyday life? Make this a reality, schedule time in your day just to play, read, be outside or meditate. If you don’t plan, it won’t happen. It has been said it takes 21 days to build a habit. Give yourself three weeks to build positive lifestyle habits into your routine. Plan something relaxing within the week of getting back and try to switch off your devices for 30 minutes each day, what could you do differently with your time? Avoid being on your devices up to an hour before you go to bed, it will help you to have a more restful sleep. Visit www.discoversvg.com for more information. Issue 5, 2015
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Legal Corner
HIPAA VIOLATIONS:
What are the
RISKS?
T
By Robert Williams
he federal health care privacy statute or HIPAA (Health Information Portability and Accountability Act) is no longer a new acronym - either in the medical profession or in general society. Like Medicare, ObamaCare and other contemporary healthcare developments it is familiar to most citizens. And most healthcare professionals have at least a passing knowledge of the basic requirements of the HIPAA Privacy Rule. But what is not so well known are the penalties both monetary and otherwise - that can be imposed if the HIPAA Privacy Rule or Security Rule are violated. Thus, the purpose of this article is to briefly summarize those potential sanctions and the process by which they are investigated and, ultimately, enforced. HIPAA sanctions can be civil, criminal and, theoretically, both. While somewhat complicated, the procedure for determining the scope of the penalty is designed to be commensurate with the facts and circumstances surrounding the violation. While to some the penalties may seem overly harsh, it cannot be said that the government has not fully informed us of those risks. See www.hha.gov/ ocr/office. So it makes sense for those at risk to at least have a basic knowledge of how serious the penalties can be and to take steps to avoid them.
The Investigation Process Complaints concerning violations of the HIPAA privacy or security rules are investigated by the Office of Civil Rights (OCR) of the United States Department of Health and Human Services. For a complaint to be investigated it must present facts which, if proven to be accurate, would violate either the HIPAA Privacy Rule or the HIPAA Security Rule. The former has been in effect since 2003 and the latter since 2005. Ordinarily, the complaint must be filed with the Office of Civil Rights within 180 days of the date the filer either knew or should have known that the alleged violation occurred. However, this time limitation may be waived under certain circumstances. 20
Obviously, to be a valid complaint, it must assert a violation by a Covered Entity as that term is defined by HIPAA and its corresponding regulations. Any number of persons or entities can be Covered Entities but certainly a physician or physician group that electronically transmits health information as part of certain financial and administrative transactions comes within that definition. If the Office of Civil Rights does notify you or your medical group that it is investigating a complaint alleging a violation of either the Privacy Rule or the Security Rule, it is imperative that immediate action be taken. Among the steps to be taken is making sure that any and all documents, in electronic form or otherwise, that may relate to what is being investigated be preserved and protected. Failure to do so could lead to other problems including the imposition of a penalty and, if imposed, the size of that penalty.
Potential Sanctions Civil Penalties In general, the civil penalties increase significantly with the level of culpability. For example, is a nurse employed by a medical practice commits a HIPAA violation the penalty could be as little as $100 for that single violation or it could be as high as $50,000. In short, a huge difference. In the above example, the minimum $100 penalty would only be available if the nurse did not know that she or he had actually violated HIPAA and, in addition, would not have known of that violation if he or she had used reasonably diligence. On the other hand, if the violation occurred due to willful neglect but was then corrected within the required time frame, the penalty could be $10,000 for that single violation. But, if that same willfully negligent violation was not timely corrected, the penalty could increase to $50,000. To repeat, the penalty increases dramatically with the level of culpability. Some healthcare providers remain indifferent about the consequences of a HIPAA violation investigation. This is a mistake. As noted above, the HIPAA Doctor’s Life Tampa Bay
Issue 5, 2015
privacy standards are enforced by the Office of Civil Rights (OCR) of the Department of Health and Human Services which has noticeably increased its HIPAA investigations in recent years.
Criminal Penalties Criminal prosecutions for violating the HIPAA statute have been less common than civil enforcement proceedings. Nevertheless, it is critical to understand that if a covered entity or any individual who knowingly obtains or discloses individually identifiable health information in violation of the administrative simplification provision of HIPAA can be fined up to $50,000 and can be imprisoned for up to one year or both. More egregious violations can result in even harsher monetary penalties and longer prison terms. HIPAA criminal cases are prosecuted by the Department of Justice through any one of the 94 United States Attorneys’ Offices throughout the United States and its territories. And because criminal liability (i.e., conviction) is governed by the federal sentencing guidelines, the potential overall sanction (money and imprisonment) can be potentially very severe. Moreover, the stakes for criminal violation just got higher. On September 9, 2015 the Department of Justice through Deputy Attorney General Sally Quillian
Yates, announced that in the future the government would increase its focus on individual corporate employees as well as the entity itself. Although this is not a new concept in federal criminal prosecutions, and it remains to be seen how the Justice Department will apply the Yates Memorandum to HIPAA prosecutions, this renewed focus on individuals should not be ignored.
Exclusion In addition to financial penalties and possible incarceration, under specific circumstances a healthcare provider could also be excluded from federal healthcare payment programs such as Medicare.
Compliance The above discussion clearly underscores the critical importance of having a well-designed HIPAA compliance plan and routine training to implement that plan. Regularly revising the covered entity’s compliance plan and training policies is, of course, also important. Mistakes are inevitable so the question to be asked is not whether a violation will happen, but when. In the author’s experience, if a covered entity has designed and implemented a robust HIPAA compliance plan, when the Office of Civil Rights comes knocking your chances of avoiding an expensive penalty are greatly enhanced, if not eliminated.
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Selling Your Practice your staffing levels compare to those of If retirement is your goal, you may opt Physicians sell similar practices? Issues such as these can for a gradual buy-in by a physician who their practices for a reduce the appeal of your practice. It’s to will take over your practice. Typically, this your benefit to deal with them well before arrangement requires you to employ the variety of reasons — you put your practice on the market. prospective buyer and, under the terms You’ll want to have a realistic appraisal of the deal, after a trial period of a year or dissatisfaction with the of your practice’s potential worth before two, offer a partnership with a documented demands of running you put it up for sale. Tangible assets, exit arrangement for you. This arrangement such as medical equipment, computers, could be in the form of a severance package. a business, the desire and furniture, are relatively easy to value, for a less strenuous though they generally make up only a REVIEW ALL OFFERS small part of a medical practice’s total work schedule, CAREFULLY value. Goodwill is an intangible asset that an offer, your focus should frustration with insurers, can be difficult to value. But there are Ifbeyouonreceive the would-be buyer’s financial methods that can be used to establish a condition and the payment terms if you retirement. If you are reasonable estimate. plan on retiring. If you plan to continue thinking about selling working at the practice with the individual IDENTIFY POTENTIAL or entity who may buy it, you should your practice, there BUYERS carefully review all ramifications, including are several steps you You may receive an unsolicited offer. If transfer expenses and malpractice terms you don’t, consider reaching out locally involved in the sale. should take now that or contacting a broker who specializes in Apart from satisfying yourself about selling medical practices. An experienced the financial and legal issues involved will help you maximize broker can identify and contact qualified in the sale, you should also feel that you the purchase price potential buyers. will be able to fit into the potential buyer’s The speed with which a sale may occur organization and that your advice and and ensure a relatively will largely depend on the deal you’re input will be welcomed. smooth transaction. seeking. Do you want a buy-out that will let Remember, whatever way your
LAY THE GROUNDWORK Start by taking a critical look at your practice’s current financial condition. Identify areas of weakness. For example, does your practice experience poor collections or weak cash flow? How do 22
you continue to practice as an employee? In that case, looking for a group practice, hospital, or other corporate buyer may be the best route. If the sale goes through to one of these entities, you will be able to continue to work in medicine without the responsibilities of ownership. Doctor’s Life Tampa Bay
practice’s sale is structured, there will be tax implications. Let us help you secure the most tax-advantageous sale terms. Please contact us if you would like assistance. The speed with which a sale may occur will largely depend on the deal you’re seeking. Issue 5, 2015
Serving PhySicianS for over 25 years and named among
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FivE yEars in a row, Rick O. Helbing cFP, chFc 941.375.7320
www.suncoastadvisorygroup.com *based on credentials, educational background, experience, size of the firm, minimum portfolio requirements and noteworthy professional achievements. See www.medicaleconomics.com.
Investment advice and advisory services offered through Suncoast Advisory Group, a Registered Investment Advisor