Florida Cancer Specialists FCS Magazine Summer 2014

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Foundation events » Jooma & boses » Spotlight on SEbring office » Radar Screen

Summer 2014

THE MAGAZINE

The Future of Oncology is Here Drs. Lucio Gordan & Mark Rubin Summer 2014

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We Support the Health of your Practice With the Same Dedication that You Support Your Patients Your number one priority is the health of your patients. With the changing healthcare landscape, our number one priority is the business health of your practice.

Dedicated exclusively to the viability of community oncology, ION Solutions provides contracting, technology, education and advocacy support that ensures you have the tools to run your practice both efficiently and effectively. With the practice support of ION Solutions, you can navigate this changing environment and focus on providing quality care for your patients.

To learn how ION Solutions enables community oncology practices to improve operational efficiency, financial performance and quality of care, contact your Strategic Account Manager or visit IONonline.com.

To experience ION Solutions advocacy support, visit ourcommunitycounts.org.

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FCS The Magazine

editor's

FCS THE MAGAZINE

letter

Message from

Dear Colleagues,

President

William N. Harwin, M.D.

“Making predictions is hard; especially about the future.”

— Yogi Berra

Assistant Managing Partner, Director, Executive Board

Stephen V. Orman, M.D. Medical Director

Scientific Director of Clinical Research, Director, Drug Development Program

Lowell L. Hart, M.D.

Director of Research Operations

Robert C. Whorf, M.D.

Executive Management Chief Executive Officer

Brad Prechtl

Chief financial Officer

Libby Slater

Chief Operating Officer

Todd Schonherz General Counsel

Tom Clark

Chief Marketing & Sales Officer

Shelly Glenn

Chief Human Resources OfficeR

Sharon Dill

Senior Vice President, Radiation/Radiology and Partnership Services

Ed Mercado

Vice President of Revenue Cycle

Sarah Cevallos

contents

Scott Tetreault, M.D.

Physician leadership

Mark S. Rubin, M.D.

summer 2014

At a recent COA meeting, I saw the future. Or, I should say, I saw a small part of the future of a small part of the oncology patient’s experience. Dr. John Peabody from UNC described his process of isolating circulating tumor cells from peripheral blood of cancer patients and then sequencing the key genomic drivers of the disease so that a patient in the future can be staged and get started on personalized treatment within three or four days with no other biopsy necessary. We already do this with CML and CLL so perhaps solid tumors and blood cancers are more alike than different.

In this issue we look forward with Drs. Lucio Gordan and Mark Rubin to the future of community cancer care. Mark was instrumental in the design and development of Onco EMR and Lucio has helped Mark and the Altos team to expand the functionality of the system and take it from a “computer system” to a full virtual cancer universe.

The future will also see our patients actively participating in directing and managing their own treatments. Dr. Nuruddin Jooma and Sarah Boses have embraced this with their unique integrative oncology program, and I think you will enjoy meeting them and learning about their exciting program.

John Hodson and the central lab and the Sebring office round out our highlights so, as always, enjoy — and keep those ideas and suggestions coming.

Vice President of Clinic Financial Services

Christina Sievert

Senior Management

Jeff Esham Jeremy Behling Tara Ruska Jeffrey Rubin Ray Bailey Lois Brown Melody Chang Rich dyson Michael essik Inga Gonzalez Katie Goodman, RN, BSN, CCRP Christopher Houser Sue Kearney lois poel Denice Veatch Samantha Watkins

IN PARTNERSHIP WITH

PRODUCED BY

Scott Tetreault, M.D. Editor, FCS The Magazine

in this issue

Departments 8 12 14 15 30

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Foundation Events Insurance Tips

D octor & Nurse Spotlight: Nuruddin Jooma & Sarah Boses Integrative Medicine

The Radar Screen News Updates

Spotlight

Legislative Soundbites

20 Office Spotlight: Sebring Office 26 Research Spotlight: Central Lab

Features 4 Profile: Drs. Gordan & Rubin Future of Oncology Summer 2014

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Profile

The Future of Oncology is Here FCS proves community-based oncology can lead the way to a cure with a culture that encourages innovative thinking

By Zandra Wolfgram

T

“ We all need to always be on the lookout for better ways to help people

he best defense in the ever-changing world of health care just may be a good offense. The rapid expansion of Florida Cancer Specialists & Research Institute (FCS) is part of a longterm strategy to maintain FCS’s competitive advantage so it can continue to realize its .” mission of providing world-class cancer care in — Dr. Mark Rubin

community-based settings close to home. “We grew the size of the organization to protect it.

Size brings leverage to nearly every aspect of our business, from negotiating with insurance carriers to reducing expenses,” says CEO Brad Prechtl.

Not to mention attracting some of the best minds in medicine and medical research. Mark Rubin, M.D., who practices out of the Bonita Springs office, and Lucio Gordan, M.D., based in Gainesville, are two of over 170 excellent physicians.

Rubin joined FCS in 1994, bringing more than 15 years of clinical experience and an internationally recognized track record in cancer research.

As a Research Fellow at Sloan-Kettering from 1991 to 1994, Rubin worked alongside Dr. John Mendelsohn, who was president of MD Anderson Cancer Center at the time. In this role, Rubin helped to pioneer the concept of targeted anti-receptor therapy as a new form of cancer treatment.

Antibody 225 — known commercially as Erbitux — was approved by the FDA in 2004 for colon cancer and in 2006 for head and neck cancer.

On a hunch, and with support from his former colleagues at Sloan-Kettering, Rubin took a chance with a young female patient who had colon cancer. “As luck would have it she was someone we could consider,” he says. Erbitux worked. She had dramatic improvements in her condition and the tumor shrunk considerably. “It was so unexpected,” Rubin recalls. The discovery made

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Summer 2014

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Photo by Scott Holstein

Profile

I take care of the quality, content and controls of the EMR,” Gordan explains. “I don’t put the engine together, but I make sure it is running well.”

headline news worldwide and landed Rubin on “Good Morning America.” He credits much of this successful breakthrough to FCS’s corporate culture.

“FCS has an innovative spirit. I am here because this company is committed to community-based practice and finding solutions to problems that are not found only at major centers,” Rubin says. “We all need to always be on the lookout for better ways to help people.”

Technology is “making lives better” A day in the life of today’s doctor is a whirlwind. The day begins early and often ends late. It is filled with the pressures of seeing patients and trying to be in several places at the same time, managing all sorts of complicated situations, from coordinating lab results to managing frontline, administrative, financial staffs and nursing teams — not to mention patients and their families.

Rubin quips that the working environment at FCS is like the GE slogan “making lives better.” And in 2005, he continued to do just that. While his wife, Anne, was hospitalized late in her pregnancy with twins, Rubin used his time at her bedside to write the protocols for an Electronic Medial Record (EMR) suited for oncologists like him. He partnered with Altos Solutions to create a web-based software program that streamlines the many disparate components of patient care. The result was revolutionary.

“OncoEMR is like an orchestra in sync. We have more productive

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FCS The Magazine

— Dr. Lucio Gordan

staff, and the ability to provide the right treatment to the right patient at the right time … and now we can’t live without it,” Rubin says.

Beyond efficiency, Rubin sees OncoEMR as an equalizer. By allowing doctors to share industry-wide practices and expertise, all doctors can be “experts” no matter what their background or where they practice. “If you don’t live near Sloan-Kettering or MD Anderson, you do not need to be excluded from treatment,” he says. “I believe in community oncology. We have to take care of everyone.”

That means constant care and OncoEMR allows more of it.

“Cancer doesn’t stop or take a holiday,” Rubin says. “With tools like OncoEMR, we are able to treat three and four times more patients in a more efficient and consistent manner.”

OncoEMR is yet another example of FCS’s commitment to finding solutions to problems that many may think are only found in a major cancer center. “It’s a tribute to the environment we work in here at FCS,” Rubin says.

Medicine meets The Information Age Dr. Lucio Gordan, based in Gainesville, who joined FCS in 2010, along with Rubin are medical directors for the Integrated Clinical Services and Medical Informatics Committee. He serves on the executive board, bringing nearly 20 years experience as an oncologist/ hematologist. His work is widely known and only recently he was presented with the prestigious Physician Frist Award, which honors

Hospital Corporation of America employees and volunteers who work in “a spirit of love, with humility and understanding.”

Gordan, who worked in computer software programming prior to entering medical school, readily offered up his services and skills to help take the company to the next level. For the past four years, this 43-year-old’s main focus has been utilizing the FCS’s technology tools, like OncoEMR, to deliver the best care possible to patients.

“I take care of the quality, content and controls of the EMR,” Gordan explains. “I don’t put the engine together, but I make sure it is running well.”

That means meticulous information management of everything from what kind of chemotherapy treatments are provided at what intervals to what medication is appropriate to dispense for each patient.

The evolution of OncoEMR has impacted the company on many levels, from safety to quality of care. And then there is the bottom line.

With less staff required and reduced time to bill there is cost savings. Plus, enhanced documentation has strengthened FCS not only from a medical standpoint, but also from a legal and compliance perspective.

Still more technology trends are on the horizon that will directly involve patients. “Important things are coming in the very near future,” Gordan says. “Significant enhancements to our patient portal, ‘See Your Chart’.

We expect to see more patients accessing their records and connecting with physicians and staff from iPads or computers from in the waiting room or from home.”

“Telemedicine,” as Gordan calls it, is the future. He envisions screento-screen connections similar to programs like Skype and Facetime that link patients directly to their doctors. “If they have concerns or questions of medications, they will have better access in real time.” The idea is giving patients access to more information will give them a better understanding of their health, which ultimately means better management of their care.

“Basically we want to know the mechanics of ‘gear shafts’ that cause cancer to grow. We can literally stick gum in these gears, so to speak, and cause the wheels to grind to a halt. We can therefore interfere with the critical growth pathways — we call them molecular switches. And I tell patients we are fast and furiously learning how to turn them off,” Rubin explains.

According to Rubin, a “tremendous explosion of knowledge” in recent years has helped to make advancements in designing effective drugs. We have gone from two to 20 “switches” that are now being targeted with drugs designed to turn them off. At this rate, it could be “lights out” for cancer very soon.

The second idea is to ask: How do we activate the very potent immune system and channel it to cancer cells?

“It’s the magic bullet question we’ve asked for 100 years,” Rubin concedes. “But recently, we may have a better shot at understanding why the immune system is not focusing on cancers.

“We’ve discovered cancers have an antennae that work like a cloaking device,” he explains. “They can be like a stealth bomber, they are not recognizable and deceive the immune system by flying below the radar.

Well, we now have drugs that destroy these antennae and uncloak cancer, and so the immune system can turn on and eat the cancer, just kill it.”

The problem is some drugs do not always just uncloak the cancer.

Rubin says a key challenge is to figure out how to uncloak the cancer cells, make the immune system aware of them and then restrict the attack so the battle is fought just against the cancer cells not the normal cells.

Rubin says he doesn’t know if breakthroughs will be slow or very fast, but he suspects it will be fortuitous, just like the young patient who took Erbitux.

Will a cure be found? Rubin says it all depends on how we approach it.

Uncloaking targeted solutions The health care industry is experiencing the most tumultuous time in its history. Costs are rising and so are the expectations for quality and quantity of care. At the same time, when many medical facilities are merging instead of specializing, FCS is thriving. Part of its success is undoubtedly due to providing research-based physicians like Rubin and Gordan with the latitude and motivation to continue to ask the big questions. Like, what is the future of oncology?

There is much we don’t know, but Rubin is encouraged by the strides medicine has made in recent years. For this optimist, the future of oncology is simply about targeted medical solutions. There are two ideas Rubin looks forward to exploring. The first is the opportunity to better understand the biology of cells.

“We at FCS, or somebody else, will have that opportunity, but if you don’t lay the seed, lay the infrastructure and support it, it’s not going to happen.”

As FCS marks its 30th year, there are many milestones to celebrate.

While we may not have all the answers yet, FCS is clearly taking the lead when it comes to creating an environment that encourages the best minds in medicine to keep exploring creative solutions. In that way, the future of oncology is here and now. n

Summer 2014

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foundation

Phil Fest 2014

April 5, 2014

ďƒŠ

events

Top: Dr. Hano playing guitar in his band, Delusions of Grandeur Bottom Right: Gus Bilirakis with Stan & Veronica - Philip A. Bryant Melanoma Foundation. Veronica is an RN at our Bardmoor office.

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foundation

SPINARAMA Livestrong

April 12, 2014

ďƒŠ

events

ďƒŠ

FCS patients spin to raise funds for Livestrong Program at the YMCA of Greater St. Petersburg.

Page 8, Bottom: FCS patients (left to right) Dr. Knipe's patient Pat Hirschman (breast cancer - undergoing treatment) and Dr. Ziegler's patient Kim Miller (breast cancer - remission) Top Right: Pat Hirschman Left: Kim Miller Summer 2014

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foundation

events

FCS 30th Anniversary Celebration 2014 ďƒŠ

The FCS procurement department celebrates the company's 30th anniversary.

Front Row: Rose Ann Meyers and Cathy Marsden-Moffo Second Row: Dee Sands, Barbara Cox, Colleen Miller, Chelsea Jones and Kelly Albrecht Third Row: Cindy Miller, Lois Schaffer, Rich Dyson and Amy Bohn Back Row: Mike Pino, Elaine Laney and Diane Riley

National Medical Laboratory Professionals Week April 21-25, 2014 ďƒŠ

During the week of April 21-25, the Pathology and Central Laboratories celebrated National Medical Laboratory Professionals Week. Along with enjoying daily catered lunches sponsored by vendors, daily themed dress up days and raffles, employees participated in several games to win prizes.

One of the games, dreamed up by Flow Cytometry Manager Silvia Fernandez, was called Harwin's Hair. With Dr. Harwin's approval, all laboratory employees were given a photo of Dr. Harwin onto which they were to create an interesting hairstyle. Ten entries were submitted and judged by Beth Bush, Shelly Glenn, Todd Schonherz, Brad Prechtl and Dr. Harwin himself. Michelle O'Hara of the Central Lab took first prize with her pink and black creation. Dr. Li of the Pathology Lab won second prize with her stippled style. National Medical Laboratory Professionals Week originated in 1975 to increase public understanding and appreciation for clinical laboratory personnel.

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foundation

events

Dr. Peles' Fundraiser at Cantina Laredo 2014 ďƒŠ

Top Left: Karen Minder and Dr. Shachar Peles Bottom Left: Dr. and Mrs. Shachar Peles Top Right: Group photo Middle Right: Dr. Augustin Schwartz III and Dr. Shachar Peles Bottom Right: Dr. and Mrs. Neal Rothschild and Dr. and Mrs. Shachar Peles

Summer 2014

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insurance

tips

Lawrence D. Share President

Lawrence D. Share Company Inc.

Do You Multitask? So Does Today’s Life Insurance.

If you’re pondering where your retirement income might come from you may have missed a source you already have: your life insurance policy.

Today’s life insurance policies may have outpaced the perception of the public: they multitask.

Traditional use of a life insurance policy meant buying it to help protect the financial interests of surviving family members. In addition to the death benefit, today’s life insurance can help provide supplemental income and long term care protection.

The Lawrence D. Share Company has been built with the same characteristics as successful members of the medical profession — ­ professionalism, respect and personal care.

A long-standing commitment to building relationships with our clients has been the determining factor in our success. For the past 40 years, we have provided quality insurance coverage tailored specifically to members of the medical profession. Lawrence D. Share Company representatives are top producers with many highly rated companies that offer solid insurance products that provide protection designed for your needs.

Today, more than 5,000 physicians and health care professionals throughout the United States depend on us for comprehensive insurance and solid financial products.

Lawrence D. Share Company, Inc. 1200 South Pine Island Road, #400 Plantation, FL 33324 (800) 329-5011 | LDShare.com info@LDShare.com

Using Your Life Insurance Policy For Retirement Income What most folks don’t know is that cash withdrawn from a life insurance policy is accounted for as the cost basis coming out first, not the gain. Taking a simplified example, if you had $250,000 of cash value in your life insurance policy and you paid $150,000 in premium since it was issued, you would have a nominal increase in the cash value of $100,000 within the policy. The entire accumulated amount within the policy may be withdrawn to use as retirement income tax free, as long as the policy owner is careful to keep the policy in force. That’s a valuable way to supplement your retirement income. Withdrawals of earnings or other taxable amounts are subject to income tax and, if made prior to age 59½, may be subject to an additional 10% federal tax penalty. Early withdrawals reduce the death benefit and may be subject to surrender charges. The reduction of the death benefit may be more or less than the actual amount of the withdrawal.

Covering Long Term Care Risk Through Life Insurance Life insurance has always offered a death benefit for survivors. It can also now serve as financial vehicle to help counter perhaps the biggest financial risk facing retirees — long term care costs. Some policies are now available with an optional long term care insurance rider. The rider involves some additional questions and separate underwriting and is available only at policy issue for an additional fee. It functions as an accelerated death benefit rider, reducing the death benefit dollar-for-dollar of benefits used. Many Baby Boomers who expect long term care costs to skyrocket as more people demand such services at the same time 20-30 years from now are using life insurance to help hedge this risk.

As an example, let’s say you had a $1 million life insurance policy with a long term care rider and at any point after the policy was issued the insured needed long term care, perhaps at home or in a facility. Assuming the policy owner chose a 2 percent option, 2 percent of the death benefit would be available per month to pay for long term care expenses until the policy limit is exhausted. That’s up to $20,000 per month during the benefit period toward long term care expenses paid by your life insurance policy — tax free!

Innovative Cash Accumulation Features The way cash value can be accumulated in some permanent life insurance policies may also surprise you. Policies are now available which are linked to an index, such as the Standard & Poors 500 Index, but with, for example, a 10 percent ceiling and a 0 percent floor. Policy owners cash value is protected from negative returns, but are capped at the 10 percent crediting rate, which may change during the duration of the life insurance policy. Therefore, the policy owner enjoys the opportunity to be credited for the growth of this index to potentially grow the cash value in the policy.

Today’s permanent life insurance policies are innovatively designed to multitask — just like their owners. And unlike yesterday’s life insurance, you may find there’s more of an opportunity to use the benefits of your policy without the need to die first.

Creditor Protection In Florida, life insurance policy owners may benefit from an additional feature of their life insurance policy, which isn’t even offered by their insurance company — it’s a benefit codified in Florida state law. The cash value of life insurance (which includes annuities) is protected from creditors. Properly structured, this protection may extend to the cash value from a life insurance policy even after the cash is distributed from the policy and may also extend to beneficiaries after the death of the policy owner. Doctors and other specialized professionals, for example, often use thoughtful financial planning techniques to protect the assets they have accumulated over their career from unexpected risks. Life insurance and annuity contracts provide the peace of mind that these assets are beyond the reach of prospective creditors.

And unlike yesterday’s life insurance, today’s permanent life insurance policies are innovatively designed to multitask — just like their owners.

Most insurance policies contain exclusions, limitations, and reduction of benefits, surrender charges and terms for keeping them in force. Your representative can provide you with costs and complete details. 513-20140515-186368 This is an insurance solicitation. An insurance agent may contact you.

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FCS The Magazine

 Individual Disability Insurance  Business Overhead Expense  Group Disability Insurance  Group Health Insurance  Variable Life Insurance  Universal Life Insurance  Term Life Insurance  Long Term Care  Medical Malpractice Insurance  Legal Defense Insurance

Lawrence D. Share Company, Inc. & Professional Casualty Corporation 1200 South Pine Island Road, Suite 400 Plantation, FL 33324 www.ldshare.com www.professionalcasualtycorp.com Phone: (954) 473-5011Toll Free: (800) 329-5011Fax: (954) 472-3982 Summer 2014

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the radar

screen

What’s on Your Radar?

MEDICARE SAYS NO TO LUNG CANCER SCREENING Surfers know the feeling of looking far off into the slowly approaching swells and spotting the “one”—the small rise of reflected sunlight heralding the coming of a huge surfable wave. There are several big waves coming to the “Oncology Beach” in the next few years and one of the most interesting is the lung cancer screening movement. Most of our hospitals are staffed with heart surgeons who occasionally perform lung cancer surgery as an additional specialization. But USPFT recently recommended lung cancer screening as part of routine preventive care in highrisk people ages 55 to 70. This is important because starting in January 2015, under the Affordable Care Act, private insurance plans are required to cover lung cancer screening based on the USPFT recommendations, and these private insurers are not allowed to require a co-pay from the patient for these scans. Common sense, and the hard data, dictates that these heart surgeons are going to have a lot more lung cancer work in the next few years as lung cancer diagnosis shifts from late stage to early stage.

By Scott Tetreault

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It is ironic then that last week the CMS National Coverage Determination Panel said that Medicare would NOT cover lung cancer screening. They cited the fact that in patients 65 years and older, the major trials showed only a 13 percent — non-significant — mortality benefit for screening.

compared with controls of similar pre-bypass BMI who had not undergone the surgery.

Add cancer prevention to the list of benefits.

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BRCA MUTATIONS: DON’T JUST TAKE OUT THE OVARIES

Another retrospective abstract presented at the same meeting by Dr. Catherine Shu demonstrated that in women with BRCA mutations undergoing risk reducing gynecologic surgery, removing only the ovaries while leaving the uterus in place results in a much higher risk of eventual aggressive uterine cancer. She followed 525 BRCA patients who underwent only

LAP BAND PREVENTS CANCER At the Annual Meeting on Women’s Cancer in Tampa recently, Dr. Kristy Ward reported on her retrospective study of 7.4 million inpatient admissions that women who had undergone bariatric surgery had a 70 percent lifetime reduction in uterine cancer

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FCS The Magazine

REFER TO XRT? So your patient had a mastectomy and had one positive lymph node and a small tumor. You gave her AC—Taxol and she’s done, she did great. You start Arimidex and see her in three months, right?

Ummm, not so fast. A huge meta-analysis of 22 trials, just published in the Lancet by UK Cancer Research, demonstrates that patients with 1 to 3 positive lymph nodes benefitted significantly, both from disease free and overall survival, with the addition of radiation therapy.

I’m sure that the FCS breast cancer docs will find a lot not to like about this study, but you can’t ignore it. It’s probably sensible to have all node positive women see the radiation therapist — lumpectomy or not.

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oophorectomy for five years and saw 14 times more aggressive biology uterine cancers (carcinosarcoma, serous cancer, leiomyosarcoma) than SEER data would suggest. It doesn’t seem sensible to leave the uterus in place in these patients.

DID YOU KNOW? According to the NCCN Guidelines, ALL women diagnosed with Endometrial Cancer before the age of 50 should be tested for Lynch syndrome by germline testing (Myriad, Ambry, Labcorp, Quest). It’s true.

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news

updates FCS and ION Solutions Expand Partnership Welcome to a new “FCS The Magazine!” We’re pleased to announce that Florida Cancer Specialists & Research Institute (FCS) is broadening its long-term partnership with ION Solutions to deliver practical clinical, practice management, and advocacy information alongside stories about the people who embody FCS. This alliance will help the magazine become not only a tool that fosters connections but also enhances patient care.

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FCS became a member of the ION Solutions group purchasing organization in 1999. As the largest oncology GPO in the nation, ION has extensive knowledge of the community oncology market and offers solutions that enable community oncology practices to improve operational efficiency, financial performance, and quality of care. Through its Community Counts advocacy campaign, ION advocates on our behalf so that we may realize our mission of providing world-class cancer care in community-based settings close to home.

FCS Selects Oncology Supply FCS will now be sourcing all of its chemotherapeutic and supportive therapy products from Oncology Supply, a unit of AmerisourceBergen, one of the largest global pharmaceutical sourcing and distribution services companies.

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"We're very pleased with the new contract and continuing our long-term partnership with Oncology Supply and ION Solutions," said Dr. William Harwin, founder, president, and managing partner of FCS. The new agreement builds on an existing 15-year collaborative relationship between these two industry-leading organizations.

The expanded partnership enhances existing supply chain efficiencies by consolidating all injectable, infusible, and oral purchases into one supplier.

“Our decision to transfer our oral chemotherapy to Oncology Supply expands an integral relationship,” said Brad Prechtl, chief executive officer of

FCS. “Because the majority of adult cancer patients throughout the country are treated in a community oncology setting like FCS, it is critical that our physicians and clinicians be able to provide all necessary treatments immediately and close to home.

Working with Oncology Supply allows FCS to have all necessary chemotherapy treatments readily available to cancer patients in the communities we serve.”

“Our relationship with Florida Cancer Specialists is one that shares expertise and drives innovation,” said AmerisourceBergen Provider Solutions President Dave Leverette. “The AmerisourceBergen organization helps clients shape healthcare delivery with unparalleled knowledge, reach, and partnership. We’re excited FCS chose to expand our relationship.”

TRUE Warrior R FLO

ANCER SPECIALISTS SALU I DA C TES

A

Karen Warmack is not only ghting her own personal battle with cancer, but is speaking out on behalf of others battling the disease. She recently testied in support of “The Cancer Treatment Fairness Act” before Florida lawmakers. Her testimony led to the enactment of the law.

Florida Cancer Specialists Medical Oncologists Scott Tetreault, MD • Viralkumar Bhanderi, MD • Paresh Patel, MD Tallahassee Location 1600 Phillips Road, Suite 300 Tallahassee, FL 32308 | (850) 877-8166

Tallahassee North Location 2626 Care Drive, Suite 200 Tallahassee, FL 32308 | (850) 219-5830

FLCancer.com

Summer 2014

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Doctor & Nurse Spotlight

Dr. Nuruddin Jooma & Sarah Boses, R.N. Integrative Medicine A complement to traditional remedies that helps patients through treatment and beyond

By Lynda Belcher

A

cancer diagnosis brings about a flurry of thoughts about the course of treatment — chemotherapy — and the ways in which the patient’s life is about to drastically change. Often, further down the list, other elements are considered: dietary changes, living healthier, relaxing more and other components of an emerging field of treatment known as integrative oncology.

At Florida Cancer Specialists & Research Institute (FCS), the Integrative Oncology and Wellness Services program is the umbrella term for an array of treatments that range from massage therapy to acupuncture to yoga and beyond. They are often used as a complement to standard cancer remedies. This is something that Dr. Nuruddin Jooma and his nurse, Sarah Boses, have discovered to great success. Working out of the Pinellas and Hillsborough County FCS offices, Jooma and Boses are the driving force behind this innovative concept.

"Integrative medicine allows us to treat the whole patient,” says Jooma. “Every little bit helps. We are able to customize a complementary program based on what type of cancer they have, what type of therapy they are receiving and what side effects they are having from treatment.”

Integrative medicine allows us to treat the whole patient,” says Jooma. “Every little bit helps. We are able to customize a complementary program based on what type of cancer they have, what type of therapy they are receiving and what side effects they are having from treatment.” — Dr. Jooma

The Integrative Oncology and Wellness Services directive incorporates a number of components. Patients have access to

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massage therapy to manage muscle and bone pain and improve anxiety and fatigue; acupuncture or acupressure to mitigate neuropathy or decreased appetite; yoga for stress reduction and insomnia; nutritional counseling and cooking classes to reduce any need for dietary supplements; exercise for quality of life; meditation for physical relaxation; music and art therapy for stress reduction and more. Benefits of integrative medicine include the fact that patients are encouraged to be hopeful and think positive, which are instrumental to successful outcomes. Moreover, it promotes a sense of wellness before, during and after cancer treatment and reduces the emotional stress of the process.

Jooma and Boses both found their path to integrative medicine after working in more generalized fields of medicine.

Jooma initially started his career with little interest in oncology until a clinical rotation changed everything.

In a move that changed his professional perspective, Jooma says that one clinic — in which he worked with cancer patients — ended up with a realization of what he wanted to do with the rest of his life. As he delved further into his oncology work, Jooma found that his interest in integrative medicine continued to grow. Despite the fact that his education hadn’t intensely focused on this area of medicine — he cites just one

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Doctor & Nurse Spotlight

lecture on nutrition in three years of residency — he knew it could help his patients.

She joined us and it has really taken off. She is the ideal person to run this program and work with these patients.”

"Once you talk to patients about their diagnosis, they immediately want to know about lifestyle changes,” he says. “They bring you a box of supplements to try to ‘cure’ the cancer. I found that we could instead supply them with standardized, evidencebased information so they are not getting ripped off or using products that are unproven.”

Boses actually brings a personal background in integrative therapies to the team. She says that homeopathic therapies have always been a part of her personal care routine. In fact, she successfully utilized acupuncture to help with childhood allergies versus medicinal remedies.

As Jooma moved in this new direction, he began to work more closely with Boses, who was working as a chemo nurse at the time. “This program is fortunate to have Sarah,” he says of Boses.

“When others saw the benefit of what the program could do, and it continued to grow, I knew we needed someone to coordinate it.

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Like Jooma, Boses had targeted a much different direction for her career in medicine. She initially wanted to work in a hospital but, after a short stint, found she had much less time with her patients than she would have liked. After taking an opportunity in oncology, Boses found that this was the environment in which she could make a difference. She could take the time to sit and talk

What we teach the patients here is what can be done to play a more active role. They begin to feel like what they are doing gives them some control.”

— sarah boses

with her patients. Moreover, she was able to assess the fact that they were not okay, physically or emotionally. Through her work in oncology, Boses found she could address the emotional part of their journey, the physical components of the disease and their general wellness.

In fact, the ideal integrative medicine approach focuses on the wellness of the patient from the time of diagnosis into survivorship. It teaches them how to make optimal lifestyle decisions. According to Boses, many cancer diagnoses can be prevented through healthier choices.

Moreover, proper treatment can guard against recurrence. The program focuses intently on this with survivors as well as those currently struggling with the disease. “We can’t control everything,” says Boses. “What we teach the patients here is what can be done to play a more active role. They begin to feel like what they are doing gives them some control.”

As the concept gains traction within FCS, Jooma points out that this is just the pilot stage. Citing statistics that say the risk of cancer can be reduced by as much as 67 percent through lifestyle changes alone, his goal is to show this through integrative techniques. Through continued patient successes, there are plans to add a dietician with oncology experience to the team and integrate the program into other FCS offices.

"Many of our cancer patients are living longer,” says Jooma. “We want to help them make those lifestyle changes that are going to be just as important to them even beyond treatment.” n

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office Spotlight

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FCS The Magazine

Sebring is Central to its Rural Community Sebring grows its ‘Big City’ services to small rural towns

By Zandra Wolfgram

C

heery light blue walls and warm wood-framed artwork that depicts comforting naturescapes of refreshing rivers flowing through lush forests and soothing sunset scenes await patients at Florida Cancer Specialists’ (FCS) Sebring, Florida location.

Centered in the Sunshine State two hours south of Orlando, Sebring is also called “The City on the Circle” in reference to its circular drive in the center of the town’s historic district. Founded in 1912, it was named after George E. Sebring, a pottery manufacturer from Ohio who developed the city. It is a rural community and this FCS site services Highland and Polk counties. But being situated in a small town does not necessarily mean the pace is slow. This FSC site is experiencing its greatest growth since merging with the practices of Drs. Syed Ahmed and Amit Shah to become an official FCS center in July 2010.

practice to increase its infusion chairs from 12 to 21. “We really like the space, we have a lot more room and we are getting a great response from our patients,” says office manager Heather Burke.

We really like the space, we have a lot more room and we are getting a great response from our patients.”

— Heather Burke

In March, local dignitaries gathered to cut the ribbon on the expansion, which doubled the size of the office from 4,000 to 8,000 square feet. The extra space enabled the

And it has not gone unnoticed by local leaders. Mayor George Hensley heralded FCS and its new office during the ribbon-cutting ceremony, saying, “The physicians and staff at Florida Cancer Specialists are devoted to their patients and passionate about community-based oncology. For many patients fighting cancer, the ability to receive the most advanced treatments in a setting close to home is beyond measure and I want to recognize FCS for their ongoing service and commitment to the Sebring community.”

Burke, 35, is a Lakeland area resident and a 14-year veteran of the health care industry. She joined the Sebring team in 2012 and says the expansion allows this FCS office to better serve its market. “We’re essentially the only FCS practice centrally located between Orlando and Lakewood Ranch, and our patient demand was increasing. We are averaging

Spring 2014

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office Spotlight

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100 patients a day between our office and our mobile PET. Unfortunately, oncology is growing all the time. This expansion allows us to meet the growing needs of our patients in the area.”

we are a rural community. We know people here on a first name basis so it’s even more important to us that we are closely connected with our patients.”

Though the physical makeover of the office certainly elevates the healing atmosphere of Sebring, the patients will likely tell you that the secret to Sebring’s success is a caring staff whose single priority is keeping them first in mind. “We are big on building relationships with our patients,” Burke says. “We know their names. We joke with them. We bond with them.” For this team it’s simply part of the culture to operate with a can-do attitude to be sure each patient not only receives the best care but also has the best possible experience.

Sebring makes first impressions a top priority. The front line staff makes it a point to learn as much as they possibly can about each patient to put them at ease. “From the moment they arrive to the time they leave, our team is working so that by the second visit there are no questions. We know their name, their family and we clearly understand why they are here,” Burke says. “They may come in scared, but they often leave with laughter. If we make them smile, it’s a success.”

From the receptionist taking note of each family member’s name to physicians making personal phone calls to worried patients, Burke says the entire Sebring team makes a conscious effort to treat every patient as a VIP. “Every employee here goes out of their way to be sure a patient is satisfied — from securing a financial counselor to customizing an appointment to better fit their schedule, we make every effort to personalize each visit to our patients. We will move appointments, come early or stay late, whatever it takes.”

Bigger doesn’t necessarily mean better when it comes to patient care. Sebring is a community of just over 10,000, but the office is proud to say it “upholds” the FCS vision and mission every day. “We make patients feel at home,” Burke says. “We are not a big metropolis,

Though Sebring has state-of-the-art technology for maintaining online records and tracking patients’ progress, for these caregivers nothing is more powerful than basic human contact when someone’s life may be at risk.

FCS The Magazine

"We have patient reminders by computer, sure, but that’s not enough,” Burke insists. “We also contact patients from the office. We think it’s important that an actual person answer all of their questions before they arrive for their appointment. When they come, they are fully prepared, they know what to bring, they know how long they’ll be here … they know what to expect.”

Patients can also expect deep expertise. Together, Ahmed and Shah have been practicing oncology for nearly 50 years; the nursing staff has 40 years of collective caregiving. Along with making themselves accessible by sharing personal cell phones and donating time to various charities and causes in the community, for these oncology physicians every outreach is an opportunity to heal.

"Medical treatment is obviously critical, but at the same time the supportive care from their own family members and our nursing and office staff is equally important. We not only treat their medical condition, but help them spiritually … and with just general well being,” says Dr. Shah.

And with the expansion comes an increased capacity for Sebring to help and heal even more. n

We are not a big metropolis, we are a rural community. We know people here on a first name basis so it’s even more important to us that we are closely connected with our patients.”

— Heather Burke

Summer 2014

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Cancer Cuts by the Numbers cancer patients in the United States receive care at a community-based cancer clinic or local doctor’s office.

If sequestration forces those clinics to close, those patients would have to travel farther for their care.

Tell Washington to #SaveCancerCare

Urge Washington to repeal sequestration cuts to cancer care for Medicare patients now!

Learn more and take action at www.ourcommunitycounts.org

research Spotlight

FCS Central Lab

Keeping it cool and calm at Central Laboratory

By Zandra Wolfgram

W

hat is on your to-do list? If it includes five million items, you likely work at the Fort Myers-based Florida Cancer Specialists (FCS) Central Laboratory, which supports over 70 FCS locations with testing anything not handled onsite.

Five million is the annual benchmark lab manager John Hodson has set. “Last year we processed only 4.98 million tests and I was pretty upset,” he concedes. What will he do if he reaches his big goal? “Raise it,” he says without hesitation.

Hodson says the daily challenges of the Central Lab make it a “dream job,” and with six years of training — he is a specialist in Hematology, a Medical Technologist, a Medical Technician and holds a bachelor’s degree in Medical Technology from the Florida Institute of Technology — he is well qualified.

It’s all about accuracy and not getting overwhelmed, and if you expect the worst you are really disappointed.”

The 3,000-square-foot laboratory is an open, airy space with benches resting under long worktables dotted with laptop computers. Other than the constant whirring sound of analyzers, it’s fairly low key … somewhat like the eye of a

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FCS The Magazine

hurricane. Hodson, 54, is a calm, cool and collected character.

He has to be. In his line of work, accuracy is mandatory and it isn’t about his reputation for being right; lives may depend upon it.

"It’s all about accuracy and not getting overwhelmed, and if you expect the worst you are really disappointed,” the technical expert says evenly.

Here, everyone feels the need for speed. Every effort is made to begin testing within four hours of receiving a sample and turning around results within 12. The lab realizes time is of the essence when someone is waiting on medical test results for what could be a lifechanging event.

Being methodical, careful and detail oriented is how this team tackles each test. “Staying in the box” is a good thing when it comes to following precise lab procedures. The process is fairly simple. Doctors order tests in the EMR system, which transfers the order to the lab system. A machine reads the bar code, sees the test and conducts the test.

— John Hodson

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research Spotlight

You focus on what you are doing to help patients. If you can help someone get their results quicker, so they are not worrying, that is something.”

The Central Lab runs up to 12,000 tests in a day on 3,500 samples, all of which center around analyzing blood and serum and running chemistry analyses.

That may seem like a lot, but they actually have a capacity to do even more. “In theory, we can do 11,000 tests an hour,” Hodson says. “All we have to do is get them on the machine. If you tested glucose you could do that many, but when you switch back and forth between various tests, you invariably do less.”

The most common test performed is CMP (comprehensive metabolic panel), which is a group of blood tests that provide an overall picture of the body's chemical balance and metabolism — how the kidneys and liver are working; blood sugar, cholesterol and calcium levels; electrolytes.

Once a test is completed and results are generated, the lab team checks them and the info is electronically relayed from the Central Lab back to the physician who ordered it. The physician receives an alert within the EMR registering normal, abnormal or critical alert.

If something doesn’t add up, Hodson’s team takes another look and repeats the process if needed.

"We have about a 3 to 4 percent repeat rate. With cancer sometimes the results are really funny, but usually even when we repeat the tests they are what they are,” he says.

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FCS The Magazine

— Michelle o'hara

Working well under pressure is part and parcel of the job. And the entire team takes things in stride.

A closely-knit team of six keeps the place humming. Reporting to Hodson are a quality assurance analyst (Michelle O’Hara), two medical technologists (Adam Feikert and Mark Sibold), a medical lab technician (Elaine Van Horn) and an aide (Chris Brightbill). They banter and share a sense of camaraderie, but they keep highly focused.

Michelle O’Hara handles quality control and has worked in the lab for FCS for 10 years. She loves the atmosphere and says Hodson is a big reason why. “He’s the best boss ever. He doesn’t micromanage anyone,” she says, adding, “I think that everyone that works here feels really lucky. We get so much stuff done, but there’s no stress. Everyone loves coming to work. Turnover is small, because no one wants to leave.”

Knowing you may be the bearer of bad news to several patients every day could be depressing for some. This team keeps a positive perspective. “You focus on what you are doing to help patients. If you can help someone get their results quicker, so they are not worrying, that is something,” O’Hara says. n

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legislative

soundbites

Stopping the Destructive Sequester Cut to the Payment of Cancer Drugs Our country has been struggling with the effects of sequestration since its implementation last year. Cancer care has been hit extremely hard during this process due to the inappropriate manner in which the Center for Medicare and Medicaid Services (CMS) applied the sequestration to cancer drugs. The decreased reimbursement, in many instances, doesn't even cover the cost of the medications given in our community cancer clinics. As a result, patients are either being shifted to the hospitals for their care (which is more expensive for the patient and taxpayer), or clinics across the country are closing their doors or merging with hospital systems.

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Advancing Payment Reform that Enhances Quality and Increases Efficiencies Community Oncology Alliance has been championing the development of the Oncology Medical Home payment reform model for cancer care delivery. The model establishes defined measures of cancer care quality, rewards providers that provide the highest quality of cancer care, is budget neutral and evolves to a shared savings with bundled payments for episode of care. The oncology community has the best developed sub-specialty health care delivery model that optimally meets the requirements from the Affordable Care Act and was designed to ensure patients receive state of the art, quality driven health care with a focus on value.

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Achieving Payment Parity for the Identical Services Regardless of the Site of Delivery Outpatient chemotherapy can be administered in community cancer clinics or in hospital outpatient facilities. Two different reports (one from Milliman, the other from Moran) published in 2013 demonstrated that

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FCS The Magazine

cancer care delivered in hospital outpatient facilities cost 25-to-50 percent more than the exact same medications given in a community cancer clinic. This disparity will be increasing since the Center for Medicare and Medicaid Services decided to increase payment for chemotherapy administration to hospital outpatient facilities for 2014.

Reigning In and Refocusing the Out-ofControl 340B Program The 340B Program was intended to help

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provide economic resources to those hospitals that see a disproportionate amount of uninsured patients. This program has minimal restrictions and oversight has been exploited by many institutions and has become a major source of revenue. Studies have shown that 80 percent of the indigent patient care is provided by 20 percent of the hospitals that have been designated as a 340B. The overall effects of this out of control program have resulted in increased insurance premiums, increased expense to taxpayers, increased cost of pharmaceutics and increased shortages of generic medications.

Getting patients the critical medications and therapies they need at the moment they need them takes more than packing trucks. It takes a global healthcare solutions leader dedicated to enhancing patient care through end-to-end solutions for manufacturers, pharmacies and providers. It takes security, accuracy and consistency.

It takes horsepower and brainpower. It takes AmerisourceBergen.

ItTakesAmerisourceBergen.com Summer 2014

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A cancer diagnosis changes everything.

Fighting cancer is a long journey. Florida Cancer Specialists Foundation helps make the road a little easier.

We deeply care about our patients and their struggles. Florida Cancer Specialists Foundation was created to help patients who need fi nancial assistance while undergoing treatment. The Foundation allows those fighting their battle with cancer to concentrate on recovery rather than their overdue rent, mortgage, electric or water bill.

Please visit our website for ways to donate. Florida Cancer Specialists Foundation is a 501(c)(3) non-profit organization.

1600 Phillips Road, Suite 300 | Tallahassee, FL 32308 | (850) 877-8166

Foundation

2626 Care Drive, Suite 200 | Tallahassee, FL 32308 | (850) 219-5830

foundation.flcancer.com