Florida md july 2016

JULY 2016 • COVERING THE I-4 CORRIDOR

Florida Hospital Cancer Institute Mark Socinski, MD: Prominent Physician-Scientist Leads in a New Health Care Era

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contents 4

JULY 2016 COVERING THE I-4 CORRIDOR

 COVER STORY

The Florida Hospital Cancer Institute (FHCI) has welcomed a new leader to help guide the institution amid a time of unprecedented change, promise and challenge in health care.

PHOTO: DONALD RAUHOFER / FLORIDA MD

Mark Anthony Socinski, M.D., a prominent thoracic oncologist and physician-scientist, said his focus as Executive Medical Director will be to raise the institute’s national profile as a leader in cancer care.

Socinski’s 30 years of clinical expertise, scientific discovery and visionary leadership have brought international recognition and have uniquely positioned him to lead the way in an era of cancer treatment that is increasingly complex and costly.

“I am focused on the goal of creating a system of cancer care that is second to none, where patients come because of the quality of care and the research that’s here,” Dr. Socinski said. “The challenge is how to provide the therapies cost efficiently and without redundancy. “Over the next several years, we will be looking to develop specialized multidisciplinary teams and attract leaders to help foster and grow that aspect of FHCI.”

PHOTO: DONALD RAUHOFER / FLORIDA MD

ON THE COVER: Mark Anthony Socinski, MD

DEPARTMENTS 2

FROM THE PUBLISHER

3

PULMONARY & SLEEP DISORDERS

8

BEHAVIORAL HEALTH

10 MARKETING YOUR PRACTICE 11 HEALTHCARE BANKING, FINANCE AND WEALTH 12 ORTHOPAEDIC UPDATE 13 CANCER 15 INPATIENT REHABILITATION

FLORIDA MD - JULY 2016 1

FROM THE PUBLISHER

I

am pleased to bring you another issue of Florida MD. When I was a boy, I used to love to play outside and get dirty. God bless my poor mother, may she rest in peace. I guess that boy still lives on inside the man because that’s still what I like to do. If there’s a boy or girl inside of you too that likes to play hard and doesn’t mind getting a little messy, there’s an incredibly fun event coming up that you should consider. It’s called MUDD Volleyball and it benefits the March of Dimes. Eight thousand fewer Florida babies were born premature last year thanks to the efforts of the March of Dimes. What could be better? Form a team with your friends, your family or your co-workers and come out August 20th for some down and dirty fun and good times for a great cause. I hope to see some of you there.

Best regards,

Donald B. Rauhofer Publisher

For more information on the MUDD Volleyball event or the March of Dimes please call: Phone: (407) 599-5077 Fax: (407) 599-5870 March of Dimes Orlando Market 555Winderley Place, Suite 105 Maitland, FL 32751

COMING NEXT MONTH: The cover story is about Celebration Orthopaedic.

Editorial focus is Sports Medicine and Robotic Surgery

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Publisher: Donald Rauhofer Photographer: Donald Rauhofer / Florida MD Contributing Writers: Heidi Ketler, Sajid Hafeez, MD, Daniel T. Layish, MD, Asad Sheikh, MD, Stephanie Morrell, RN, Jennifer Thompson, Corey Gehrold Art Director/Designer: Ana Espinosa Florida MD is published by Sea Notes Media,LLC, P.O. Box 621856, Oviedo, FL 32762. Call (407) 417-7400 for more information.

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Although every precaution is taken to ensure accuracy of published materials, Florida MD cannot be held responsible for opinions expressed or facts expressed by its authors. Copyright 2012, Sea Notes Media. All rights reserved. Reproduction in whole or in part without written permission is prohibited. Annual subscription rate $45.

PULMONARY AND SLEEP DISORDERS

Idiopathic Pulmonary Fibrosis – Current Approach to Therapy By Daniel T. Layish, MD Idiopathic pulmonary fibrosis (IPF) is also known as usual interstitial pneumonitis (UIP). There are estimated to be 48,000 new diagnoses of IPF per year in the United States, with 40,000 deaths per year.

About two thirds of patients with IPF pass away within five years of diagnosis. For many years, combination therapy with prednisone and azathioprine had been used. However, the PANTHER trial revealed convincingly that combination therapy with prednisone and Imuran actually resulted in greater mortality, more hospitalizations, and more serious adverse events than placebo. Therefore, combination therapy with azathioprine and prednisone is no longer recommended. For a while, treatment of IPF had been essentially supportive including supplemental oxygen, pulmonary rehabilitation and vaccination against Streptococcus pneumoniae and influenza. Lung transplant can also be considered when appropriate.

Pirfenidone (Esbriet) is an antifibrotic agent, which has now been shown in several clinical trials to reduce disease progression and improve progression free survival in patients with IPF. Pirfenidone inhibits the synthesis of transforming growth factor Beta, which plays a role in cell proliferation and differentiation.

There have been two previous phase III trials of Pirfenidone that seem to have conflicting results. One study (published in 2010) showed that Pirfenidone slows disease progression while another study (published in 2011) did not meet its end point.

However, this last study did have some trends that were in a positive direction; this resulted in the FDA requesting the “ Assessment of Pirfenidone to Confirm Efficacy and Safety in Idiopathic Pulmonary Fibrosis Study” (ASCEND). The result of this study was published in the New England Journal of Medicine. In the ASCEND study, 278 patients with IPF were randomized to receive Pirfenidone 2403 mg per day for 52 weeks. 277 patients were randomized to receive Placebo. The primary endpoint was forced vital capacity and secondary end points included 6-minute walk test distance, progression free survival, dyspnea, overall mortality and disease specific mortality.The proportion of patients who had an absolute reduction of at least 10% in predicted forced vital capacity (FVC) or who died was 47.9% less in the Pirfenidone group as compared to the Placebo group. In addition, the average decrease in FVC from baseline was lower in the Pirfenidone group versus the Placebo group (235 versus 428 mL).

Furthermore, the proportion of patients who had no decline in FVC was 132% higher in the Pirfenidone group than in the Placebo group and there was also less decline in the 6-minute walk distance in the Pirfenidone group compared to the Placebo group as well as better progression free survival. However, there was no significant difference in dyspnea score and all cause mortality or disease specific mortality between the two groups.

There has been a pooled analysis of data from all three Pirfenidone trials, which revealed that the overall risk for death at 52 weeks was lower in the Pirfenidone group versus the placebo

group with a hazard ratio of 0.52. In this pooled analysis Pirfenidone improved both all cause mortality and disease specific mortality. The most common side effects included gastrointestinal and skin related adverse effects, but these rarely led to treatment discontinuation.

Unfortunately, patients on Pirfenidone do not necessarily perceive improvement and Pirfenidone is certainly not a cure for this serious illness. Nevertheless, it appears to be a good option for slowing down the progression of this serious condition.

Another new option for treating UIP/IPF is Nintedanib (OFEV®) This is a tyrosine kinase inhibitor that targets growth factors including the vascular endothelial growth factor receptor, fibroblast growth factor receptor and platelet derived growth factor receptor. In May 2014, Luca Richeldi et al published the results of two 52 week randomized, double blind phase 3 studies of nintedanib (150 mg twice/day) versus placebo in the New England Journal of Medicine. 1066 patients were enrolled in a 3:2 randomization. The adjusted annual rate of change in FVC was negative 115 ml with Nintedanib versus negative 240 ml with placebo. Diarrhea occurred in over 60 percent of patients on Nintedanib but led to discontinuation in less than five percent.

The most frequent serious adverse reactions reported in patients treated with OFEV® (more than placebo), were bronchitis (1.2% vs. 0.8%) and myocardial infarction (1.5% vs. 0.4%).

However, in the predefined category of major adverse cardiovascular events (MACE) including myocardial infarction, fatal events were reported in 0.6% of OFEV® treated patients and 1.8% of placebo-treated patients. Therefore, the clinician must weigh the risk/benefit ratio of using this medication in a patient with known coronary artery disease (or cardiovascular risk factors) carefully.

In conclusion, IPF/UIP is a relatively common and progressive pulmonary disorder. Pirfenidone and Nintedanib are two new agents that appear to slow down the progression of this disease.

Further research needs to be done to identify agents that can reverse pulmonary fibrosis. Since Nintedanib and Pirfenidone seem to have similar efficacy, most clinicians choose one over the other based on side effect profile and dosing considerations.

References available upon request

Daniel Layish, MD, graduated magna cum laude from Boston University Medical School in 1990. He then completed an Internal Medicine Residency at Barnes Hospital (Washington University) in St.Louis, Missouri and a Pulmonary/Critical Care/Sleep Medicine Fellowship at Duke University in Durham, North Carolina. Since 1997, he has been a member of the Central Florida Pulmonary Group in Orlando. He serves as Co-director of the Adult Cystic Fibrosis Program in Orlando. He may be contacted at 407-841-1100 or by visiting www.cfpulmonary.com.  FLORIDA MD - JULY 2016 3

COVER STORY

Florida Hospital Cancer Institute –

Mark Socinski, MD: Prominent Physician-Scientist Leads in a New Health Care Era

By Heidi Ketler The Florida Hospital Cancer Institute (FHCI) has welcomed a new leader to help guide the institution amid a time of unprecedented change, promise and challenge in health care.

Mark Anthony Socinski, M.D., a prominent thoracic oncologist and physician-scientist, said his focus as Executive Medical Director will be to raise the institute’s national profile as a leader in cancer care.

develop specialized multidisciplinary teams and attract leaders to help foster and grow that aspect of FHCI.”

COLLEAGUES AT FHCI WELCOMED DR. SOCINSKI’S ARRIVAL

“Over the last 10 years, our thoracic cancer program has been rising in national standing in providing innovative clinical trials, in providing access to treatment options that had not before Socinski’s 30 years of clinical expertise, scientific discovery and been available and in having an impact on drug development,” visionary leadership have brought international recognition and said thoracic oncologist Tarek Mekhail, M.D., M.Sc., F.R.C.S.I., have uniquely positioned him to lead the way in an era of cancer F.R.C.S.Ed., who heads the Florida Hospital Cancer Institute treatment that is increasingly complex and costly.

Thoracic Oncology Program and served as interim Executive Medical Director for 18 months prior to Dr. Socinski’s hiring.

“I am focused on the goal of creating a system of cancer care “Dr. Socinski will take us to a new level.” that is second to none, where patients come because of the quality Radiation oncologist Matthew Biagioli, M.D., M.S., said he of care and the research that’s here,” Dr. Socinski said. “The challooks forward to Dr. Socinski expanding FHCI’s quality of treatlenge is how to provide the therapies cost efficiently and without ment. redundancy. “Over the next several years, we will be looking to “It’s essential that the Executive MediMark Socinski, MD and Tarek Mekhail, MD discuss tumor board – where thoracic oncology cases are reviewed on a weekly basis by an interdisciplinary team to determine the best treatment plan cal Director is able to balance the needs of the hospital and the hospital sysand approach for each patient. tem – to be cost effective in treatment delivery – with the clinical practice of the physician and how they treat their patients,” said Biagioli, who is Medical Director of Radiation Oncology Specialists at FHCI. “To do so effectively so Florida Hospital can be successful in the next decade is going to hinge on creativity in terms of the programs that are designed.”

A MEDICAL CAREER IMMERSED IN RESEARCH

PHOTO: DONALD RAUHOFER / FLORIDA MD

Dr. Socinski has dedicated his career as a physician, researcher, teacher and mentor within the setting of academic institutions to advance the treatment of all thoracic malignancies.

He has produced hundreds of peer-reviewed articles and published abstracts, 22 monographs and 16 book chapters.

His most recent honor was the Director’s Distinguished Scholar Award presented in 2012 by PNC Bank/University of Pittsburgh Cancer Institute.

Dr. Socinski specializes in the devel4 FLORIDA MD - JULY 2016

opment of novel chemotherapy agents and treatment strategies for advanced non-small cell lung cancer and small cell lung cancer. He has played a leading role in developing aggressive and innovative combined-modality approaches to treat advanced non-small cell lung cancer, and he is at the forefront of integrating novel targeted agents with cytotoxic chemotherapy regimens. In recent years his research has focused on incorporating personalized medicine and the use of molecular biomarkers in the treatment of lung cancer.

Prior to joining Florida Hospital, Dr. Socinski was with the University of Pittsburgh School of Medicine, where he was its first Dr. Mekhail has a strong background in clinical trials, and with the addition of Dr. Socinski to the FHCI faculty member to have a joint ap- team they hope to bring about even more new clinical trials and cutting edge therapies for thoracic oncolpointment as professor of thoracogy patients. ic surgery in the Department of high-quality care more affordable and accessible.

Cardiothoracic Surgery. He served as director of the Lung Cancer Among the strategies about to be implemented at FHCI is a Section, Division of Hematology/Oncology at the University of pilot multimodality lung cancer clinic that will streamline the Pittsburgh School of Medicine; co-director of the University of process for referrals, testing, treatments, specialists and office visPittsburgh Medical Center Lung Cancer Center of Excellence; its. The clinic will bring the entire medical team to the patient and co-director of the Lung Cancer Program at the University of at one time and place. The plan is to expand the model to other Pittsburgh Cancer Institute. oncological sites following positive results.

Before that, Dr. Socinski spent 16 years at the University of “The vision for FHCI is to create disease-specific teams that are North Carolina at Chapel Hill and the Lineberger Comprehensupported by the proper infrastructure, not only to provide the sive Cancer Center, as professor of medicine in the Division of best care, but to support an active clinical research program and Hematology-Oncology and director of the Multidisciplinary to make that as broadly applicable to the patients we serve,” said Thoracic Oncology Program. He was also involved in the develDr. Socinski. opment of UNC’s multidisciplinary thoracic oncology program.

Another FHCI initiative is to structure a “hub-and-spoke” sysDr. Socinski earned his undergraduate degree in zoology, mastem for delivering cancer therapies in an evidence-based way to ter’s degree in pathology and medical degree from the University patients in communities that are served by an array of Florida of Vermont, College of Medicine. He completed his residency Hospital facilities in Central Florida. The design is for the “hub” training in internal medicine at Beth Israel Hospital, Harvard – the main Orlando hospital campus – to provide the more comMedical School and fellowship training in medical oncology at plicated, resource-intensive cancer treatments, such as surgery.

Dana-Farber Cancer Institute, Harvard Medical School. He went Other subsequent treatments, such as chemotherapy or radioon to the Medical Center Hospital of Vermont and University of therapy, would then be provided with the same high standards in Vermont, where he practiced from 1989 to 1995. the “community” hospitals.

Dr. Socinski is an active member of several leading professional A centralized radiation oncology department is moving in this and scientific organizations, among them, the American Society direction and now serves the tri-county area. of Clinical Oncology, International Society for the Study of Lung “We have to create a common vision throughout the Florida Cancer and the American College of Chest Physicians. He forHospital system. We have to achieve the vision through developmerly co-chaired the National Cancer Institute Thoracic Maligment of pathways to ensure all patients are getting a high standard nancy Steering Committee. of care, evaluation and treatment,” said Dr. Socinski. “Through system-wide endorsement for clinical trials we will be able to offer STRATEGIES FOR SUCCESS IN A NEW ERA up-and-coming treatments for patients who will be seen under Never before has the management and cure of cancer been the Florida Hospital umbrella of care.” more promising — or complex and costly — for patients, providA NEW TREATMENT PARADIGM/BALANCE ers and payers. FHCI is one of the many major treatment centers across the country implementing new delivery systems to make Gone are the days of niche therapy for one or two tumor types.

FLORIDA MD - JULY 2016

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PHOTO: DONALD RAUHOFER / FLORIDA MD

COVER STORY

COVER STORY “If you look back 10 years ago, we divided lung cancer into basically three main types, and there was a limited number of chemotherapy agents available. Now moving forward, our knowledge of these cancers on a molecular level has exploded. There is a growing list of lung cancer subtypes, each with a different type of molecular signature that is likely to respond to a specific targeted agent. In addition, immunotherapy now has become a standard of care in lung cancer,” says Dr. Socinski.

“As a result, it’s important to keep up to speed with every cancer and the details needed to make treatment a personalized experience.”

SPECIALIZATION “My vision for the Florida Hospital Cancer Institute is to bring together the best of academia and the best of clinical care in a mixture of disease-specific specialists and general oncologists,” says Dr. Socinski. “With that model, I don’t have to know the very latest about breast cancer therapies, but I do know a great deal – more than most – about lung cancer. So that’s where I can focus my expertise.”

Mark Socinski, MD Executive Medical Director Florida Hospital Cancer Institute

“That’s how the field of oncology is evolving, with many of your academic leaders and diseasespecific experts knowing the latest in treatment options that they can relay to more-general oncologists working on more difficult, refractory, cancer cases,” says Dr. Socinski. “People realize that it’s increasingly difficult to keep up with the many things a generalist needs to keep up with. Having said that, certainly there is room for generalists who want to focus on a specialty.

We want to be more inclusive rather than exclusive.”

ACCURATE DIAGNOSIS AND PERSONALIZATION “Cancer is a wide spectrum of molecular alterations, not a one-size fits-all issue. The cornerstone of care is getting the right treatment to the right patient at the right time. It comes down to making the right diagnosis and doing the appropriate biomarker test to subset patients into categories that are going to require different treatments. We want to identify the cancer alteration, the makeup of the cancer, and get the correct stage beyond a shadow of a doubt, which will dictate what you do from that point on,” Dr. Socinski says.

“That said, it’s a huge challenge. We aren’t able to truly personalize treatment for every patient, because there is a lot we still don’t understand, and there are things we may find that don’t have effective treatments. But this can only get better and more efficient as progress marches on.”

Tarek Mekhail, MD, MSc, FRCSI, FRCSEd, Medical Director, Thoracic Cancer Program, Florida Hospital Cancer Institute

The diverse array of advanced treatment options for pediatric and adult cancer patients at FHCI include: image-guided radiation therapy, stereotactic radiosurgery, intensity-modulated radiation therapy and brachytherapy.

Stereotactic body radiation therapy (SBRT) is a short-course treatment that uses precise, high-dose-intensity radiation without damaging adjacent tissue. In general, the number of treatments varies from one-to-five sessions, allowing completion within one-to-two weeks. Treatment times can range from 15-to-30 minutes per session.

“We’ve had early success with lung cancer. Clinical trials on stereotactic body radiation therapy (SBRT) have demonstrated that outcomes in patients with early-stage lung cancer are the same, whether they undergo surgical resection or SBRT, as for the control. So those patients who are not good surgical candidates have an equivalent option,” says Dr. Biagioli.

The use of SBRT is being expanded, particularly as a treatment option for live metastatic and pancreatic cancers, as well as in patients with oligometastatic disease, a state of metastasis that is between purely localized and widespread metastasized.

RESEARCH

Matthew Biagioli, MD, MS Medical Director, Radiation Oncology Florida Hospital Cancer Institute 6 FLORIDA MD - JULY 2016

“There has been a significant amount of time, effort and money invested by Florida Hospital that has resulted in the complete reorganization of how research is performed here, so the Florida Hospital system can compete with academic centers in terms of the breadth and depth of clinical offerings from a research standpoint,” says Dr. Biagioli.

“Part of the logic is to bring research to the forefront in order to attract the best and brightest physicians with track records of successful research.”

COVER STORY This strategy led to the recruitment of Tarek Mekhail, a surgeon turned renowned thoracic oncologist; and now Mark Socinski.

“Certainly for certain programs we want to attract nationally recognized, disease-specific leaders, similar to our surgeons who subspecialize in treating gastrointestinal tumors,” says Dr. Socinski, adding, “The institute has great strength now in gastroenterology and gastrointestinal cancer surgery.”

The Florida Hospital Clinical Research Center is nationally recognized as one of the most active in the state. It has been providing patients with direct access to promising new drugs, gene therapy treatments and diagnostic tests since it was founded in 1989.

In addition to the National Cancer Institute, FHCI maintains research affiliations with the Sarah Cannon Research Institute, Duke Comprehensive Cancer Center, University of California, Los Angeles Jonsson Comprehensive Cancer Center and various pharmaceutical companies.

of care with services ranging from disease prevention to state-ofthe-art diagnosis and treatment, as well as leading-edge clinical trials.

Cancer care coordinators with extensive oncology experience are the point people, says Dr. Socinski. “Care coordinators work closely with the physicians and in every single way are just as important. They are the link between the patient, doctor and others on the medical team, providing a single point of contact for everything a patient needs, from scheduling appointments with specialists, to providing access to clinical trials and second-opinion referrals.

“They are advocates for quality of care that is tailored to a patient’s individual needs. They are key to ensuring that the delivery of care occurs in a logical, connected and timely manner. They ensure patients have the education, support and resources needed to make informed choices.”

COMPREHENSIVE, CUTTING-EDGE CANCER TREATMENT

Care coordination is free to all patients and families. A cancer care coordinator can be reached by calling (407) 303-1700. Afterhours calls are returned within one business day. For more information visit FloridaHospitalCancer.com/care-support

FHCI is a leading cancer center in the United States and the largest in central Florida. Recognized as a “destination” for cancer care, patients come from around the world for its cutting-edge technologies and therapies.

FHCI patients, caregivers and health care professionals also have access to resource libraries that are equipped with interactive computers and helpful volunteers. A variety of general-cancer and disease-specific support groups always welcome new members.

Today, more than 200 Florida Hospital medical oncologists, radiation oncologists, surgeons and subspecialists work in multidisciplinary teams to treat each patient, from diagnosis and throughout treatment. They provide a comprehensive continuum

CONTINUOUS QUALITY

PHOTO: DONALD RAUHOFER / FLORIDA MD

Among them are the American College of Surgeons Commission on Cancer, in the Academic Comprehensive Cancer Program (ACAD) category, the Quality Oncology Practice Dr. Mekhail served as the interim Executive Medical Director for 18 months prior to Dr. Socinski’s arrival, they will be working very closely together on the opening of the new multimodality lung cancer clinic.

Initiative and the American College of Surgeons National Accreditation Program for Breast Cancer.

“Continuous quality improvement is a vital part of the FHCI mission,” says Dr. Socinski. “And that’s been the strength of FHCI to date. The cancer institute is recognized by over 100 different organizations that assess quality in a number of different ways.

Our goal is to maintain and improve upon and sometimes challenge the definition of quality and reassess as new standards arise.”

For more information, call (407) 303-1700 or visit FloridaHospitalCancer.com 

FLORIDA MD - JULY 2016

7

BEHAVIORAL HEALTH

Understanding the Legality of Involuntary Hospital Commitment

By Sajid Hafeez, MD Unlike many medical fields, mental health has perhaps the strangest relationship with its patients in that it frequently administers services to patients who many times do not desire them.

This prospect is something that can be quite disconcerting to the patients and their loved ones. This is also something that may not be completely understood by the practitioners of other medical

disciplines. So to those ends, it’s helpful to have an understanding of the true nature of involuntary commitment, the legality of it, and what it means to the patient and practitioner.

Most states have allowed for a legality of sorts that allows for trained individuals to act in what they feel is in the best interest of a person who is not of sound mind. In Florida, the ruling law of this is the Baker Act, the common name for the Florida Mental Health Act of 1971. The Act allows for the immediate detainment of any individual who is deemed to be of imminent risk of harm to self or others and is deemed mentally incompetent.

Frequently, at-risk individuals are identified by police officers responding to calls who are trained to identify key criteria and transport the individual in question to the nearest Baker Act receiving facility to be assessed by a doctor. The law also allows for a physician, clinical social worker, mental health counselor, marriage and family therapist, or psychiatric nurse with a master’s degree to Baker Act anyone that the feel meets the criteria.

Once a person is “Baker Acted,” so long as that patient is cleared as medically stable by a hospital, a person may be held involuntarily for 72 hours. (Similarly, a judge may order an ex-parte wherein a family may beseech the court to file involuntary commitment based on testimony without the person in question present- hence the term Ex Parte, which means “derived from the party” in Latin. The only difference between this and the Baker Act is that an Ex Parte allows for a person to be held involuntarily for 7 days.)

What confuses most is what happens To learn more, call 407 587-8600. once a patient is transferred to a psychiatric hospital before the allowed time period has A Higher Level of Care® expired. Under the law, a psychiatrist must examine this patient within 24 hours of arrival to the facility. The doctor then has the remaining time left in the Baker Act or Ex Parte to rule the patient as competent or 831 South State Road 434 • Altamonte Springs, FL 32714 incompetent. If the patient is found competent, he or she is given the opportunity to healthsouthaltamontesprings.com be transitioned to a Voluntary admission to the hospital where he or she is able to receive ©2015 HealthSouth Corporation 1110525 doctor recommended treatment until the

Better Outcomes.

Quality Care.

Stroke. Trauma. Brain Injury.

8 FLORIDA MD - JULY 2016

BEHAVIORAL HEALTH doctor feels that the patient has reached maximum benefit from acute inpatient hospitalization and is stable enough to proceed to a step down into outpatient care. Or, if a patient (or parent) decides that he or she has no desire to pursue stabilization, that patient (or parent) may elect to discharge from the hospital. However, if the doctor feels the patient is competent, but still in need of inpatient care, the discharge may be against medical advice (AMA), which is a way for the doctor who protect himself from liability should the patient relapse.

However, if by the end of the allowed involuntary time period the doctor feels that the patient is not of sound mind and unable to make competent decisions, the doctor may initiate what is referred to as a “32.” This is a petition to extend the involuntary commitment.

When the petition is initiated, the allotted time period freezes. During this time, a second doctor is contacted to do an independent assessment. If the second doctor reaches the same conclusion that the person is not mentally competent, the petition is forwarded to the local court , which will arrange a hearing with a judge. At this hearing the doctor, patient, and or parents are given an opportunity to testify before the judge. If the judge believes the doctor’s assessment is correct, he will extend the length of time that a patient can be involuntarily held at the suggestion of the doctor with the intention to provide treatment for stabilization. At this time, if the patient lacks a parent or proxy to act as the decision maker in the best interest of the patient, the court will initial the process to provide a guardian ad litem decision maker. (This is necessary, as a person who is deemed to be incompetent cannot consent to treatment or medications and requires a proxy to act on his or her behalf.)

To those new to it, involuntary commitment can seem to be an overwhelming concept mired in a mire of uncertain legality. In reality, at its heart, it is a fairly straightforward set of rules developed to protect those whose unstable mental status leaves them vulnerable to a world that they are not, unfortunately, sound enough to understand. These laws provide the opportunity for the professionals to work toward returning these patients back to a place in life where they can once again make rational, thoughtful choices and work to improve the quality of their life.

Sajid Hafeez, M.D., is a child and adolescent psychiatrist who is serving as a Medical Director of the Acute Care Baker Act Unit at the University Behavioral Center. He also served as the Center’s Medical Director of the long term Residential Units: ASAPP Unit (for adolescent boys with inappropriate sexual behaviors), Solutions Unit (for adolescent boys with behavior problems), Promises and Stars Unit (for adolescent females with behavioral problems as well as victims of sexual abuse), and Discovery Unit (for children ages 5-13 with behavioral as well as inappropriate sexual problems). In addition, Dr. Hafeez also Served as an Assistant Professor of Psychiatry at the University of Central Florida (Voluntary Position). He was also the Chief of the Adolescent Psychiatry Unit, an Attending Psychiatrist of the Comprehensive PsychiaOften times the stress of everyday life can be overwhelming. A particutry Emergency Program and of the larly traumatic event can change your life in an instant. We are here.

Mobile Crisis Team at the Westchester Let us help you navigate through life’s sometimes unpredictable turns.

Medical College. At Vassar Brother’s UBC is a 112 bed psychiatric inpatient and substance abuse/detox hosMedical Center in New York. Dr. pital. UBC offers children, adolescents, and adult programs and accepts Hafeez was the Director of Outpamost insurances including Medicare and Tricare. We offer specialized tient Child & Adolescent and Adult treatment based on the individual and treat the following common diPsychiatric Clinic as well as Director agnoses as well as others: of Consultation and Liaison Psychia Anxiety/Phobias  Trauma Related Issues try. Dr. Hafeez received his adult Psy Depression  Substance Abuse Treatment chiatry and Residency Training at the (Adult)  Bi-polar Disorder University of Kansas Medical Center  Detox services (Adult)  Co-occurring Disorders in Kansas City. He received his Child  Intensive Outpatient- Substance  Phobias and Adolescent Psychiatry fellowship Abuse (Adults)  Grief training at the New York Medical  Intensive Outpatient and Partial  Adjustment Disorders College New York and at Children’s Hospitalization- Mental Health  Anger Management National Medical Center of George (Adults)  ADHD Washington University in WashingTO SCHEDULE A FREE AND CONFIDENTIAL ASSESSMENT ton, DC. Dr. Hafeez can be reached at 407-281-7000 or by visiting www.

CALL 407-281-7000 or FAX REFERRAL TO 407-282-5410 universitybehavioral.com.  2500 Discovery Drive Orlando, FL PLEASE PLACE STAMP HERE

FLORIDA MD - JULY 2016

9

MARKETING YOUR PRACTICE

How Patient Testimonials Can Drive Appointments

By Jennifer Thompson Do you want to grow your medical practice easier, faster and more effectively? How can you, as a medical practice administrator, a physician managing your own clinic or a medical marketing professional, engage potential customers and get them through the door? The answer is using some of the most valuable resources you already have: your patients. In today’s day and age, patient testimonials drive appointments like never before and this post will help show you how.

The most successful doctors and clinics in America today are rejuvenating and enhancing their marketing efforts using patient testimonials as part of a patient-first marketing plan.

Patient testimonials propel customer engagement, increase potential patient interest and commitment, and significantly boost search rankings on search engines like Google and Bing.

If you have patients raving about how much they love your practice, or telling everyone they know how you helped them live a better, healthier life, then marketing with patient testimonials can help take your practice to the next level.

separately by a video of the doctor describing that procedure.

After that, you can take both videos and transcribe them into written form. By combining the two videos, you can create first-rate, long form content in a journalistic style, and you’ll have wonderful long form content that’s fresh and that’s great for your website.

EVERGREEN CONTENT Creating a good patient testimonial is an art form, and when done well, an exceptional testimonial will serve as evergreen content.

Evergreen content is a gift that keeps on giving. Like a great pair of jeans, it’s timeless and never goes out of style; the more you use it, the more compliments you’ll get, and the more fruit it will bear. Evergreen content is a piece of content that you can put it up anytime, anywhere, and it will still be effective for you and your practice. You can use it at Christmas time, spring, or fall, as long as the procedure related to it is still relevant, then the testimonial will also be pertinent and fresh.

3 WAYS PATIENT TESTIMONIALS CAN FILL APPOINTMENT SLOTS 1. Short-form videos: The first way to capitalize on patient testimonials is to set up a series of videos that have a compelling story to tell. Sit down with your patients for about fifteen minutes each, and get their stories on video. You’ll need them to sign a release waiver, but after that, the process is quick and straightforward, and can be completed from any computer.

Edit the video down to a 3-5 minute segment, and you can then put it up on YouTube, or onto your own website. Google loves videos (on YouTube and on your site) They’re always looking for relevant content, and your patient testimonials fit the bill perfectly. Here’s an example of one we recently put together for a client: 2. Procedural content from the experts: The next step in developing and supporting your patient testimonials is to sit down with your physicians and medical practitioners, and have a quick and understandable discussion about the procedures they perform. You’ll then have a great testimonial discussing a procedure that a patient went through, complemented 10 FLORIDA MD - JULY 2016

Google loves relevant, long form content. It’s something your competitors will never have; because these are your patients and your doctors discussing their own experience in the first person. The best thing is that it’s simple to do; you can create long and short versions of the content all on your computer.

3. Through social media: Schedule regular social media posts to promote the patient testimonials. Post the videos on Facebook or on Twitter, or post air quotes from the testimonials, accompanied with a nice graphic (i.e. “We love Dr. Jones for helping us get pregnant!”). High quality, engaging graphics are particularly effective on social media platforms like Facebook, Pinterest and Instagram.

Small, simple quotes go a long way on social media - and they’re fast and easy to schedule.

SEIZE THE DAY The internet and social media have radically changed the way people communicate, and have revolutionized how patients now search for, and choose, their doctors. Today’s potential patients are looking for an emotional connection with their doctor, and they want to know about other people’s experiences with that physician.

There is untapped marketing potential among the many stories our patients have to tell. Properly leveraging your patients’ stories can enable you to develop a practice that fosters trust, strengthens your credibility, and helps carry out your marketing plan for you.

Jennifer Thompson is co-founder and chief strategist for DrMarketingTips.com, a website designed to help medical marketing professionals market their practice easier, faster and better. 

HEALTHCARE BANKING, FINANCE AND WEALTH

Little Known Easy and Valuable Business Account Protection – A service that most practices and CPAs are unaware of!

By Jeff Holt, CMPE, VP, Senior Healthcare Business Banker with PNC Bank When I speak with CPAs, Medical Billers, doctors and practice managers about some easy ways to protect a practice’s business checking account, I always include details about UPIC (Universal Payment Identification Code). I find it is very interesting that so many have never heard of this simple low cost valuable service.

The level of protection (unauthorized electronic debits), and ease with changing where you bank (in relation to changing ACH deposits) makes this service essential to most practices and businesses.

In one of my recent presentations to Tom Abrassart, CPA, CFP, CGMA and Janelle Zell, Staff Accountant with Longwood CPA they each were very excited about the value of UPIC and amazed that they were just finding out about it. After our meeting Janelle Zell wanted to educate others about UPIC and wrote the following article: As an accountant, if I didn’t highlight an internal control that could be implemented immediately, which could also improve cash flows, at a minimal cost, I would be doing a disservice to the profession. I would like to share something that I learned about in a recent meeting with banking colleagues which can accomplish all of this for businesses, especially medical practices.

It’s called a UPIC®, an acronym for Universal Payment Identification Code. I view this as an invaluable tool for any business receiving direct deposits, in particular, medical practices receiving insurance reimbursements. A UPIC is basically a virtual bank account with a universal routing number that allows electronic (ACH) credits only, with no debit functionality. Since the routing number is not tied to a specific financial institution, it’s portable and all banks have access to provide this service to their clients.

From an internal control standpoint, no one is able to make debits to a UPIC, as only credit transactions can be processed.

No worry of employee embezzlement, no worry of cyber-based withdrawals. Whew! I don’t know about you, but I’m feeling more secure just thinking about this facet.

Using a UPIC, you are able to freely print a routing number and account number onto invoices or on your website to encourage your patients or clients to make payments electronically. I promise that you, as well as your accountant, will be thrilled with a faster collection period and improved cash flows!

a moment…for a nominal fee (around $5 per month, per UPIC, but please contact your bank for further details), you have total protection against unwarranted debits and portability, should you decide to switch banking relationships, with no downtime or menial paperwork to process with the insurance companies.

Internal control, improved cash flow, and freedom…seems like a no-brainer for insurance reimbursements or any other business with a heavy flow of ACH deposits.

Attention physicians, office managers, and owners of small businesses: If you’re not using this tool already, do yourself a favor and contact your bank to inquire further.

Jeff Holt is a Senior Healthcare Business Banker and V.P. with PNC Bank’s Healthcare Business Banking and is a Certified Medical Practice Executive. He can be reached at (352) 385-3800 or Jeffrey.Holt@pnc.com.

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For a medical practice, a single UPIC routing and account number could be given to all reimbursing insurance companies who make direct deposits to the practice. Think about this for FLORIDA MD - JULY 2016 11

ORTHOPAEDIC UPDATE

Getting Back on the Baseball Diamond After Broken Bones By Corey Gehrold When Jacob broke his forearm in two places, his parents initially brought him to a children’s hospital for treatment. After two weeks, the bones were still not in place and weren’t healing properly. At a loss for what to do, Rhonda, Jacob’s mother, turned to friends and family for advice.

Through a recommendation from her boss, Rhonda turned to Bryan L. Reuss, M.D., a double board certified orthopaedic surgeon and sports medicine specialist at Orlando Orthopaedic Center, to help get Jacob back on the baseball field.

“We got a phone call within ten minutes of the clinic hearing the story about Jacob,” Rhonda recalls. “We were in the office the very next day, with surgery scheduled for the day after that; and, six weeks after having surgery, my son is playing baseball, running, jumping, and sliding into bases, which is absolutely amazing.” Jacob adds: “I was really excited to find out that I was going to be able to play baseball again.”

The forearm (the area bounded by the wrist and the elbow) is comprised of two bones: the radius and the ulna. Forearm fractures represent more than 40 percent of all juvenile fractures, and three-quarters of forearm breaks in children happen near the wrist.

The healing process in children’s bones occurs faster than in adults, so it is crucial to treat children’s fractures right away, to avoid complications later on.

“When my husband and I first met Dr. Reuss, we felt very comfortable and at ease,” says Rhonda. “He was very knowledgeable about the break and about what could be done to fix it. He left all the decisions up to us, but he walked us through everything, from the beginning to the end of surgery.”

In general, the bones of the forearm can crack slightly, or they can fracture into many fragments. In the extreme case of an open fracture, a bone will crack in an awkward way, leaving it sticking out through the skin, needing urgent medical care due to the risk of infection. In adults, the most common causes of a forearm fracture are a direct blow, falling on an outstretched arm, often during sporting activities, or as a result of a motor vehicle accident. Both the radius and ulna are usually broken at the same time, because of the immense power needed to break either bone at its center point.

What is Arm Reconstruction Surgery and How is it Performed?

When a single bone has been fractured and is not out of align-

12 FLORIDA MD - JULY 2016

ment, a cast or brace alone may be able to repair it. Regular visits to your orthopaedic surgeon will be needed to keep an eye on the healing process, as a shifting Bryan L. Reuss, MD in the position of the bones may require the patient to undergo a surgical procedure to restore the fracture.

If both the ulna and the radius are fractured, or if the patient has suffered an open fracture, surgery is often required to treat the injury to return to regular daily activity without long-term issues.

Your orthopaedic surgeon may want to wait until the swelling has subsided before operating.

“The most typical form of surgery to repair forearm fractures, an operation that is known as an open reduction, involves fixating the bones with plates and screws,” says Dr. Reuss. “We’ll begin by opening the skin, realigning the bones, and then holding them together with screws and metal plates, fastened to the exterior surface of the bone. This is what had to be completed in Jacob’s case.”

In another type of procedure, the surgeon will place a metal rod embedded in the center of the bone, where bone marrow is found. And in extreme cases, where the bones and skin have been badly injured, and the risk of infection is high, an external fixation may be used. Steel pins are inserted into the bone over and under the site of the break; the pins will be fastened to a bar away from the skin, keeping the bones in a stable position so they can heal properly.

“When Jacob was done with surgery, I was so impressed by how Dr. Reuss explained all the procedures he performed, the things he found, and what we could expect after surgery,” says Rhonda.

What is the Recovery Process for Arm Reconstruction Surgery?

“Our bones have great healing capacity, and forearm bones normally mend completely within three to six months,” says Dr. Reuss. “Recovery depends on the severity of the fracture, and on each patient’s medical history.”

In nonsurgical care, rehabilitation of the arm can begin after keeping the arm immobilized for several weeks in a cast. A physical therapist can support the healing process by providing exercises for increasing mobility and building up strength.

After surgical treatment, a cast or brace might be needed for between two to six weeks after the procedure. To limit stiffness, your surgeon may provide you with gentle mobility exercises, to be started soon after surgery. Your physician may also recommend a physical therapist. Depending on each patient’s fracture and type of surgery, the surgeon will determine when the patient can go back to work and resume sporting activities.

The plates and screws inserted during surgery normally stay in place permanently. Patients wishing to remove the metal fasteners will need to wait one or two years to schedule the removal procedure. “As a mom,” says Rhonda, “I felt very comfortable bringing Jacob here to Orlando Orthopaedic. The staff and the whole team was outstanding. Dr. Reuss was, above all, the best I’ve ever encountered; I would not hesitate to bring my children back here.” 

CANCER

Bringing Cancer Care to Patients: Why Community Clinics are So Popular

By Asad Sheikh, MD For millions of Americans, community clinics are a lifeline and provide primary care that they can’t afford to get elsewhere.

According to the Bureau of Primary Health Care, there are more than 1,300 health centers in the U.S. that operate 9,000 delivery sites, which provide care to more than 23 million people.

I strongly believe vulnerable populations need and deserve the best care possible. It’s why when UF Health Cancer Center - Orlando Health was expanding into South Seminole Hospital, I was eager to be involved.

As a doctor and a family member, I understand the indelible impact cancer has on families. A few days into my orientation, after I finished my fellowship, I found out that my only sister had been diagnosed with stage 4 gastric cancer. She was only 41 and died eight months later, leaving behind two beautiful children.

PROVIDING CANCER CARE TO PATIENTS IN NEED

health or drug assistance programs so that there isn’t a gap in the continuity of their care. Up to 70 percent of the time, even without insurance, we’re able to treat patients.

EXTENDING OUR REACH Watching my sister battle cancer caused me to change my oncology practice. In addition to starting the clinic, I also wanted to extend my reach in the community.

After my sister’s passing, I started volunteering at Shepherd’s Hope, a 20-year old organization that has several volunteer health care centers throughout Orlando. Similar to our clinic, Shepherd’s Hope is focused on giving care to those most in need, many of whom don’t have health insurance. It works with several community organizations and health agencies to provide resources to vulnerable populations. I work at Shepherd’s Hope about once a month and have been able to bring many patients from Shepherd’s Hope to our clinic and give them free treatment.

I’ve seen firsthand how community clinics can support vulnerable patients. One patient I saw at Shepherd’s Hope, a single

My family felt the real pain and suffering that many families experience when they have a loved one with cancer. This experience has informed the work I do at our clinic. As a hematologistoncologist, our practice requires a multidisciplinary support system. Through the resources made available by UF Health Cancer Center – Orlando Health and other partners, our clinic is able to support at least 10 patients a month. In the first three years of opening the oncology practice, we had seen more than 3,000 new patients.

At our South Seminole clinic, we provide several services and we care for a variety of patients. We offer outpatient and inpatient services and treat patients with IV chemotherapy (among other treatment approaches) and see patients with both benign and malignant hematology, breast cancer, lung cancer and colon cancer. We also work with a multidisciplinary team of Orlando Health Save Thousands Instantly On physicians, which includes oncologists who Credit Card Processing focus on everything from breast to gastrointestinal cancers. Working with a clinical team that has diverse expertise informs the treatment plan and care decisions for my patients, allowing them to get a high level of Secure Supporrt care regardless of their ability to pay.

About 20 to 30 percent of the patients I see don’t have health insurance, but being Free Savings Analysis At part of a huge oncology group allows me to Fattmerchant.com/Florida-MD access more resources to help these patients.

Or Call 407-204-9657 There are many assistance programs that offer free chemotherapy to patients. After a patient is diagnosed, we also work with case managers and social workers to find other

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FLORIDA MD - JULY 2016 13

CANCER mom in her 20s, came to the clinic for a blood-related issue. When I asked her more detailed questions about her clinical history, she started crying and told me she had been selling her plasma every two weeks to pay her rent. This caused her levels to go down and made me realize that there are so many people suffering in our community. Unfortunately, there are countless patient stories similar to this.

In addition to the economic challenges our patients face, lack of access to preventative care also is a huge challenge. At our South Seminole clinic, we’ve seen how lack of access to care affects patients. Many of our patients have stage 4 cancer by the time they get to us, so we try to focus on putting the disease in some sort of remission.

With all our patients, regardless of their disease stage, we focus on compassionate, individualized care. I think this is one main reason our clinic has been able to help so many people. We show compassion as part of the treatment plan and help patients be more in control of their health. At community clinics, the relationship between patient and doctor often is more closely connected, because there are many issues for which they need support. At our clinic, we gain patients’ trust and help them make well-informed decisions that can improve their health.

Cancer affects millions of people every year, so there’s a huge need to provide quality care to both the insured and uninsured. A multidisciplinary approach is critical component to giving these patients the best possible care. UF Health Cancer Center – Orlando Health is expanding its reach with a new satellite office in Lake Mary, and my hope is that our larger footprint in Seminole County will further inform and enhance the care patients in our clinic receive.

Community clinics are so important because they relieve people of the fear and Serving Central Florida Since 1982 worry about paying for care when they instead should be focused on their health. I reOur physicians are Board Certified in Internal Medicine, ally feel these patients need a lot of support Pulmonary Disease, Critical Care Medicine, and Sleep Medicine and that we need to work as a team to help them. When you’re diagnosed with cancer, Specializing in: you don’t have just one battle, you have • Asthma/COPD multiple battles — a dynamic I understand • Sleep Disorders all too well because of my sister’s experience • Pulmonary Hypertension • Pulmonary Fibrosis with cancer. My sister was one of the kindest • Shortness of Breath people I’ve ever met, and I know she would • Cough be beyond proud of the work we do every • Lung Cancer day at the clinic and at Shepherd’s Hope.

• Lung Nodules By providing care to these patients, I hope • Low Dose CT - On Site that I am making a measurable difference in • Clinical Research their lives, and in some tangible way, honorDaniel Haim, M.D., F.C.C.P. ing my sister’s memory.

Central Florida Pulmonary Group, P.A.

Daniel T. Layish, M.D., F.A.C.P., F.C.C.P. Francisco J. Calimano, M.D., F.C.C.P. Francisco J. Remy, M.D., F.C.C.P. Ahmed Masood, M.D., F.C.C.P. Syed Mobin, M.D., F.C.C.P. Eugene Go, M.D., F.C.C.P. Mahmood Ali, M.D., F.C.C.P. Steven Vu, M.D., F.C.C.P. Ruel B. Garcia, M.D., F.C.C.P. Tabarak Qureshi, M.D., F.C.C.P. Kevin De Boer, D.O., F.C.C.P. Jorge E. Guerrero, M.D., F.C.C.P. Roberto Santos, M.D., F.C.C.P. Hadi Chohan, M.D. Jean Go, M.D. Guillermo Arias, M.D. Erick Lu, D.O.

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14 FLORIDA MD - JULY 2016

Asad Sheikh, MD, serves as the director of oncology at UF Health Cancer Center – Orlando Health. He is board certified in medical oncology.

Dr. Sheikh earned his medical degree from Allama Iqbal Medical College in Pakistan and completed an internship for the Department of Surgery and Medicine at Services Hospital in Pakistan the following year. He then completed his internship and residency in internal medicine at the University of Florida in Gainesville and a fellowship at Georgia Health Sciences University in Augusta.

To schedule an appointment with Dr. Sheikh, call 321.843.2100. Visit UFHealthCancerOrlando.com, for more information. 

INPATIENT REHABILITATION

Rehabilitation Nursing: A Growing Specialty

By Stephanie Morrell, RN, BSN, RN-BC, CRRN America is facing a growing population of individuals with disability, advanced age, injuries, and chronic disease. Advances in healthcare have enabled people to survive injuries and illness like never before. The Center for Disease Control reported in 2015 that 22% of adults in the US have some type of disability. As this number increases and our population continues to age, the need for professional nurses who possess skills to treat chronic illness and the effects of the illness on function and quality of life has grown significantly. Rehabilitation nurses are rising up to meet this growing need and the specialty field is advancing rapidly.

In my nineteen years of nursing practice, no clinical area has been as rewarding to me as rehabilitation nursing. I have been blessed to witness people who have suffered a stroke regain speech and the ability to walk again. I have seen patients involved in multiple traumas regain function. And I have watched a new amputee take their first steps on a prosthetic limb. These are just a few of the inspirational stories that keep me passionate about physical rehabilitation nursing.

Rehab nursing is the transdisciplinary process of assisting a person with disease-organ impairment, personal functional disability, and societal handicap to reach the fullest physical, social, psychological, vocational, avocational, and educational potential consistent with his or her physiologic or anatomic impairment, environmental limitations, desires, and life plans. Rehab nurses assist individuals with disabilities or chronic disease toward maximal health through health restoration, maintenance, and promotion. This is accomplished by using education and supportive strategies based on rehab philosophy, goals, and concepts.

Rehab nursing requires understanding that crosses and integrates knowledge from nursing, medicine, cultural beliefs and traditions, allied health disciplines and psychosocial sciences.

It begins with immediate preventative care and moves through stages of accident or illness. It continues through restorative care and involves adaption of the whole being to a new life. Rehab nurses want to restore function and optimize lifestyle choices. The rehab nursing care focuses on assisting the disabled patient in developing self care skills through care, education, and support to the patient and family while managing the needs of medically complicated patients.

Successful rehabilitation requires interaction among many different disciplines. An integrated team of physicians, nurses, physical therapists, respiratory therapist, speech therapists, occupational therapists, case managers, pharmacist, dieticians, and others collaborate to help patients reach their full potential. Rehab covers a wide range of diagnoses ranging from joint replacement surgery, sports/ occupational injuries, stroke, severe spinal cord injury, traumatic brain injury, or progressive conditions such

HELPING YOUR PATIENTS

GET BACK TO WHAT THEY LOVE

Rehabilitation can be dated back to the days of ancient Egypt when adaptive aids were developed such as crutches and artificial limbs but its greatest incitement came from consequences of wartime combat. Soldiers survived injuries but were faced with serious disabilities. As a result, some of the first rehabilitation units were in military hospitals. Florence Nightingale applied rehab principles in her 1859 book, Notes on Nursing: What Is It and What It Is Not, documenting that allowing patients to do for themselves was an important intervention- maximizing self determination. Physicians were being trained in the field of rehab medicine by 1946 and in 1964 rehab nursing had developed into an organized nursing specialty (Spasser et al., 2006).

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INPATIENT REHABILITATION as Multiple Sclerosis.

The rehab nurse functions as a teacher, caregiver, collaborator, and patient advocate. As a teacher, they share information about disease processes and teach techniques to help the patient and their families develop self care skills. As a caregiver, they plan, implement, and evaluate the plan of care for the patient. As a collaborator, they develop goals with the rehab team and collaborate interventions to achieve cost effective care. As a patient advocate, they listen and advocate services to promote quality of life to ensure the patient has maximum success.

The Certified Rehabilitation Nurse (CRRN) credential is a nationally recognized program and is appropriate for nurses who

care for patients with all disabling and chronic conditions. The certification is available through the Rehabilitation Nursing Credentialing Board (RNCB). Attaining CRRN certification validates professional standing as an experienced rehab nurse with knowledge in a specialized area of practice. These nurses demonstrate knowledge, experience, and commitment to excellence in complicated care for people with physical disabilities and chronic illness in all specialties and settings of rehab. These nurses have improved patient outcomes and increased patient satisfaction.

According to research conducted by American Journal of Nursing (2001), CRRN reported they experience fewer adverse events and errors in patient care. For every 1% increase in CRRNs, study showed a 6% decrease in length of stay (Nelson et al., 2007).

Rehabilitation is an exemplary process of functional improvement. By involving patient, family, community, and healthcare providers, rehab nurses prove that optimal function can be achieved when the uniqueness and wholeness of the individual is recognized (Spasser et al., 2006).

Be sure and check out our website at www. floridamd.com!

16 FLORIDA MD - JULY 2016

INPATIENT REHABILITATION REHABILITATION NURSES WORK IN A VARIETY OF ROLES AND SETTINGS: Roles: Settings: Rehab staff nurse Hospitals Rehab nurse liaison Free standing rehab facilities Homecare rehab nurse Clinics Gerentological rehab nurse Home Health/ Community agency Rehab case manager Long term care Rehab nurse educator Insurance companies Rehab nurse researcher Educational institutions Rehab nurse manager Private companies/ private practice Advanced practice rehab nurse Department of Veterans Affairs                                    

COMING NEXT MONTH: The cover story is about Celebration Orthopaedic.

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FLORIDA MD - JULY 2016 17

Meet Robert.

He beat oral cancer.

Robert found a lump in his throat.

Turns out it was HPV-related oral cancer.

Fortunately, the expert cancer team at Florida Hospital helped him beat the odds. Early detection and the right treatment approach is key to survival. Oral cancer affects twice as many men as women,* so make sure your patients know their risk factors. And encourage screenings today.

16-CANCER-03235

*Source: The Oral Cancer Foundation

StopOralCancer.com