Orlando Medical News April 2022

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APRIL 2022

Proudly Serving Central Florida, North Central Florida, Volusia & Brevard

American Nurses Association Reveals Top Federal Legislative Priorities

Health System Transformation Eclipses Other Issues





APRIL 2022





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CONTENTS TBI Traumatic Brain Injury TBI

4 5

ANA Reveals Top Federal Legislative Priorities PHYSICIAN SPOTLIGHT. Dr. Ross Taylor: Data and Networking Make a Difference


EOCC Helping New Business Build a Strong Foundation


IT SERIES PART 2 Do You Use SPF, DKIM, and DMARC to Authenticate Outgoing Email?


The Importance of a HIPAA Compliant MSP


The Psychology Behind Medical Care Avoidance


The Central Florida Healthcare Circle of Excellence


American Lung Association’s EV Report Zeros in on Saving Lives and Generating Billions in Public Health Benefits in Orlando




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ANA Reveals Top Federal Legislative Priorities Health System Transformation Eclipses Other Issues

Safe Staffing A sufficient supply of skilled workers dedicated to providing high quality healthcare services should include an adequate number of highly trained RNs, and increased funding via grants or loan repayments for programs and services intent on increasing the primary care workforce. This funding should elevate support for expanding nursing faculty and workforce diversity. “The ANA continues to lobby for safe staffing ratios critical to achieving the correct staffing levels,” said Fuller, noting that Congressmen Peter Welch (D-Vermont) and Morgan Griffith (R-Virginia) recently coauthored a letter to the White House COVID-19 Task Force calling for an investigation into staffing agencies’ price gouging during the pandemic. Collaborative efforts have resulted in state-level safe staffing laws in seven states: Oregon, Texas, Illinois, Connecticut, Ohio, Washington and Nevada.


The American Nurses Association (ANA) recently unveiled its leading federal legislative priorities for Congress covering safe staffing, nursing workforce development, home health, opioid epidemic, workplace violence, and COVID-19.

Nursing Workforce Development Because nurses continue to represent the largest group of healthcare providers whose services are linked to quality and cost-effectiveness, fully trained nurses are critical. “Increased demand for RNs in the coming years will be driven in part by an aging population,” said Fuller. According to the Pew Research Center, an estimated 10,000 people are turning 65 on a daily basis, a trend that will continue until 2030. “As such, the healthcare workforce will need to grow to keep up with demand for nursing care in traditional acute care settings and the expansion of non-hospital settings such as home and long-term care,” said Fuller. In 2020, Congress signed into law the Title VIII Nursing

Health System Transformation Renovating America’s health system tops the list and calls for following four major principles: safeguarding universal access to a standard package of essential healthcare services for all U.S. residents; optimizing primary, community-based and preventive care, while also supporting the cost-effective use of innovative, technology-driven, acute, hospital-based services; boosting mechanisms to stimulate the cost-effective use of healthcare services while also minimizing burdens on those without the means to cost-share; and delivering a sufficient supply of a skilled workforce dedicated to providing high quality healthcare services. “Universal access includes an essential benefits package to provide access to comprehensive services, prohibition of the denial of coverage due to pre-existing conditions, inclusion of children on parents’ health coverage until the age of 26, and expansion of Medicaid as a safety net for economically disadvantaged people,” said Willa Fuller, BSN, RN, executive director of the Florida Nurses Association, and a national ANA spokesperson. Optimizing care calls for primary healthcare focused on developing an engaged partnership with patients, and includes preventive, curative, and rehabilitative services delivered in a coordinated manner. It also means removing barriers and restrictions that hinder RNs and APRNs from fully contributing to community patient care; and care coordination that lowers costs and improves outcomes via consistent and sustaining payment models. “Encouraging mechanisms to stimulate the cost-effective use of healthcare services starts with a partnership between the government and private sector to address healthcare affordability,” explained Fuller. “Payment systems must reward quality and the appropriate, effective use of resources. Also, beneficiaries paying a portion of their healthcare should be provided an incentive for the efficient use of services while being assured that deductibles and co-payments do not negatively impact care.” Elimination of lifetime caps or annul limits on coverage should be part of the plan, and federal subsidies based on an income-based sliding scale should assure insurance coverage.





APRIL 2022

Workforce Reauthorization Act that was included in the CARES Act. It reauthorizes nursing workforce development programs through fiscal year 2024. “Not only is it the largest source of federal funding for nursing education, but the programs are invaluable to institutions that educate RNs to practice, particularly in rural and underserved communities,” said Fuller, noting the ANA will continue to lobby Congress and the Administration to appropriate more annual funds to the Title VIII programs. Major grant programs within Title VIII cover advanced education nursing; workforce diversity grants; grants for nurse education, practice, and retention; national nurse service corps’ Nurse Education Loan Repayment Program; nurse faculty loan programs; and comprehensive geriatric education grants.

Home Health The ANA promotes the authorization of APRNs to provide appropriate, timely care for their home health patients, instead of allowing patients needing the service to languish while waiting for physician approval, particularly in rural and underserved areas. For now, the CARES Act allows NPs and CNs to order home health services for Medicare beneficiaries without physician approval.

Opioid Epidemic Because nurses remain at the forefront of the national health crisis, the opioid epidemic must be addressed with a comprehensive approach from community-based programs to government action at every level, said Fuller.



Dr. Ross Taylor: Data and Networking Make a Difference For the first time in Florida’s history, more than 450 HCA Florida Healthcare affiliated sites of care across the state have united under a shared brand, a transformation that creates a leading collaborative healthcare network throughout the state. those around me,” Taylor said. “I have the opportunity to lead a tremendously talented team in quality and safety, who have been key in implementing best practices at the hospital and unit level.” Being part of HCA Florida Healthcare’s physician network doesn’t just benefit the physicians, it also benefits patients across the state – particularly through the COVID-19 pandemic. “Across the HCA system, early in the pandemic, HCA hospitals were situated in areas, like Texas and Florida, where the local effects were particularly pronounced,” Taylor said. “HCA was brilliant in taking what was learned in caring for those patients early in the pandemic when there was no playbook and creating a network with which that knowledge could be shared across all HCA hospitals. We were on phone calls every day to learn the latest techniques and bringing that to our physicians at the bedside. We had regular town halls at the national, divisional and local level to ensure those best practices were disseminated. We had a very robust experience with COVID and outcomes that stand up as some of the best in the world.” However, the pandemic isn’t the only area where this type of communication and learning occurs. “When it comes to trauma, stroke and heart attack care, three areas where HCA hospitals also excel, we’re constantly sharing best practices across the network to promote better outcomes,” he said. “We are part of the largest physician learning network in the world and part of a healthcare system that promotes learning through artificial intelligence in ways that improve patient care. By leveraging that innovation, the scale of 450 affiliated sites of care and the experience of 11,000 physicians, we are able to bring all of our best practices to the bedside in Central Florida to provide the highest level of care for our patients,” he continued. “That connectedness brought me here and it’s why I stay.”

HCA Florida Healthcare connects approximately 11,000 physicians and 77,000 colleagues serving their communities at 49 hospital campuses, more than 350 physician practices and freestanding emergency rooms and more than 50 urgent care centers. New facility names clearly illustrate connection to a unified, collaborative network of caregivers. Ross Taylor, MD, joined Osceola Regional Medical Center, now known as HCA Florida Osceola Hospital, where he is Chief Medical Officer, two years ago, and the healthcare system’s connected physician network was a major factor in his decision to take the role. Taylor was first drawn to the medical field due to his natural curiosity to learn about all things living and all things human paired with his drive to make the greatest possible impact on human life. He took an interest in the leadership side of healthcare when, as an orthopedic surgeon, he started spotting opportunities to increase the quality of care and efficiencies in his practice. “As I developed a desire to lead, I took on roles of increasing responsibility over time, first as president of my orthopedics practice, then leadership roles within the medical community in Myrtle Beach, South Carolina, and then with the South Carolina Orthopedic Association,” Taylor said. “I really grew into the opportunity that was presented to me with HCA. Before joining HCA Florida Osceola Hospital, I realized there was an opportunity to borrow from my other experiences and apply them to a local hospital. HCA is well known for its quality and driving that quality using data to implement best practices and achieve better outcomes within the overall healthcare system.” In the nearly two years since he joined the hospital, Taylor has led his team to reduce hospital-acquired infections, patient mortalities and C-section rates and improve lengths of stay. “Everything I have done is really more of a credit to

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CONTINUED ... ANA Reveals Top Federal Legislative Priorities During the past two Congresses, dozens of bills have addressed this issue. In 2018, the SUPPORT for patients and the Communities Act gave NPs and PAs permanent authority to prescribe Medication Assisted Treatment (MAT), which also grants clinical nurse specialists, certified RN anesthetists, and registered nurse-midwives this authorization through 2023. Last year, the Mainstreaming Addiction Treatment Act of 2021 aimed to eliminate the separate registration requirement for dispensing certain narcotic drugs for maintenance or detoxification treatment. “Current law requires prescribers to apply for a waiver to prescribe buprenorphine to treat addiction after completing a multi-hour educational course,” said Fuller.

Workplace Violence Because one in four nurses has been abused in the workplace, the ANA has led the charge to end nurse abuse at the federal and state levels. Last February, the House of Representatives introduced the Workplace Violence Prevention for Health Care and Social Service Workers Act (HR 1195) to require Occupational Safety and Health Administration (OSHA) to develop enforceable standards to protect employees. This legislation passed the House last April 16 with wide bipartisan support on a 254-166 vote. The ANA is working with bill sponsors to facilitate its passage and be signed into law by President Biden this Congress.


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APRIL 2022

“As response to the pandemic evolves, so too has the nature of ANA’s work—addressing priority issues from availability of Personal Protective Equipment (PPE) and decontamination to vaccine rollout and distribution guidance,” said Fuller, adding that ANA also promotes improved public health infrastructure funding, mental health and hazard pay, and controversial vaccination requirements.

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Coffee Club East: Often imitated, never duplicated…the ORIGINAL Coffee Club

Helping New Business Build a Strong Foundation

(1st Thursday of the month) Can You Hear me Now? Katie Mitzner, Brightline THURSDAY, APRIL 7 – 8:30 – 9:30 AM Bonefish Grill Waterford Lakes FREE to EOCC Members | $10 for Non-Members

EOCC Advocacy Advisory Council FRIDAY, APRIL 8 – 10:00 – 11:00 AM Virtual Meeting, Register to participate

Testimonial Tuesday on Location

TUESDAY, APRIL 12 – 9:00 AM – 12:30 PM LIVE of Facebook & On Location. Featuring: Guacamole Mexican Grill; Two Men and a Truck; The Ewing Family Security & Staffing; Mutual of Omaha

Misters & Sisters Great Lunch Adventures TUESDAY, APRIL 12 – 12:30 – 1:30 PM Guacamole Mexican Grill

The Hybrid Member Academy: Roadmap to Member Success WEDNESDAY, APRIL 13 – 8:30 AM – 10:30 AM Hybrid Event - East Orlando Chamber office

EOCC Real Estate Advisory Council Planning Meeting TUESDAY, APRIL 19 – 9:00 – 10:00 AM The 5th Floor Orlando

East Orlando Chamber Luncheon Candid Conversation with Kathleen Plinski President Valencia College WEDNESDAY, APRIL 20 – 11:30 AM – 1:00 PM

Coffee Club Nona: Often imitated, never duplicated…the ORIGINAL Coffee Club (3rd Thursday of the month) Where Do I Fit In? Redistricting with Orange County Supervisor of Elections Bill Cowles THURSDAY, APRIL 21 – 8:30 – 9:30 AM Sam’s Club Lake Nona FREE to EOCC Members | $10 for Non-Members

EOCC New Member Orientation Breakfast hosted by Hampton Inn & Suites FRIDAY, APRIL 22 – 8:30 – 10:30 AM Hampton Inn & Suites UCF

EOCC Legislative Update Florida Politics Breakfast

TUESDAY, APRIL 26 – 7:30 – 9:30 AM Holiday Inn East UCF Area

EOCC Nonprofit Roundtable “Recruiting, Training & Retaining Volunteers” Workshop WEDNESDAY, APRIL 27 – 9:00 – 10:00 AM East Orlando Chamber

EOCC Brain Trust

THURSDAY, APRIL 28 – 8:00 – 9:30 AM East Orlando Chamber office

Ace Relocation Grand Opening & Ribbon Cutting TUESDAY, MAY 3 – 5:00 – 8:00 PM Ace Relocation

W.I.S.E. presents “Getting Your House in Order: Financial Well-Being Evelyn Cardenas (Central Florida Auto Dealers Association) & Teresa Colling, SunTrust Bank WEDNESDAY, MAY 4 – 11:30 AM – 1:00 PM Hilton Garden Inn Orlando $40 EOCC Members | $50 Non-members

Visit EOCC.org for a complete listing of April events



“A small business is an amazing way to serve and leave an impact on the world you live in”…. Nicole Snow Along with COVID came stress, burnout and isolation, which led to people rethinking what they are willing to tolerate at work. For organizations unwilling to step up to the plate, employees began looking for new opportunities elsewhere. The Great Resignation, Big Quit or Great Reshuffle, is an ongoing economic trend in which employees have voluntarily resigned from their jobs en masse, beginning in early 2021, primarily in the United States. Stagnation in wages, rising cost of living and safety concerns added to the mass exodus. While it has dominated the headlines and impacted every industry in the American workforce negatively impacting companies in specific industries, it has fueled the startups and small business throughout the country. StartUpNation examined how startups and small businesses began benefiting from turning the “Great Resignation into a Golden Opportunity to succeed.” Freelancing and independent contracting is on the rise. A survey among eight hundred business executives found that 70 percent planned to increase freelancers within the market. With more resignations from corporate roles, the “Gig Economy” expands working well for startups, especially those leveraging the latest digital technology to improve operations. The increase in remote work opens hiring opportunities. Startups can capitalize on this trend by attracting new talent among those resigning. Attractive benefit packages help the recruiting efforts as well. Over time the opportunities will continue to grow allowing small business to thrive. Are you among the 31.7 million small business owners in the United States and more than 2.4 million in Florida? According to Fincyte, 8 out of every 10 small businesses fail or shut down. A shortage of funds and lack of competitive advantage contribute, as well as ignoring the latest trends. Examining the issues experienced by others developing solutions is a starting point. The Small Business Administration provides a 10-step guide to start a business identifying market research, business plan, funding, and location as the top four. Working in the Chamber we often get calls from solopreneurs ready to dip their toe in the small business pool. Procedures to comply are overwhelming, challenging their dream let alone the requirements based on where they live. The East Orlando Chamber seeks to be the leading resource in business advocacy, community engagement and regional connectivity. We are an advocate for small business, so therefore launched the East Orlando Chamber Foundation (EOC Foundation), a 501(c)(3) nonprofit organization supporting entrepreneurial trailblazers. The aim is to support small and medium enterprises to launch and expand their footprint with East Orange County. The Foundation will provide financial support, mentorship and guidance while paving the way for a suitable environment for the establishment and development of projects.


The Foundation has developed a series of workshops to help small business achieve their MWBD and Service-Disabled Veteran Owned Small Business certification, as well as workshops to address funding and accounting, as well as marketing. On May 13, the EOC Foundation is partnering with Valencia College Lake Nona and many of our East Orlando Chamber members to conduct a workshop during the Day of Learning. We will offer six sessions for attendees covering key content to help offer the foundation for those launching into business or branching out. Topics will include:

• Business Plan, Elevator speech, MWBE Certification overview & Finances • Marketing, Branding & websites, establishing social media presence, Press releases & Printing and promotion • Sales, HR & Payroll, Staffing • Tech IT, platforms, automation & e-commerce • Legal • Accounting, budgeting & balance sheets • Medical & liability insurance During the summer, the EOC Foundation will launch their microgrant application. Those completing the application and meeting all the qualifications will be invited to participate in the annual Pitch Competition with a chance to secure a microgrant for business. For more information or to register call (407) 277-5951 or visit our website at eocc.org. The East Orlando Chamber of Commerce everywhere East of I-4.

|| O R L A N D O M E D I C A L N E W S . C O M || J A N U A R Y 2 0 2 2

Do You Use SPF, DKIM, and DMARC to Authenticate Outgoing Email? • Email domain: everything on the right side of the @ symbol is the email domain. Therefore, Bob’s email domain is sender.com, and Mary’s email domain is recipient.com.

What do SPF, DKIM, and DMARC mean, and what do they do?

• *Email spoofing: when impostors send forged emails that appear to come from within your organization. Now what do those acronyms mean?

• SPF (Sender Policy Framework): SPF provides a way to specify which mail servers are allowed to send an email from your email domain. When Mary receives an email from Bob, her mail server checks to see if it came from an allowed server. If it matches, the email goes through. If not, it can be blocked, quarantined, or deleted depending on how SPF is set up.


(Second, of a Multi-Part Series)

SPF, DKIM, and DMARC are designed to help confirm that emails that come from your domain are not forgeries or sent by an impostor.

• DKIM (Domain Keys Identified Mail): DKIM is another way to prove that an email comes from your organization. Outgoing emails are given a digital signature and are secured with encryption. The recipient’s mail system can then confirm that the contents of an email have not been tampered with or changed.

You will need to know a few basic things to understand how this works:

• bob.smith@sender.com will be our sender’s email address.

With DMARC, you can specify how recipients should handle emails that did not pass SPF or DKIM checks—either by blocking altogether or quarantining into a spam folder.

Why are SPF, DKIM, and DMARC important? Email spoofing* has become common. Such emails appear to come from within your organization. Impostors may use malicious links in spoofed emails to commit phishing attacks, social engineering scams, or ransomware attacks. (See Part 1 of this series: Cyber Insurance Applications: New Stringent Requirements Are NOT Designed to Protect YOU) Example: a spoofed email appearing to come from upper management is sent to a lower-level employee (or other managers) with an urgent request. The recipients, believing that the email came from a trusted source, may be fooled into clicking something dangerous or may follow instructions that lead to ransomware, data theft, or even fraudulent wire transfers. Likewise, a spoofed email could be sent to vendors, customers, or others—also with an urgent request. Remem-

• DMARC (Domain-based Message Authentication, Reporting and Conformance): DMARC uses SPF and DKIM to ensure that an email did not come from an impostor.

• mary.jones@recipient.com will be our recipient’s email address.


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APRIL 2022

The Importance of a HIPAA Compliant MSP

CONTINUED ... Do You Use SPF, DKIM, and DMARC to Authenticate Outgoing Email? ber: These types of emails are designed to get the recipient to panic and act quickly without thinking. Using SPF or DKIM can greatly reduce spoofing attacks. Using SPF, DKIM, and DMARC all together can possibly even eliminate spoofing attacks.


Data Security: As hacking incidents continue to

The Managed Service Provider (MSP) you choose to help run your business will determine your business success level.

plague the healthcare sector, data security is of utmost importance. End-to-end encryption (E2EE) is the best way to prevent hacking incidents. E2EE prevents unauthorized access to data as it is transmitted through receipt. Although not explicitly mandated by HIPAA, the Security Rule states that “The encryption implementation specification is addressable, and must therefore be implemented if, after a risk assessment, the entity has determined that the specification is a reasonable and appropriate safeguard in its risk management of the confidentiality, integrity and availability of e-PHI. If the entity decides that the addressable implementation specification is not reasonable and appropriate, it must document that determination and implement an equivalent alternative measure, presuming that the alternative is reasonable and appropriate. If the standard can otherwise be met, the covered entity may choose to not implement the implementation specification or any equivalent alternative measure and document the rationale for this decision.”

Ultimately, your MSP’s vulnerabilities are your vulnerabilities, which is why HIPAA emphasizes the importance of business associate compliance. Business associate MSPs must be compliant with HIPAA standards. So how do you ensure that you are choosing HIPAA compliant MSPs?

Does your business already use SPF, DKIM, and/or DMARC? You or your IT provider can fairly easily determine if your email is authenticated by SPF, DKIM, and/or DMARC. The method depends on your email provider and whether you have your own email domain. Here are the differences: If you DON’T have your own email domain:

What is a Business Associate? A business associate is any entity that creates, receives, transmits, or stores protected health information (PHI) on behalf of a healthcare organization. Some examples of business associates include electronic medical record platforms, email service providers, cloud storage services, online appointment schedulers, teleconferencing tools, electronic payment software, & Managed Service Providers. When choosing which business associates are appropriate for your practice, you are obligated to vet them to ensure that they are HIPAA compliant.

• If you use either Office 365 or Google as your mail provider, and your email domain is either outlook.com or gmail.com, then SPF, DKIM, and DMARC are already set up for you, and you need no further action. • If you DON’T use Office 365 or Google as your mail provider, you may or may not have authentication in place. Instructions on how to determine follow below.

What Makes an MSP HIPAA Compliant? Many of the requirements that healthcare organizations need to meet also apply to business associates. HIPAA compliant MSPs must ensure the confidentiality, integrity, and availability of PHI. To do so, they must implement safeguards to prevent unauthorized access or disclosure of PHI. HIPAA compliant MSPs implement the following:

If you DO have your own email domain:

• If you are using Office 365 or Google, then a basic form of authentication may be set up by default, but for full protection, you or your IT provider will need to ensure that SPF, DKIM, and DMARC are all working together.

Access Management: A key component of HIPAA

• NOTE: If you have your own email domain, it is up to you or your IT provider to fully set up authentication.

compliance is controlling who has access to PHI. In today’s environment, most PHI is stored in an electronic format, making access management the best way to do so. Access management incorporates several components, including user authentication, access controls, and audit logs. To implement user authentication, unique login credentials must be given to each user of a platform or software. HIPAA points to the need for unique login credentials in their minimum necessary standard, which requires PHI access to be limited to only the information needed to complete a specific task. Under this standard, employees must be given access to only the PHI they need to perform their job functions through unique login credentials, known as access controls. PHI access must also be tracked to ensure the minimum necessary standard is adhered to. To accomplish this, organizations must keep audit logs. Audit logs enable administrators to track which employees access what data and how long they access it. Tracking PHI access also establishes regular access patterns for each employee to detect inappropriate or unauthorized access quickly.

As for how to determine what (if anything) you have in place, you can click on the following links. Enter your email domain to get your results:

• SPF – https://www.mimecast.com/ products/dmarc-analyzer/spf-recordcheck/ • DKIM – https://www.mimecast.com/ products/dmarc-analyzer/dkim-check/ • NOTE: You must enter your DKIM selector(s) to run this test. Ask your IT provider if you don’t know your DKIM selectors. • DMARC – https://www.mimecast.com/ products/dmarc-analyzer/dmarc-check/

Do you need help understanding or implementing SPF, DKIM, and/ or DMARC? If your business is not using authentication, or if you cannot determine its use with certainty, you will need to ask your email provider or your IT staff to help. If you don’t have anyone to ask, you can reach out to Atlantic Data Team, and we will help you find out at no charge. We are committed to making the web a safer place. In next month’s article, I will discuss Remote Desktop Protocol (RDP) and how to keep your remote users working safely. Stay vigilant! James Gentry is the president of Atlantic Data Team, a central-Florida-based business IT company. If you cannot get a straight answer on whether you use filtering or not, we will be happy to help you, at no charge to determine if you are protected. We are committed to making the web a safter place. For more information go to www.atlanticdatateam.com or email office@atlanticdatateam.com





APRIL 2022

Data Backup: Businesses working with PHI must also implement data backup procedures. Establishing and implementing procedures to create and maintain retrievable, exact copies of electronic protected health information (ePHI) is essential to implementing an effective data backup plan. In the case of a breach or natural disaster, data backup facilitates business continuity and the quality of patient care. HIPAA Business Associate Agreement: Regardless of how secure an MSP is, they are not a HIPAA compliant MSP if they do not sign business associate agreements (BAAs). MSPs that will not enter into a BAA with their healthcare clients cannot be used for business associate services. A BAA is a legal agreement between a healthcare provider and their business associate MSP that requires each singing party to be HIPAA compliant and agree to maintain its compliance. A business associate agreement is essential to compliance as they ensure that each party implements measures to safeguard PHI.

Closing Thoughts As an MSP who has earned our HIPAA compliancy shield, we understand the importance of not only being a compliant business partner, but also ensuring that your policies, procedures, and training stand up to the test should an audit occur. Contact us if you need assistance in this regard. Chris Caffera is sales chief at SeamlessCS. SeamlessCS strives to create a better work environment that enhances small businesses and helps them to thrive. We get to know our customers on a deeper, more personal level, to better understand how we can best help your business/organization enhance with technology support and services. You aren’t just another number with our company. For more information visit us at www.SeamlessCS.com. Email Chris at ccaffera@seamlesscs.com

The Psychology Behind Medical Care Avoidance

Past Bad Experiences - Many people have experienced a medical trauma, a difficult procedure, a poor outcome, or a negative reaction from care providers for themselves or a loved one. These past negative experiences often create a psychological barrier to care.


your blood work in one week or two? Do you want an open CAT Scan or are you okay with a closed?” Giving options helps give the patient a level of control. Active Listening - When our patients demonstrate fears, it is easy to want to tell them, “don’t worry, everything will be fine,” or to even become frustrated or want to ignore the behavior. But when someone feels heard they are more likely to be open to recommendations and behavior changes. When a patient is struggling engage them with active listening skills. Listen, rephrase what was said, and wait for confirmation that you got it right before offering suggestions or problem solving. Validation - There is no quicker tool to help deescalate someone who is expressing a high level of emotion, than to tell them that what they are concerned about “makes sense.” “It makes sense that you are concerned about getting another cancer diagnosis,” or “it makes sense that you are frustrated going through more diagnostic testing.” And even for irrational fears, “it makes sense that because you worry about going into the hospital and never coming out you don’t want this procedure.” Once validated, you remove the barrier and have space to explain the treatment recommendations.

Health care avoidance is a type of patient disengagement that impedes an individual's health behaviors or causes them to delay obtaining health care, and thus can negatively influence well-being. According to the NIH and other sources, 30 percent to 40 percent of people report avoiding medical care even when they think they should go to a doctor. As medical providers, we know that health outcomes are greatly improved when patients comply with medical recommendations, maintain regular health care schedules, and seek help right away when experiencing concerns about their health. Unfortunately, many of our patients avoid care and only show up when they are in an acute situation. As a result, they experience a worsened prognosis, have fewer treatment options, and have more difficulty responding to treatment, especially in the areas of mental health, heart disease, strokes, cancers, arthritis, urinary incontinence, and infectious disease. When the avoided healthcare is finally accessed, more radical treatment is often required, hospital stays are prolonged, institutionalization may be necessary, and there are higher associated costs. Understanding the psychology behind medical care avoidance can improve health outcomes and decrease costs. What causes avoidance of healthcare? Many of the causes are apparent; lack of adequate healthcare coverage, costly copays, out-of-pocket expenses, lack of access to providers in a geographic area, and time constraints all keep people from seeking care. In 2018 NORC found that a significant number of people are more afraid of the cost of medical care than they are of a severe illness. All these reasons are substantial and create a Public Health Crisis in themselves. But there are other reasons for medical avoidance, which we will explore in this article. Many people who avoid medical care suffer anxiety, fear of death, and fear of being diagnosed with a life-altering condition, among other things. These fears are pervasive and debilitating and cause mental and emotional anguish as people struggle to reconcile fears of being ill with fears of seeking treatment. Who makes up medical avoiders, and what are the reasons? In “Predictors of Avoiding Medical Care” (Medical Care Journal 2014), the authors found that people who avoid medical care are characterized by low health self-efficacy. They tend to have less experience with quality care, have difficulty expressing concerns, and fail to get help to resolve their uncertainty about their health. Frequently they do not have their fears attended to by a medical provider. They frequently have no consistent primary care physician, have a negative self-concept, engage in risky behaviors like smoking or drinking, and have a fatalistic attitude about cancer. They also reported that the reasons for avoiding medical care are: preference for self-care or alternative care, dislike or distrust of health care providers, fear or dislike of medical treatments, time and money, the experience of prejudice in healthcare, discomfort with body exams or body-shaming experiences, fear of having a severe issue or hearing bad news, and thoughts of dying. It is apparent that for medical care avoiders 1) feeling as if they have no control and are not understood, 2) past negative medical experiences or trauma, and 3) being discounted due to prejudices, weight, or risky activities are the most common categories we should address to improve patient health outcomes. Interventions to prevent patient delay in obtaining healthcare and improving health outcomes:

Past Experiences Trauma Informed Practice - Many people have experienced sexual and physical violence and continue to be reactive in expected and unexpected ways. This is a common reason for avoiding medical care. The vulnerability one experiences when seeking healthcare can trigger a reaction. It has become common practice to discreetly ask or put in your paperwork a question that addresses what might cause or trigger panic or fear in the patient. If you are not yet doing this, please do. Perhaps saying something along the lines of, “We understand that all of our patients have had many different life experiences, some experiences may make seeking medical care uncomfortable. Please note here if you need us to be aware of anything, such as difficulty with touch, high levels of anxiety or fear, etc. “

No control or Not Understood: Choices - When patients feel overwhelmed by what is happening to them it is easy to avoid doing anything at all. Giving a patient a simple choice, such as “do you want





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Prejudices - Our country has a long history of disparities in healthcare. This awareness must be integrated into how we practice and discussed with the patient if it impacts the patient’s hesitancy, avoidance, or fear of obtaining appropriate medical care. Weight and Body Shaming - While weight can be a significant health issue, patients who feel out of control with their weight often avoid seeking medical care because of fears of being shamed, blamed, and made to feel as if they are a bad person because of it. Taking a body positive approach at any weight will help patients feel connected to their practitioner so they will be more likely to participate in interventions. Motivational Interviewing (MI) techniques are great for this population. Risky Behaviors - Similarly patients who smoke, drink, use recreational drugs, or even abuse these substances still need medical care. The risk of being shamed, blamed or ridiculed keeps many people away from treatment. MI techniques are great for these issues too. Alternative Care - Some people prefer alternative treatments. Consider working with patient’s alternative treatments by incorporating them in the treatment plan, rather than rejecting them outright, unless contraindicated. At some point most of us have put off or skipped a procedure, and then fought with our own fears to reel ourselves back in to medical compliance and good self-care. Realistically, not everyone can. If you have patients that have high anxiety around any healthcare issue, procedure, or compliance, please don’t forget the benefit of counseling. There are trauma reducing techniques, phobia protocols, and other tools that mental health practitioners have that will help patients manage their fear and help them become more actively engaged in their own healthcare. April Boykin is a Licensed Clinical Social Worker and cofounder of Counseling Resource Services (CRS). Established in 2013, CRS is a community-based in-home integrated behavioral health agency serving the aged and disabled population in Central Florida. As a mental health counselor, she has provided individual, family and caregiver counseling to children, teens and adults. She can be reached at april@counselingresourceservices.com

The Central Florida Healthcare Circle of Excellence technical colleges and universities.


• Create a vetting process to ensure that each candidate has already shown qualifications and legitimate interest in attaining employment.

A brain trust of experienced healthcare business professionals addressing the full spectrum of medical and dental health services.

Interviewing 10 people and hiring none is an unexpectable opportunity cost loss. While making the right hire is critical, reducing the time, money, and energy to find that right hire is also important. A lot of recruiting expenses can be reduced with a well thought out candidate acquisition program. Start looking at setting-up interviews as though that is the first step in vetting and recruiting your next hire.

This vetted consortium brings the highest quality medical and dental practice consulting services to the table, empowering each member with the confidence that their area of expertise will be supported across all verticals of the healthcare environment. As an expression of our commitment to support rapid innovation through network collaboration the HCofE will produce monthly articles you can find in this section of the Orlando Medical News magazine. This month we have tackled current issues with healthcare staffing.

Improving the conversion rate of people who interview into joining the staff: • During interviews show a career path chart that illustrates professional growth within the practice as a possibility.

Staffing Challenges for Healthcare The labor issues across the country have taxed all industries. The medical and dental industries have added challenges that when outlined and discussed help bring clarity to potential solutions. This month the HCofE came together to address strategies that our consortium has identified to support medical offices that grapple with maintaining adequate staffing. COVID-19 burnout issues are everywhere, but the higher hiring standards for healthcare produce additional unique challenges. Under Florida law, healthcare workers, including those who work at assisted living facilities, are required to undergo criminal background checks to hold employment. Although a front office worker may not need a skill-level beyond having graduated high school, all clinical staff are entrusted to maintain HIPAA compliant policies. While that is not difficult, it carries significantly more responsibility than stocking shelves at a local box store or joining the gig economy, which may have a higher starting pay rate. Clinical practices have set negotiated rates for reimbursements that somewhat control the budget for pay rates in the clinical space. This creates less flexibility to respond to the inflationary factors that other industry employers can address. For example, a box store can sell their goods with marked-up prices to cover the requirement of more competitive wages; the clinical office cannot. In addition to these unique challenges, the medical office is also competing with the new work-fromhome market. What we are living through is nothing short of a revolution of the labor market. Your office is competing with the opportunity of zero commute, zero exposure to disease, little to no uniform cost, and maximum time at home - lowering food and childcare costs. The HCofE is responding to this challenge with solutions in three areas. These areas include increasing and improving the quality of people who interview for open positions, improving the conversion rate of people who interview into joining the staff, and improving staff retention to maintain operational continuity and resiliency.

• Show educational support opportunities that match up with career path. • Establish a fund for educational support or a scholarship program that will pay tuition for courses or certifications that benefit the practice and forward the employee’s career. • Leverage the work/life balance of the medical office, illustrating how office hours match with standard childcare and school hours. Nothing is better for the success of a practice than a great hire. Much of an employee’s success is based on grounded expectations when starting their job. During the interview process, make sure they are as engaged in understanding the job requirements and expectations as you are in evaluating their skills, credentials, and personality.

Improving staff retention to maintain operational continuity and resiliency:

Increasing and improving the quality of people who interview for open positions: • Job posts should articulate a clear opportunity for a career in healthcare, not just the job description. • Reach out to schools that have graduating classes with newly degreed or licensed students. • Set-up referral programs to compensate your staff for bringing in people to interview. • Increase your practice’s networking capability by joining membership organizations that have referral and internship programs with local ||


• Perform annual evaluations that support and track employee professional growth expectations. • Address the work atmosphere and implement systems and programs that produce a sense of community, camaraderie, and shared team fulfillment. • Encourage receptionists to transition to billers and schedulers through funding reimbursement for training additionally in billing. • Ensure salary increases are consistent with job accountability and not just a percentage raise over current income. • A system that allows staff to participate in a profit-sharing bonus program. Clear expectations are important; however, throughout a worker’s employment, following through on those expectations will keep them engaged and help avoid workplace dissatisfaction for years to come. People stay where they are happy. Many variables go into job satisfaction and if your practice maintains open communication with team members, understanding the variables that each individual needs to remain positive, goes up exponentially. The true value of staff retention goes far beyond the value of not having to find a replacement. When you have staff that have moved through multiple positions in the office, the continuity of operation is vastly improved. Practices will always have key staff take personal time off due to sickness, maternity or family loss. When others in the office know the job requirements, the risk and liability of operational disruption goes down dramatically. The Central Florida Healthcare Circle of Excellence has over 45 member experts serving the Central Florida area. Members include vendors, consultants, and professional organizations. Contact founders Jeff Holt jeffrey.holt@ pnc.com or Tony Cowan tonyc@weareibec.org for more information.

• Provide longevity incentives and celebrations that boost morale, and acknowledge staff loyalty, and encourage commitment.


• Provide childcare support programs and assess tax benefits or any financial benefit to the provider, practice, or individual.


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American Lung Association’s EV Report Zeros in on Saving Lives and Generating Billions in Public Health Benefits in Orlando A nationwide transition to clean, zero-emission vehicles would have a dramatic impact on the air quality and health of Orlando area residents, according to a new report by the American Lung Association. The “Zeroing in on Healthy Air” report, released last week, reveals that a widespread transition to vehicles powered by clean electricity generation would result in up to 1,160 avoided deaths and $12.9 billion in public health benefits here in the Orlando metro area. In fact, the Orlando market was ranked as one of the top 20 metro areas that would benefit the most from the transition. “Zeroing in on Healthy Air” outlines the broad benefits of the transition to a zero-emission transportation sector over the coming decades. The report illustrates the potential health and climate benefits if all new passenger vehicles sold are zero-emission by 2035 and all new trucks and buses sold are zero-emission by 2040. The report projects that the nation’s electric grid will be powered by clean, non-combustion electricity replacing dirty fossil fuels by 2035. Nationally, a widespread transition to electric vehicles would generate more than $1.2 trillion in health benefits and $1.7 trillion in additional climate benefits by 2050. Here in the Orlando metro area, the transition would generate $12.9 billion in public health benefits and result in up to:

“The transportation sector is a leading contributor to air pollution and climate change,” said Ashley Lyerly, Senior Director of Advocacy at the American Lung Association. “Thankfully, the technologies and systems are in place to make these benefits a reality, especially in communities most impacted by harmful pollution today. We need our state leaders to act to implement equitable policies and invest in the transition to healthy air today. This is an urgent health issue for millions of people in the U.S.” Especially as the Orlando area faces the impacts of climate change such as extreme storms and extreme heat, this is a powerful and practical opportunity to take action to improve our economy, our health and our future.” Climate change threatens the health of all Americans, from wildfires and extreme storms to worsening air pollution. And poor air quality caused by transportation and electricity generation contributes to a wide range of negative health impacts, including childhood asthma attacks, impaired lung function and development, lung cancer, heart attacks, strokes and premature deaths. These are sources of health disparities in lower-income communities and communities of color, both in terms of exposure to harmful air and the associated health consequences. The Lung Association also distributes an annual air quality “report card” that tracks and grades Americans’ exposure to unhealthful levels of particle pollution (also known as soot) and ozone (smog) over a three-year period – this year’s report covers 2017-2019.

• 1,160 avoided deaths • 22,400 avoided asthma attacks • 121,000 avoided lost workdays





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“The levels of ozone seen in Orlando can harm the health of all of our residents, but place our children, older adults and people living with lung disease, particularly at risk,” said Ashley Lyerly. “Fortunately, the area was ranked as one of the cleanest cities for short-term particle pollution, which means that there were no unhealthy days for this common pollutant.” The annual “State of the Air” report found that nationwide, more than 4 in 10 people (135 million) lived with polluted air, placing their health and lives at risk. In Orlando, ozone pollution placed its residents at risk, including those who are more vulnerable to the effects of air pollution, such as older adults, children, and people with lung disease. The report also shows that people of color were 61% more likely to live in a county with unhealthy air than white people, and three times more likely to live in a county that failed all three air quality grades. The report located at Lung.org/SOTA also finds that climate change made air quality worse and harder to clean up. Achieving major benefits to our health and our climate will require dedicated and sustained leadership. Investment at all levels of government, and public education and engagement will ensure the transition to zero-emission vehicles provides clean air for everyone. The American Lung Association is asking the public to sign our petition calling for a more rapid transition to zero-emission vehicles and energy at Lung.org/EV. For more information about "Zeroing in on Healthy Air,” visit Lung.org/EV.


nation’s No. 15 public program and No. 25 among all institutions. That is up from No. 24 among public schools and No. 36 overall last year. Among public health doctoral programs, the UF College of Public Health and Health Professions now stands at No. 18 among publicly funded schools of public health and No. 29 overall — up four and 12 places, respectively, from a year ago. Factors used to compile the College of Medicine rankings include a nationwide survey of faculty and academic administrators, faculty-to-student ratio, federal research funding and acceptance rates. In recent years, the College of Medicine has adopted novel approaches for discovery and medical education, including being a national leader in advancing the application of artificial intelligence. Its faculty also includes world-renowned physicians and scientists. The doctoral program in biostatistics, which is run by the UF colleges of Public Health and Health Professions and Medicine, is 11th among public universities and 21st overall. The College of Nursing’s D.N.P. program earned a place among the nation’s best once again. Earlier in the year, U.S. News also ranked the nurse practitioner role No. 1 in the 2022 Best Health Care Job list, further solidifying the importance of a quality DNP program. The latest rankings help solidify UF’s thriving national reputation. In September, U.S. News & World Report ranked the school the country’s No. 5 public university. Other UF colleges remain highly ranked by the publication, including the College of Pharmacy at No. 5 nationally and the College of Veterinary Medicine at No. 9. Those rankings are unchanged because not all programs are ranked every year by U.S. News & World Report.

Florida Academy of Family Physicians and Florida Medical Association Launch Joint Campaign for Patient Empowerment The Florida Academy of Family Physicians (FAFP) and the Florida Medical Association (FMA) have joined forces to launch The Physician Decision, a patient empowerment campaign to help educate on the importance of seeking a physician-led care team. In the state of Florida, Advanced Practice Registered Nurses (APRNs) can practice independently within parameters. Prior to the scope of practice expansion for APRNs, only a physician was granted independent practice. Physicians (MD/DO) undertake eight years of formal education and a minimum three-year residency under supervision involving more than 15,000 hours of clinical training to properly diagnose and treat patients, compared to a nurse practitioners’ five-and-a-half to seven years of education and 500-1,500 hours of clinical training. Data from the American Medical Association shows that mid-level health professionals who can practice independently in Florida are more likely to prescribe unnecessary medications, diagnostic imaging and referrals, jeopardizing the quality, safety and cost of patient care. “In an ideal healthcare setting, a patient’s care is overseen by a physician who’s uniquely trained and qualified to diagnose and treat the patient,” said John Gross, MD, Florida Academy of Family Physicians Board Chair. “Our goal is to empower patients to seek a physician-led care team to ensure they receive the best possible healthcare outcome.” Under a physician-led care model, often patients are seen by a Nurse Practitioner or Physician Assistant for their initial visit, where the professional will listen to the patient’s symptoms or concerns, discuss medical history, consider the diagnosis and potential treatment options and involve the supervising physician. Critically important is the collaboration happening, either seen or unseen, that ensures the best possible outcome for the patient’s health and wellbeing. “Physicians highly value the contributions that Nurse Practitioners, Physician Assistants and all mid-level practitioners make to their practices and the healthcare system as a whole,” said Douglas Murphy, MD, Florida Medical Association Board President. “What we’re advising patients is to seek a physician as their lead primary care provider for the best possible care outcome.” For more information, please visit ThePhysicianDecision.com.

Walmart Health Expands to Florida with Five New Health Centers Florida families can now experience convenient access to health care with the opening of five new Walmart Health centers across North and Central Florida. The openings mark Walmart Health’s expansion into Florida, beginning with the new Jacksonville location at 7075 Collins Rd., situated adjacent to the Collins Road Supercenter. The Orlando area location opens April 14. TTwo years after the launch of Walmart Health, we continue evolving and growing to make health care even more accessible to the communities we serve,” said Dr. David Carmouche, senior vice president of Omnichannel Care Offerings at Walmart. “With only one primary care doctor per 1,380 Florida residents, these Walmart Health centers will help address the demand for care in three major cities in the Sunshine State, delivering quality health care at the right time in the right setting, right next to where many Floridians get their groceries. We are part of these

UF Colleges of Medicine, Public Health and Nursing Among Nation’s Elite in Graduate School Rankings 3 Photo cutline “The Harrell Medical Education Building” The University of Florida College of Medicine retained its spot as the state’s top-ranked medical school and remains among the nation’s premier institutions, according to new graduate school rankings issued today by U.S. News and World Report. Two other UF colleges — Nursing, and Public Health and Health Professions — made significant gains in the rankings, placing them among the country’s best. The College of Medicine is ranked No. 16 for research among public universities and No. 37 in the nation overall. In primary care, the college ranked 34th nationally for public institutions and No. 48 overall. In the U.S. News diversity index, the College of Medicine is No. 19 among public universities and No. 26 overall. Those standings are calculated using metrics that include enrollment of underrepresented groups — 24.3% in 2021. The UF College of Nursing’s Doctor of Nursing Practice program, or D.N.P., made major strides in the national rankings while remaining No. 1 in Florida. It is now the





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communities, and we are excited to bring more options for in-person and telehealth care services to our neighbors.” Five Locations Across Florida Situated adjacent to Walmart Supercenters, these convenient state-of-the-art Walmart Health centers provide a range of services, including primary care, labs, X-ray and EKG, behavioral health and counseling, dental, optical, hearing, and more. Onsite Walmart Care Hosts and Community Health Workers will help customers navigate their visit, understand resources and be a familiar presence for regular visits. Walmart is committed to Florida with more than 380 retail locations and 120,000 associates. The company is excited to meet the needs of Florida’s residents as the state’s population grows. From 2010 to 2019, Florida’s population grew 13%, more than double the total U.S. population growth. The locations and opening dates are scheduled for: April 5, 2022: 7075 Collins Road (Jacksonville) April 7, 2022: 1586 Branan Field Road (Middleburg) April 12, 2022: 904 B Cypress Parkway (Poinciana/ Kissimmee) April 14, 2022: 3647 South Orlando Drive (Sanford) June 7, 2022: 28516 State Road 54 (Wesley Chapel) To meet the needs of busy families, these Walmart Health centers will offer care seven days a week with convenient weekend and evening hours as well as telehealth options on Sundays: Monday – Friday: 7:30 am – 7:30 pm Saturday: 9:00 am – 5:00 pm Sunday telehealth: 9:00 am – 5:00 pm Walmart Health is operated by qualified medical professionals, including physicians, nurse practitioners, dentists, behavioral health providers and optometrists. Walmart Care Hosts and Community Health Workers on-site will help customers navigate their visit, understand resources, and be a familiar presence for regular visits. Patients can make an appointment, input insurance information, and confirm eligibility at walmarthealth.com. First in Florida: Epic Electronic Health Records Announced in 2021, all Walmart Health locations in Florida will be the first centers to utilize Epic health technology. Epic is the most widely used and comprehensive health records system in the U.S., used by more than 2,000 hospitals and 45,000 clinics, including most U.S. News & World Report’s top-ranked hospitals and medical schools. Through this single, unified system, Walmart Health will engage patients, health care professionals, insurance carriers and other stakeholders while enhancing communication, personalization and information sharing amongst health care professionals and patients utilizing a patient portal. Walmart Inc. (NYSE: WMT) helps people around the world save money and live better – anytime and anywhere – in retail stores, online and through their mobile devices.

In Florida, we serve customers at 387 retail units and online through Walmart Online Grocery, Walmart.com and our family of brands. We are proud to employ 120,954 associates in Florida. Walmart supports local businesses, spending $8 billion with Florida suppliers in FYE21 and supporting 82,394 Florida supplier jobs. Walmart continues to be a leader in sustainability, corporate philanthropy and employment opportunity. In FYE21, Walmart and the Walmart Foundation contributed more than $109.2 million in cash and in-kind donations to local nonprofits in Florida. Learn more at http://corporate.walmart.com, on Facebook at http://facebook.com/walmart and on Twitter at http://twitter.com/walmart.

supported by top tier nursing staff. This second location expands the coverage of outpatient GI procedures to southern Orange County residents, as well as residents in Osceola County. The same breadth of procedures is available at the new Endo-Surgical Center of Kissimmee and include colonoscopies, upper GI endoscopies, colorectal surgeries, hemorrhoid treatments, and serves surgeons from other specialties such as pulmonology, cardiology, ophthalmology and orthopedic procedures. Digestive and Liver Center of Florida is a gastroenterologist practice founded 16 years ago with the mission to provide sophisticated medical care in a compassionate environment for our patients.

Baptist Health First in Southeast U.S. to Implant New Device for Treating People with Atrial Fibrillation

Community Paramedicine Project Delivers Care and Vaccines to Individuals with I/DD The Florida Developmental Disabilities Council is pleased to announce the immediate availability of a community paramedicine program for persons with intellectual and developmental disabilities (I/DD), their families and caregivers in Orange County. The pilot project, Community Paramedics, is designed to deliver healthcare at-home by trained paramedics. Visits typically include a basic health and safety assessment, education about COVID-19, and administration of the COVID-19 vaccine or booster. A minimum of two home visits is offered and services are free. Healthcare providers and community agencies in Orange County can refer individuals with I/DD and their families to Community Paramedics. Individuals with I/ DD, their families and caregivers can also self-refer to the program (www.ParamedicsforIDD.org). Community paramedicine allows paramedics to operate in expanded roles by assisting with public health, primary healthcare and preventive services to underserved populations in the community. Primary goals of community paramedicine programs are to improve access to care, reduce barriers to care and decrease costs of healthcare services. The Community Paramedics program is a nonprofit partnership spearheaded by the Florida Developmental Disabilities Council, WellFlorida Council and Health Council of East Central Florida. It is funded in part by the Florida Developmental Disabilities Council, Inc. and the Administration for Community Living. Paramedic services are provided by Care-A-Medix, a program of the Health Council of East Central Florida.

4 photo cutline “Dr. Ruby Satpathy during successful live case device implantation.” Baptist Health is once again leading the region in the treatment of atrial fibrillation as it becomes the first health system in the southeast United States to use a new device following its approval by the U.S. Food and Drug Administration (FDA). Ruby Satpathy, MD, FACC, FSCAI, internationally recognized interventional cardiologist with Baptist Heart Specialists and medical director of the Baptist Structural Heart Program, performed the procedure. The device, Amplatzer™ Amulet™ Left Atrial Appendage Occluder, is designed to treat patients with Afib who are unable to tolerate blood thinners to reduce risk of stroke. The left atrial appendage (LAA) is a small pouch connected to the upper left chamber of the heart. For people with Afib, it is an area where blood clots can form. If those blood clots reach the bloodstream, they can travel to the brain and cause a stroke. Following the successful completion of clinical trials in the US, the FDA approved the device, which seals the LAA so clots cannot form in this area. Dr. Satpathy implanted the LAA closure device in Douglas Dixon, 75, from Green Cove Springs, Florida. During routine monitoring of his pacemaker, Aaditya Vora, MD, clinical cardiac electrophysiologist, Baptist Heart Specialists, discovered Dixon had experienced an Afib event, though he did not know it. Having had a brain bleed two years prior, dependence on blood thinners was not a good solution for Dixon. Hence, the referral of Dixon to Dr. Satpathy. “Mr. Dixon was a good candidate for this new device because of his prior brain bleed,” said Dr. Satpathy. “The treatment option opens the door for many more patients who cannot be on blood thinners for even a short period. It also allows the LAA closure for different shapes and sizes.” Baptist Heart Specialists is committed to research, education and innovation, using new devices and procedures to help patients with structural heart diseases extend and improve the quality of their lives. Dr. Satpathy and the Baptist Heart Hospital team recently completed a successful live case device implantation to thousands of physicians attending the annual Cardiovascular Research Technologies (CRT) conference. The conference, held in Washington, DC, is a leading educational forum on new cardiovascular technology and procedures for physicians and health care professionals. The team is also actively engaged in research through involvement in clinical trials. For the newly-FDA approved LAA closure device, Baptist Health was the No.1 enroller in the state of Florida and No. 4 in the nation. Dr. Satpathy and Carlos Zamora, MD, FACC, served as lead clinical investigators at Baptist Health.

Orlando Health Orlando Regional Medical Center Researchers Reveal Blood Test for TBI Performs as Well as Clinical Guidelines A new study by researchers at Orlando Health Orlando Regional Medical Center (ORMC) found a blood test for traumatic brain injury performs just as well as the clinical guidelines emergency medicine physicians use to decide if a patient with a mild traumatic brain injury or concussion needs a computed tomography (CT) scan. The discovery of the high performance TBI biomarkers blood test may improve the detection of brain injuries on CT, while reducing the need for CT scans. The study was recently published in JAMA Network Open, an international, peer-reviewed, open access, general medical journal. Currently physicians rely on CT imaging to initially evaluate mild traumatic brain injury or concussion. During the study, participants had a CT scan ordered by emergency physicians based on current clinical guidelines — the Canadian CT Head Rule (CCHR), the New Orleans Criteria (NOC), and the National X-Radiography Utilization Study II (NEXUS II). The same participants also received the blood test that detects the two FDA-approved biomarkers (GFAP and UCH-L-1) that are present after brain injury. The results of the blood test were compared to these three validated clinical decision rules. Findings indicate the blood test, the CCHR, and the

Endo-Surgical Center of Kissimmee Grand Opening Digestive and Liver Center of Florida and sister company, Endo-Surgical Center of Florida, has opened their second ambulatory surgery center. Endo-Surgical Center of Kissimmee (www.esck.us) presents patients with another state-of-the-art outpatient facility where patients receive exceptional care from tenured GIs and surgeons





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NOC were each 100 percent sensitive in detecting CT lesions on their own. The sensitivity for NEXUS II was only 83 percent. The study also found the combined use of the test and clinical guidelines improved the accuracy even more. Specifically, the combination of the GFAP biomarker with the CCHR had the highest diagnostic performance of all combinations. The study also asked physicians, while they were caring for these patients, if they thought testing for biomarkers would be helpful. A blood test to detect mild traumatic brain injury has been a significant milestone in traumatic brain injury research – critical to diagnosis and treatment for patients. “Physicians use blood tests in combination with clinical decision making for many conditions like coronary heart disease, kidney disease and diabetes,” said Dr. Papa. “The prospect of having a blood test that could enhance our clinical decision making in patients with mild TBI and concussion is remarkable. This could potentially change the way we treat these patients going forward.” Researchers at ORMC were leaders in identifying the two biomarkers used in the blood test to detect brain injury and have continued to evaluate different aspects of the blood test through various studies. Previous studies have been published in various publications including Journal of Neurotrama, JAMA Neurology, BMJ Paediatrics Open, Academic Emergency Medicine, and Journal of Trauma.


New Parrish Health and Wellness Center Now Open TITUSVILLE - Exercising in greater comfort and health safety are the reasons exercise “pods” are a key feature of the new Parrish Health and Wellness Center in Titusville. The wellness center’s 20 pods are configured for different types of workouts – each pod includes a variety of cardio and weight-training equipment. The exercise pods can be reserved, eliminating the need to wait for someone else to finish with a piece of equipment. The Parrish Health and Wellness center is located at Crossroads Shopping Plaza, 3065 Columbia Blvd., Suite C104, in Titusville.

Sarah Johnson, MD, Joins Halifax Health – Hospice and Palliative Care

The 5,500 square-foot center, which opened on March 5, also has personal training services, private restrooms and shower and complimentary WiFi. “The pod concept is growing in popularity throughout the country, particularly as a result of the COVID-19 pandemic,” said Kellie Way, director of the health and wellness center. “There are people who are more comfortable not working out around others, and we’re giving them that option along with traditional ways of exercising.” “The Parrish Health and Wellness Center has new answers to an old question: how can someone get the best possible workout in the most convenient and comfortable place,” Way added. Way said the pods were a hit from the opening day. Annual and monthly membership options are available for individuals and families. Daily, guest passes also available for $10 per day. Senior and student discounts available. For more information, visit parrishhealthcare. com/healthandwellness

DAYTONA BEACH – Sarah Johnson, MD, has joined the Hospice and Palliative Care team at Halifax Health – Continuing Care. Dr. Sarah Johnson graduated Magna Cum Laude from Marshall University in Huntington, West Virginia, with a bachelor’s degree in Biological Science. Dr. Johnson went on to obtain her medical degree from Marshall University School of Medicine before completing her emergency medicine residency training at Vanderbilt University. After practicing emergency medicine in Florida for several years, Dr. Johnson decided to pursue a hospice and palliative medicine fellowship at Dartmouth-Hitchcock Hospital in New Hampshire. Halifax Health – Continuing Care physicians have extensive training and experience in providing adults, adolescents and seniors with hospice and palliative care services. Dr. Johnson will care for Central Florida residents with life-limiting illness and their families in homes, nursing homes, assisted living facilities, care centers and hospitals.

Parrish Medical Group Welcomes Orthopedic Surgeon Bryan Parry, MD

Samantha Orr, Halifax Health Stroke Manager, Appointed Secretary/Treasurer of the American Board of Neuroscience Nursing Board of Trustees

TITUSVILLE - Parrish Medical Group is pleased to welcome Board-Certified Orthopedic Surgeon Bryan Parry, MD, to the North Brevard community. Dr. Parry specializes in general orthopedic surgery, acute fracture care as well as sports medicine. His office is located at Parrish Healthcare Center at Port St. John, 5005 Port St. John Parkway, Cocoa, FL 32927. Dr. Parry earned his medical degree from Pennsylvania State University in Hershey, Pennsylvania. Following his studies, Dr. Parry completed an orthopedic residency at Hamot Medical Center in Erie, Pennsylvania. Before relocating to Brevard County in 2012, Dr. Parry spent 15 years in Atlanta, GA, providing medical care in Walton, Barrow and Newton County. Residing in the Brevard area for 10 years, Dr. Parry has become an involved member of the local community. As an avid distance runner, he enjoys volunteering as the Medical Director for large local races such as the Space Coast Marathon. Dr. Parry is excited to join the Parrish Medical Group team and provide timely acute orthopedic care to patients of the North Brevard community.

DAYTONA BEACH – Samantha Orr, Stroke Manger at Halifax Health has been appointed Secretary/Treasurer to the American Board of Neuroscience Nursing Board of Trustees for the 2022-2023 calendar year. The ABNN Board of Trustees is composed of eight Trustees and one public member who have demonstrated experience and expertise in the area of Neuroscience Nursing. Orr has 25 years of nursing experience with a dedicated focus in neurosciences. She holds a professional certification as a Stroke Certified Registered Nurse (SCRN) through ABNN. While at Halifax Health, Orr has developed processes and protocols that have enabled Halifax Health to become a Thrombectomy-Capable facility and receive accreditation from The Joint Commission. The ABNN is an independent not-for-profit corporation established to design, implement and evaluate a certification program for professional nurses involved in the specialty practice of neuroscience nursing and its subspecialties. The mission of ABNN is to promote and advance the practice of neuroscience nursing through specialty certification.

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$25,000 Donation Secured for Dialectical Behavior Therapy

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5 photo cutline: Pictured left to right: Blaise Aguirre, MD; Joe Meeske; Rose Meeske; Suzanne Steiner; Walt Steiner; Gillian Galen, PsyD DAYTONA BEACH - In an effort to provide local mental healthcare providers with access to Dialectical Behavior Therapy training and address the growing needs of our community, the Walt and Suzanne Steiner Foundation agreed to match donations made to a local non-profit organization, Youth Emotional Support (YES) in the amount of $25,000, which Halifax Health has committed to raising through leveraging local partnerships. Following the unexpected loss of their daughter, Port Orange Fire Department Division Chief of Operations, Joe Meeske and his wife, Rose Meeske, have become advocates for spreading awareness about mental health and working to expand the current offering of services in our community, for both children and adults. The Youth Emotional Support (YES) Foundation was born out of this commitment to getting other families the help they need and connecting them with the appropriate resources. To address the growing need for mental health services in Volusia County, Halifax Health hosted a series of

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collaborative meetings that brought together community members, stakeholders and healthcare professionals and physicians, highlighting the importance of expanding local resources and identifying high risk groups. Largely focused on an emerging modality, Dialectical Behavior Therapy, has been shown to effectively treat patients with a variety of diagnoses, including borderline personality disorder and suicidality by providing a structured step-bystep program that involves not just the patient, but their families as well, giving them the tools needed to live more fulfilling, hopeful and purposeful lives. Industry-leading practitioners from McLean Hospital in Boston, Massachusetts, Blaise Aguirre, MD and Gillian Galen, PsyD orchestrated a series of open forum discussions with Halifax Health leadership, medical staff and stakeholders to develop a strategic plan for equipping local mental healthcare providers with this specific tool set and making this treatment plan available to those in need.


Advanced Dermatology and Cosmetic Surgery Opens Colony Location Advanced Dermatology and Cosmetic Surgery is celebrating the grand opening of its Colony location, one of four offices serving The Villages community and surrounding areas on Thursday, March 24. The Colony location joins established offices in Spanish Springs™, Lake Sumter Landing™, and Brownwood Paddock Square®. In addition to treating common and complex dermatologic conditions including skin cancer, eczema, psoriasis, and acne, the Colony location offers leading-edge cosmetic/aesthetic treatments to reduce effects of sun damage, the environment, and the natural aging process. These treatments range from BOTOX® Cosmetic and Juvéderm® Dermal Fillers to lasers and intense pulsed light (photofacial) treatments.

HCA Florida Ocala Hospital Hiring Expo Meet with recruiters and leadership at Thrasher-Horne Center in Orange Park. This is an exciting opportunity where 7 of our HCA Florida Healthcare hospitals from the greater areas of Ocala, Gainesville, Lake City, Palatka and Jacksonville will be in one location. We will be interviewing for registered nurses, new grad registered nurses, licensed practical nurses, patient care technicians, respiratory therapists, surgical technicans, cardiovascular technicians, CT technologists and many other hospital roles. We unlock possibilities for our colleagues to learn, grow and enjoy a rewarding career. Register now to discover career paths that last a lifetime. Interview on the spot. Same day offers may be extended. We are hiring for the following hospitals: HCA Florida Lake City Hospital HCA Florida Memorial Hospital HCA Florida North Florida Hospital HCA Florida Ocala Hospital HCA Florida Orange Park Hospital HCA Florida Putnam Hospital HCA Florida West Marion Hospital Click here to register Tuesday, April 19, 10 am to 4 pm EST Thrasher-Horne Center 283 College Dr. Orange Park, FL 32065 Dress code for this event is not formal. Please come casual and ready to connect. We encourage you to bring your professional resume, CV, and cover letter with you to the event. Browse open positions and apply online before the hiring event to speed up the process.

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