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In the Flood of COVID-19 Patients, Independent Physicians are Battling to Continue Serving As COVID-19 continues to take a toll on the State of Florida, the entire healthcare community is straining to meet the demands of the sickest patients. Independent physicians are faced with shortages, uncertainty and changes to regulations and standards on a daily basis. It was never easy, but now, healthcare providers are staring down a surge of patients that will almost certainly overwhelm the system before the flood of disease begins to ebb. At the same time, according to reports from ProPublica, and others, employed doc-

ON ROUNDS

PHYSICIAN SPOTLIGHT Jason Pirozzolo, DO ... 3

EOCC MEDICAL CITY The New Normal 2020 ... 4

Not All Lab Tests are Created Equal – Including Testing for COVID-19 Where TIME is of the ESSENCE! ... 5

tors and nurses on the frontlines of patient care with PPE shortages are facing pay and benefit cuts. Orlando Medical News talked with two champions of independent physicians to find out what they see as critical needs and strategies for survival of their medical practices. Larry Jones is the Executive Director of the IP Network, and CEO of HPOF Holdings, LLC, a healthcare company headquartered in Maitland, Florida. As the CEO of HPOF Holdings, his company’s main mission is to preserve and

protect the independent practice of medicine. Larry has been on both the payer and provider side of healthcare. He served on the Business Advisory Board of Seminole County Public Schools for 12 years, representing the insurance committee and 9000 employees’ lives and almost $60M in premium. He is a member of the National Association of ACOs. He is a founding board member of the Florida Association of ACOs. His organization currently runs eight Multi Specialty IPAs, an MSO with two Medicare contracts, and also manages four

ACOs with MSSP contracts with CMS. Marni Jameson Carey is the Executive Director of the Association of Independent Doctors (AID) in Winter Park. A national nonprofit trade association with 1000 members in two-thirds of the United States, a national nonprofit, nonpartisan trade organization dedicated to helping reduce healthcare costs by keeping America’s doctors independent.

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Governor DeSantis, Under Pressure, Issues Statewide Stay-at-Home Order Florida Gov. Ron DeSantis, after days of resistance, issued a statewide stay-at-home order Wednesday April 1, abandoning the county by county approach he has taken to this point. The Governor said he issued the order after consultations with the White House indicated Americans should stay home during the month of April. Total reported cases in Florida are near 7,000 with 890 patients in hospitals and 87 death. Orange County has 392 total reported cases and 64 hospitalizations. DeSantis issued a stay-at-home order Monday for Miami-Dade, Broward and Palm

Beach counties and the Florida Keys, and ordered anyone arriving from the New York area and Louisiana into quarantine and issued statewide measures such as closing bars and gyms and limiting restaurants to takeout and delivery. Studies have indicated Florida will be facing a rapid increase in hospitalizations and deaths during April, with 100 people dying daily by mid-month and over 175 by May 1, when the number nears its peak. Predictions are that 10,000 people will be hospitalized by mid-month and 20,000 on May 1. The model predicts that more than 6,500 Floridians and more than 90,000 will die nationally from the virus by June 1.

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In the Flood of COVID-19 Patients, Independent Physicians are Battling to Continue Serving Patients, continued from page 1 OMN: What steps are you taking with your members to help keep their practices running?

sure that the right care at the right place, at the right time for the appropriate amount of cost is delivered. We’re not sure Jones: First, this past week, what this pandemic is going to we collaborated with all the cost in that algorithm formula major payers: CMS, Blue for value-based care. It’s still to Cross, Cigna, Aetna, United, be seen. Fortunately, CMS has Humana, Simply, and Careannounced that they’re going Plus. We obtained all their to drop the requirements for Larry Jones telehealth/telemedicine inforMIPS reporting for 2020. mation on how to deal with The thing about our intheir patients telephonically dependent doctors, particuwith a virtual appointment and larly IPN, our physicians are in also billing codes that apply. major commercial ACO conOur doctors are currently in the tracts and we’re also in MSO, process of rolling out and seeMedicare Advantage contracts. ing as many patients virtually as All of those require things like possible. That’s a big step right HETUS, STARS, quality metthere. rics, care gap closure. It’s going Second, we do have some Marni Jameson Carey to be more difficult right now offices that have set up drivewith the offices completely bomthrough areas in their parking lots to take barded to get it done. I think the feds are care of their routine patients and to not have realizing this and I think you’re going to see those patients come into the office. That’s some alleviations in some of the policies, at working well. We’re doing that for mainleast during this time period. tained chronic illnesses that you just have to OMN: You mention layoffs.. are they reporting get a checkup every now and then to come in a lot of them? and you get your meds renewed, reordered, that type of thing. We’ve got a lot of docs Carey: Doctors are probably going to that are trying to do that in a drive-through be able to weather this personally through manner at their offices on their property. Ina few missed paychecks, but it’s a cascade dependent physicians are looking for every effect we all need to worry about. Doctors way they can to make sure that they are still employ lots of people. I have a doctor who communicating with their patients. has had to layoff a third of his staff. AnNext, we do have some offices that have other doctor I spoke to yesterday has a staff set up shorter hours to see patients. We see of 12 that he said are absolutely wonderful some doctors close at noon because they’re people. He would hate to lose any of them, running out of supplies. Some offices have and he doesn’t know how he’s going to be closed completely during this time. able to keep them. If a doctor isn’t working, Unfortunately, some practices have had isn’t seeing patients, isn’t doing surgery, isn’t to lay off as much as half their staff due to bringing in revenue, the trickle-down effect the slowdown. is the staff gets impacted and may need to be laid off. One doctor has told me he canceled OMN: Generally speaking, what are you, 27 surgeries. The hospital where he operates what are you hearing from, from the doctors normally would have had all of these elective you’ve been speaking with? surgeries, but now all those beds are empty Carey: They’re very worried. They don’t that would have been filled. A whole group know what’s, going to happen to their pracof employees at that hospital have been told tice. The ones who are doing well are the dito stay home…so the patients suffer, the staff rect care doctors. They don’t have to worry suffer, the hospital employees take a hit. It’s about getting reimbursed by anybody, so a cascade effect. We all need to care because they’re in pretty decent shape. I’m getting they’ve just impacted a hundred people. calls from surgeons and other specialists that OMN: Are there ways you are looking at have various independent centers that are helping offices keep staff? not affiliated with hospitals, like vein centers and cardiologists who don’t do surgery but Jones: One of the things that IPN, our see patients, and no one’s coming in. Surboard, our management team, are very congeries are being canceled, staffs are being cerned with, is that we know that certain laid off, income is drying up, and they don’t offices are going to be laying off staff, and know where the relief is going to come. we’re trying to come up with some kind of They’re very concerned. a program that we can assist these people that are being laid off to still have some inOMN: How are practices set for weathering come during this time period. What that’s this for six to nine months? going to look like or how that develops or Jones: The specialists certainly have a the timeframe for that developing, we don’t greater ability to weather this storm than the know, but we are certainly having those conprimary care physicians do, mainly because versations now. of the higher income. They’re also making OMN: With are the pressures on primary care use of telehealth and telemedicine to keep physicians, do you see any of them merging up with their patients as well. practices down the road? This era of moving from fee-for-service to fee-for-value, is going to be a challenge Jones: No, I don’t see anything like that over the next few months. We’re graded on happening. We’re going to do everything we closing care gaps, maintaining costs, making 2

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can to support our physicians and give them the tools and the backup necessary. In fact, IPN has a relationship with a GPO, OneAccess, who we have already contacted to ask them to give our doctors different ordering processes to be able to still maintain a supply of masks, gowns, hand sanitizer, hand soap, and that type of thing. We’re just trying to keep the doors open with supplies for our independent physician practices. OMN: Do you have some specific steps that you’re recommending to your practices to help them survive? Jones: We’re recommending that they still continue to manage their chronically ill and patients that show up thinking that they have coronavirus. With the other patients, they need to postpone their appointments if it’s just a routine appointment and schedule it down the road, or if it’s a chronic situation, hold it by a telemedicine virtual visit. I think you’re going to find that the primary care guys are just going to be overloaded and overwhelmed. The specialists, I would say your respiratory, like pulmonary, allergy, maybe even a cardiovascular with COPD and CHF, those are going to be the ones that are going to be completely overwhelmed right now. Then the other idea is to just push it as fast as they can but know that IPN’s there for them and our physicians. You can’t imagine the number of calls we’re getting. We have 1500 physicians in 11 counties, which includes 475 primary care and the balance is

all multi-specialty. We are doing everything we can to reach out to them. OMN: What are you suggesting for the next several weeks? Carey: My best advice is lean on your advisors. It’s very different state to state. It’s very different practice to practice and it’s very different specialty to specialty. This is not a situation where one size fits all. You really need to lean on your administrator and your tax accountant and your legal team to find out what you can do to position yourself to get through this I just want them to hang tough. It’s frustrating to me that there were $150 billion allocated to hospitals in this stimulus package. But I don’t see where that’s trickling to independent doctors. The hospitals have more unsecured assets. In our own town, they have $4 billion in unsecured assets that could take them for a long time and our independent doctors don’t have those kinds of reserves. It’s a little frustrating to see so much stimulus going to hospitals, although I know many of them are going to be overwhelmed and are going to need resources, but they have a lot of resources the independent doctors don’t. I am concerned that independents are going to be underfunded, under equipped, and they’re going to have a little harder ride through this time than some of their cushier counterparts, but I want them to stay strong and independent because America needs our independent doctors.

PROTECTING YOUR PRACTICE DURING THE CORONAVIRUS PANDEMIC

10 THINGS TO REMEMBER A Discussion with the Integrated Independent Physicians Association (IPA), regarding protecting your practice: 1. PPE supplies - order from multiple suppliers, not just your normal vendor. 2. Utilize Telehealth to communicate with regular patients to • Maintain management of chronic patients, prescription refills, etc. • Maintain consistent office practice revenue, as most payers are allowing same level E&M codes billing for telehealth visits and waiving copays  3. Set up drive through in your parking lot for low level patient visits, prescription refills, etc. 4. Hospitals are asking for volunteers, be aware of your specialty malpractice coverage and boundaries. • Many physicians have asked advice on personal protection assurances from the hospitals, that are requesting additional services and help. 5. Email or text to your entire patient base announcing the waiving of copays and assuring them, that your practice is open and accepting patients  6. Ask patients to call your office BEFORE they go to ER or hospital. This will save them time and money and avoid additional exposure for them.  7. IPN has sent out Telehealth Guidelines for most payers, as well as an interpretation of the Surgeon General’s order on using Telehealth services 8. IPN has requested the payers eliminate copays for patients seeing our Independent PCPs and Specialists, in our Value Based programs. This will incentive patients to call their PCP vs. just going to the ER or hospital.  9. Maintain contact with your Hospitalist Representative for your patient admissions  Courtesy of Integrated Independent Physicians Network Please call the IPN office, if you have questions; 407-475-9213

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PHYSICIANSPOTLIGHT

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The Role of Telehealth in Bringing Orthopedic Specialists to the Coronavirus Outbreak Jason Pirozzolo, DO

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Telehealth has been slowly integrating itself into the daily operations of primary care physicians over the past few years. It provides convenient, efficient, and cost-effective medical care. But until recently, the use of telehealth by orthopedic specialists was nearly non-existent. This was in part due to the regulatory landmines that physicians would have to tip-toe around, and when you got past the landmines, you had to deal with buggy and unreliable telehealth platforms to work on. Enter the Coronavirus Pandemic of 2020. On March 6, with one swoop of the pen, President Trump signed the Coronavirus Preparedness and Response Supplemental Appropriations Act into law, which gave the U.S. Department of Health and Human Services (HHS) the authority to temporarily waive certain Medicare requirements for telehealth services. This in turn, cleared those landmines and now allows physicians to utilize common everyday mobile apps like Facetime, WhatsApp, and Skype to evaluate and treat their patients. What this means in the setting of a pandemic, is orthopedic specialists can now join the fight and help primary care physicians and hospitals to slow the spread of the virus, and eventually eradicate it. One of the first orthopedic practices to embrace telehealth was Orlando Hand Surgery Associates. “Our ability to partner with primary care physicians and hospitals by allowing patients to be evaluated for any problem, shoulder to hand, from the convenience of their own home will drastically reduce the risk of exposure for our most vulnerable patients,” said Dr. Jason Pirozzolo, the Director of Sports Medicine and Trauma for Orlando Hand Surgery Associates. Dr. Pirozzolo was appointed by Governor DeSantis in 2018 to his Health and Wellness Transition Committee. In that role he helped to curate the administration’s health care policy goals and participated in discussions that involved potential outbreaks, like coronavirus. As more U.S. patients are diagnosed with coronavirus, health agencies have urged hospitals and providers to expand their use of telehealth, both within their facilities and to reach patients at home. The Centers for Disease Control and Prevention now recommends using telehealth during the outbreak. The World Health Organization which designated the coronavirus as a global public health emergency in January, said healthcare organizations should consider using telehealth to minimize the use of personal protective equipment, such as gloves and masks. Telehealth has always been advertised as a powerful way of diverting patients from the Emergency Room, and now with the coronavirus pandemic it seems it has never been more important. The ability of this treatment modality as a supplement to ease the overburdened health care system is in3

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creasingly becoming crucial to the overall greater good of public health. “Anything we as physicians can do to help reduce the spread of coronavirus by keeping them out of crowded waiting rooms, while still addressing their needs is something that we all should be doing,” Pirozzolo said. “Moreover, telehealth visits allow us to reallocate scarce medical supplies like masks and gowns so that those supplies can be directed to those patients in need.” Dr. Pirozzolo has noticed an exponential increase in the volume of patients utilizing their telehealth service. “We can evaluate most conditions through video conferencing on Facetime or WhatsApp, and do everything from ordering MRI’s and nerve tests, to medications and physical therapy,” Pirozzolo said. “We can review X-rays and other imaging and even plan for a potential surgery if needed.” Patients seem to love the telehealth option. “When Dr. Pirozzolo suggested a telemedicine visit, I didn’t really know what that was. When he explained that I could use the same Facetime app that I talk to my grandchildren with, I was excited!” said Rosa, a patient of Dr. Pirozzolo’s. “Now I don’t have to worry about exposing myself to the virus, not to mention that I normally drive two hours just to see him.” In addition to Medicare, most commercial insurance carriers are following the same guidelines. In fact, many are waiving patients’ co-pays all together in order to make the telehealth visit even easier. The physicians at Orlando Hand Surgery Associates have even expanded their telehealth appointment slots to evenings and weekends to better serve patients. Jason Pirozzolo, DO, CAQ , CSCS, is an Orlando-based physician, community leader, pilot, professor, and author. He is the Director of Sports Medicine and Trauma at Orlando Hand Surgery Associates. He earned his Doctorate of Osteopathic Medicine at Nova Southeastern University, and also completed a clinical externship in Emergency Medicine at Harvard Medical School, a residency in Family Medicine at Duke University, and a fellowship in Sports Medicine at the Ohio State University. While at the Ohio State University and Duke University, Dr. Pirozzolo was part of the physician team dedicated to caring for the student-athletes’ sports injuries and overall health. During that period, he also earned the certification as a Certified Strength and Conditioning Specialist. In 2005, his employment began as a physician at the Ohio State University Medical Center. The following year he became the Director of Sports Medicine at Florida Hospital Centra Care. Dr. Pirozzolo joined Orlando Hand Surgery Associates as Director of

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the British Journal of Sports Medicine. As an active member of the Florida Medical Association, Dr. Pirozzolo is a member of the Board of Governors and serves as the Vice-chair of the Council on Legislation Board and is a member of the PAC Board. He was also appointed to the Executive Committee of the Florida Medical Association. In July 2014, he was elected to serve on the delegation to the American Medical Association, helping to represent all physicians in the state of Florida. Dr. Pirozzolo is very involved with his community and has volunteered at Shepherd’s Hope Free Clinic since 2010. In 2012, he was accepted and later graduated from the Central Florida Political Leadership Institute. In 2015, Dr. Pirozzolo co-founded the IP Network and serves as the Vice President. The IP Network is an integrated network of nearly 1100 physicians affiliated with high acuity urgent cares that is attempting to redefine the current healthcare system by utilizing proprietary technology to lower costs and improve quality. ccomer@flcb.com

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Sports Medicine and Trauma five years later where he now specializes in non-surgical orthopedic upper extremity problems. For the past seven years, Dr. Pirozzolo has also been serving as an Assistant Clinical Professor at Florida State University College of Medicine. His distinguished work in the field of sports medicine has appeared in publications such as: Medicine and Science in Sports and Exercise, Clinics in Sports Medicine, and

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EAST ORLANDO CHAMBER OF COMMERCE

CALENDAR: Rebuilding Florida: Business Growth & Partnership Program Thursday, April 2, 2020 9:00 – 10:00 AM Sponsored by UCF Register to participate virtually

How to Create a LinkedIn Profile that Magnetizes Clients & Lands You That Job Chris Prouty, NineTwice Friday, April 3, 2020 2:00 – 3:00 PM

Telehealth Maximizing the Health System Workforce – a Chamber Benefit You Can’t Ignore

Joe Filice, Avalon Insurance Services Tuesday, April 7, 2020 9:00 – 10:00 AM

The Member Academy: Roadmap to Member Success Wednesday, April 8, 2020 8:30 – 10:30 AM

Recruiting, Hiring, Employment Guidance & the Law in a COVID-19 Environment Featuring: Frank Jones, CareerSource Central Florida; Millisen Griffin, EM2HR; Roger Lear, OrlandoJobs.com; Jennifer Englert, The Orlando Law Group Thursday, April 9, 2020 9:00 – 10:00 AM

Marketing Healthcare in a COVID-19 Environment

Featuring: Jennifer Thompson, Insight Marketing Group; John Kelly, Orlando Medical News; Quintin Gunn, Sr., Social Media Solutions for Doctors Tuesday, April 14, 2020 9:30 – 10:30 AM

CORE: Children of Restaurant Employees Helping families throughout the US Thursday, April 16, 2020 9:00 – 10:00 AM

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The New Normal 2020 By DOROTHY HARDEE

In February, Sean Snaith spoke about an optimist outlook for 2020. The year began with what could be considered an optimistic beginning. The US economy was on stable footing going into the new year. Unemployment was at a 50-year low, giving consumers the confidence to continue to spend. According to Forbes, it was almost certain that the “bull” would breath its last breath sometime before 2030, but the stage was set for continued positive returns. All was right with the world. Meanwhile on the other side of the world the World Health Organization (WHO) had been alerted to an unusual pneumonia brought on by an unknown virus. Within days the virus spread from several to 40, then 200 within a couple weeks. On January 23, WHO said the outbreak “did not yet constitute a public emergency of international concern and there was “no evidence” of the virus spreading between humans outside of China.” Fast forward two months, when WHO declared the coronavirus outbreak a pandemic, up until now when the United Nations chief warned the pandemic presents the world with its “worst crisis” since World War II. There is no need to repeat the number of cases growing in Florida and throughout the United States because the data consumes the airwaves and social media nonstop. As I glanced through my Facebook feed, I came across the meme, “I’m done with the 90-day free trial of 2020…how do I cancel???” Our community adjusts to ever changing orders attempting to stay one step ahead of the virus. I can’t help but ask the universe if we can have a “do over,” cancelling the 90-day trial of 2020. Since that is not a realistic option, the East Orlando Chamber team has been working diligently behind the scenes to see how we can support the members and community as an advocate for East Orange County. Given the trends across the globe, we anticipated the need to postpone events through the second week of May for the safety of our members. Business still needed to move forward in this “new normal” requiring us to think outside the box to continue connecting businesses with the community. We have populated the calendar with important virtual events helping businesses understand the resources available to support them and their employees. Telehealth is the critical way for patients to see their provider, but not all providers offered the service. We collaborated with Insight Marketing Group showing healthcare professionals how to set up telehealth for their practice in 24 hours. Small business is seeking financial support to continue moving forward. The Florida Department of Economic Opportunity and Office of Small and Minority Business Capital was scheduled to dig into the questions our members had about the Bridge Loan and other funding resources available

to keep them afloat. We want you to be prepared to start doing businesses once the virus finally comes to an end. Companies will be looking for new clients and displaced employees will look for a new job. Member Chris Prouty is energizing those interested with a virtual workshop to show attendees “How to Create a LinkedIn Profile that Magnetizes Clients and Lands You That Job.” We have also included a few lighthearted opportunities to help our followers take a break from the COVID-19 overload. We were “LIVE FROM EAST ORLANDO! With Coffee Club Live on Facebook answering those important questions like, “What is your favorite comfort food?” and “How many chickens would it take to eat an elephant?” Your business is Our business and the East Orlando Chamber is here to help members promote deals, hours, press releases, job openings, webinars and more. We have shared the hours and menus of our member restaurants incorporating a Take-out, delivery and pick up section in our Chamber Directory to make it easy for guests to locate. To keep the networking, connecting and sharing of key information going, we created three Groups focusing on Small Business, Non-Profits and Restaurants.

We are reminding members or prospects that member benefits include an opportunity for MDLive Telehealth for just $14 a month with no deductible and no copay for employees and their households. For those concerned about membership renewals, we offer a payment options for most of our levels so you can continue investing in your business. Need to know more? Give us a call at 407-277-5951. We are working remotely, but always available by phone, email or by Go To Meeting. Remember, we are in this together and the East Orlando Chamber is thinking differently for members. #EOCCCares. Dorothy Hardee is the Chamber Administrator for East Orlando Chamber of Commerce

Watch for MORE at EOCC. org including After Hours Trivia and Focus on Finances with Kyle Davis, Integrity Financial Group; Sam Fragale, Edward Jones and Tanya Leonce, True Books, LLC.

Please visit www.EOCC.org for a complete listing of April’s events APRIL 2020

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Not All Lab Tests are Created Equal – Including Testing for COVID-19 Where TIME is of the ESSENCE! By RAMI PACKARD

What is PCR testing? What makes it different from traditional culture lab testing? Why is PCR testing needed for COVID-19 tests?  Everyone is at risk of illness and infection from respiratory pathogens. However, young children, the elderly, immunocompromised or weakened individuals (including those with chronic disease, cancer or in intensive care) are most likely to suffer serious and potentially life-threatening conditions.

Using Real-Time Polymerase Chain Reaction (Pcr) For Pathogen Identification And Detection Of Antibiotic Resistance Provides A Rapid And Accurate Diagnosis In As Little As 24-48 Hours. The use of antibiotics is the SINGLE MOST IMPORTANT FACTOR leading to antibiotic resistance around the world. Antibiotics are among the MOST COMMONLY PRESCRIBED DRUG in human medicine. Up to 50 percent of all the antibiotics prescribed for people ARE NOT NEEDED or are not optimally effective as prescribed. Nearly everyone in society has heard the name Louis Pasteur. He’s considered one of the most brilliant scientists in history and basically revolutionized the world as we know it. His breakthroughs have saved countless lives and improved the quality of life for people around the world, and his work paved the way for the field of microbiology. In the 1800s, it was Pasteur that first proved that germs make us sick. This led to Culture and Sensitivity testing that most Labs use today to determine what pathogen is causing an illness. For over 200 years, doctors have been sending samples of wounds, urine, fluids and other bodily parts to labs to be tested and grown. In 3-5 days (sometimes even up to 20 days for fungal infections), doctors would hope to get results so they could then treat accordingly. There are a lot of disadvantages with this test although it’s been the only test available to us at this time. For example, samples have strict storage guidelines and LESS THAN 1 percent of known microbes will grow in traditional culture methods. In fact, cultures have a high probability of returning with “no growth” results and anaerobes are extremely difficult to grow in culture. 5

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Advancements have now been made that utilize a new way to test and the ability to get results back to a physician in as little as 24 hours. Molecular PCR testing is the 21st century’s answer to what Louis Pasteur created 200 years ago. PCR technology extracts the Microbial DNA from each sample, similar to lifting fingerprints at a crime scene. Pathogens can be identified with 99.8-99.9 percent accuracy and in as little as 24 hours. ALL microbes AND fungi can be tested in one test AND the test can detect antibiotic resistance genes for 8 antibiotic classes. The most significant factor that this testing allows is ACCURATE DATA of what is living inside your patient’s infection so you can be confident in your treatment decisions for their recovery and overall health. A few labs have converted to this much more accurate and timely testing method and can perform testing on pathogens including Wounds, Nails, GYN, UTI and RESP (including Covid-19). With Covid-19 spreading so rapidly, we don’t have time to wait up to 7 days for results.  This test gives

results in 24-48 hours. Doctors rarely receive accurate timely answers with traditional testing. Traditional approaches to identify the pathogens responsible for enteric infections can be time consuming and lack sensitivity, which can lead to misdiagnosis. They face a large burden from a variety of respiratory tract infections which can be very expensive and difficult to diagnose. Urinary Tract Infections are one of the most commonly diagnosed illnesses in older adults and one of the leading reasons antibiotics are prescribed in long term care facilities. All of these statements are reasons to find a lab that can give your office results in as little as 24 hours.  If your lab is not currently offering you the following services and/or PPE to assist during the current pandemic, I encourage you to find one that does.

KEY BENEFITS TO MOLECULAR PCR TESTING:

• Identifies difficult to culture pathogens • Reduces antibiotic utilization • Identifies bacteria regardless of recent antibiotic use • Improves patient outcomes • Cost reduction and avoidance • Increased patient satisfaction • Yields greater than 95 percent analytical sensitivity and specificity Molecular PCR testing IS covered by Traditional and Medicare Advantage plans, and many commercial insurances. Rami Packard is a Regional Developer for RX2Live. If you would like to learn more about RX2Live and how we can implement these Lab Services into your practice at no cost to you, please reach out. We also have plenty of PPE available and ready to ship anywhere in the country! Contact her at 904-907-4542 or rpackard@rx2live.com Dr. Estée Davis, PharmD, owns an RX2Live franchise in Melbourne, FL. She specializes in improving care scores while increasing revenue with NO out of pocket costs to the practice.

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Upper Extremity Expert! Treating Fractures from Hands to Shoulders • Avoid the ER & Hospital • Same Day Appoints • TELE-MEDICINE Appointments for ALL Patients Stay HOME and Get Immediate Answers!

Jason Pirozzolo, D.O. Director of Sports Medicine and Trauma at Orlando Hand Surgery Associates 4 0 7 - 8 4 1 - 2 1 0 0 | O R L A N D O H A N D S U R G E R Y. C O M orlandomedicalnews

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THE HR LADY

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Families First Coronavirus Response Act Explained for Employers By WENDY SELLERS

First, let me start by saying that any information given prior to 3/25 on the FCCRA is most likely not accurate - including information given by me. All information you are taking advice from should have a date stamp of 3/25 or later. Why? The Department of Labor clarified a lot of info on 3/24 then again on 3/25 including changing the effective date of this new law to 4/1 (so it is neither March 18 nor April 2 as originally stated). Many other items have been clarified as well. Second, there are only 6 reasons an employee can get paid leave up to 80 hours (there are caps), while the employer gets a tax credit for this on their quarterly payroll tax return. This starts April 1 and ends December 31 (as of now). There is not a waiting period for the employee to take the leave per say, they cannot take leave and get the FCCRA paid sick leave before April 1 and the employer cannot submit for the leave tax credit until after the leave is taken. What if the employee was out before April 1 for one of the 6 reasons? Simply follow your normal employer time off policy.

THE 6 REASONS ARE AS FOLLOWS:

Under the FFCRA, an employee qualifies for paid sick time if the employee is unable to work (or unable to telework) due to a need for leave because the employee: 1. is subject to a Federal, State, or local quarantine or isolation order related to COVID-19; 2. has been advised by a health care provider to self-quarantine related to COVID-19; 3. is experiencing COVID-19 symptoms and is seeking a medical diagnosis; 4. is caring for an individual subject to an order described in (1) or self-

quarantine as described in (2); 5. is caring for a child whose school or place of care is closed (or child care provider is unavailable) for reasons related to COVID-19; or 6. is experiencing any other substantially similar condition specified by the Secretary of Health and Human Services, in consultation with the Secretaries of Labor and Treasury. Under the FFCRA, an employee qualifies for expanded family leave if the employee is caring for a child whose school or place of care is closed (or child-care provider is unavailable) for reasons related to COVID-19. Note that #1 and #6 have not been clearly defined yet by the DOL or another agency as of 3/26. Third, the Department of Labor website has the latest and greatest information and it is somewhat easy to understand. • On March 25, the Department of Labor posted employer fact sheets, required posters for employers to disseminate and Q&A here as well as fact sheets for employees. https:// www.dol.gov/agencies/whd/pandemic • I have also posted some information my blog that you may find helpful https://thehrlady.com/my-blog • The caps range from $2000 per employee to $12,000 per employee depending on the reason they are taking leave: self-care, medical isolation order or government isolation order; family care or childcare. • Childcare is the costliest (yet credited back through payroll tax) since it can get extended for up to 12 weeks whereas the other reasons are only for up to 80 hours. • Several reasons allow reduction in pay at 67 percent • Reminder that this DOL information

is for the FFCRA law not the stimulus bill (CARE).

DEFINITIONS AND ADDITIONAL INFORMATION:

What employers must comply with FFCRA? It is important to note that all employers under 1-499 employees must protect jobs (even new hires who have been employed more than 30 calendar days effective April 1) for up to 12 weeks if someone falls under one of the 6 reasons. • The only exception at this time is employers under 50 employees. • The employer might be able to become exempted from the childcare FMLA leave protection and paid leave for weeks 3-12 but they will have to prove it. How? This has not been defined yet. HEALTHCARE PROVIDERS: As of March 26, we are still missing some information for health care providers and emergency responders, who are exempt from complying

with this leave mandate and are also referred to as “essential employees” who can travel to work during a community/ government “stay at home” order. There is no definition yet from the federal level but many are assuming it will be the same definition the FMLA already uses (found here https://webapps. dol.gov/elaws/whd/fmla/3.aspx?Glossary_ Word=PROVIDER), however this leaves questions about sending/ keeping non-medical staff home during a government mandated stay at home order (reason #1). ESSENTIAL WORKERS: As defined by homeland security https://www.cisa.gov/publication/guidanceessential-critical-infrastructure-workforce The stimulus bill (CARE) is passing one shape or another so that should also help displaced workers. Wendy Sellers, The HR Lady ® wendy@thehrlady.com www.thehrlady.com Offering virtual advice regarding downsizing and other legal compliance. Follow me on LinkedIn as I post more information when it becomes available https://www.linkedin.com/in/wendythehrlady/

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CBD Fact: ANXIETY Anxiety is a very normal emotion that we all experience. Anxiety can be related to events, like what we are going through at this time with the Coronavirus, but having to go to the doctor can also trigger anxiety, Patients often experience anxiety when they get their diagnosis or waiting to receive a diagnosis. Holidays can and do cause anxiety, as well as public speaking. CBD can be an awesome way to take the edge off the high levels of anxiety that is going on now. It’s a good idea to talk with your health provider about using CBD to help with your anxiety.

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American Lung Association Researcher at Helm of Protein Discovery that Constrains COVID-19 Breakthrough could inform Coronavirus treatment strategies By JANELLE HOM

COVID-19 is currently the top story worldwide. Other events of the new year seemingly pale in comparison to how this evolving health crisis – now upgraded to a pandemic by the World Health Organization (WHO) – continues to unapologetically consume our daily lives. So, in this spirit, we exchanged germfree elbow bumps upon learning that one of our researchers, John Schoggins, PhD, made an exciting medical discovery in early March. An associate professor of microbiology at UT Southwestern Medical Center in Dallas, Texas, Dr. Schoggins and his international collaborators (Charles Rice, PhD, at The Rockefeller University in New York and Volker Thiel, PhD, at University of Bern in Switzerland) are credited with identifying LY6E, a naturally occurring protein that has been shown to inhibit coronavirus infection. Their findings are detailed in a pre-print article, entitled “LY6E Impairs Coronavirus Fusion and Confers Immune Control of Viral Disease.” “My lab has a longstanding history researching how cells defend themselves from viral infection. This particular protein, LY6E, demonstrates the ability to block the COVID-19 virus and other coronaviruses like SARS and MERS from fusing to the cells, thus significantly reducing the probability of infection when tested in vitro. It also helps the immune system control coronavirus disease in vivo,” explained Dr. Schoggins to the Lung Association. Dr. Schoggins received the Lung Association’s Innovation Award in 2019-2020, which aims to match the brightest minds with the best science, in support and recognition of his pioneering project, “New Avenue for Keeping Influenza in Check.” Through this project, which set out to investigate how macrophages affect the influenza virus, the team ultimately landed on LY6E and determined it plays a key role in the primary immune response defending against coronavirus. Quite an opportune outcome during an ongoing global race to curb the fast-paced spread of COVID-19. Now that LY6E has been detected and examined, they plan to expand their inquiry to see whether it can be translated into treatment options. “We’re thinking about ways to mimic LY6E in the hopes of developing a complementary small molecule or peptide drug target, along the lines of a fusion in7

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hibitor,” Dr. Schoggins added. “The team is appreciative of organizations such as the American Lung Association for taking chances on cutting-edge research such as ours.” We’ll keep you updated on next steps of Dr. Schoggins’ study, but in the meantime, we’re proud that our Research Team is hard at work on timely and impactful research!

coronavirus and other germs?

PROTECTING YOURSELF AND LOVED ONES Signs and Symptoms of the Coronavirus (COVID-19) Reported illnesses of the coronavirus (COVID-19) have ranged from mild symptoms to severe illness and even death. The CDC reports that symptoms may appear 2-14 days after exposure, and include fever, cough and shortness of breath. STEPS TO PREVENTING ILLNESS AND SPREAD The virus is thought to spread from person-to-person between people in close contact, including through coughs and sneezes. So how do you protect yourself from the

• Be careful to limit your handshakes, high-fives and fist bumps where the virus can be easily transmitted. In fact, we have five alternatives to the traditional handshake when greeting someone. • Avoid touching your eyes, nose and mouth—as it allows the germs on your hands to reach moist, porous surface tissue where the germs can enter your body and cause infection. • Wash your hands early and often, and with soap and water for at least 20 seconds. Need help counting? Try singing instead. Read our blog for more handwashing best practices. • No soap and water near? Use hand sanitizer with at least 60-95% alcohol. • Limit your contact with people who are sick. • If you experience symptoms of an illness, have been in close contact with a person known to have COVID-19 or have recently traveled from an area with widespread or ongoing

community spread of COVID-19, contact your healthcare provider and stay home to avoid crowds and contact with others. Cover your mouth when you cough or sneeze and disinfect objects and surfaces you touch. WHO IS MOST AT-RISK FOR THE CORONAVIRUS (COVID-19) Like the seasonal flu, older adults and those with underlying health conditions may be more at risk for severe symptoms. That being said, unlike the flu, COVID-19 does not seem to create complications in young children. Individuals of all ages have been infected with COVID-19 with symptoms that range from mild to severe. So, practicing good hand washing and alternatives to the handshake should be something all age groups partake in. Janelle Hom is the Executive Director of the American Lung Association in Florida. Email her at Janelle.Hom@lung.org. Visit Lung.org

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How to Close Your Revenue Gap in a Value-based World By JASON CONSIDINE

Did you know a whopping 90 percent of missed revenue opportunities can be linked to denied claims, according to a study by Frost and Sullivan? At a time when providers are working to make up this lost revenue, they are also dealing with patients who are expected to cover more of their medical bills through out-of-pocket expenses. High-deductible health plans, free-care programs and crowdfunding are more prominent, leaving hospitals vulnerable to the patient’s ability to pay. Add in the rise of valuebased care, and it’s no secret patients expect an experience that matches their interactions with other consumer services. They’re more engaged in their health and know they have options. Patient collections are down, but expectations are up. Loyalty wavers somewhere in the middle. How should providers respond? Legacy revenue systems aren’t set up for financial models based on value over volume, so providers need to adapt. It’s vital to find ways to help patients navigate the financial side of healthcare and make patient collection processes as efficient as possible.

WHAT DOES VALUEBASED CARE MEAN FOR YOUR REVENUE CYCLE?

Shifting to value-based reimbursements, patient-centric incentives and quality of care programs means your clinical and revenue cycle workflows need to be better connected. Patients must receive consistent and accurate communications throughout their healthcare journey, setting them up for the best possible health outcome and payment options. When the care and finance functions work together, your patient records can be kept up to date and the next admin task will be triggered at the right time. Here are some things your revenue cycle management (RCM) process might be missing: • clear and convenient processes for patients • accurate patient identification from registration to billing • ability to collaborate with payers to customize workflows • streamlined workflows to reduce time and resources spent on avoidable tasks • automated processes to support effective collections and spot root causes of denials • real-time reporting to help improve performance over time Data, analytics and automation can help you create more agile processes to minimize revenue leakage and create a better financial experience for patients.

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3 WAYS TO CLOSE THE GAPS IN A VALUEBASED RCM MODEL

Use consumer data to help patients make informed decisions A major cause of denied claims stems from patients being unsure about what their treatment will cost. Others are unclear about whether they have appropriate coverage. Help your patients weigh their financial options by providing accurate estimates and working with them to check coverage. Consumer data can support this process by giving you insights into your patient’s social identity, medical history, coverage status, insurance eligibility and propensity to pay. With an intuitive billing process, you’ll improve the patient payment experience and reduce revenue leakage.

USE ANALYTICS TO PREDICT GAPS IN YOUR REVENUE CYCLE

Many top-performing health systems use advanced data analytics to predict where the bottlenecks, errors and denials might creep in, so they can take swift action to address them and keep their patients and C-suite happy. For example, with analytics, you can get to know your patients better so you can segment them according to their financial responsibility and ability to pay. Not only does this mean you can focus your collections efforts more effectively, but you’ll have the right insights to help patients navigate the payment process with personalized nudges and relevant messaging. In addition, analytics have a huge role to play in eliminating avoidable denials resulting from unreliable or inaccurate patient

data. You’ll be able to spot patterns in denials, so you can implement checks and processes to avoid them in future.

PUT THE RIGHT TOOLS IN PLACE TO CLOSE THE GAPS

Close the widening gap between claims and collections starts by ensuring your patients are aware of their financial responsibility. A self-service patient portal could give your patients convenient access to their information in a time and place that suits them. They’ll be able to schedule appointments, enroll in payment plans, and apply for charity. They’ll see real-time, transparent and accurate information about price estimates and their eligibility and coverage. When the financial experience is transparent and frictionless, patients are more likely to feel satisfied and less likely to shop around for care – not to mention being better prepared to meet payment deadlines. And internally, data-driven automated software can help you monitor and manage every step of your revenue cycle. You can make life easier for clinicians and management teams with EHR-integrated dashboards, web-based financial reporting and timely alerts for the relevant teams. It’s simply no longer viable to use RCM processes that aren’t integrated across your entire digital ecosystem. Providers that can offer a convenient and personalized consumer experience, automate collections workflows and join the dots between clinical care and revenue management will have the competitive advantage in the era of value-based care. Jason Considine is Senior Vice President & General Manager, Patient Experience Solutions at Experian. For more information visit: www.experian.com/healthcare

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Technology is the Future of Medical Cannabis By MICHAEL C. PATTERSON

Medical Cannabis is slowly becoming more acceptable to the medical community as a form of treatment for certain ailments. As the number of medical cannabis dispensaries increase across Florida and other states, a sense of normalcy is beginning to emerge with medical cannabis becoming part of our everyday lives. Some of the areas that are not well known about the cannabis industry are the “picks and shovels” encompassing quickly advancing computer and biotechnology. These systems make medical cannabis more beneficial and safer for patients. These systems will also lower production and compliance costs for manufacturers. Technology and innovation are playing major roles in the growing cannabis market in the following areas: “SEED TO SALE” TRACKING SOFTWARE- computer software that is able to track each cannabis plant from when it is a seed, all the way to when a person buys the cannabis is called “seed to sale”. It has become the standard mandated by Florida law and almost every other legal cannabis state. This software is critical for public safety to ensure the public trust of the supply chain and to ensure that patients know exactly where their medicine was manufactured. DNA MATCHING- With the proliferation of DNA testing kits (Ancestry.com, 23 and me), Americans have become used to having their DNA tested to give them information about themselves. This DNA information will help your physician to identify types or strains of cannabis that will work well with your body’s chemistry and makeup. Physicians will be able to determine the best delivery method (pill, topical, vapor, tincture, smokable, edible, etc.) based on your DNA and access to de-identified data on thousands of other people with similar diagnoses and successful cannabis treatment plans. This technology will allow Physicians to become better at recommending a specific cannabis treatment and protect themselves from future liability. Furthermore, it will decrease the cost of the medicine to the patient because it will allow the patient to take the best cannabis medication the first time, rather than going through trial and error in taking different strains and forms of cannabis to see what works for them. We expect to see Florida Medical Marijuana treatment centers (MMTCs) begin to implement DNA matching technology in 2020. 9

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NFC TRACKING TECHNOLOGYNFC, near field communication, is already being used to purchase items with your cell phone at the register of a store (i.e. Apple pay). NFC has been adapted to be imbedded in packaging to allow businesses and consumers to validate chain of custody and content of products without opening the item. This technology will allow for better and faster inventory management by updating the location of cannabis medication in real time anywhere in the world. NFC will also assist law enforcement and customs officials to validate legal products by simply downloading an app and scanning each package to receive accurate information on each product. BLOCKCHAIN TECHNOLOGY- blockchain is a distributed ledger computer technology system that makes software immutable to fraud. Eventually, all computer software will move to blockchain due to its anti-fraud capabilities and its ability to handle an extreme amount of data. This technology will revolutionize medicine in many ways by allowing health systems to find and correct problems faster and use data-analytics to make healthcare delivery more efficient . One of the ways it will help the cannabis industry is through instant recall notification of product. If it is discovered that a batch of medical cannabis has contaminants or needs to be recalled, the blockchain software will allow the manufacturer to quickly notify the patient who purchased the medication. The manufacturer will enter the batch number or lot number of the medication, and every patient who ever purchased the medication will be instantly notified via text or email to bring the medication back to the store of purchase. This will decrease the time required to notify patient of a recall and ultimately save lives. The medical marijuana system is growing faster than any other form of healthcare in the modern era. Continued technological advancement in the cannabis industry is important to increase efficacy, safety, reliability, and trust of using cannabis as a medicine. Michael C. Patterson, founder and CEO of U.S. Cannabis Pharmaceutical Research & Development of Melbourne, is a consultant for the development of the medical marijuana industry nationwide and in Florida. He serves as a consultant to Gerson Lehrman Group, New York and helps educate GLG partners on specific investment strategies and public policy regarding Medical Marijuana in the U.S. and Internationally. He can be reached at mpatterson@uscprd.com

Make a Clever Decision Purchasing Solar Panels During COVID-19

By JENNIFER FLOREZ

Become energy independent using solar panels above your roof. This action will also bring you savings. Yes, you are reading right: savings. First, you do not need to invest one dollar on your new system; your first payment will be 30 days after the installation, and it will be lower than what you are paying now. News, articles, blogs everywhere are announcing the economic crisis that we all will be facing. This is a time where we need to understand and take control of our monthly budget. Solar Energy is a great option to reduce the monthly budget in the short and long term. It guarantees at least the first 18 months you will have payments of 60 percent of current payments and it brings a 26 percent tax credit on a federal level and after month 19 it will never increase; not like your current utility bill that goes up every year. Solar Energy from every perspective means a good financial decision. In addition, you will be energy independent. Are you worried about not having energy in the future? Well, the sun will never go away. Use it to power your

house and bring you savings. We are all facing COVID-19 together and we should be taking advantage of the time we need to be home, not only to enjoy our family time and the comfort of our house, we should be thinking what decisions/habits and actions are we going to be making to become stronger as humans beings – are we doing something to make the world a better place? After all this, it is clear how fragile we are, how important it is what could happen in other countries and how fast it can impact us all. We need to take care of ALL of us, by being responsible for the environment, being conscious about the use of water, energy and food. Solar Energy is one of the most affordable ways of living in the Sunshine State to make a positive impact on our economy, as well as the environment. Clever Energy is a family local business, that can do a solar consultation virtually and can present you in English or Spanish the benefits of going solar based on your specific energy consumption, roof location, and energy bill. Text or call 407.274.1531 or email us at info@gocleverenergy.com with a copy/picture of a recent electric bill and your phone number and we will reach you back with a customized solar proposal that requires $0 dollars out of your pocket.

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Discussing Coronavirus with Your Child By ALICIA COONCE, DO, FAAP

First, it is important to understand what exactly COVID-19 is and why it has become a case for concern. The human coronaviruses are a family of viruses that are most typically known for causing the common cold. Most people have been exposed to one of these viruses at some point in their lives. We all know what the common cold is: cough, runny nose, fever that lasts for a few days and then resolves. Most people do not seek medical attention for this, and the media never writes a story about the common cold. It’s common! So why is this any different? The difference is that the COVID-19 virus is a new coronavirus. It was first discovered in China in December 2019. The virus is named SARS-CoV-2 and the disease it causes is the “coronavirus disease 2019,” abbreviated as COVID-19. In the past few months, it seems to have rapidly spread from China and is now worldwide. Because it is a new virus, it is hard to predict how it will affect people. We are continuing to learn more and more about the new virus every day. Fortunately, for the majority of cases, symptoms are mild much like the common cold; however, this virus is very contagious and can be dangerous to older people and people with underlying medical conditions such as lung disease, heart disease, diabetes and suppressed immune systems (i.e. cancer, HIV, or other immunodeficiency). The CDC recently reported that 16% of cases in China resulted in serious illness.

SO WHY ALL THE PRECAUTIONS?

Although this illness is mild for children and otherwise healthy adults, we all affect the health of those around us and must take necessary precautions to keep those around us healthy. There have been multiple cases of people without symptoms testing positive for the virus. This means they can pass the disease without knowing they are sick. If they pass it to a healthy person who then takes it home to an elderly loved one or a chronically ill family member, they can give them a potentially serious illness, which could result in death. This is why the CDC is asking everyone to take the necessary precautions of social distancing, washing hands frequently, only going out of the house when necessary, and limiting contact with older adults and persons with chronic diseases.

SO HOW DO WE

DISCUSS THIS WITH OUR CHILDREN?

COVID-19 has dramatically changed our daily lives for the time being and you are stressed, scared, or even annoyed. Now imagine how your young child is feeling. This can be overwhelming and lead to behaviors that can create a stressful home. They might have questions that you do not know how to answer. After all, we are all trying to make the best of an unprecedented situation. Here are some recommendations from pediatricians and family psychologists on how to discuss the situation with your children. Start off by asking them questions about what they know. The conversation should be age directed. It is very possible that what your child is worried about is not what you are worried about. For instance, you might be concerned about the light bill and having enough food for dinner, whereas your first grader might be worried if he is going to see his friends again or not. These are two very different conversations. So, start the conversation with “tell me what you know about what is happening?” or “what are you worried about or scared of ?” Then you can direct your answers accordingly. Remember, limit your response to simply answering the question and providing comfort with reassurance.

For children over 10 years old: you can start to discuss more of the science of what is going on if you feel like your child is developmentally appropriate.

Again, avoid terms that can lead to anxiety, feelings of impending doom, or fears of dying. Stick to the facts: this is a cold-like illness that is mild in children and other healthy people, but spreads quickly, so we must take precautions to protect those who are not healthy. Again, try to empower your child in how they can help. Overall, remember to be a good role model. Your children are looking to you and watching how you react. Avoid social media and excessive media coverage on TV. Try to keep your daily routines as much as possible. Wake up at your typical time, eat breakfast, do schoolwork, go to bed at typical bedtime, etc. Have clear expectations, give clear directions, and try to spend time with your children as much as possible in a fun and playful manner.

Alicia Coonce, D.O., FAAP, is a pediatrician with Community Health Centers - Tavares

REFERENCES: American Academy of Pediatrics. (2020, March 16th). Novel Coronavirus (COVID19). Retrieved from https://healthychildren. org/English/health-issues/conditions/chest-lungs/ Pages/2019-Novel-Coronavirus.aspx Centers for Disease Control and Prevention. (2020, March 16th). Coronavirus (COVID-19). Retrieved from https://www. cdc.gov/coronavirus/2019-ncov/index.html Fox, Darby. (2020, March 13th). Talking to Kids about the Coronavirus. Retrieved from https://www.darbyfox.com/ Schonfeld, D. (2020, March 18th). Talking to and Supporting Children During a Pandemic. https://www.youtube.com/watch?v=FcY ZWiF3PNc&feature=youtu.be

FOR TODDLERS AND PRESCHOOLERS, LIMIT YOUR DISCUSSION.

Reiterate that your child is perfectly safe and they can do a big part by doing as you do (washing hands, coughing into a tissue or their elbow, and using hand sanitizer frequently). Try to create a safe environment and limit any concerning tones or conversation to areas where your child cannot hear you. For early elementary school ages (K2nd grade): use concrete terms. Ex: “Yes, there is a virus that is like the cold that you have had in the past. You are just fine now and will continue to be. However, it is important we keep everyone healthy by washing hands, etc. (as above).” For late elementary school ages (3rd-5th grade): You can expand on what you tell them but try to omit terms like death and dying. You can tell them this can be a bad cold (like the flu) for people who are older and they can play a big part in keeping everyone healthy. It is important for them to feel empowered and that they can do something to help. Remember social distancing, hand hygiene, and avoiding trips to older relatives’ houses.

For more information, click on the following link:

https://healthychildren.org/English/health-issues/conditions/chest-lungs/ Pages/2019-Novel-Coronavirus.aspx . This is a great resource for parents written for parents by medical professionals.

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Guideline for Supplying and Maximizing Reimbursement for Telehealth Services By CAREL VISSER

GUIDELINE FOR SUPPLYING AND MAXIMIZING REIMBURSEMENT FOR TELEHEALTH SERVICES Telemedicine (Telehealth) involves the exchange of medical information from one site to another through electronic communication to improve a patient’s health. With COVID-19 spreading throughout the United States the big five insurance companies (Medicare, Aetna, Blue Cross Blue Shield, Cigna and United Healthcare) have relaxed their requirements for submitting Telemedicine claims for the next 60 to 90 days. This is intended to help the vulnerable and senior patients in particular and all others who are self-quarantining so they don’t need to venture out to visit their physicians. This relaxation covers COVD-19 related issues as well as other medical conditions that don’t require physical tests. For the duration of the relaxed Telemedicine submission requirements the HHS Office for Civil Rights (OCR) will waive penalties for HIPAA violations against healthcare providers that serve patients in good faith with everyday technologies like Skype and FaceTime. Practitioners that will benefit from this service include physicians, nurse practitioners, physician assistants, nurse midwifes, certified nurse anesthetists, clinical psychologists, clinical social workers, registered dieticians and nutrition professionals. This article deals with non-COVID-19 visits, what is allowed and how they are billed. MEDICARE TELEMEDICINE FACT SHEET • The HHS Office of Inspector General (OIG) has given healthcare providers the option of waiving or reducing costsharing for telehealth services. • Medicare pays for three types of virtual services. MEDICARE TELEHEALTH VISITS • Provider must use interactive audio and video telecommunications that provides real time communication between the provider and the patient at home. • The Health and Human Services (HHS) will not conduct audits to ensure prior relationship between provider and patient. • Visits are considered same as in-person visits in terms of payment rate. • Place of Service (POS) 02 is used for billing with normal diagnosis codes and procedure codes with no modifiers • Cost-sharing may be waived VIRTUAL CHECK-IN • Brief communication between provider and patient by telephone or exchange of information through video or image • Initiated by patient • Existing relationship between provider and patient is required • 5 to 10 minutes of medical discussion

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• POS 02 for billing with HCPCS code G2012 • Cost sharing may apply E-VISITS • Patient initiated non face-to-face visits using online patient portals • Must be existing relationship between patient and provider • POS 02 plus CPT codes 99421 – 99423 and HCPCS codes G2061 – G2063 • Coinsurance and deductible will apply AETNA TELEMEDICINE FACT SHEET • Telemedicine for Commercial Plans • Pays for 2 way synchronous (real-time) audiovisual interactive medical services between patient and provider • Use normal CPT and HCPCS codes with either GT or 95 modifiers • Reimbursed at current fee schedule • All cost-sharing for waived for telehealth services TELEMEDICINE FOR MEDICARE ADVANTAGE PLANS • Medicare policies on telehealth apply. • POS 02 with normal CPT and HCPCS codes and no modifier • Telehealth transmission fees not payable – deemed part of service. BCBS TELEMEDICINE FACT SHEET • Telemedicine for Commercial Plans • Primary care providers, behavioral health providers and specialists are all approved for supplying telemedicine services. • This service is available for 90 days and will be reimbursed at current fee schedule. This timeframe will be reassessed as needed • Normal office visit costs for patients apply • For general medical care normal Evaluation and Management (E/M) codes (99201 – 99215) apply with POS 02 and modifier 95 or GT TELEMEDICINE FOR MEDICARE ADVANTAGE PLANS • All referral requirements for all service types have been relaxed • Out-of-network providers will be paid for medically necessary services if innetwork providers are not available • Primary care physicians, behavioral health providers and specialists can bill for virtual visits • Virtual visit program will be in effect for 90 days • Normal office visit cost share responsibility will apply • Normal E/M services CPT codes for office visits will be used with POS 02 and modifier 95 or GT • Reimbursement rates same as in person visits CIGNA TELEMEDICINE FACT SHEET

• Normal CPT and HCPCS codes reimbursed for all synchronous realtime virtual visits by telephone, video or both. • HCPCS code G2012 reimbursed for brief communication by telephone (usually 5 to 10 minutes) and all cost share waived. • POS where care happened • Append GQ modifier • Normal reimbursement for care applies • Virtual care program will continue to May 31 • All in-network providers can make use of this service • Failure to secure referrals for care that is emergent, urgent or with extenuating circumstances will not be penalized during this period if there is proof of staff shortage. In normal circumstances referrals to other physicians, specialists and facilities apply. • Standard cost shares (copays, coinsurance and deductibles) apply for virtual visits UNITED HEALTHCARE TELEMEDICINE FACT SHEET • Telemedicine for Commercial Plans • All in network providers can

participate in telehealth program • Program lasts 90 days until June 18, 2020 • Telehealth services recognized by CMS with modifier GT will be paid • Telehealth services recognized by AMA with modifier 95 will be paid • Reimbursement rates are the same as in person visits TELEMEDICINE FOR MEDICARE ADVANTAGE PLANS • Medicare policies on telehealth apply. • POS 02 with normal CPT and HCPCS codes and no modifier There are numerous medical insurance companies, too numerous to be covered in a single article. It would be prudent to check with each payer on how they are dealing with telehealth in this critical period before submitting claims. A rule of thumb would be to follow the Medicare guidelines for plans associated with Medicare (POS 02 and no modifier) and to use the modifiers GT or 95 for commercial plans with POS 11. The author, Carel Visser, is the COO of Florida Business Systems which provides medical billing and revenue management services. He is a qualified medical biller and coder dealing directly with the day to day business of the company and providing training to companies in medical billing and revenue management skills. Email address cvisser@ flbsystems.com and website www.flbsystems.com

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The Modern Approach to Comprehensive Management of Diabetes By MATTHEW SHLAPACK, MD

Diabetes is a common disorder affecting millions of Americans and leading to a negative impact on their health and quality of life. Diabetes can be challenging to control and lack of glucose control can produce multiple, disabling symptoms and result in serious complications. Understandably, patients often feel that the medical management of their diabetes is too burdensome and requires them to make unsustainable changes to their routines. Fortunately, there has been tremendous growth in our understanding of how to treat diabetes. Further, medical providers now have available more tools and medications than ever to assist us in getting our patients’ diabetes under control and protecting their health. Modern management of diabetes is light years ahead of where it was even a decade ago. One of the most important advantages to our expanded medication options is that providers can now select medications that have benefits beyond just glucose control. We can now pair medication choices to our patients’ unique needs and comorbidities. At the same time, we can do more to find medications that work with our patients’ unique lifestyles and schedules. In a world of night shift work, long days without meal breaks, varied physical activity, and unique dietary limitations, there is now much more that we can offer our patients beyond a one size fits all model. New treatment options include a class of medications called SGLT-2 inhibitors, for example Jardiance and Farxiga. These medications do help to control blood glucose, but they also facilitate weight loss and help to protect against diabetic complications such as recurrent cardiovascular events and worsening renal failure. In my own clinical practice, I have seen that these medications tend to have an insulin sensitizing effect. In my Type 2 Diabetic patients who are on treatment with insulin, adding an SGLT-2 agent has allowed me to reduce insulin dosages, which leads to further weight loss and overall patient satisfaction. We also now have once weekly formulations of GLP-1 Agonists such as Bydureon and Trulicity. These medications facilitate weight loss and have also been found to have favorable effects in terms of renal protection and possibly CV benefit. Generally, these medications are well tolerated and the injection devices themselves are user friendly and painless. On the topic of insulin, we now have newer and better insulins that help to achieve glucose control with less risk of hypoglyce-

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mia. Most insurances cover at least one type of these new insulins and in my experience, patients find these preparations to be more convenient. Insulin pens are a convenient way for our patients to take their insulin on the go and the tiny pen needles means less risk of injection site reactions and no discomfort. At the same time, Insulin pumps and glucose sensors are becoming not only smaller, but smarter and less time demanding for those using them. The pairing of sensors and pumps has helped us to finally have options for the most brittle diabetic who till now, have often had to ride the roller coaster of glucose lows and highs, despite their best efforts. Time and time again, research has shown us that the goal of diabetic management encompasses not only achieving ‘good glucose numbers’ but also the prevention of diabetic complications and addressing symptoms that can be associated with a diagnosis of diabetes. This is best achieved by working as a multiple provider-patient team to facilitate manageable lifestyle changes, and utilization of the best treatments for each patient. This often does require some changes on the part of our patients, but we can now tailor treatment to minimize the difficulty of these changes and to do more to preserve good quality of life. Proper screening is essential to detect any emerging diabetic complications and to ensure that any potential complications are addressed before they worsen. For example, all diabetics need annual eye examinations to look for diabetic changes and to treat these changes if they are present. The feet need to be inspected regularly and sensation assessed periodically, as diabetics can develop both impaired wound healing and loss of sensation. Obviously, staying on top of all of this is challenging to say the least. For a provider to try to comprehensively manage diabetes while simultaneously treating their patient’s other conditions is difficult in the limited amount of time that we are allotted for each visit. That is why now, more than ever, modern diabetic management requires a team approach, with multiple providers working together to achieve the best outcomes for our patients. To be blunt, with all the factors in place, it is asking too much for one provider to try to do everything. Regular appointments and good communication between providers and patients facilitate essential monitoring, and provides an opportunity to discuss options for enhancing treatment I would argue that while the management of diabetes remains challenging, we are now finally getting the tools and research

results that we as providers need to be able to offer more to our patients. We are now seeing new medications, new study results and new technology emerging on a regular basis. In parallel to this, diabetic patients have more options and are seeing an improving clinical course and better quality of life.

Matthew Shlapack, MD, is a BoardCertified Endocrinologist and practices at Orlando Heart and Vascular Center. Shlapack completed both his Internal Medicine residency and his Endocrinology Fellowship at The University of South Carolina, School of Medicine. He attended Ross University Medical School. His clinic is located at: 11616 Lake Underhill Rd. Orlando. Contact him at 407-482-7788 or visit OHVC.net

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COVID-19: Finding Calm Amongst the Chaos By VINTEE NARANG, MD, Psychiatrist at Community Health Centers – Forest City

As a community, we find ourselves to be under a great deal of pressure these days. As healthcare workers, we are in the forefront of this battle against the COVID-19 pandemic. Life outside of work has also become increasingly stressful, as we often find ourselves worrying about the well-being of our loved ones as well as our own personal safety. Being flooded with news updates on our cell phones, computers, and televisions compounds this pressure and increases our daily stress levels. We’ve all been affected by this viral pandemic in some way and we are being asked to make sacrifices in our daily lives for the greater good of society. During these difficult and uncertain times, it is very important that we take good care of our mental health to ensure that we’ll be able to continue to give the best of ourselves to our patients and families. Anxiety comes from lack of control of a situation or fear of the unknown. The world of is full of this uncertainty right now. However, we can help keep our anxiety levels down by adopting some simple coping strategies, which will help to modify cognitive distortions and help prevent us from adopting a catastrophic thought process. To help mitigate the unknown, one can gather information regarding the current situation and how best to stay prepared and remain calm. It is advised to pick one reliable source of information (i.e CDC.gov or WHO website) rather than perusing various sites or sources. Also, it is best not to stay glued to the news coverage throughout the day, rather, set reasonable limits on the total amount of time spent viewing the news (on television and the internet). Without setting limits for ourselves and the loved ones whose care we are responsible for, we run the risk of creating a negative mindset. On a similar note, limit Social media updates regarding Coronavirus and mobile reminders as this can contribute to feelings of anxiety and despair. Start with local updates (regarding local schools, businesses) rather than constant focus on international updates.

SIMPLE STEPS THAT YOU CAN TAKE TO HELP LOWER DAILY ANXIETY LEVELS:

• Having a contingency plan in place for the future to mitigate catastrophizing and “what-if ” thinking. Being proactive and taking charge of the “what-ifs” can reduce the anxiety that is a natural part of dealing with the unknown. • Acknowledge coping mechanisms that have helped in the past and try to utilize these daily. • Accept negative feelings and acknowledge them (i.e.: journaling).

Inability to express the feelings can build up and lead to long term anxiety or depression. • Get regular, daily exercise. A brisk walk or at home workout can do wonders to relive stress. • Eat a balanced diet consisting of plenty of fruits, vegetables, and water. • Reach out to your support system (talking to your medical provider, family, or friends). Focus on getting plenty of restful sleep and practice good sleep hygiene techniques.

OTHER COPING MECHANISMS THAT CAN BE INCORPORATED INTO OUR DAILY LIVES:

Breathing techniques: Deep breathing helps you think more clearly and relieves muscle tension. Slowly inhale through your nose. Hold it for a moment and then exhale slowly through your mouth. Repeat this breathing exercise three times whenever you start to feel overwhelmed or stressed. It will help calm and refocus the mind. Body relaxation techniques makes it easier to control your breath if you are pacing, clenching, or fidgeting. Try to stand still, sit down, or even lie down as you focus on your breath. Meditation and or Yoga: The meditation may be through Breathing, Mantras, or one may also utilize meditation Apps (i.e Headspace, Calm). Practice Mindfulness: cope by focusing on the current moment. Begin to identify exactly what is going on around you, what emotions you are feeling, what you are thinking, and how your body feels without trying to stop the flow. Grounding exercises: I.e. identify five colors around you, something around you completely new to you, close your eyes and identify what you hear, etc. A change of environment and physical distance can help you cope by relieving some of the stress and tension you feel. This may include a walk, spending the night with a close friend, or taking a weekend vacation. Regular Physical activity can help release built up energy, tension and stress. To combat those feelings, schedule some athome workouts, which can boost your mood or try Running/walking outside. If needed, use social media as a form of enjoyment and for support. Facetime/ Skype/group chats can provide a way to connect with friends and family. However, it is important to set reasonable limits on our daily use of social media. On a very important note, if you find that you, a co-worker, or a loved one are beginning to feel overwhelmed with anxiety and stress and are experiencing thoughts of self-harm, then please contact youronmediProviding the best advice senior cal provider Additionally, the livingimmediately. and care optons: American Psychiatric Association ● Independent Living has some resources emergent situations: ● for Assisted Living ●

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407-917-9027

DISASTER DISTRESS HELPLINE

Call 1-800-985-5990 or text TalkWithUs to 66746

NATIONAL SUICIDE PREVENTION LIFELINE

Call 1-800-273-8255 or Chat with Lifeline

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Text TALK to 741741 Given the current circumstances, it is imperative that we put forth efforts into maintaining a positive mindset and not giving into fear and uncertainty. We must consider our minds to be an environment that must be kept clean and healthy so that we can continue to perform our important roles as healthcare workers to the best of our abilities. We must avoid littering our minds with negativity and must practice self-awareness in order to ensure that our minds remain focused and healthy. We must also pick one another up and remember that there is always, always, always something to be grateful for. Kindness towards others and a sense of gratitude go a long way in taking care of our own mental health. In addition, here are is a list of sug-

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gested resources for relaxation exercises:

PODCASTS: • • • • •

Mindfulness Mode Pathway to Happiness Untangle Meditation Minis The Daily Meditation Podcast

RELAXATION/ MEDITATION APPS: • • • • •

Calm Headspace Aura 10% Happier Smiling Mind

YOUTUBE:

• The Honest Guys Guided Meditation exercises • Deepak Chopra Guided Meditation series • Progressive Muscle relaxation series

Vintee Narang, MD, is a Psychiatrist at Community Health Centers – Forest City. The Behavioral Health team is available to assist you and your family during these uncertain times. If you would like an appointment for Behavioral Health services at Community Health Centers, please call us at 407-905-8827.

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Want to Improve Patient Relationships? Let Them Express Their Preferences By JEFF JARVIS

Selecting preferences is commonplace in our digital world. Users subscribe or unsubscribe from email lists, request notifications from their favorite brands, and update their privacy settings on social media networks. It’s a win-win for both parties; consumers receive relevant communications when they are given a voice regarding their areas of interest, preferred frequency, and preferred communication channel. Likewise, businesses get better ROI on their campaigns and build trust and loyalty with their customer base. These principles apply to healthcare organizations and their patients as well. Healthcare marketing teams are granted first-hand insight to unique customer characteristics and interests - the ultimate opportunity to give patients exactly what they want and to enhance relationships. And patients now expect it; especially in view of strict regulations including TCPA and CCPA. However, while preference collection is important, how a business manages that information is critical to maintaining compliance. Unfortunately, many organizations still miss the mark. The first step is for healthcare marketing executives to understand their needs. Not all preference management platforms are created equally; yet many companies try to take the easy way out, choosing to leverage an existing system that is not designed to meet the needs of complex organizations. For example, the majority of SMS and email service providers have built-in preference collection interfaces, where data is stored within the system and provides access to administrators. While this approach provides basic functionality and may meet the needs of healthcare facility offices with a sole communication channel, larger healthcare organizations or providers face complex challenges, requiring more robust and integrated technology. All too often, large healthcare companies with multiple departments and communication touchpoints require a more sophisticated solution to better service their patients and avoid compliance risk. They are simply unaware of the risks they assume, and opportunities forgone by relying on a simple preference collection webpage. Surprising to many organizations, preference and consent collection is not a simple issue to tackle. DIY solutions lack proper governance that drives preference 14

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management capabilities and fail to distribute information across the entire enterprise, leaving each business unit with varied perspectives of a patient and their preferred communications. Without a unified view of the patient, each department risks sending impersonal communications to those who have made the effort to share their preferences. Further, compliance is jeopardized by the systems’ inability to record consent history and track changes to preferences. In the wake of a violation accusation, patient consent and preference history are essential to defend your company. As the amount of data escalates and regulations continue to evolve, employing an oversimplified preference collection webpage heightens the potential for legal battles and presents more alarming issues than it attempts to solve. Patients view their healthcare providers, like most companies, as a single entity, but basic preference collection webpages prevent providers from behaving like one. They behave as siloed systems, information systems that isolate data from the rest of the healthcare organization. By resorting to a simple preference webpage, healthcare companies are missing out on the opportunity to communicate more effectively. When patient preference information is shared across the organization, marketing efforts can be customized to effectively deliver a personalized and consistent message. Instead, customers experience inconsistent interactions, unwanted emails or texts, and phone calls; they are turned away feeling unheard. For example, many doctor offices today offer cosmetic services or product offerings that may not be covered by insurance. However, some of their patients may prefer to only receive communications related to their regular visits and desire minimal marketing communications offering additional services to them. Having a more intelligent system that can manage the preferences of all individual patients makes it easier to understand what each one wants and needs. Once healthcare organizations are aware of the dangers associated with oversimplified or DIY systems, they realize the value of comprehensive enterprise preference management solutions. A centrally located management system is necessary to minimize risk; integration across the whole organization guarantees all units are insync with the patient, communicating with them accordingly. These systems build trust, enhance vital patient relations and ROI. Additionally, if compliance is called into

question, robust preference management systems protect legal authority through following regulatory rules, recording data, and providing healthcare organizations with a full history of each consent permission to date. Many healthcare organizations build their own internal solution for consent and preference collection in an attempt to save money or retain control; ironically, they are losing money and missing the mark. When deciding whether to build or buy, these organizations must be aware of the differences with each approach. Preference webpages collect fragmented data and fail to integrate information provided by the patient. As a result, organizations open themselves up to compliance violations and negative patient relationships. On the other hand, investing in a preference management sys-

tem integrates information company-wide and continuously evolves with data privacy regulations to protect your company and remain compliant. These systems allow you to optimize your communications and patient relationships. Jeff Jarvis, SVP, Strategy & Consulting for PossibleNOW brings an extensive background in domestic and international business environments holding executive positions with FreebeePay, Agentek, SupportSoft, and CoreNetworks and management positions with Mosaix, Sequent Computer and IBM. MyPreferences from PossibleNOW is purpose-built to help large, complex organizations gain control over communications, mitigate compliance risk and reduce marketing expenses while improving customer experience and loyalty. For more information, call (800) 585-4888, email info@possiblenow.com or visit http://www.possiblenow.com.

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Waiting Room Seating – Upholstery IS the Difference By DOUG MINTZ

Because of the COVID-19 pandemic, I thought it a very appropriate time to discuss how important upholstery materials are for waiting room furniture. There are two primary categories of fabrics that are used in the medical field: Crypton™ super fabrics and antimicrobial vinyls. Crypton™ super fabrics were first developed in 1993. They are designed to RESIST moisture and provide a barrier to keep liquids away from internal foams and paddings, where germs, bacteria, and mold can grow and spread. Crypton™ is also stain resistant and can also be microbe resistant. Crypton™ fabrics have come a long way, but they are still rather expensive (starting at $30.00/yard wholesale) compared to entry-level antimicrobial vinyl products that are now available. The vinyls of today are no longer the stiff, boring, solid-colored Naugahyde of yesterday. They can be supple in feel, textured to the point that they look just like fabric, and because patterns can be digitally generated and applied, the available designs and colors are now endless. As a rule of thumb vinyls perform slightly better than Crypton™ super fabrics in hospital settings and general medical settings. Vinyls are also easier and faster to clean. But most important, either of these materials should be incorporated into waiting rooms in every medical setting to reduce the spread of VRE (vancomycin-resistant enterococcus) and PSAE (pseudomonas aeruginosa) organisms. Please keep in mind that these upholstery materials on their own DO NOT PREVENT the spread of harmful bacteria and viruses. Surfaces need to be routinely and properly cleaned, and hygiene practices of both patients and medical professionals are major deterrents. I have several relatives in the medical field, including a former emergency room specialist, a pediatrician, and a hematologist. Regardless of their backgrounds, they’ve all recommended the same thing to me in the event I get sick . . . Get in and out of the hospital as soon as possible – it’s a breeding ground of germs, infection, and disease! Regardless of the cleaning practices and schedules of these facilities, this is where all the sick people are! This also applies to any other visits you might make to a waiting room, such as an urgent care facility or an 15

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emergency room. Obviously when you need these services, you need them. But take care of yourself and protect yourself in the event you must make such a visit. Now let’s get back to vinyls vs. Crypton™ fabrics. First, we’ll address cleaning. As I stated earlier, Crypton™ fabrics come in a large variety of patterns, colors, and textures. They offer just about anything an interior designer would want for a sophisticated waiting area. The key to these products is the backing, which acts as a moisture barrier to prevent penetration to the internal padding and components. The fabrics are also chemically treated for time-released resistance to microbes. However, by nature these fabrics are still as a rule of thumb more difficult to clean than vinyl. Depending on the selected upholstery, cleaning may involve chemicals beyond soap and water, and some of the solvents may not be water-based. Additionally, Crypton™ is not “green.”

With vinyl, spills can be easily wiped up without leaving any stains, and vinyl-upholstered furniture can be quickly disinfected at the end of each day. Vinyls are also virtually waterproof by nature. Most spills will simply bead up on the surface and can easily be wiped away. In healthcare settings it is also recommended to use vinyls that have been treated with an antimicrobial additive. These chemicals, as with Crypton™, are also designed to be time released so there’s a consistent level of protection from microbes over the life of the furniture. Vinyls are also pretreated with germicides which also remain active throughout the life of the furniture. One other consideration regarding vinyls; they can be extremely durable. They have high double rub abrasion ratings, starting at 100,000 cycles and in many offerings exceeding 1,000,000 cycles. And for those who also embrace sustainability, vinyl is easy

to recycle, and often contains recycled materials as well. So, there you have it. At the end of the day, I recommend that health clinics seriously consider going to all vinyl furniture upholstery in their waiting rooms. It’s cheaper, it’s green, it’s easier to clean and maintain, it protects from the spread of germs and microbes, and it’s now available in hundreds (if not thousands) of colors, patterns, looks and feels. For more information and access to samples, contact me anytime. Doug Mintz, founder of CPOF Inc – Cubicles Plus Office Furnishings, has been in the office furniture industry for over 20 years. His focus is primarily on the patient’s waiting room experience, as well as the ergonomic health and wellbeing of clinic employees. Visit www. CubiclesPlusOF.com or email Doug@CubiclesPlusOF.com anytime for access to samples.

The 2020 PSCF Spring Tour Physician Member Events will be held on:

March 10, 2020 – Crooked Can Brewery, Winter Garden April 14, 2020 – Bear & Peacock Brewery, Winter Park April 28, 2020 – 3 Sisters Speakeasy, Kissimmee May 19, 2020 – Café Murano, Altamonte Springs PHYSICIANS VISIT https://pscfl.org/EVENTS/event_list.asp To Register

Join the PSCF as we take a tour around Central Florida this Spring and network with local physicians of various specialties. No talks or agendas, just relaxing evenings to connect with your colleagues while enjoying some delicious food and drinks. This year we’re also having a special Medical Student Mixer on April 14th during our event at the Bear & Peacock Brewery. Meet medical students from the UCF and FSU Colleges of Medicine while also connecting with PSCF physician leaders. SPONSORS VISIT: https://form.jotform.com/200434642142140 to participate

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The Travel Industry’s Response to a Global Pandemic By BRYCE MORRISON

More than twenty years ago, I ran a small shop onboard the USS San Jacinto. We had just completed six months at sea and the team had been working hard. So hard, in fact, that I sent them all home before 10am to spend some much-needed time off with their families. Ten minutes later, the first of the team came through the door asking me for orders. A junior officer had determined, simply based on the time of day, that nobody should be able to leave yet. Long story a little less long, the team was still able to go on liberty with just a few minutes delay. This was made possible by a leadership that understood what was truly important…morale. Morale is important in travel too. Think of the junior officer and the upper echelon that ultimately corrected the situation as the travel providers of today; companies that provide transportation between locations, tour operators, cruise lines, airlines, etc. My team are the more than one billion travelers yearly. Ultimately, these companies can make or break your morale if you happen to be one of those travelers. That has never been more apparent than it is during this crisis. A quick google search will bring up all the negative. This editorial is not about the junior officers (online travel agencies, warehouse clubs, etc.) that only work on travel part time and have ruined countless vacations and cost people far too much money. We are here to talk about the true leaders. Those that are in travel because they are passionate about it. The providers that understand how hard you worked for that once-in-a-lifetime trip to Hawaii. The companies that would rather sacrifice short-term profits than risk losing your respect. The best part? In travel, there are far more of the upper echelon than there are those junior officers. Since this began, Americans have gone from being concerned with a few minor inconveniences on the other side of the world to the disappointing reality of a complete ban on world travel. With these developments comes the unpleasant realization that, in many ways, they have little control once they have purchased travel. When a cruise ship encounters a storm, the captain alters the itinerary and the cruisers enjoy either additional days at sea or completely different ports of call. When you purchase the cruise, you acknowledge this to be a possibility. The same is true if the ship is turned away from a port by the island’s health minister. The cruise lines are not required to provide compensation. However, during these unprecedented times, there are anecdotes of on-board-credit, actual refunds, and even future cruise credits. Hotels have last minute cancellation fees. 16

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It is challenging, particularly for independent hoteliers, to survive without these fees. They count on them to ensure maximum possible occupancy. Companies that create travel packages will bundle these hotels with flights and other transportation. They too have fees. Many of the larger hotel companies have waived these fees during our current travel environment. In some cases, the bundlers have even provided travelers with future travel credits. This, despite being required to cover the hotel’s cancellation fees. Then there is travel insurance, which is often underappreciated. Whether its compensating you for lost luggage or covering the upwards of a $1,000,000 medivac off the cruise ship because you needed emergency surgery for your acute appendicitis, travel insurance provides safety and security during uncertain times. However, every major policy has exceptions. One such exception is for, you guessed it, epidemics. Most policies also do not generally cover fear. Even before the travel bans started, many travelers were already asking to cancel. Though these company’s contracts fully protect their profits, at least one insurance provider made the extraordinary decision to reverse many of their policies for this event. This came after strong encouragement from many of their partners, including one of the largest travel agencies in America. It is also important to note some of the health safety measures these travel companies have adopted. Ahead of temporarily ceasing normal operations, cruise ships began taking passengers’ temperatures and conducting medical screenings before allowing them to board. Buffets in casinos and cruise ships have chosen to add servers with gloves, require guests to wash and/or sanitize, and are even requiring a new plate for every section. Now that the cruise lines have ceased normal operations, many have turned to caring for the morale of their crews. From the ships that are supplying free internet and organizing crew talent shows all the way to providing balcony cabins to the entire crew. Carnival is now supplying ships to be utilized as floating hospitals. Disney is donating food to the Second Harvest Food Bank of Central Florida. They are also paying employees during down time. Some of the travel vendors are working to ensure travel advisors are paid even during cancelations. It is not likely any vendor responded perfectly during this crisis; this is a truly unprecedented event. However, having witnessed so many other industries respond poorly to crises, I have been pleasantly surprised by just how far the travel industry will go to retain the favorable opinion of both their colleagues and their clients. Bryce Morrison is a Navy veteran, Travel Advisor, and owner of a Cruise Planners franchise. Traveling internationally since age 5 and partnering with the 25-year-old Cruise Planners, Bryce finds the best for travelers by land or by sea, anywhere in the world. Bryce can be reached at bryce.morrison@cruiseplanners. com or www.foodandwinecruiseplanners.com

How Choosing a Super Absorbent, Fully Breathable Adult Incontinence Product Can Help Reduce the Risk of Hospital Readmissions By DEANNA VIGLIOTTA

According to a study of 8.3 million Medicare beneficiaries, falls are a leading cause of injury-related hospitalizations among elders (Medscape Medical News 5.24.19). Elders, whether aging in place and/or living in senior living communities, can reduce their risk of pressure sores, reduce their risk of falls, reduce their risk of UTI’s, and subsequently reduce hospital readmissions by choosing the right incontinence products. While we should be viewing adult incontinence products as a critical component of healthcare, my hunch is that many people are still viewing adult diapers as a commodity, ie. a package on a shelf with a price tag. I am convinced that with a significant shift in the way we view the importance of choosing high-quality incontinence products, elders and their caregivers will fare better with incontinence challenges and skin care related issues. Follow me here and you will better understand just how important it is for elders to be wearing the right products. Let’s talk about pressure sores. Fully breathable products that allow the skin to breathe will reduce pressure sores and yet there are few choices on the market today that offer full breathability. Without breathability, the person wearing the product may get skin irritations and skin breakdowns. Medical costs related to treating pressure sores range anywhere from $500 to $70,000, according to the National Pressure Ulcer Advisory Panel, depending on the stage and severity. In addition, the pain, worry, and ancillary negative effects are staggering. Not only is wearing a fully breathable product important, choosing skin care products and washcloths that protect elderly thinning skin is equally as important. Transparent barrier creams and “no water needed” cleansing creams, for example, can aide in reducing risk. Super absorbent products are key in helping elders sleep through the night. Restorative sleep, the term meaning 7-9

hours of uninterrupted sleep that allows a person to go through the 4-5 sleep cycles, has proven benefits, ie. cell regeneration, tissue healing, hormone regulation, more alert in the morning, etc. If an incontinent elder is wearing a product that keeps them dry longer and is comfortable (soft nonwovens), the likelihood of them staying in bed at night is greater. If they stay in bed, they reduce their risk of falling during the night, whereas others wearing a less absorbent product may wake up in the night, wet and uncomfortable. In turn, that elder gets up out of bed groggy and thus a fall may happen. Falls are a leading contributor to hospital admissions. Super absorbent products may also reduce the risk of UTI’s in elders if they are wearing a high-quality product with a double absorbent core that locks in urine while decreasing bacterial growth. In addition, high quality incontinence products require fewer changes. Fewer changes equal fewer gloves needed and gives time back to caregivers. These positive ripple effects of using high-quality products provide significant overall financial value too. I often wonder if more conversations should be taking place between healthcare providers and elders being discharged from hospitals about incontinence products being used at home. If they aren’t, they should be. Why risk a readmission due to an elder going home using an inferior incontinence product? It’s time we make this conversation a part of the discharge planning to help reduce hospital readmissions and better understand the importance of using high-quality incontinence products. With our elderly population living longer, quite simply, we need to. Deanna Vigliotta has 30 years of experience in healthcare sales and joined Seni in early 2019 to educate people about high quality adult incontinence products. Seni products are new to the U.S. market. Seni is a brand under TZMO SA, a medical hygiene manufacturing company based in Poland. Prior to joining Seni, Deanna spent many years in the Diagnostic Imaging field both in sales and management roles. A Boston native, Deanna has lived in central Florida for 16 years. She can be reached at Deanna.vigliotta@tzmousa.com

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Senior Placement or Online Referral … Know the Difference By JOHN HENRY

According to the U.S. Department of Health and Human Services, “about 70 percent of individuals over age 65 will require at least some type of long-term care services during their lifetime.” Some are calling it the silver tsunami. Though it is quite clear that the elderly would like to live at home for the rest of their lives, many cannot live safely at home. There are numerous reasons including the following: • Alzheimer’s or another form of dementia make it too difficult on the family to provide care. • Family dynamics including those living long distances from one another. • There are no family members to take care of the senior. • High cost of outside caregivers when assistance is needed regularly. With over 40,000 licensed assisted living locations in the United States and only 15,000 skilled nursing facilities, the movement is toward long-term living at various types of assisted living locations. In Central Florida there are well over 300 assisted living facilities that start at six-person residential homes and grow to communities with more than 200 residents. Today, skilled nursing facilities are placing greater emphasis on short-term stays versus long-term stays. Short-term rehabilitation has become a necessity for skilled nursing facilities, bringing in additional revenue and higher margins.

Because of this shift in long-term care living, companies of all types and sizes are starting up to capture a segment of this growing population. One type of company is known as a senior placement agency. This segment of our industry has the ability to provide tremendous value to families whose loved ones need a different place to live and be cared for. Following are various types of services and details of each:

SENIOR PLACEMENT SERVICES

These services have local representatives who are trained and experienced to assist with various aspects of the placement process. Some of these companies do market online where information can be learned about the needs of the senior. Commissions are paid to these services, similar to the real estate model, so families will not have to pay additional costs. These companies usually represent most of the care facilities in the area. Services may include assessing the needs of the family’s loved one, meeting “face to face” with the family, providing background information on locations including any state reports noting citations or deficiencies, touring with families, being familiar with each location, helping negotiate the best rates and assisting with any medical information from physicians and other resources to help with a smooth transition. The key benefit of this service is having a

non-biased professional who assists the family through a process that can be daunting and filled with stress.

REFERRAL SERVICES

As the name describes, a referral is when someone is directed to a source for help or information. In the case of senior placement, this can happen in several scenarios, but below are two that are most common: • Online companies that ask a few questions on a web form and send information directly to several assisted living facilities to have them contact the family directly. These locations may not even be the best fit considering numerous factors, and the representative from the online company probably has not even seen the locations. The challenge is that the “referral” is sent to several locations that will contact the family representative by phone, adding additional stress to the situation. WHAT TO DO? If you search online for information, make sure you read the fine print so they are not automatically sending your information to several facilities. Also, some companies have telemarketers contacting the family by phone but have not visited the locations nor are they familiar with the history or any citations that may have been issued by the state on the locations. Make sure you ask. • Hospitals and Skilled Nursing

Facilities (SNFs) both provide lists of licensed locations to the family in the area. Though the locations may be licensed, they may also have a myriad of citations issued against them. The families will have to visit and determine on their own if the location is the right fit for their loved one. This also adds to the stress of an already daunting task. WHAT TO DO? Ask the discharge planner, social worker or other representative if they know of a “full-service” senior placement agency. Helping to reduce family stress and not add to it during this decision-making process is essential as the need continues to rise for advice on assisted living options. Select a Senior Placement Service that is local in your market and ask for references. A good senior placement service can also help refer you to other providers who can assist, including VA assistance, senior moving services, attorneys and the list goes on. John Henry is an Eldercare Strategist and Area Owner for Senior Care Authority in Orlando. Senior Care Authority offers placement services to families at no cost in most cases. Our Senior Care Advisors provide options to only the best locations, and the hallmark of our service commitment is that we are by your side every step of the way. You can learn more at SeniorCare-Orlando.com or reach John at john.henry@seniorcareauthority.com

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Coronavirus Update: How to Stay Healthy and Engaged While at Home By ALICIA COONCE, DO, FAAP

Now that the kids are out of school with an extended holiday and the U.S. government has requested that you limit your personal social interactions, you are most likely finding yourself stuck at home having a lot of free time with the kids. This can be overwhelming if you don’t have a game plan. In efforts to minimize the spread of the COVID-19 virus, it is not advised to have playdates; however, here are a few things you can do to keep your kids healthy and entertained.

REMEMBER, ROUTINES, ROUTINES, ROUTINES! Children do much better, behaviorally, when they know what to expect. Since their daily schedule has likely changed dramatically, it is important to establish new routines for the time being. I encourage everyone in the family to continue to wake up at a normal time and maintain established mealtimes and bedtimes. If you do not have these routines currently, now is a perfect time to start. It is very important for your children to stay active! Grab everything you can play with - jump ropes, balls, games, etc. You can use tape to tape off an area for hopscotch. Use a laundry basket and a ball to create an impromptu game of basketball. Be creative! Board games help teach children how to follow rules and encourages using skills such as counting and identifying colors and shapes. Reading with your child is a great way to help develop your child’s vocabulary. Paintby-numbers and crafting encourages fine motor development. Family dance parties or choreographed workout videos on YouTube are a way the entire family can stay in shape. The AAP (American Academy of Pediatrics) recommends one hour of vigorous exercise a day for children of all ages. This keeps your heart healthy and is a great way to relieve stress and anxiety. As always, avoid excessive videogame playing and screen time (TVs, tablets, and phones). This can be difficult when everyone is stuck at home together and unsure of how to keep themselves busy. When you can, try to utilize screen time in an educational way and limit screen time to less than two hours of recreational use (meaning outside of schoolwork) a day. When watching videos or educational shows, take breaks and discuss information learned as a family. You might be surprised what your kids have to say. This is a great time to teach your children various “life skills.” If you are a handyman, mechanic, or particularly good cook, now is the perfect time to spend some extra time with your children teaching them what you know. A few examples of life skills that you could teach are how to do basic car maintenance (changing oil, rotating tires, etc.), cooking meals, operating a washing 18

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machine or dishwasher, balancing a checkbook, addressing an envelope, etc. My favorite part about this is that it gets kids away from the screens and encourages family bonding. In general, doing activities together; whether it is reading, learning, or playing games, strengthens the parent and child bond helping to facilitate a healthy family life at home. If you are working from home and need some necessary alone time, encourage your child to indulge in his or her specific interests. For instance, if your child always tells you they want to be a “YouTuber or a video gamer” in a future career, suggest taking online coding classes or film production classes via Khan Academy or other resources listed below. Don’t forget to maintain a healthy diet! I know that fresh foods might be limited, but in general, you want to stick to picking more foods that look like they do when they come out of the ground and fewer foods that do not. That means choosing more fruits, vegetables, beans, meats, etc. (canned and frozen are okay alternatives to fresh) and less processed foods like breads, pastas and packaged snacks (gummies, crackers, etc.). Be mindful of portion sizes. Don’t leave the kitchen with the bag of potato chips. Take a handful and leave the bag behind. It is easy to overeat when we are distracted

watching TV or playing games. Avoid eating out of boredom! Minimize or totally eliminate sugary beverages. This includes sodas, sweet tea, Gatorade/Powerade, and ALL juices (fresh squeezed or processed). I would rather your children eat their fruits instead of drink them! They miss out on beneficial fiber and other healthy vitamins and minerals by just drinking the juice. Fruit juices are also a source of excessive calories for many children and is not a necessary part of the diet. So, what should your child drink? You got it, water! Typically, 3-4 bottles a day (16 ounces each) depending on their age. As for desserts, once a week or less. If you want to have dessert after dinner, I recommend fresh fruits or yogurts. Remember, stick to these rules to maintain a healthy lifestyle for you and your kids both now and after COVID-19. Below are a few resources for parents to help keep your children entertained in educational ways. Free Educational Activities from Scholastic: (in English and Spanish), grade specific: https://classroommagazines.scholastic.com/support/learnathome.html

munity/virtual-field-trips/ Virtual Art Museums, Zoos, Aquariums and field trips: blog site with a list of 20+ websites complete with follow up activities to do with the family. https://adventuresinfamilyhood.com/20-virtual-field-trips-to-take-withyour-kids.htmlr Lunch Doodles with Mo Willems, author and illustrator of popular children’s books: https://www.kennedy-center.org/education/mowillems/ All-in-one toolkit from Khan Academy, complete with daily lesson plans and guidance to support you and your child for effective learning from home: https://www.khanacademy.org/about/blog/ post/611770255064350720/remote-learningwith-khan-academy-during-school Don’t forget your local county library has tons of resources online including free audiobooks, music, movies and classes. Alicia Coonce, DO, FAAP, is a pediatrician with Community Health Centers - Tavares

Virtual Field Trips from Discovery Education: https://www.discoveryeducation.com/com-

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It’s Business as Usual, Amongst All the Disruption of COVID-19, or is it? By AARON LISTON

We are indeed, living and working in unprecedented times for most people of our generation. Never before, outside a time of war, have we seen such concern and disruption, not only for the health of ourselves and immediate family but for the worldwide population, our jobs, our businesses, our economy. Independent practices and SMB Group Clinicians are concerned about the continuity of care for their patients, how they can maintain patient encounters safely as well as keeping themselves and their practice staff safe from the virus. Non-essential surgeries and procedures have been cancelled, healthcare staff, and administrative staff have been unable to work due to childcare demands with schools closing or caring for relatives. Added to this is the disruption to billing continuity, the worry that business revenues will drop and they will not be able to meet payroll and business commitments, including earning a salary themselves. Interestingly, the landscape feels familiar, as the Independent healthcare sector, which makes up the majority of our client base, has been under attack for some time, by payers, health systems and groups. My company, AIMA, has specialized in supporting practices with administrative processes and innovative accelerated billing to secure our clients

business continuity. Referrals, prior authorizations, patient follow ups and benchmarking are all daily headaches that AIMA have addressed and made efficient to support our clients and increase their collections. What next? Billing for COVID-19? How? What codes? Would patients with COVID-19 symptoms be billable? if so, how and how would we solve this quickly? These questions are all topics of the day in the medical billing world. The same is true for laboratories, how can they become licensed to run the COVID-19 tests quickly, what would be the level of payment? The deluge of calls to medical insurance payors has risen exponentially, Payor departments have closed, and it is difficult to reach them. Gradually, solutions have begun to emerge, the Government has rallied with financial rescue packages for Healthcare Providers and Health Service Providers. CMS has released designated codes and relaxed their position in regard to Telemedicine. The RCM space has begun to see a light at the end of the tunnel. One of the pandemic success stories, in terms of solutions, has been Telemedicine. In the current climate, Telemedicine is a lifeline for healthcare providers, it enables physicians and healthcare workers to see their patients in real-time in a safe, secure

environment. It also reduces the pressure and need for protective equipment and infection control measures. Reducing risk and allowing continuity of service. Solutions have advanced significantly recently, to allow far easier access on a wider range of technology. If you were an early adopter, turned off by clunky systems it’s worth taking a fresh look. Moving on, from how do healthcare providers continue seeing their patients, to how they continue to get paid and manage their offices has also had its challenges but the Government has issued financial rescue packages and relaxed regulatory restrictions to enable revenue to flow and remove administrative barriers through the expansion of the ‘Accelerated and Advance Payment Program’. This program of measures helps to ensure that Medicare-participating healthcare providers and suppliers have the resources they need to combat the COVID19 challenges, lessening the financial hardships Healthcare providers are facing so they can focus on patient care. The Revenue Cycle Management industry is working hard to support its clients to maintain healthcare and business continuity and constantly innovating to develop intelligent solutions and smarter ways of working at this difficult time. Within my company we have dedicated

teams constantly researching and implementing new ideas and keeping abreast of regulatory conditions so we can offer our clients the best advice and guidance possible. Keep safe everyone by staying home!

IMPORTANT LINKS Accelerated and Advanced Payments Fact Sheet (PDF) Emergency Declaration Health Emergency Declaration Health Care Providers Fact Sheet (PDF) www.coronavirus.gov https://www.cms.gov/About-CMS/AgencyInformation/Emergency/EPRO/CurrentEmergencies/Current-Emergencies-page

Aaron Liston is CEO of AIMA Business and Medical Support LLC, and gives his view, from a Revenue Cycle Management perspective, on the effect of the Coronavirus outbreak within the healthcare community and laboratory space. AIMA is a family run company which has been around for over 25 years resulting in year-on-year continued financial growth and a workforce of over 200 people. Visit www.aimabms.com or email sales@ai

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Finding Serenity in the Midst of Uncertainty By RONNIE AND DEBBIE SMART

“Lord grant me the serenity to accept the things I cannot change. Courage to change the things I can and the wisdom to know the difference.” Many of us can be found muttering this old prayer during times like these. This widely accepted prayer was first written a little differently by the American Theologian Reinhold Niebuhr. It is difficult to attain a state of serenity concerning the things we cannot change. Some synonyms of serenity include coming to a state of composure, quietness, calm, tranquility, patience, and peacefulness. While most individuals would aspire to these states of being, it can be amazingly difficult to process through the journey. Our troubled emotions in difficult times like these are not often even within the serenity ballpark! We all go through many planned and unplanned changes within our lives. The journey to processing and acceptance of change as we move forward in healthy ways is called the adjustment process. The DSM 5 terms these issues with change as adjustment disorders. When these periods of time are extended and include more severe issues of depression, anxiety and other emotional/ behavioral conditions; more exact diagnoses are applied. The impact of Coronavirus has been life changing! It has placed the sufferings of many of us at the very least within the adjustment process. Emotions that include fear, uncertainty, hopelessness, loneliness, sadness, being overwhelmed, loss, anxiousness, and grief pervade so many of our thoughts at this time. This current national crisis has paralyzed and overwhelmed so many of us. Certain areas of the medical field are on high alert while others are not allowed to practice due to the important procedures they offer being termed as elective procedures in some geographical areas. Some folks within the business and vocational sectors are working tremendous hours without rest while others are out of work and quarantined to their homes Jack London, an American novelist once said, “Life is not always a matter of holding good cards, but sometimes a matter of playing a poor hand well.” We may look at our current cards and feel that we are totally without control of anything in our lives. We must realize that we are in control of how we will play the cards dealt to us. It has been said that we are bombarded with approximately 50 thoughts per minute, 3,000 thoughts per hour and 72,000 thoughts per day. It is difficult to control our mindset with so many thoughts swirling through. However, we must remember that 20

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we have the ability to choose which thoughts we are going to accept and reject based on our mindsets. We must decide to process our thoughts in healthy ways. We must remember that is not stress itself that is the problem; but our response to the stress creates our problems. We know that bodily stress can be good in that it alerts us to danger and the need to act; however, it can also become toxic if not dealt with properly. A few ideas for processing through the current crisis in emotionally healthy ways are listed below. 1. It is important to be honest with ourselves and others about our emotional states. We must work to bring our thoughts into our awareness, identify our true feelings and process through them. Life has recently changed across the world in ways that is more than scary for most of us. We all hurt on so many fronts and may have lost trust in all that is around us. Learning to reach out to others during these times is also difficult when we are “socially distancing.” There are ways to reach out through telephone, social media, and meeting with those around us while using proper distancing. Reaching out may include sitting in lawn chairs on each of our front porches, playing with a dog, or sharing a laugh and some humor. It is important that we are honest when people who care about us ask how we are doing. It is ok to say, “I am feeling down” or “business stinks.” Our emotional beings have been attacked and it is urgent that we open ourselves

up to one another with some healthy trust. Being honest with someone we can trust helps us to process our feelings and begin healing. Opening up gives us all opportunity to help one another think rationally about the current situation; and speak back to irrational thoughts that paralyze us. 2. For those of us who live in faith; it is important that we also reach out to God in these times. Repeated research shows that reaching out within our faith can be a crucial step to healing. Faith based meditation and directive imagery have positive results for many clients of faith. Some have described reaching a peace that is beyond understanding. A great admonition for all people to put into practice within their daily lives is found In Philippians 4:8: “ Whatever is true, whatever is noble, whatever is admirable, if anything is excellent of praiseworthy, think on these things.” Remember that our mindset is heavily influenced by the thoughts we allow to occupy space. 3. Concentrating on healthy lifestyles is urgent during these times of longterm continuous stress. While the three major stress hormones- cortisol, adrenaline, and norepinephrine help our bodies react to danger or stress; these hormones can become excessive and negatively affect our bodies during prolonged stress. Four neurotransmitters- dopamine, serotonin, oxytocin and endorphins are often called our happy chemicals because they help promote positivity in us. It is important, especially in a pandemic, to eat healthy, exercise

regularly, find ways to participate in leisure activities, sleep an adequate number of hours each night, and find reasons and friends to laugh with. Other coping mechanisms that include meditation, mindfulness, yoga, and tapping can be found on the internet through you tube videos. It is also noted that many individuals affirm that various vitamin supplements and essential oils have made immense positive difference in their overall health. Please remember that it is of urgent importance that individuals check with their physician before deciding and proceeding in these areas. Reaching out and helping others is also an important self-help skill and can be done in many creative ways. The internet has several sites listed and include some of the following activities: giving blood, giving money to non-profits, volunteering, calling a neighbor, giving extra supplies purchased previously, and helping organizations with meals for those in need. These healthy lifestyle activities should be helpful to us in reducing excess stress hormones and increase our happy chemicals! Please remember that there are times when it is important and best to talk to a professional counselor or visit your doctor during times of duress. Please keep this important step in mind as you walk through this journey. Ronnie and Debbie Smart founded ‘The Bridge Counseling and Coaching.’ Ronnie has a B.S. in Ministry and an M.ED in Supervision of Education. Debbie is a Licensed Mental Health Counselor. Contact them at ronnie@healatthebridge.com or debbie@healatthebridge.com or visit https://www.healatthebridge.com/index.html

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GrandRounds AMA Resources Available to Physicians to Navigate COVID-19 Pandemic To assist physicians on the front lines of the COVID-19 pandemic, the American Medical Association (AMA) today highlighted the latest, comprehensive resources it has published and shared to ensure access to the latest news and information in a rapidly changing environment. “Physicians are on the front line of the current COVID-19 pandemic and the AMA is working to ensure they have the information, resources and advocacy they need to care for patients and keep themselves safe,” said AMA President Patrice A. Harris, M.D., M.A. “The AMA continues to forcefully advocate for PPE and critical policy and regulatory changes needed to address our public health and health system needs. Because so many of the challenges of the pandemic are felt at a practice level, we are also providing new tools and information to help physicians respond.” The COVID-19 physician and practice resources released by the AMA include: The COVID-19 physician and practice resources released by the AMA include: • A Physicians Guide to COVID-19, to help physicians prepare their practices, address patient concerns, and provide answers to physicians’ top questions; • An AMA COVID-19 online resource center, and a COVID-19 FAQ that are updated each day with the latest informa-

New Cardiovascular Surgeon Joins Orlando Health Orlando Regional Medical Center and Orlando Health Heart Institute

tion on the COVID-19 epidemic; • A Quick Guide to Telemedicine in Practice, a new resource to help physicians implement remote care which can help achieve a dramatic increase in the nation’s telemedicine capacity; • The AMA Journal of Medical Ethics published ethical guidance for physicians to help them in making determinations about how to combat COVID-19; • The JAMA Network COVID-19 Resource Center for evidence-based, actionable resources, plus videos of firsthand accounts from physicians on the front lines; • CME for physicians through the JAMA Network’s JN Learning website, including COVID-19 epidemiology, infection control and prevention recommendations The AMA will continue to release additional resources in response to the urgent public health crisis to support physicians and the patients they care for.

Karen “Kalei” Walker, MD, MHS, cardiovascular surgeon recently joined Orlando Health Orlando Regional Medical Center (ORMC) and the Orlando Health Heart Institute. Her clinical interests include all aspects of cardiac and vascular surgery with a specific focus on coronary artery bypass grafting (CABG), valve surgery, aortic surgery, and revisional surgery (or second time operations). She uses traditional surgical techniques, endovascular technology, and hybrid approaches which incorporate both surgical and endovascular techniques to create individualized care. Dr. Walker is a native Floridian and earned her medical degree from the University of Florida, College of Medicine. She completed her residency in vascular surgery at Dartmouth Hitchcock Medical Center in New Hampshire and is board certified in vascular surgery. Following her training in vascular surgery, she trained in cardiothoracic surgery at Washington University in St. Louis. She has a Master

of Health Science from the Johns Hopkins Bloomberg School of Public Health. Dr. Walker’s research has focused on resource utilization and the incorporation of new technology in cardiac and vascular surgery. She received the Alley-Sheridan Scholarship from the Thoracic Surgery Foundation to attend the Leadership Program for Health Policy and Management at Brandeis University. She is a member of the Society of Thoracic Surgeons and the Society of Vascular Surgeons.

Cushman & Wakefield Arranges $31.45M Sale and $30.5M Financing of Jupiter Innovation Center Cushman & Wakefield has arranged the sale and financing of Jupiter Innovation Center, a ±186,238-square-foot medical, office and research and development building in Palm Beach County. The Cushman & Wakefield Capital Markets team of Scott O’Donnell, Michael Ciadella, Dominic Montazemi, Greg Miller and Miguel Alcivar negotiated the sale on behalf a private investor. 1707 Military Trail, LLC, a joint venture between Pebb Enterprises and Tortoise Properties, acquired the building for $31.45 million ($169 per square foot). Jason Hochman of Cushman & Wakefield’s Equity, Debt & Structured Finance group secured a $30.5 million loan from Rialto Capital Management for the buyer, which provided funds for both the purchase and future capital and leasing costs. Jupiter Innovation Center is a unique, hybrid one-story medical, office and research and development structure built in 1990 on a ±16.0-acre site at 1701 Military Trail in Jupiter. The asset is the largest forlease office building in Jupiter, providing tremendous scale and presence in one of South Florida’s most dynamic markets.

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The property was originally constructed for Marquette Electronics, which was subsequently acquired by GE Medical Systems Information Technologies (GEMS) in 1999. The asset had been anchored by GEMS, before the company vacated its research and office space in December 2019. “With GE Medical Systems vacating their anchor position in the building at year-end, new ownership can now realize out-sized, opportunistic returns through the renovation and lease-up of the remaining space in an extremely tight Jupiter submarket,” said O’Donnell. Jupiter Innovation Center was 66.8% leased at the time of sale. Notable tenants include Florida Turbine Technologies, Jupiter Medical Center, Central Institute for Human Performance and Jupiter Kidney Center. “Given our client’s creative business plan, we were seeking a lender who could provide the best mix of proceeds, flexibility and pricing,” said Hochman. “We were pleased to find a solution that was accretive to our client’s investment returns with a lender that moved quickly and efficiently towards a smooth closing.”

Along with its convenient location just south of the award-winning Jupiter Medical Center hospital system, the property is located less than three miles from world-class facilities like the Scripps Florida Research Facility, the Max Planck Florida Institute and United Technologies brand-new $115M technology showcase center, which help attract tenants who are drawn to Jupiter’s growing life sciences hub. The property is also fully entitled for

the development of a ±50,000 square foot medical/professional office building with an accompanying 175-space parking structure. “This development opportunity will allow the buyer to capitalize on the demand for medical and professional office space near Jupiter Medical Center while also dramatically increasing net operating income and overall value of the property,” added O’Donnell. “It is the only ‘shovel-ready’ development site of its kind in Jupiter.”

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GrandRounds

Connect with Physician Colleagues at the PSCF Networking Social in Kissimmee

DOJ Establishes Nation-Wide Reporting Process to Report Coronavirus Fraud On March 20, 2020, Attorney General William Barr announced a nation-wide process for Americans to report fraud in the fight against Coronavirus (COVID19). The Justice Department also confirmed that all U.S Attorneys would “prioritize the investigation and prosecution of Coronavirusrelated frauds.” According to the Attorney General’s announcement, the Justice Department’s National Center for Disaster Fraud (NCDF) will manage the nation-wide reporting system, and the Attorney General directed all U.S. Osceola and Seminole County Medical Societies have Attorneys to appoint a Coronavirus FraudThe Orange, The Orange, Osceola and Seminole County Medical Societies have Coordinator. The release urged all personsofficially unified under a singular organization, the Physicians Society of officially unified under a singular organization, the Physicians Society of with relevant information to report these Central Florida. Central Florida. concerns through the NCDF’s hotline (1-866720-5721) or email (disaster@leo.gov). The DOJ also published a special webpage dedi-We invite We invite to join Sisters Speakeasy Speakeasy ininKissimmee on April 28, 28, you you to join us us atat 3 3Sisters Kissimmee on April cated to informing the public about Corona2020. Our initial event in the region gives the physicians in Osceola County an an 2020. Our initial event in the region gives the physicians in Osceola County virus frauds and how to report these crimes. opportunity to connect with peers, make new professional contacts, and meet “This is a great first step in ensuringopportunity to connect with peers, make new professional contacts, and meet leaders. that no person’s health is placed at risk duePSCFPSCF leaders. to fraud and that every penny spent by the federal government is used according to the Learn more about PSCF and our goal to provide physicians with a unified law,” said whistleblower attorney StephenLearn The Orange, Osceola and Seminole Medical Societies have officially unifia edunified under more PSCF and our goal to provide physicians with vision andabout strategic advantage asCounty we address the needs of our members and a M. Kohn. Kohn also serves as the Chairman singular organization, the Physicians Society of Central Florida. visionthe and strategic advantage as we address the needs of our members and future of our profession. of the Board of Directors for the National the future ofyou our profession. Whistleblower Center. We invite to join us at 3 Sisters Speakeasy in Kissimmee on April 28, 2020. Our initial event On Monday, before the Attorney GenNo presentations, noMedical talks. The Orange, Osceola and County Societies have make new in the region gives the physicians inSeminole Osceola County an opportunity to connect with peers, eral’s announcement, Kohn sent a formal letSimply joinprofessional us for social and professional networking. officially unified under a singular organization, the Physicians Society of contacts, and meetno PSCF leaders. No presentations, talks. ter to the Attorney General asking the DOJ Central Florida. to create a national-reporting process and Simply join us for social and professional networking. Learn more about PSCF and our goal to provide physicians with a unified vision and strategic ensure that Coronavirus-related frauds were advantage as join we address theSisters needs of Speakeasy our members and future of ouron profession. We invite you to us at 3 in the Kissimmee April 28, the number-one prosecutorial priority of the PSCF Networking Social Justice Department. Kohn’s law firm had also 2020. Our initial event in the region gives the physicians in Osceola County an No presentations, no talks.April Simply join2020 us for social professional Tuesday, 6:00and - 8:30 PM networking. published on-line a detailed Q&A explaining opportunity to connect with peers,28, make new| professional contacts, and meet the legal protections for whistleblowers who 3 Sisters Speakeasy PSCF leaders. reported Coronavirus-related frauds. PSCF Networking Social 226 Broadway, Kissimmee, Florida 34741 Also published was a detailed article April | 6:00 -physicians 8:30 PM with a unified in the National Law Review explaining Learn more about Tuesday, PSCF and our 28, goal2020 to provide https://pscfl.org/event/April2020 how whistleblowers can use the qui tam asSisters we address the needs of our members and vision and strategic advantage 3 Speakeasy provisions of the False Claims Act to hold the future of our profession. fraudsters who misuse monies dedicated to 226 Broadway, Kissimmee, Florida 34741 fighting the adverse health or economic imVisit our website to register https://pscfl .org/event/April2020 No presentations, no talks. pacts of the Coronavirus accountable. The False Claims Act has extremely powerful Simply join us for social and professional networking. anti-retaliation provisions, and also permits as collaboration between Orange and Seminole County Medical The PSCF was founded in 2019 Visit our website totheregister whistleblowers to obtain a financial reward. Societies. The PSCF represents allopathic and osteopathic physicians, residents, and medical students “Experience teaches us that in the face of a crisis, fraudsters often seek ways to Orange, Osceola, and Seminole County. PSCF Networking Social The PSCF was founded inin2019 as collaboration between the Orange and Seminole County Medical profit while others suffer. The False Claims Societies. The PSCF represents allopathic and osteopathic physicians, residents, and medical students in Medical 2019 as collaboration between the Orange Seminole County April 28, 2020 | 6:00 - 8:30and PM Act has been used in the past to prosecute The PSCF was founded inTuesday, Orange, Osceola, and Seminole County. fraudsters who sold faulty bulletproof vests 3 Sisters Speakeasy Societies. The PSCF represents allopathic and osteopathic physicians, residents, and medical students to police departments and who stole from Kissimmee, Florida 34741 Physicians Society of226 Central Florida Osceola, disaster sites by committing FEMA contractinBroadway, Orange, and Seminole County. ing frauds. The False Claims Act is a powerhttps://pscfl.org/event/April2020 844-234-7800 ful law that can effectively hold fraudsters pscfl.org accountable,” Kohn added.

PSCF Networking Social Tuesday, April 28, 2020 | 6:00 - 8:30 PM 3 Sisters Speakeasy 226 Broadway, Kissimmee, Florida 34741 https://pscfl.org/event/April2020

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The PSCF was founded in 2019 as collaboration between the Orange and Seminole County Medical pscfl.org Societies. The PSCF represents allopathic and osteopathic physicians, residents, and medical students


GrandRounds DOH-Orange opens an Appointment Only COVID-19 Testing Site

CMS Announces Relief for Clinicians, Providers, Hospitals and Facilities Participating in Quality Reporting Programs in Response to COVID-19 The Centers for Medicare & Medicaid Services (CMS) announced unprecedented relief for the clinicians, providers, and facilities participating in Medicare quality reporting programs including the 1.2 million clinicians in the Quality Payment Program and on the front lines of America’s fight against the 2019 Novel Coronavirus (COVID-19). Specifically, CMS announced it is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs with respect to upcoming measure reporting and data submission for those programs. The action comes as part of the

Trump Administration’s response to 2019 Novel Coronavirus (COVID-19). “In granting these exceptions and extensions, CMS is supporting clinicians fighting Coronavirus on the front lines,” said CMS Administrator Seema Verma. “The Trump Administration is cutting bureaucratic red tape so the healthcare delivery system can direct its time and resources toward caring for patients.” Specifically, CMS is implementing additional extreme and uncontrollable circumstances policy exceptions and extensions for upcoming measure reporting and data submission deadlines for the following CMS programs:

Provider Programs

2019 Data Submission

2020 Data Submission

• Quality Payment Program – Meritbased Incentive Payment System (MIPS) • Medicare Shared Savings Program Accountable Care Organizations (ACOs)

• Deadline extended from March 31, 2020 to April 30, 2020. • MIPS eligible clinicians who have not submitted any MIPS data by April 30, 2020 will qualify for the automatic extreme and uncontrollable circumstances policy and will receive a neutral payment adjustment for the 2021 MIPS payment year.

• CMS is evaluating options for providing relief around participation and data submission for 2020.

Hospital Programs

2019 Data

• Ambulatory Surgical Center Submission Quality Reporting Program • Deadlines for October 1, 2019 • CrownWeb National ESRD Patient Registry – December 31, 2019 (Q4) and Quality Measure Reporting System data submission optional. • End-Stage Renal Disease (ESRD) Quality • If Q4 is submitted, it will be Incentive Program used to calculate the 2019 • Hospital-Acquired Condition Reduction performance and payment Program (where appropriate). If data for • Hospital Inpatient Quality Reporting Program Q4 is unable to be submitted, • Hospital Outpatient Quality Reporting Program the 2019 performance will be • Hospital Readmissions Reduction Program calculated based on data from • Hospital Value-Based Purchasing Program January 1, 2019 – September • Inpatient Psychiatric Facility 30, 2019 (Q1-Q3) and available Quality Reporting Program data. • PPS-Exempt Cancer Hospital Quality Reporting Program • Promoting Interoperability Program for Eligible Hospitals and Critical Access Hospitals

Post-Acute Care (PAC) Programs • Home Health Quality Reporting Hospice Quality Reporting Program • Inpatient Rehabilitation Facility Long Term Care Hospital Quality Reporting Program • Skilled Nursing Facility Quality Reporting Program • Skilled Nursing Facility Value-Based Purchasing Program • for Eligible Hospitals and Critical Access Hospitals

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2020 Data Submission • CMS will not count data from January 1, 2020 through June 30, 2020 (Q1-Q2) for performance or payment programs. Data does not need to be submitted to CMS for this time period. * For the Hospital-Acquired Condition Reduction Program and the Hospital Value-Based Purchasing Program, if data from January 1, 2020 – March 31, 2020 (Q1) is submitted, it will be used for scoring in the program (where appropriate).

2019 Data Submission

2020 Data Submission

• Deadlines for October 1, 2019 – December 31, 2019 (Q4) data submission optional. • If Q4 is submitted, it will be used to calculate the 2019 performance and payment (where appropriate).

• Data from January 1, 2020 through June 30, 2020 (Q1-Q2) does not need to be submitted to CMS for purposes of complying with quality reporting program requirements. • * Home Health and Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data from January 1, 2020 through September 30, 2020 (Q1-Q3) does not need to be submitted to CMS. • * For the Skilled Nursing Facility (SNF) Value-Based Purchasing Program, qualifying claims will be excluded from the claims-based SNF 30-Day All-Cause Readmission Measure (SNFRM; NQF #2510) calculation for Q1-Q2.

The Florida Department of Health in Orange County (DOH-Orange) has opened a Coronavirus (COVID-19) testing site in Orange County. The testing is by appointment only and it is geared for those high-risk individuals who meet the Center for Disease Control and Prevention (CDC) COVID19 testing criteria. In order to get screened for the criteria, Orange County, Florida residents can contact the DOH-Orange’s Call Center Monday through Friday; 8am 5pm at 407-723-5004. To better gauge the spread of the virus in the community, DOH-Orange plans to implement a random testing effort of selected volunteers. This method of information gathering will further the planning process and will enhance the approaches utilized to combat the virus. As a reminder to residents, DOHOrange recommends these everyday preventive actions to help impede the spread of the COVID-19 virus:

• Social Distancing – stay within six feet of other people; • Avoid close contact with people who are sick; • Staying home when you are sick and avoiding contact with persons in poor health; • Avoiding touching your eyes, nose and mouth with unwashed hands; • Cover your cough or sneeze with a tissue, then dispose of the tissue; • Washing your hands often with soap and water for at least 20 seconds, especially after going to the bathroom, before eating, after blowing your nose, coughing or sneezing; • (If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty); and • Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.

Dr. Cooduvalli Cosmetic Dermatology Opens The upscale suite of Dr. Cooduvalli Cosmetic Dermatology, LLC is located in the beautiful town of Oviedo, Florida, just next door to Waterford Lakes and Winter Springs. Here, you will find the personalized, attentive service you deserve in a luxurious boutique setting, as Dr. C’s PASSION is showing her patients that she cares while providing the highest quality cosmetic and aesthetic dermatology with exceptional results. As a physician with a board certification in dermatology, Dr. Cooduvalli has a special interest in cosmetic dermatology, and she leverages her expertise to introduce the most innovative and safest

For those programs with data submission deadlines in April and May 2020, submission of those data will be optional, based on the facility’s choice to report. In addition, no data reflecting services provided January 1, 2020 through June 30, 2020 will be used in CMS’s calculations for the Medicare quality reporting and value-based purchasing programs. This is being done to reduce the data collection and reporting burden on providers responding to the COVID-19 pandemic. CMS recognizes that quality measure data collection and reporting for services furnished during this time period may not be reflective of their true level of performance on measures such as cost, readmissions and patient experience during this time of emer-

technologies in anti-aging and skin rejuvenation via laser procedures, injectables such as Botox, Dysport, Xeomin, Restylane, and Juvederm, as well as with peels, a medical skin care line, and other modalities. Contact us for a consultation with Dr. Betsy Cooduvalli by clicking here or by calling 407-605-6372.

gency and seeks to hold organizations harmless for not submitting data during this period. CMS will continue monitoring the developing COVID-19 situation and assess options to bring additional relief to clinicians, facilities, and their staff so they can focus on caring for patients. This action, and earlier CMS actions in response to COVID-19, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, please visit www.coronavirus.gov. For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website.

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GrandRounds Axiom Bank, N.A. Offers Relief to Customers Financially Impacted by Covid-19 Axiom Bank, N.A., a Maitland-based, leading community bank, is offering support for its commercial and consumer customers who are being financially affected by the COVID-19 pandemic. Axiom has reiterated its commitment to work with commercial customers and provide practical solutions to get them through this difficult period. Current borrowers are encouraged to contact their relationship manager to determine what options are available. Axiom is also suspending the initiation of any new foreclosure actions specific to residential properties, unless required by federal or government agencies. These suspensions are effective immediately through the end of March 2020. They will be continuously re-evaluated for extensions, as needed. Residential mortgage and consumer loan customers may inquire about their options for relief by calling 1-800-584-0015 to speak with a bank representative. “The COVID-19 outbreak impacts all of us,” said Dan Davis, President and CEO of Axiom Bank. “Our number one priority as a company is the safety and well-being of our employees, customers and business partners in the communities we serve. We are committed to helping our customers weather this crisis and work towards recovery.”

Community Health Centers, Dental Emergency and Urgent Care Appointments Available In the current healthcare crisis, the shortage of hospital beds, resources, and staff creates a notable challenge as the number of COVID – 19 diagnosed patients is on the rise. As a partner in healthcare, Community Health Centers, Inc. (CHC), would like to extend our help in addressing the oral/dental problems that may present to our local Emergency Departments. CHC is pleased to announce immediate appointments for dental emergencies at the following locations: Apopka, Winter Garden, Forest City, Meadow Woods (Peds Patients only), Pine Hills, Lake Ellenor, Tavares, Leesburg, and Groveland. We have staff present and available at these locations to provide Dental Emergency and Urgent Care - evaluation and treatment of the dental infection, swelling and/or pain in patients of all ages. To schedule an appointment, please call 407-905-8827 or 352-314-7400. During the COVID-19 Pandemic, CHC is following all CDC guidelines and complying with Governor DeSantis’ Executive Orders. CHC appreciates our partner agencies and salutes our colleagues in the healthcare industry. Our thoughts are with those affected by COVID-19 and our condolences are with those who have lost a loved one due to COVID-19. 24

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Community Health Centers Update Community Health Centers (CHC) continues to monitor the activity of COVID-19. We are working with state and community partners under the guidance of the Center for Disease Control (CDC), the Florida Department of Health (DOH), and local health departments to stay informed regarding coronavirus. In regard to the mandatory Stay at Home Order in Orange County: Those seeking healthcare or visiting their pharmacy, including Community Health Centers’ services, are excluded in Orange County’s “Stay at Home” Order. All 13 Community Health Centers locations will remain open with no disruption in hours of operation. Visit www.chcfl.org for hours of operation and COVID-19 updates. CHC is offering immediate appointments for dental emergencies at the following locations: Apopka, Winter Garden, Forest City, Meadow Woods (Peds Patients only), Pine Hills, Lake Ellenor, Tavares, Leesburg, and Groveland. We have staff present and available at these locations to provide Dental Emergency and Urgent Care - evaluation and treatment of the dental infection, swelling and/or pain in patients of all ages. To schedule an appointment, please call 407-905-8827 or 352-314-7400. The CHC Pharmacy is offering free mail-order prescription refills. TeleMedicine for existing patients will be offered soon. The Optometry department is offering free mail-order of lenses/frames. CHC is prepared for the possibility of having to respond to a Person Under Investigation (PUI) by implementing procedures, resources and capabilities to lessen the impacts on our communities and team members. CHC continues screening all patients and team members for risks and symptoms of COVID-19 infection. CHC has obtained the necessary equipment and protection for team members to provide COVID-19 testing for current CHC patients. For non-CHC patients, per DOH and CDC recommendations, those are instructed to call their Primary Care Provider or their county health department as appropriate from home to control the transmission.

Retired Physician Volunteers Receive No-Cost Malpractice Coverage during COVID-19 Pandemic As U.S. healthcare systems are being tested to the limit during the COVID-19 pandemic, The Doctors Company has announced that it will provide free medical professional liability coverage to retired physicians formerly insured by the company who volunteer during the crisis. “Today, our mission to advance, protect, and reward the practice of good medicine is more important than ever. We appreciate our members’ lifesaving work during this crisis and want to make it as easy as possible for (CONTINUED ON PAGE 25)

APRIL 2020

Cushman & Wakefield Arranges ±88,000-SF Lease for United Medco HQ at Coral Springs Commerce Center II Cushman & Wakefield has represented United Medco, a leading national provider of pharmaceutical products to the managed care market, in leasing an ±87,885-square-foot space in Coral Springs. The distribution and office space, located within Coral Springs Commerce Center II, will eventually serve as United Medco’s national headquarters, where the company plans to add 50 to 75 new jobs over the next several years. Cushman & Wakefield Industrial Team of Executive Director Rick Etner, Executive Director Chris Metzger, Executive Director Christopher Thomson and Director Matthew G. McAllister negotiated the lease on United Medco’s behalf. The landlord is Exeter Property Group, a global real estate investment manager. Coral Springs Commerce Center II is a four-building distribution park comprising ±564,651 square feet of space. United Medco will be located in

Building 1, which was built in 1981 and extensively renovated by Exeter in 2019. The lease brings this Class A industrial building to 100% occupancy. At 4250 Coral Ridge Drive, the property is strategically positioned in west Broward County, minutes from the Sawgrass Expressway, Interstate 95 and Florida’s Turnpike. “Exeter Property Group’s investment into this property has paid off in a short amount of time,” said Etner. “We are pleased to have brought several highquality tenants such as United Medco to this facility, resulting in the full lease-up of this Class A asset.” The eight-member South Florida Industrial team led by Metzger, Etner Jr., Thomson and McAllister negotiated just over 12 million square feet of sale and lease transactions valued at more than $252 million in 2019. For more information, please visit www.southfloridaindustrialteam.com.

Orlando Health Welcomes New Chief Medical Information & IT Innovation Officer Orlando Health is pleased to announce Marshall Denkinger, MD, has joined as new chief medical information and information technology/clinical engineering (IT/CE) innovation officer. In this new leadership role, Dr. Denkinger will be responsible for provider relationship including virtual care, clinical informatics and IT innovation. He will lead initiatives to identify, research, pilot and support adoption of new information technology solutions and processes to best enable business and clinical enhancements. “We are pleased to welcome Dr. Denkinger to his new position within Orlando Health,” said Novlet Mattis, chief information officer at Orlando Health. “Dr. Denkinger has an extensive track record of leadership and impressive accolades that showcase his ability. We look forward to his leadership as we strive to deliver on our vision of excellence.” Previously, Dr. Denkinger served as chief medical informatics officer for Centura Health in Colorado Springs,

Colo. At Orlando Health, Dr. Denkinger will serve as the physician champion during the organization’s initiative to implement a comprehensive health record system from Epic. In this role, he will work with the project team on the remaining build, its personalization for physicians, and engagement and adoption among physicians. Dr. Denkinger earned his medical degree at Dartmouth Medical School. He recently completed executive education at Harvard Business School. Dr. Denkinger completed his undergraduate studies at Princeton University with a degree in geology/geophysics. Dr. Denkinger is a U.S. Army veteran who served during Desert Storm in 1991 and led as commander for the Army’s Health Clinic Hoenfels/Combat Maneuver Training Center in Germany. “I am very excited to transition into this new role at Orlando Health,” said Dr. Denkinger. “I know this is a place where I can share my expertise, contribute to a meaningful cause and grow in my career.”

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GrandRounds our retired members to assist,” said Richard E. Anderson, MD, FACP, chairman and chief executive officer of The Doctors Company. If retired former members of The Doctors Company return to practice as volunteers, this decision will not impact their extended reporting period, or tail, coverage. Additionally, there will be no impact on previous Tribute® Plan awards received for their loyalty and commitment to superior patient care. To qualify, a retired healthcare professional must be providing professional services for no fee, salary, or other compensation— with the exception of expenses incurred delivering those services. Retired former members of The Doctors Company interested in the free coverage can complete an online form or call (800) 421-2368, and press 1 for Member Services, then 6 for coverage activation. Retired members considering volunteering can find more information at “COVID-19 Malpractice Coverage FAQs.” All healthcare providers can visit “COVID19 Resource Center for Healthcare Professionals” to keep up to date on the pandemic.

Position Statement Highlights Importance of Sleep for Physician Self-Care Physician burnout is a significantly underappreciated public safety issue, and sleep loss is often overlooked as a contributing fac-

Newly Released Telehealth Codes and Policies

tor, according to a new position statement published by the American Academy of Sleep Medicine. Sleep is essential to health, and sleep deprivation due to shift-work schedules, high workload, long hours, sleep interruptions, and insufficient recovery sleep have been implicated in the genesis and perpetuation of physician burnout. The risk for burnout is especially high due to the novel coronavirus (COVID-19) pandemic, which is requiring physicians and other health care personnel to work long hours under stressful conditions. “Physicians tend to reside in a culture of working hard at the expense of self-care, including adequate sleep. We need a major culture shift to allow physicians to get the sleep they need,” said senior author Dr. Indira Gurubhagavatula, associate professor of medicine at the Veteran’s Administration Medical Center at the University of Pennsylvania and chair of the AASM Public Safety Committee, which developed the position statement on behalf of the AASM board of directors. The position statement, published online as an accepted paper in the Journal of Clinical Sleep Medicine, calls for more research exploring sleep disruption, sleep deprivation and circadian misalignment in physician burnout, as well as examining efforts to address sleep problems among doctors. It notes that the physicians most at-risk are at the peak of their careers, and burnout may cause them to seek early retirement, which could negatively impact the physician

JOIANY!

Major health insurers have released their updated policies and billing codes related to their handling of telehealth visits in response to the Coronavirus outbreak. Here are the links to each carrier’s latest post regarding their policies and CPT codes. • Aetna • Empire BCBS • Cigna workforce needed to care for a growing and aging patient population. While the position statement was developed before the current public health emergency, Gurubhagavatula said it’s even more important now for health care workers to address sleep. “Insomnia related to stress and anxiety about the pandemic may compound the physical, emotional and cognitive demands of working in high-stress environments,” she said. “Some coping habits, such as the use of alcohol or excessive caffeine, can worsen sleep quality and quantity, which may in turn impact the ability to function at high levels. Healthy sleep is one of the major restorative activities that will help health care workers cope and perform well.” She noted that heath care employers should consider creating opportunities for rest breaks, including designated nap areas; providing counseling services for those dealing with stress-related insomnia; and distributing education about sleep health and sleep hygiene to help maximize productivity and well-being. The position statement and a detailed companion paper on the role of sleep in

• Emblem Health • UnitedHealthcare • Horizon BCBS • Healthfirst • Fidelis Care • Humana Courtesy Association of Independent Doctors and Bert Lurch, of E-Central Medical Management, of New York physician burnout are available on the Journal of Clinical Sleep Medicine website.

NeuLife Rehab Announces Availability to Admit Individuals diagnosed with Brain Injury, Spinal Cord Injury, and other Catastrophic Diagnoses NeuLife Rehab President Tera Welch announced today that NeuLife, a licensed specialized residential post-acute facility has IMMEDIATE availability to admit, treat and care for individuals as described that may need to be transferred from hospitals and other locations due to COVID-19. NeuLife provides specialized comprehensive rehabilitative services and care that is tailored to the clinical and personal needs of each patient. Diagnoses include: • Traumatic Brain Injury (TBI) (CONTINUED ON PAGE 26)

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GrandRounds WeCare tlc Health & Wellness Centers remain open across the country to help patients

PUBLISHER

WeCare tlc, one of the nation’s leading providers of employee health centers for a variety of companies, school districts and governments, has launched a telehealth model of care at all of its health and wellness centers. The Florida-based company says it has a responsibility to keep its health and wellness centers open and serving patients, many of whom have diagnosed chronic illnesses and are the most susceptible to the coronavirus or COVID-19. Company President Raegan Garber Le Douaron said WeCare tlc has been working in concert with its partners and clinical teams to keep centers open and providing the highest quality of healthcare, especially when patients need it the most. At this time, WeCare tlc operates 54 on-site and near-site health and wellness centers across the U.S. “We have a duty to keep our centers open and caring for our patients. We serve

many people with chronic illnesses and they are scared about how this health crisis will affect their conditions,” Le Douaron said. “Our clinical teams have worked tirelessly to provide top-notch care and use telemedicine to aid patients, easing people’s nerves.” While other clinics have been closing across the country, WeCare tlc has stepped up its service and communication to clients, patients and staff. Each day, a briefing is sent to clients about the coronavirus and the latest health regulations on the federal, state and local levels. There are also briefings distributed to the clinical teams to keep both patients and the medical staff as safe as possible. “We’ve had the pleasure of serving more than one million patients at our health and wellness centers, but I’ve never been more proud of our team as I am today. Their effort to serve those in need is heroic,” said Dr. Fayshonda Cooks, Chief of Clinical

Services at WeCare tlc. “We are working to keep our centers operational throughout this crisis and will continue to provide the care our patients need at this critical time.” WeCare tlc is on a mission to change how healthcare is delivered across the U.S. It provides on-site and near site health and wellness centers to companies and co-ops of companies. WeCare tlc’s clients also include governments, school districts and other organizations. Telehealth allows patients to connect with their healthcare providers and receive health services remotely via telephone and/or video conferences. Through telehealth, providers can diagnose and treat allergies, colds, flu, bronchitis, vomiting, urinary tract infections and more. WeCare tlc has partnered with Spruce to offer telehealth services. For more information on WeCare tlc, visit https://wecaretlc.com

• Acquired Brain Injury (ABI) including Stroke, Aneurysm, Hypoxia and more • Multiple Sclerosis, Muscular Dystrophy and Parkinson’s Disease • Spinal Cord Injury (SCI) including paraplegia and tetraplegia • Complex Orthopedic injuries and Multiple Trauma • Amputations NeuLife’s clinicians are on staff and available around the clock to conduct pre-admission screening assessments at any location. Please visit NeuLife’s website for more information and a tour of the facility: www. NeuLifeRehab.com Tera Welch, President: 813.447.1789 Tera@NeuLifeRehab.com

ment to inpatient to ICU to post-acute and community management; Protect and Support Frontline Teams. Efficiently share emerging needs by text, call or email for rapid, coordinated response, while providing leaders with ongoing, live updates on critical information including access to the latest resources and contact information of key personnel Communicate Effectively and Quickly. Replace multiple, fragmented emails and calls with rapid crisis communication that makes visible key information to the appropriate stakeholders as a ‘single source of truth’; Drive Key Decision Making With Data. Support system-, division-, hospital-, service line- and community-level updates and town halls, as well as rounds and huddles, to provide meaningful updates, and support datadriven decision-making; Issue Escalation. Escalate issues to experts or leaders by tagging and adding them to a given issue; and Organizational Status and Resource Allocation. Enables informed management and prioritization of resources across hospitals, regions, or business units at a glance. Demonstration of the LENS Incident Command Center Board here “Many hospital and community incident command centers are compiling this information manually. Related problems from fragmented communication and email overload are making it even more difficult to manage this terrible pandemic. Our solution automates the incident process while making it easy to engage and capture the voice of key stakeholders in real-time, improving our responsiveness to their critical needs in managing this crisis,” said Dr. Allan Frankel, a Managing Director at Safe & Reliable Healthcare. Tom Grace, Ph.D, RN, former Vice President of Emergency Management for the Hospital Association of Pennsylvania, offered a professional review, commenting, “the LENS Incident Command Center is breaking new ground in emergency management. It is the most intuitive visual

display to support incident management, giving organizations immediate visualization of key data and information to manage the incident from the emergency department, through inpatient and critical care and to post-acute and community management. It enables communication and coordination with all key stakeholders.” The core LENS technology is in use across several hundred organizations and is healthcare’s first and only real-time high reliability board that helps leaders and managers visibly “close the loop” on ideas, concerns and risks shared by frontline teams, supporting leadership rounds, huddles, improvement work and incident command. LENS is based on a proven framework for culture change and high reliability transformation that Safe & Reliable Healthcare co-developed and published with the Institute of Healthcare Improvement [IHI] based on more than two decades of fieldwork across thousands of hospitals and clinics. The LENS Incident Command Center is being made available to hospitals, clinics and essential provider organizations without any software or subscription fees during this pandemic, as part of Safe & Reliable Healthcare’s ongoing mission to protect both patients and caregiver teams from harm and safety issues. LENS is the field’s first and only scalable real-time digital solution for high reliability transformation, supporting service line-, hospital- and system-level huddles, walkrounds and continuous improvement for both unit-level initiatives, and uniform execution of organizational strategy. Safe and Reliable Healthcare [“S&R”] is a recognized pioneer in the field of patient safety and high reliability transformation. Having surveyed culture and burnout across more than 1300 organizations and designed and led transformation efforts for dozens of systems including Mayo Clinic, Kaiser Permanente, Advent Health, the NHS, the Military Health System and Veterans Heath Affairs, the firm has spearheaded lasting and measurable improvements in culture, safety, operations, and experience - the healthcare Quadruple Aim.

LENS Incident Command Center Supports COVID19 Response Across 8 US States, Including Florida Hospitals Free for use during the COVID-19 pandemic, the LENS Incident Command Center enables rapid identification and resolution of patient and staff safety issues from COVID-19. Already in use in 8 US states, it is a simple turn-key solution accessible from any connected device for credentialed users. Safe & Reliable Healthcare LLC, a leading provider of patient safety and high reliability technologies and services to more than 700 healthcare organizations, is offering the LENS Incident Command Center to support leaders, front line teams and incident command centers who are managing the COVID-19 pandemic. Leveraging the firm’s more than 150 years of collective experience in designing, leading, and supporting incident command centers during times of acute crisis - including 9/11, SARS, and Ebola, the LENS Incident Command Center was developed to help leaders to: Visualize Key Incident Data and Information in Real-time. Intuitive visual display to support incident management across the care pathway from the emergency depart26

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April 2020

Early Findings from COVID-19 Testing in The Villages® Encouraging; Experts Urge Vigilance University of Florida Health experts and their collaborators completed over 2,000 COVID-19 tests in The Villages® last week, and while the number of positive cases is still low, experts urge continued vigilance to reduce the risk of community spread. A team of volunteer UF Health medical professionals together with personnel from The Villages Health primary care network evaluated 2,280 people who had preregistered for an appointment. Testing was done for people with symptoms associated with COVID-19 and for those without symptoms. Of nearly 900 people with symptoms, 23 tested positive, 15 of whom were evaluated Thursday and Friday. Among 1,400 tests for people who indicated they were not having symptoms, two were positive, both from testing conducted on Friday. While these participants indicated they did not have symptoms at the time they registered online for an appointment, when questioned at follow-up, both indicated recent travel and had developed symptoms such as cough, fatigue and/or loss of taste and smell. Although the total number of positive results remains low, the number of positives increased slightly as the week progressed, suggesting the infection is starting to move into the community. UF Health experts say it’s more important than ever to follow Centers for Disease Control and Prevention guidelines for social distancing, frequent hand-washing and other best practices. “These results show evidence of initial community spread; however, it does not appear to be widespread, at least so far. We are continuing to closely monitor the situation,” said Michael Lauzardo, M.D., deputy director of the UF Emerging Pathogens Institute and an associate professor in the division of infectious diseases and global medicine at UF’s College of Medicine, part of UF Health. “While a week is a short period of time, the fact that we saw increases in the number of positive tests as the week progressed raises concerns that the infection is just begin27

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ning to take hold in the community. “Under these circumstances, and in keeping with recommendations from the governor, we would strongly encourage everyone to continue to practice social distancing, and, for persons 65 years of age and older, to remain at home to reduce the risk of further transmission as much as possible,” he said. UF Health was able to surpass the goal of 2,000 tests for the week because additional testing supplies became available. Working in collaboration with The Villages® community, The Villages Health, Gov. Ron DeSantis’ office and state health and emergency management officials, testing will be extended into this week. Visit UFHEALTHCOVID.COM for this week’s schedule, which will be posted once it is updated. “The Villages is an extremely cohesive, socially connected community. In a situation like we are now facing with COVID-19, this ‘connectivity’ could work against us in enhancing the spread of the virus. However, it appears from the data compiled to date that the concern our residents have for each other and their community overall is resulting in social distancing and self-quarantining,” said Elliot Sussman, M.D., chairman of the board of The Villages Health, and former board chairman of the Association of American Medical Colleges. Carla VandeWeerd, Ph.D., director of research for The Villages Health, said area residents have an opportunity to “flatten the curve” in the region. “The low rates we are finding in our community are encouraging and reflect the commitment that people in our community have not only to their own health, but to the health and well-being of their neighbors and friends,” she said. “We must remain vigilant in following the CDC’s recommendations. These efforts are helping, but they must be maintained for us to be successful in this fight.” Participants were assessed for symptoms, travel and exposure history and tested if they met clinical criteria. Depending on the severity of their illness,

they were further evaluated on-site or at a UF Health facility or sent home to selfquarantine while awaiting test results. If someone was concerned yet did not have symptoms nor meet standard clinical testing criteria, they had the opportunity to sign up for a UF Health research study that enabled them to receive a test as part of an epidemiological protocol known as community surveillance. The purpose of the study is to assess the degree of asymptomatic viral shedding at the onset of a COVID-19 outbreak. This is a valuable public health activity to identify people with early disease — those who have the virus but are not exhibiting symptoms. “We still have a lot to learn about this virus, and the factors that determine why some people become very sick, and others do not. We hope to be able to follow the people who we are testing, to see who becomes ill and what symptoms they have, so we can better protect the community and the people who live in it,” said Glenn Morris, M.D., M.P.H.&T.M., director of UF’s Emerging Pathogens Institute. “People who are over the age of 60 are of particular concern, which is why we have been focusing our research efforts in The Villages® and surrounding areas. What we learn will help in management of this epidemic, as well as possible future epidemics.”

The coronavirus research study is thought to be one of the largest of its kind in the United States. “Research plays a crucial role in guiding policy and practice,” said David R. Nelson, M.D., senior vice president for health affairs at UF and president of UF Health. “Our knowledge base about COVID-19 is still fairly limited, so the more we can learn through studies such as this one, the better we will be able to treat it and prevent its spread in the future. “The testing has been incredibly efficient and well-organized, and could certainly serve as a model for future testing of large populations,” he added, saying that he is extraordinarily proud of the health care providers and volunteer medical students, physician assistant students and nursing faculty who have led the effort. Lauzardo said health officials want to keep monitoring the area as the epidemic unfolds. “We feel like this has been a very worthwhile endeavor, and it will be an ongoing endeavor with an at-risk population that we’re really working hard to keep safe,” he said.

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NorthCentralFlorida GrandRounds

UF Health Leesburg Hospital and UF Health the Villages® Hospital Launch Virtual Screening Program. As cases of COVID-19 — the novel 2019 coronavirus — continue to increase throughout Central Florida, UF Health Leesburg Hospital and UF Health The Villages® Hospital have launched a virtual telephone screening program. “Telehealth, the virtual care platform that allows health care professionals and patients to meet by phone, seems tailor-made for this moment in time,” said Chris Wood, MHA, Corporate Director of Clinic Operations and PHO at UF Health Central Florida. “Virtual care solutions can help flatten the curve of COVID-19 infections and help us deploy medical staff and lifesaving equipment wisely.” A clinician will ask callers screening questions to help establish if they are in a low-, medium-, or high-risk group, and if they have mild, moderate, or severe symptoms of upper respiratory infection that

could be due to COVID-19. “Before you call, write down your symptoms, whether you have a fever, and whether you’ve taken any medicine,” continues Chris. “Be ready to answer a few questions that might seem tedious, such as where you have traveled recently. Resist the urge to ask reasonable but nonmedical questions that are time-consuming. General questions should be referred to the Centers for Disease Control and Prevention website.” If you are experiencing symptoms of COVID-19 such as fever, cough, or shortness of breath, and would like to schedule a telehealth appointment, call 352.751.8790 between the hours of 8:00 a.m. and 4:30 p.m. Monday through Friday. For more information about how UF Health facilities are responding to COVID-19, please visit https://coronavirus.ufhealth.org

Two Ocala Residents are First Marion County Covid-19 Deaths OCALA - Two Marion County residents, an 88-year-old male and a 58-year-old male, passed away this weekend after contracting COVID-19. Both were Ocala residents. These are the first two deaths linked to COVID-19 in Marion County. “We are saddened to learn of the passing of two members of our community,” said Florida Department of Health in Marion County Administrator Mark Lander. “Our deepest condolences go out to the families and loved ones of the individuals who are no longer with us.” As of 6 p.m., Sunday, April 5, Marion County has 50 total COVID-19 cases. The most recent individuals confirmed to have the virus range in age from 36 to 77; five are from Ocala, two are from Summerfield, and one is from Dunnellon. For more detailed information, including zip code level data of all Marion cases, view Florida’s COVID-19 Data and Surveillance Dashboard.

How to Get Tested

VA Announces Award for Clermont Clinic The Orlando VA Healthcare System announces the award of a lease to Blue Cord DevGroup, to build its new Clermont Community Based Outpatient Clinic (CBOC). The Clermont CBOC will be located approximately 3 miles from the current clinic located at 805 Oakley Seaver Dr. The new clinic will provide 10,500 net square feet of space which will be double the size of the Clermont CBOC. Services provided at the clinic will include primary care, mental health, a dedicated women’s health 28

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area, telehealth rooms and a lab area. The Clermont CBOC construction is expected to be completed by December 2020. Once construction is complete, the VA will install equipment and furniture prior to the clinic’s activation, and relocation of staff and services. Patients will be seen at the clinic in January 2021. The Clermont CBOC will continue to provide services to Veterans throughout the construction period.

Residents can get tested for COVID-19 at multiple places in Marion County. Places offering testing include the Department of Health, Heart of Florida Health Center, Langley Medical Center, and some primary care providers.

Testing at the Department of Health

Individuals who are experiencing symptoms of COVID-19 AND who meet one or more of the following categories should call the Department of Health in Marion County’s 24/7 COVID-19 hotline (352-644-2590) to schedule an appointment:

· Over age 65 · Over age 50 and have diabetes or cardiovascular disease · Health care worker · First responder · Recent traveler to any international locations or domestic locations (New York tri-state area, California, Louisiana, etc.) currently impacted by COVID-19

Testing at Another Medical Provider’s Facility

Contact your primary care provider to see about the possibility of testing at the provider’s office if you would like to be tested but don’t meet the above criteria for testing at the Department of Health. If you do not have a primary care provider or if your primary care provider is unable to test, contact the following to see if you qualify for screening: · Heart of Florida Health Center (352732-6599, www.myhfhc.org/) · Langley Medical Center (352-6807000, www.langleymedicalcenter.com)

For more guidance

For the most up-to-date information on COVID-19 in Florida, visit floridahealthcovid19.gov. For general questions about COVID-19, call the state hotline (866-7796121), local hotline (352-644-2590), or email COVID-19@flhealth.gov. Individuals can also follow the Department of Health in Marion County on Twitter at www.twitter. com/FLHealthMarion for the latest updates on COVID-19 in Marion.

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NorthCentralFlorida GrandRounds Florida DOH-Marion Issues Rabies Alert MARION COUNTY —The Florida Department of Health in Marion County has issued a rabies alert for the area within the following boundaries: Northwest Highway 320 to the north West Highway 326 to the south Interstate 75 to the east County Road 335 to the west The alert commences March 20 and is in response to a positive laboratory results for rabies from a bobcat and raccoon. People who live or work within the rabies alert boundary should maintain a heightened awareness that rabies is active in the area. Residents in the depicted area should avoid contact with free roaming domestic animals or any wild animals. They should not leave pet food outside and should secure outside garbage in covered containers to avoid attracting wild animals. They should also ensure animals have current rabies vaccinations. An animal with rabies could infect other animals that have not received a rabies vaccination. Domestic animals are at risk if they are not vaccinated, while rabies is always a danger in wild animal populations. Rabies is a disease of the nervous system and is fatal to humans and warmblooded animals. The only treatment for human exposure to rabies is rabies-specific immune globulin and rabies immunization. Appropriate treatment started soon after the exposure will protect an exposed person from the disease. If you have been bitten or scratched by a wild or domestic animal, seek medical attention and report the injury to the Florida Department of Health in Marion County. If your pet is bitten by a wild animal, seek immediate veterinary assistance for the animal, and contact Marion County Animal Services. For more information on rabies, visit www.floridahealth.gov/diseases-and-conditions/rabies.

HCA Healthcare Names Richard Hammett North Florida Division President HCA Healthcare (NYSE:HCA), one of the nation’s leading healthcare providers, announced that it has appointed Richard Hammett as president of HCA Healthcare’s Tallahassee-based North Florida Division, effective June 1, 2020. Hammett will assume leadership from Michael Joyce, a 33-year veteran of the organization, who will retire on the same date. Hammett has been with HCA Healthcare for 15 years and currently serves as president and chief executive officer of

Swedish Medical Center in Englewood, Colorado, a 408-bed acute care hospital and level 1 trauma center that serves the Rocky Mountain region. Before assuming that role in 2015, Hammett held numerous leadership positions within HCA Healthcare, including serving as president and chief executive officer of The Medical Center of Aurora in Aurora, Colorado. Hammett also served as the chief operating officer and interim chief executive officer of St. David’s Medical Center in Austin, Texas.

“Richard is an accomplished healthcare leader with a proven history of generating hospital growth and advancing clinical quality,” said Chuck Hall, president of HCA Healthcare’s National Group. “His deep roots with our company and experience in different markets make him uniquely qualified to lead our North Florida Division into the future.” In his new role as president of the North Florida Division, Hammett will lead the division and its 14 affiliated hospital campuses and six surgery centers across North and Central Florida. He will also serve as leader to the division’s more than 14,000 employees. Joyce is retiring after spending 33 years with HCA Healthcare. In his role as president of the North Florida Division, Joyce led the development of four Level

II trauma programs, 18 free-standing ERs and 24 GME programs. He has held multiple chief executive officer roles within the organization, including Summerville Medical Center in Summerville, South Carolina, Port St. Lucie Medical Center in Port St. Lucie, Florida, and Trident Health System in Charleston, South Carolina. “Michael is a phenomenal leader and hospital operator who has been instrumental in mentoring our emerging hospital leaders as well as consulting some of the most accomplished executives across our organization,” said Hall. “He has been a longtime colleague and friend of the Tallahassee community, and will be greatly missed. We wish him all the best in his next chapter.”

UF Health Leesburg Hospital and UF Health the Villages® Hospital Announce New Patient Visitation Restrictions As cases of COVID-19 — the novel 2019 coronavirus — continue to increase throughout Central Florida, many area residents want to know about the most up-to-date policies regarding patient visitation at area hospitals. “To protect the health of our patients and health care providers, no visitors are permitted at UF Health Leesburg Hospital and UF Health The Villages® Hospital except under special circumstances such as patients receiv-

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ing end of life care or the imminent birth of a child,” said Don Henderson, CEO of UF Health Central Florida. Additionally, no one under the age of 18 will be permitted to enter the hospital at this time. For more information about how UF Health facilities are responding to COVID-19, please visit https://coronavirus.ufhealth.org

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April 2020

Parrish Medical Center’s Alternate Care Site Serving Public Health Emergency Parrish Medical Center’s Alternate Care Site (ACS) has been established. It is 40 x 60 feet in size, air conditioned and equipped with computers and supplies. PMC’s ACS can be quickly converted into a medical treatment site to allow for expanded bed capacity and patient care as needed. “Currently, PMC’s ACS is being used as a centralized−clearance station before anyone

is granted access into the hospital. This is necessary to protect the health and wellbeing of our health care professionals (care partners), and the patients in our care,” said Natalie Sellers, Vice President, Communications, Community & Corporate Services. When reporting for duty, employees and physicians are being cleared using the CDC recommended non-diagnostic screening

Online COVID-19 Risk Assessment Leads to Lifesaving Intervention to South Brevard Resident Parrish Medical Center is Florida’s only hospital enabling website visitors to take a coronavirus (COVID-19) non-diagnostic risk assessment that identifies their risk level for the virus. The online risk assessment has already helped Brevard residents get proper treatment for COVID-19-like symptoms. The assessment tool is called “COVIDAware”. The public can complete the assessment by visiting parrishhealthcare.com/ COVID19HRA or by texting Coronavirus to 321-204-1966. More than 1,300 people have taken the assessment since it went live on March 20, and hundreds more have been completing the assessment every day. Of those, PMC’s care navigators have provided follow-up contact with 107 respondents whose information showed they needed additional medical advice and direction. “A PMC care navigator contacted a south Brevard woman who had taken the assessment after working with an individual who had died from COVID-19-like symptoms. The woman was short of breath and had other symptoms to the point the PMC care navigator could hear her wheezing as she tried to speak,” said Natalie Sellers, Vice President, Communications, Community & Corporate Services. “The woman decided to self-isolate after hearing reports that people should not flood emergency rooms,” Sellers said. “She took the assessment and her responses indicated she was at a high risk for COVID19. One of our care navigators called her 30

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to further assess. On the call, our navigator advised her to go to the emergency room. In addition, the care navigator called ahead to notify the hospital’s ER so that they could be prepared for her arrival. She was subsequently admitted to the hospital.” The risk assessment was developed by HealthAware, a Denver, Colorado, company that uses technology to encourage behavior that improves quality of life for individuals and communities. From start-to-finish, the assessment takes about seven minutes to complete. “PMC has been offering online risk assessments to the community for a variety of health conditions, it only made sense to develop an online assessment given the need for social distancing and self-isolation required to stem the spread of the COVID-19 virus. If someone wants to better understand their risk and get guidance on if, or when, to seek medical care, we can help, but they need to take the assessment,” said Sellers. PMC also makes available similar assessment tools for sleep disorders, determining a person’s “heart age,” understand heart disease risks, cancer issues, and others. “Preventing the spread of this highly contagious virus is our priority and we are devoting all of our resources to that end,” said George Mikitarian, PMC President and CEO. “Using the technology available to us and providing this service free of charge to further protect our community from COVID-19 is just one more way we are fulfilling our mission.”

questions and their temperatures are taken before being granted access into the hospital. The ACS is not a COVID-19 testing site. Non-urgent patients who are seeking care in the ER are also screened within the ACS before entering the ER lobby using the same CDC recommended screening questions and having a temperature check. Patients with flu-like symptoms or with a fever

are given a mask to wear before entering. Urgent or emergent patients do not go through the ACS. They are immediately taken into the ER for care and screening is conducted per CDC guidelines. “These, and our new visitor restrictions, are necessary safety precautions to keep our hospital environment a safe and healing environment for everyone,” said Sellers.

Newly Released Telehealth Codes and Policies Major health insurers have released their updated policies and billing codes related to their handling of telehealth visits in response to the Coronavirus outbreak. Here are the links to each carrier’s latest post regarding their policies and CPT codes. • Aetna • Empire BCBS • Cigna

• Emblem Health • UnitedHealthcare • Horizon BCBS • Healthfirst • Fidelis Care • Humana Courtesy Association of Independent Doctors and Bert Lurch, of E-Central Medical Management, of New York

VA Announces Award for Palm Bay Community Based Outpatient Clinic The Orlando VA Healthcare System announces the award of a lease to 5200 Professional Center LLC, to house its new Palm Bay Clinic. The Palm Bay Clinic will be located at 5200 Babcock Street N.E., Palm Bay, Florida 32905. The new clinic will provide approximately 8,500 net square feet of space which will open in phases, with the first phase providing primary care services to Veterans already enrolled in care at the Viera Health Care Center. Basic laboratory services will also be available at the initial phase. The need for future services will be evaluated as the clinic develops and will be determined based on the care demands of Veterans utilizing the clinic. Congressman Bill Posey who was instrumental in obtaining approval for the Palm Bay facility expressed his excitement

for the new clinic: “After almost 8 years of working towards this important goal, I’m pleased that Palm Bay area Veterans will now soon be able to get the VA medical services they need closer to home in Palm Bay,” said Congressman Posey. “With almost 35,000 Veterans enrolled at the Viera Clinic, this new primary care VA facility will help the VA keep up with the growing demand for services.” Activation of the Palm Bay Clinic is expected to be completed by June 1, 2020 with patients being seen during the first week of June.

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