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Orlando Health’s Center for Proton Therapy Reaches a Milestone Center has seen “strong growth” and “worldwide recognition” What began in 2006 as a continuing mission to develop advanced care for cancer patients, and in 2013 saw the delivery of the massive Mevion Medical Systems S250 superconducting synchrocyclotron to the site that became the Marjorie and Leonard Williams Center for Proton Therapy at Orlando Health UF Health Cancer Center, has now become a milestone moment seeing the 500th patient treated. For that patient, Juan Campos, proton therapy was of critical importance in safely treating a brain tumor which had received two prior conventional radiation treatments over the past 12 years. The use of proton therapy will allow for effective treatment of the tumor while decreasing the long-term risk of brain injury and preserving neurological function.

ON ROUNDS PHYSICIAN SPOTLIGHT Hiep Nguyen, MD ... 3

DOCTORS CORNER

Being A Student of Your Practice is Better Than Being an Owner. Why? ... 2

EOCC MEDICAL CITY Big Data – Advancing Technology for Small Business ... 4

Audience Engagement Spurs Orlando Medical News’ Digital Expansion ... 20

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PHYSICIAN VIDEOS HEALTH PODCASTS UP-TO-DATE CONTENT

The 15,000-square-foot Marjorie and Leonard Williams Center for Proton Therapy consists of three floors – two above ground and one underground – in order to accommodate the system that operates similar to a linear accelerator. The idea for the original $25 million, 15,000-squarefoot Center began at a time when many of the large proton facilities had an exorbitant price tag: hundreds of millions of dollars. By waiting a few years, the size of the machine decreased, along with the cost. Proton therapy is considered the most precise and advanced form of radiation treatment, primarily radiating the tumor site while leaving intact surrounding healthy tissue and organs. Instead of radiotherapy that is (CONTINUED ON PAGE 7)

Frontiers in Robotic Surgery By SAM ATALLAH, MD and JORGE TRILLES

For contemporary readers and practicing physicians, the term ‘robotic surgery’ may conjure up thoughts of mechanical anthropomorphic beings armed with artificial intelligence quickly rendering the human surgeon obsolete. Yet, this forethought stands in contrast to the current prevailing paradigm for robotic surgery: the master-slave layout, where an experienced surgeon exerts full control over a surgical robot in a symbiotic relationship of sorts that ultimately aims to improve

•• •• • •

patient outcomes in surgery. In this article, I will offer insights on key advantages and limitations of robotic surgery, shed light on some of the more recent advances in this quickly evolving field, and discuss future directions. The da Vinci Surgical System, designed and manufactured by Intuitive Surgical in 1997, and approved by the FDA for use in the U.S. in 2000, remains the most commonly used robotic surgical system to this day. It is classified as a telesurgical system, where a surgeon fully controls a robot situated over a patient on an operating table, but does so from a remote console, usually within close (CONTINUED ON PAGE 6)

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Being A Student of Your Practice is Better Than Being an Owner. Why? 10. The Doctor Practice relies heavily on discount promotions, specials or even Groupon to drive in new clients. And while they may get many initial consults or a one-time treatment from the specials that are offered. Many patient prospects do not return and their average cost per patient transaction ends up very low. Discounting is a bad idea if it is part of your practice marketing plan. Check Out This Video Link For Discounting

By QUINTIN L. GUNN SR.

Being a student of your practice is better than being an owner? Why do you ask? So often practice owners get bogged down in the day to day task of running the business and end up losing sight of what’s really happening with their practice profits, growth opportunities, and community outreach.

We unfortunately, label those types of Doctor Practices: The Walking Dead, because usually, they have a high staff turnover rate and not many old clients who will return. They are the one and done type practice groups who usually have a very low customer revisit rate. Patient prospects rarely return due to the bad energy and tension surrounding this type of Doctor Practice. However, on the other hand, we have the Student Practice. Which is often seen thriving even when there is extreme competition!

What are the signs of the Owner Practice versus the Student Practice? The Owner Practice:

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1. An Owner Practice is bogged down in daily process and procedures related to treatments administrative protocol, and management of their staff 2. The Owner Practice will tend to hyper-focus on the way things have been done in the past, and or be unwilling to transition to the new realities of patient care, technologies, new communication tools or treatment pathways…..Basically stuck in the way things used to be, versus the way things work today, not open to change

How is the Student Practice different than the Doctor Practice?

3. They give their staff very little authority or room to make decisions, which slows down patient interaction and practice growth. They must be in charge…

1. The staff energy and customer interaction are very positive because it is patient driven and patient-focused. In most cases, the staff knows the patients by name and knows some personal detail or event that is important to their clients

4. They micromanage employees time, task, and work processes, which basically means they don’t trust the staff which they’ve hired or don’t feel the staff is competent enough to do the job as they would do it

2. The Student Practice not only does a monthly newsletter, but the doctor enjoys writing Blogs as it’s his or her way of letting patients know how much they enjoy taking care of patient needs. Along with that, a Student Practice is not afraid of patient feedback. In fact, the Student Practice continually seeks patient feedback via surveys, patient recommendations, as well as elicits staff feedback.

5. They are not flexible or willing to try new products or services, while their competition down the street gains more and more market share and new patients. So, they end up blaming their staff for failures or financial losses 6. They rarely have in office special patient events or celebratory staff events for monthly goals being met or accomplished.

3. The Student Practice has quarterly patient events where they can talk to happy patients and find out what’s going on and get suggestions about products and services. They utilize a Patient Loyalty program and consistently track how often it gets used by monthly reports. They look for patient activity trends.

7. Rarely does a Doctor Practice attend any local or social community events because perceived lack of value and time limitations 8. They rarely or inconsistently publish monthly or quarterly practice newsletters or even write a practice blog about successful treatment outcomes and why they love what they do in their chosen profession.

4. A Student Practice conducts monthly staff meetings that open the dialogue to identifying problems in process or procedures but also talks about products, services, equipment, and treatment pathways. The Student Practices is always seeking knowledge and looking for areas of improvement.

9. When they have a great year or month, they tend to be thankless toward their staff or team members who helped them reach those goals. Never offering a bonus or incentive program. In fact, some don’t even give staff raises as a way to show appreciation for a job well done. And likely because they don’t value the employeecustomer connection. Everything from their perspective is about them and their lifestyle.

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5. The Student Practice, makes a personal investment in their staff, ensuring that they stay up on the latest trends via continuing education, events within the community and encourages the staff to review various industry journals like MedEsthetics, (CONTINUED ON PAGE 5)

Website Older than 2-Years? You need a website update!

How you look online will attract or repel new patients. If your image colors and design layout are outdated, new patients might think your practice is outdated.

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PHYSICIANSPOTLIGHT

Care Coming Full Circle

Hiep Nguyen, MD, brings cardiac surgery skills to the Heart and Vascular Institute of Osceola Regional Growing up in Vietnam in the 1960s, Hiep Nguyen, MD, saw the realities of war firsthand. His father was a commanding officer in the South Vietnamese military who worked with American physicians in mobile army surgical hospital (MASH) units. Through his father, Nguyen met several surgeons who made a lasting impression. “I was seeing them save the lives of GIs, and I thought they did miracle work,” he said. “I wanted to grow up and be like them. That was the tipping point for me to get into medicine.” In the 1970s, Nguyen’s family moved to Guam, then stayed in a refugee camp in Pennsylvania and spent a couple of years in New Jersey. The family ultimately settled in Houston, where Nguyen went to Rice University. He earned his medical degree at the University of Texas Medical Branch in Galveston, Texas. “In medical school I fell in love with the physiology of the heart and how it functions,” he said. “There’s a mystique about the heart. It’s the soul of the person. And when you can fix it with medications or improve a valve that isn’t functioning, you see results quickly. It’s instant gratification.” Nguyen completed his general surgery residency at New York Medical College and his cardiothoracic surgery fellowship at New York University. Then he spent 20 years prac-

ticing in Delaware before returning to Texas. A Healthcare Hub Nguyen recently relocated to Florida and currently practices at the Heart and Vascular Institute of Osceola Regional Medical Center (ORMC) in Kissimmee. He specializes in minimally invasive procedures such as valve repair and replacement, endograft vascular surgery, robotic coronary artery bypass grafting surgery, and aortic surgery. As a healthcare hub for the community, ORMC must provide all the leading-edge technology that patients expect, Nguyen says. That includes the county’s only 256slice CT scanner, allowing Nguyen and his team to visualize coronary arteries in millimeter-thin sections. “The higher the resolution, the more detail you can get in the minor vessels,” he explains. “That’s the investment that our hospital is making in the community.” Minimally Invasive Procedures With minimally invasive procedures and robotic-assisted surgery as the gold standard, Nguyen and his team are continually expanding the Institute’s surgical offerings. He frequently performs transcatheter aortic valve replacement (TAVR), a minimally invasive procedure to replace a narrowed aortic valve that fails to open properly. And to reduce the risk of stroke in pa-

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tients with atrial fibrillation, the Institute recently began performing procedures to implant a left atrial appendage closure device (LAAC). The LAAC device seals off the left atrial appendage, a heart section that’s the site of almost all stroke-causing blood clots in people who have A-fib. Nguyen works closely with cardiologists to place the device. In addition, the Institute will soon offer a new minimally invasive catheter-based procedure to treat issues in the mitral valve that cause blood to leak backward when the left ventricle contracts. The Institute currently performs mitral valve repairs through a small incision. While the techniques and technology involved in cardiac surgery have advanced, Nguyen says the primary goal has remained the same. “At the end of the day, you want to make sure that the patient’s quality of life is better,” he said. “Surgery allows patients to breathe more easily, be more involved with their families and enjoy their lives more. And with minimally invasive surgery, they can recover even more quickly.”

Coming Full Circle With his childhood in Vietnam shaping his calling to medicine, Nguyen always Your Host Presenter: dreamed of returning to helpand people there. He has led more than 10 annual medical mission trips to Vietnam, working with local physicians to establish new heart surgery

INDEPENDENT PHYSICIANS

Dr. DeArcy Vaughan PharmD, MBA, BCACP, CDE, CTTS

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programs all over the country. “We’re proud to spread the joy of cardiac surgery, and it’s also good for our team to appreciate what we can do with less equipment, because it makes us grateful for what we have back home,” he said. In his spare time, Nguyen enjoys an outdoor lifestyle, including fishing, biking, and spending time at the beach with his family. His wife is a local dentist, a daughter attends Rice University, and another lives at boarding school in Michigan. He also looks forward to adding to his passport with upcoming travels in South America, having already journeyed throughout Europe, Africa and Asia. Meanwhile, he’s settling right into his new life in Osceola County. “The people here are warm and friendly, and it’s gratifying to help expand the services they need right here in the community,” he said. “My approach is to treat the patients as my own family. I love seeing the immediate impact I can have on their lives.” Nguyen is a board-certified cardiothoracic surgeon and practices at the Florida Heart & Lung Institute of Osceola in Kissimmee, Florida.

THE FUTURE OF US HEALTHCARE

“This is a s results spe

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Dr. DeArcy Vaughan, PharmD is the owner of the Jacksonv growing medical service franchise in the country. She earne of Business Administration degrees from the University of Flo 23 years in pharmacy in the pharmaceutical industry, comm settings. Her last assignment in managed care was working quality measures and HEDIS scores. She has a passion for specialty credentials through the years including a Board C (BCACP), Certification in Diabetes Education (CDE), and Ce (CTTS). She also served as President of the Duval County and is still active on their board. Throughout her years in h failures in the system for both the patient and provider. DeA consultant and is excited to share with you how partnering patient outcomes while, at the same time, greatly increas work, DeArcy and her husband, Alyn, like doing home imp their kids, Genevieve and Campbell, playing on the beach in

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Big Data – Advancing Technology for Small Business

The Latest offering of the EOCC to help your business By DOROTHY HARDEE

In July, we discussed the evolution of telehealth as part of the protocol to reduce healthcare costs and address access to care by low-income families. Big data and sophisticated analytics have been critical in refining the science in personalizing remote patient monitoring. It is a widely used term for data, so large or complex that the traditional processing applications are inadequate. But as we discovered during the Orlando’s Professional Technology & Innovation Collaborative (OPTIC) Big Data panel discussion series, Big data analytics is not only driving telemedicine, but advancing our ability to assess production results, focus on cost control, customer retention, optimizing operations, refining hiring and more for many local companies and physician groups. Keeping up with the demand for the celebrated ski boats, wake boards and water crafts, Nautique Boat Company, a subsidiary of Correct Craft, gathers “big data” to identify how to improve timely production, engage employees and provide consistent quality. Drew Pope, industrial engineer and

interim materials supervisor explained how they use information gathered to identify the production process of each boat part. A deep dive revealed not only areas of opportunity to increase production, but also identified teams driving solid results helping them to refine their onboarding process improving outcomes. The data is analyzed and refined to examine the completion of each part, as well as the time any redoes cost a crew. The strong team environment with friendly competitive spirit of posted results engages employees to better their best without compromising quality. Cedric Gaines, software architect with VHB, an engineering firm of engineers, scientists, planners and designers partnering with clients in transportation, real estate, institutional and energy industries, as well a federal, state and local governments, described their use of “big data” for predictive analytics. With more than 52,000 locations updated every 5 minutes, VHB can report average speeds, travel time, areas of congestion and originating site of the issue for their client FDOT. Assessment of the data for a signal tim-

ing improvement project resulted in concrete return on investment. Moving into future development, VHB is working toward predictive analytics, drones enabled with remote data collection tools and autonomous vehicles. This along with historical data may allow transportation planners and engineers to respond to emerging events through known trends, “using algorithmic models to accurately forecast impacts as they occur and effectively position transportation professionals to proactively manage the impacts of incidents.” Their effective use of big data won the VHB team recognition as the 2016 Orlando Business Journal’s IQ Tech Award recipients. “Big data management principles developed by VHB are changing the world” and “building their reputation as a major player in the Big Data Management arena.” From manufacturing and transportation to recruiting technology for meaningful talent interactions, Talentify offers recruitment automation, screening and talent analytics for hiring managers. Andy France, A.I. Recruiting Marketing for the company explains that Talentify significantly reduces recruitment marketing costs and maximizes

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EOCC MEDICAL CITY applicant conversation with mobile-first engagement and artificial intelligence. They generate and prescreen candidates from organic channels like Google and Facebook before using programmatic job ads on paid sources, helping companies exponentially increase their talent acquisition capabilities. In HRTech Outlook, Othamar Gama Filho, Founder & CEO shared that “Talentify anticipates businesses’ recruiting business needs and gathers information at different stages on each candidate, qualifying them and ranking them for interviews. When an employer has an open job, the platform finds people digitally, ranks applicants with a jobfit score, gets them into the Applicant Tracking System (ATS) and schedules interviews with the prospective employers.” Their platform uses the power of AI and ML capabilities to optimize the recruiting process. Big data is now, but for the small business it may seem overwhelming and unnecessary. According to Jeff Charles in Small Business Trends, if a small business isn’t focusing on analytics and trends, they may be missing out on an opportunity ultimately hurting their business. Budget and lack of the in-house professional may be the deterrent making your business part of the 77 percent that have not yet developed a big data strategy. Small businesses find the presentation of the data offered too complicated or poorly designed making it impossible for a non-IT professional to use. However, there are solutions to help make data sets easier for the novice to use allowing them to make decisions based on data helping their company be more effective. What is next for our OPTIC Big Data Series? November 8, we will explore Big

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Data: Information Security with a 4-hour workshop discussing end user security hygiene offering tangible takeaways for small to medium sized businesses as well as value to technology experts. We will address areas such as end user privacy, password policies/ managers, MFA on existing SSO accounts and more. OPTIC is presented by The East Orlando Chamber of Commerce (EOCC) and hosted by Full Sail University. The East Orlando Chamber of Commerce (EOCC) understands and works diligently to further the interest of businesses providing valuable benefits, industry focused programs and networking and connections to encourage growth in and around East Orange County. Identifying this critical need to support small business, the EOCC offers health benefits to its members including Telehealth for $14 per month per household. EOCC members can offer our health benefits package of Telehealth, Allstate Accident, Allstate Cancer (& 23 specified diseases plan) plus Wellcard to their employees. Our insurance representative with Avalon Insurance Services does all the administration of the plan(s) selected by you and/or your employees. Are you an independent physician seeking ways in which to increase exposure, revenue, and attract talent to grow with your practice? Joining the East Orlando Chamber, becoming actively involved in all it has to offer, is the perfect way to start. Give us a call at 407-277-5951 or visit our website at eocc.org. Your Business is Our Business.

Being A Student of Your Practice is Better Than Being an Owner. Why?, continued from page 2 online and social blogs like Aesthetic Everything, Cosmetic Surgery Times, New Beauty etc. And additionally, they have a bonus or some type of incentive program that motivates the practice and individuals in the practice to reach a monthly or quarterly goal via secondary product offerings or upsells to new treatments. 6. The Student Practice creates an environment where continuing education and understanding of the aesthetic industry stays top of mind for himself or herself as well as their staff. These activities demonstrate that they are more than just a practitioner but in fact, remain an avid student of practice development who is progressive and able to adapt to the new products, services, and laser light source technologies which can have a direct impact on practice revenue. 7. A Student Practice is curious about marketing. What are the latest and most effective ways to communicate with both current and potential new customers? Is it social media, is it mailers, is it newsletters, blogs or mobile phone text messaging? How well is the practice website working on attracting new patients? Is it time to upgrade the practice website, is the practice website mobile ready? Are the social media links connected to the website at the header of the website? Is there a call to action on every page with a contact form? 8. A Student Practice becomes part of their local community where he or she lives. They become an active and available resource for their local news organizations 9. The Student Practice has monthly newsletters which keep their patients up to date on the new things the doctor, staff, or practice is learning or doing to make their patient experience better. 10. They have a higher dollar per transaction per client because they’ve created a Patient Care Plan for each client and keep up with their repeat customers via loyalty programs, which in turn raises the average dollar per transaction by per client!

In the end, many of the Owner Practice habits are a necessary requirement for practice operations. But practice Growth and Prosperity are tied to the Student Practice mentality. Being open, being positive, trusting your staff, making sure that your staff is current on all new treatments and technology with continuing education, being a part of the community, looking for new and improved ways to doing things, and encouraging your staff to have that same mentality. This will lead to a much more sustained growth pattern even when there’s a lot of competition. It will prevent you from falling behind your competition and losing market share to the new kids on the block. By making your practice a place where both customers and potential employees want to come for services and to work. You will build a legacy, one that you will be proud to put your name! A place where those with great skills and curious minds want to come. Being more of a Student Practice than a Doctor Practice. You’ll create excitement, anticipation, and curiosity with word of mouth in the community surrounding your practice. You’ll become a driver instead of a follower for consumers to walk into your door because you use the latest technology for treatments and patient communication. Quintin L. Gunn Sr. is a Practice Development Consultant with Social Media Solutions for Doctors. Email socialmediafordoctors@gmail.com or visit www. SocialMediaSolutionsforDoctors.com

11. Lastly, the Student Practice uses social media to help solidify their brand awareness. Host Presenter: Check Out ThisYour Video Link For and Discounting

Dorothy Hardee is the Chamber Administrator for the East Orlando Chamber of Commerce.

“This is a s results spe

- Dr. Brian

Dr. DeArcy Vaughan PharmD, MBA, BCACP, CDE, CTTS

hello phiibi.

Dr. DeArcy Vaughan, PharmD is the owner of the Jacksonv growing medical service franchise in the country. She earne of Business Administration degrees from the University of Flo 23 years in pharmacy in the pharmaceutical industry, comm settings. Her last assignment in managed care was working quality measures and HEDIS scores. She has a passion for specialty credentials through the years including a Board C (BCACP), Certification in Diabetes Education (CDE), and Ce (CTTS). She also served as President of the Duval County and is still active on their board. Throughout her years in h failures in the system for both the patient and provider. DeA consultant and is excited to share with you how partnering patient outcomes while, at the same time, greatly increas work, DeArcy and her husband, Alyn, like doing home imp their kids, Genevieve and Campbell, playing on the beach in

IMPROVING

Outcomes for Patients • Accelerate Practice Growth & Building Personal Wealth of Affiliated Physicians • Improve MACRA and MIPs Scoring 5

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Frontiers in Robotic Surgery, continued from page 1 vicinity of the operating room. Key differences for the surgeon between the robotic vs. open surgery format are that the surgeon is no longer at the bedside, giving up tactile feedback and direct visualization of the anatomy, and instead secondary visualization is achieved via a specialized fiberoptic lens that feeds to 3D digital imaging display. Although robotic surgery was originally seen as an evolution of laparoscopic surgery, and physicians initially attempted to compare the two techniques against each other, it is probably best to view these as having a divergent evolution, with each technique retaining unique functionalities and indications in future surgical practice. While both employ CO2 for exposure and secondary visualization via a lens and imaging display, laparoscopic procedures keep surgeons at the bedside. Robotic surgery, like traditional laparoscopic surgery, is a minimally invasive surgical technique—it allows for a smaller number and length of incisions, resulting in less trauma to achieve a surgical outcome. Advantages include less pain, faster recovery and lower incidence of infection. In certain subsets of patients, the use of robotic surgery has been shown to improve the quality of cancer resection (negative margin rate) and decrease operative morbidity (Ramsay, et al, Health Technol Assess Winch Engl.; 2012). Another key advantage of robotic surgery is exposure—the instruments are much smaller, being able to get into and work in small spaces with stable 3D visualization and

up to 12x magnification capability (essentially, the system can thus be used to perform intricate operations within a focused field analogous to microsurgery). Lastly, robots allow for extreme precision in the operating room—a robot’s hands simply won’t tremble the way even the best surgeon’s hands might, and the robot is able to ignore any tremor in an operator’s hands. Ultimately, the objective is to better much mimic the movement capabilities of a human wrist than any traditional laparoscopic instrument. This allows surgeons to preserve natural motion mechanics while operating in spaces that their hands would never be able to fit into. Limitations of robotic revolve around cost and training. The approximate 2019 cost for some systems is $2 million (USD) and annual maintenance fees can add up to several hundred thousand dollars, arguably making it more expensive than open or laparoscopic equivalents. It’s possible that robotic surgery could be a cost-effective option if capital costs were to decrease (increased competitors in the market for surgical robots) or a sufficient caseload could be maintained. Furthermore, the rest of the surgical support staff must also receive varying degrees of training in order to efficiently and effectively carry out these procedures. Lastly, surgical robots occupy a large physical footprint and are cumbersome to set up, adding to the time it takes to prepare a room and patient prior to surgery, and adding to the clutter in an already congested operating room. Next generation robotic systems will

incorporate other, non-surgical tools to assist the surgeon in precision surgery. For example, near-infrared fluorescence imaging can be used to help surgeons evaluate blood vessels and tissue perfusion in real time. Other interesting advancements include the SOFIE surgical robot, developed in 2010 at Eindhoven University of Technology. It is the first of its kind to provide haptic feedback—recreating the tactile sensation that a surgeon would normally experience when operating with standard tools for open procedures and supplements visual feedback. Unfortunately, the SOFIE surgical robot has not yet been commercialized, but it does serve as a promising preliminary proof of concept. As for the future of robotics in medicine, it’s predicted to grow tremendously over the next decade. Does this mean open and laparoscopic procedures will become obsolete? No—there will always be a place for these procedures. Next-generation surgical innovation will look to do things otherwise not possible with traditional laparoscopy, relying more on informatics and the concept of Digital Surgery—the platform for this innovation will almost certainly be robotic surgery. According to an industry report by MarketsandMarkets published December of 2018, the surgical robot’s market is expected to grow from $3.9 billion (USD) in 2018 to $6.5 billion by 2023, with other analysts estimating growth to upwards of $20 billion. Analysts indicate that key drivers of growth include improving technology, availability of R&D capital, increasing applicability of robotic

surgery and wider adoption of these systems by hospitals and other surgical centers. I leave you with some conceptual food for thought: In 2015, a team of researchers at Vanderbilt University successfully constructed a prototype wrist (diameter = 1.16 mm) for needle-sized surgical robots that can rotate and has an actuation tendon that permits it to bend up to 90 degrees, possibly paving the way for surgeons to access previously inaccessible areas of the body with robotic surgery. In 2016, the Smart Tissue Autonomous Robot (STAR) was able to suture in an ex vivo and in vivo setting and quantitatively outperformed surgeons in formal studies; and lastly, Elon Musk’s latest project, Neuralink, recently unveiled its research on computer-brain interfacing, including the development of a microsurgical robot with enhanced optics that allows it to implant electrodes into the brain with extreme precision, avoiding blood vessels in the process, and potentially ushering in a new standard for tomorrow’s minimally invasive surgery. Sam Atallah, MD, is a Colorectal Surgeon and Director of Research and Clinical Trials at Digestive and Liver Center of Florida. He pioneered robotic transanal surgery and was the first in the world to perform this technique. He is one of the leaders in advanced technology for rectal cancer surgery and has developed the technique of stereotactic navigation for transanal total mesorectal excision (taTME) — an important step forward in the evolution of computer-assisted surgery. Visit https://www.DLCFL.com Jorge Trilles is a third-year medical student at the UCF College of Medicine and is set to graduate as part of the Class of 2021. UCF’s medical school requires all of its students to conduct research during their training, so they play a part in contributing new scientific and medical knowledge.

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Orlando Health’s Center for Proton Therapy Reaches a Milestone, continued from page 1 delivered via photons, proton radiotherapy uses positively charged protons consisting of a hydrogen atom stripped of its electron. Protons are harnessed for treatment using the three-story cyclotron. Compared to conventional forms of radiation, side effects are minimal from proton therapy, particularly in pediatric patients. Tumors best treated by proton therapy include those that are localized and haven’t spread to distant areas of the body. If the tumor is near a critical organ, such as the spinal cord or optic nerves, proton therapy may allow for preservation of the function of the organ while delivering effective doses of radiation to the tumor. Proton therapy may be used in combination with traditional radiation, chemotherapy and/or as a follow-up to surgery. The timetable for proton therapy varies with each patient, from a day to seven weeks, depending on the tumor site. The length of treatment time decreases over time, as heavier doses begin to increase. Many insurers and Medicare cover proton therapy, which costs more than conventional radiation but usually less than surgery.

Even though proton therapy was initially proposed in 1954, its use has been very limited worldwide. Loma Linda University Medical Center in California was the site of the first hospital-based treatment center when it opened a proton therapy center in 1990. The Center for Proton Therapy is one of only 29 regional centers across the United States and has treated a diverse group of patients with cancers of the brain, spine, prostate, breast, thorax and lungs, head and neck, as well as a large group of pediatric patients. Treatments have involved a wide range of clinical protocols and enrolled patients in a multiinstitutional proton treatment registry. The Center for Proton Therapy has enjoyed strong growth since opening its doors, drawing a wide range of adult and pediatric patients throughout Florida, and from as far as the Middle East, Canada and Asia. “We offer an innovative multi-disciplinary approach to cancer treatment that is an important factor in the growth of our proton therapy program,” says Naren Ramakrishna, MD, PhD, director of proton therapy for Orlando Health UF Health Cancer Center. “Patients

MORE ON PROTON THERAPY NOW Naren Ramakrishna, MD, PhD, is the Director of Proton Therapy, and Neurologic and Pediatric Radiation Oncology, and Co-Director of the Brain and Spine Tumor Program at Orlando Health UF Health Cancer Center. Dr. Ramakrishna completed his bachelor’s degree in biology at Johns Hopkins Uni-

Dr. Naren Ramakrishna

Can you update us on the innovative factors involved in your program at the center and why that is drawing patients from around the world for treatment at the center? Dr. Ramakrishna: Our multidisciplinary cancer program pursues innovative clinical research and treatment including cancer vaccines, immunotherapy, cellular therapy, tumor-treating fields, and development of treatment guidelines which are referred to internationally. Our radiation oncology program is recognized for important contributions to the field of image-guided radiotherapy. The proton therapy program was among the first single vault centers internationally and is known for its multidisciplinary expertise, diverse patient mix, and advanced image-guidance capabilities. Tell us about the versatility of the program in treating many different kinds of cancer with the unit? The range of patients treated at our center include those with pediatric cancer, brain and spine tumors, head and neck cancer, breast cancer, lung cancer, lymphoma, sarcomas, and gastrointestinal cancer. This diverse patient mix reflects our disease-specific expertise in these areas and the versatility of our image-guided proton therapy platform. Our proton therapy platform and treatment planning systems have undergone rigorous certification for adult and pediatric clinical trial participation. Please explain how the use of advanced mobile CT works with the unit to monitor response of the treatments? One of the critical factors underlying precise proton therapy is the mapping of patient anatomy, tumor position, and tumor size which may change from day to day. These changes have a greater impact on the quality of proton treat-

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versity, and graduate education in the Medical Scientist Training Program at Cornell University Medical College where he received his MD, and a PhD in Cell Biology and Genetics. Dr. Ramakrishna served for eight years on the faculty of Harvard Medical School where he was an Instructor in Radia-

ment than on conventional X-ray treatment. The in-room mobile AIRO CT unit allows for monitoring these variables on a daily basis and this facilitates accurate treatment of tumor and better sparing of surrounding normal tissue. Critics of proton therapy say the cost isn’t justified when looking at the benefits considering purchase and installation of a unit with the relatively small number of patients that qualify for treatment. Can you tell us your views? Complications following radiation treatment may not manifest for many years following treatment. As the long-term prognosis of cancer patients improve, the number of patients who may benefit from proton therapy increases, as the dose to normal tissue and resulting risk of complications is lower with protons than with conventional X-rays. The economic benefit of this reduction in long term complications is an area of active investigation. At our center, we are modeling this incremental cost/effectiveness ratio for adult brain tumors treated with protons vs. conventional treatment. By doing so, we hope to demonstrate the economic cost-effectiveness of proton treatment for selected patients and improve access for those patients. Another criticism is that there haven’t been comprehensive studies that compare proton therapy with traditional treatments. Can you also give your views on that and explain why those types of studies may or may not be relevant? The improvement in dose distribution achievable with proton therapy relative to conventional radiation is indisputable. This prompted the historical use of this modality for critical applications such as pediatric cancers, brain and spine tumors, and certain eye tumors. Given the dosi-

According to the National Association for Proton Therapy, patients experience a number of clinical benefits: • Proton Therapy delivers less radiation to healthy tissues and organs resulting in fewer, less severe short and long-term side effects than standard radiation therapy.  • Due to fewer complications and side effects, physicians can potentially deliver higher curative doses of radiation to cancerous tumors.  • Multiple studies have demonstrated that patients treated with proton therapy have improved survival rates when compared to other radiation treatment modalities.  • Chances of developing a secondary cancer in later life due to radiation treatment are

significantly reduced. • Proton Therapy is highly indicated for radiation treatment of pediatric cancers due to the high risk of children to develop secondary cancers from their initial treatment later in life.  • Studies have consistently demonstrated that proton therapy patients experience a higher quality of life during and after treatment.  • The only radiation treatment available that can treat recurrent tumors that have previously been treated with radiation.  • Treatments are non-invasive and painless and typically take 15-45 minutes per treatment.

are coming to us from near and far because of that philosophy and the unique benefits proton therapy has to offer.” In January 2018, the Center for Proton Therapy became the first facility to combine a compact proton therapy system with advanced mobile CT (computed tomography) imaging, which allows physicians to efficiently monitor a patient’s tumor response under treatment. The development furthered Orlando Health’s his-

tory as a pioneer in the use of state-of-the-art image-guided radiation therapy. As the program moves forward, there is great excitement regarding future plans for growth. Clinical expansion is on the horizon and new technologies, like next-generation intensity modulated proton therapy (IMPT), will further enhance benefits and open treatment options for an even broader range of cancer patients from Florida and beyond.

tion Oncology and was the Chief of Cenadvanced applications of stereotactic radiotral Nervous System Radiation Oncology at surgery, and proton treatment for primary Dana-Farber Cancer Institute and Brigham and metastatic brain tumors. and Women’s Hospital, and the Director of Orlando Medical News asked Dr. Rathe Central Nervous System Radiosurgery/ makrishna about the Center and some of Radiotherapy Fellowship program. He is the controversies surrounding proton thercurrently a Professor in Radiation Oncolapy in general. ogy at the University of Central Florida College of Medicine. His current research centers on radiobiological and Your Host modeling, and Presenter: metric and theoretical advantage in these patient groups, there will likely never be comparative clinical trials comparing outcomes for these highrisk settings. The use of proton therapy for more common cancers has been relatively recent and the long-term data necessary to validate the benefits of treatment will require completion of ongoing clinical trials involving disease sites such as prostate, breast, and lung Dr. cancer. DeArcy Vaughan PharmD, MBA, BCACP, CDE, CTTS

There has been concern expressed over neutron radiation risk to patients and staff from proton therapy. Can you tell us what the latest information is on that? Secondary neutrons may be produced both inside and outside the patient during treatment with proton systems as well as high energy conventional X-ray units. However, the magnitude of this neutron exposure is extremely small compared to the delivered dose of protons, and there have been no observed clinical effects attributed to this neutron dose. The occupational exposure for staff to secondary neutrons is mitigated by shielding and distance to safe levels. The level of secondary neutrons is further reduced using pencil-beam scanning systems.

Can you tell us a little more on what improvements to the unit and the program at the center are planned for the future? As our clinical volume and range of disease sites expands, we plan to add additional treatment capacity and incorporate next generation dose-shaping and treatment verification technology. We are currently evaluating next generation pencil-beam scanning systems and in vivo dose imaging technology to further enhance our ability to deliver dose accurately and with the least side effects.

“This is a s results spe

- Dr. Brian

Dr. DeArcy Vaughan, PharmD is the owner of the Jacksonv growing medical service franchise in the country. She earne of Business Administration degrees from the University of Flo 23 years in pharmacy in the pharmaceutical industry, comm settings. Her last assignment in managed care was working quality measures and HEDIS scores. She has a passion for specialty credentials through the years including a Board C (BCACP), Certification in Diabetes Education (CDE), and Ce (CTTS). She also served as President of the Duval County and is still active on their board. Throughout her years in h failures in the system for both the patient and provider. DeA consultant and is excited to share with you how partnering patient outcomes while, at the same time, greatly increas work, DeArcy and her husband, Alyn, like doing home imp their kids, Genevieve and Campbell, playing on the beach in

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Revenues for Physicians

RAMI PACKARD 904-907-4542 RPACKARD@RX2LIVE.COM

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Is Your Practice Doing What HIPAA Requires it to Do? By M BRETT JAFFEE

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that protects the privacy and security of patient’s health information in all formats. In addition to HIPAA, state and local laws will also protect this Patient Health Information (PHI). HIPAA has both privacy rule and security rule to cover patient PHI. Any entity that creates, collects, process and transmits patient’s PHI is required to protect privacy and security of the information. Privacy rule applies to PHI in any form such as paper, electronic etc. Security rule applies to electronic PHI. (ePHI) Security corresponds to physical security to the area where the ePHI is stored, access to this information, protecting while storing and transmitting through proper encryption. Covered entities, such as Health Plans, health care providers, business associates and health care clearing houses, are required to implement the HIPAA Privacy, Security and Breach Notification Rules in their health care practice. The Office of the National Coordinator for Health and Human Services (HHS) Office for Civil Rights (OCR), created the “Guide to Privacy and Security of Elec-

tronic Health information” to help covered entities implement and protect PHI. Covered entities have a responsibility to protect patient’s right including provide Notice of Privacy Practice, respond to Patient’s requests for access, amendment, accounting disclosure, restrictions on uses and disclosure and confidentiality of communication of their PHI. A patient’s ePHI is likely to reside on different systems within a practice including laptops, desktops, tablets, cloud, etc. and health care providers are required to provide Cybersecurity to protect this information. Bottom Line: This is not a choice. This is what HIPAA demands! So now, in an environment where data is hacked and seized multiple times a day across the country, Health Care offices need to comply and fast. Step One – Risk Assessment. HIPAA actually requires covered entities and their partners to conduct risk assessment on their organizations. (spoiler alert: They don’t) Risk Assessment reveals the weaknesses in the organization’s vulnerabilities in the protection of PHI. There are even free downloadable tools developed by the Office of National Coordinator and HHS for performing risk assessment. The SRA tool can be downloaded at: https:// www.healthit.gov/topic/privacy-security-

and-hipaa/privacy-security-resources-tools This tool can help healthcare providers conduct the required security risk assessment. It is an easy tool and all information entered is stored on providers local system with nothing being transmitted to outside entities. The results are even printed into a report. The tool will check how your practice meets the HIPAA regulation. Addressing security policies, workforce, data, the practice, and associates. This comprehensive free tool is the perfect start for every healthcare organization. The practice of burying our heads in the sand is no longer a viable solution. The risk to the practice is now too severe. Organizations can be brought to their knees by hackers and ransomware and suffer a far greater consequence if it comes to light after the organization didn’t properly prepare, handle or notify regarding security breaches. Hospitals and any large organization are now paying ransoms because it’s a cheaper more efficient solution than refusing to pay. That should put every healthcare office in the country on notice. They are next. If the hospital has decided it’s less expensive to pay the ransom and be able to resume business as usual, then that philosophy will likely apply to the smaller health care offices as well.

However, I assure you, it is incredibly less costly to prepare. And preparing ensures your compliance with HIPAA. Preparing reduces your organization’s vulnerabilities. Preparing protects your patients. Preparing protects your employees. Preparing protects you and the tools you need to begin are free. Yet all over America, health care providers are NOT preparing. They are not taking the simple first steps to protect their organizations and be HIPAA compliant… Steps they are actually required to make. The days of burying your head in the sand are over. This has now become a game of Russian roulette with 5 bullets in the chamber. The alarm is sounding, not only from the bad guys, but the good guys too. Organizations MUST take all the steps necessary to protect their PHI and if they don’t, they are NOT HIPAA compliant. AND, they are vulnerable. M. Brett Jaffee is VP of Sales for NSG and has over 25 years of experience selling and marketing primarily to Fortune 1000 companies.  After successful stints at HearFromMe. com and WelltalityHealth.com, where Brett was responsible for HIPAA and Data Compliance systems, Brett has brought his experience and protocols to NSG. Visit www.nsgi-hq.com  

AdventHeAltH CAnCer InstItute’s Formerly known as Florida Hospital Cancer Institute

Formerly known as Best of ASCO®

AUGUST 24 & 25, 2019 – ORLANDO, FLORIDA tHe rItz-CArlton orlAndo, GrAnde lAkes

REGISTER TODAY AdventHealth Cancer Institute is proud to bring the highlights of the 2019 ASCO Annual Meeting to you through its licensed ASCO Direct™ Highlights. The ASCO scientific committee selects the highest rated abstracts from the Annual Meeting to be available for licensed ASCO Direct™ Highlights meetings around the world. Highly Requested Meet the Professor | Breakout Sessions Round Table Discussions* Lunch Provided · RSVP Required · Limited Seating

The Ritz-Carlton Orlando, Grande Lakes 4012 Central Florida Parkway | Orlando, FL 32837 Hotel Reservation Line: 800-266-9432 For more information or to register: AdventHealthCancerInstitute.com/ClinicianEvents AH.ORL.CI.Registration@AdventHealth.com 407-303-1945 or 800-375-7761 Physicians: AdventHealth Orlando is accredited by the Florida Medical Association to provide Continuing Medical Education for physicians.

*Physician Participation Only at Round Table

Intended Audience: Physicians, Fellows, Residents, Medical Students, Oncology Nurse Practitioners, Oncology Nurses and other Oncology Allied Health Care Professionals.

Florida Society oF clinical oncology (FlaSco)

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AdventHealth Orlando designates this live activity for a maximum of 9 AMA PRA Category 1 Credit(s)™ and Sunday, Breakout session 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in this activity.

Nurses:

Up to 1.5 Nursing Continuing Education Credit Hours have been applied for Saturday, August 24th and 5.5 Nursing Continuing Education Credit Hours have been applied for Sunday, August 25th through the Florida State Board of Nursing Provider Number NCE2012/CEBroker Provider Number #50-724.

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THE HR LADY

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y d a HR L

THE

Is it Enough to Have Satisfied Employees? Must They be Engaged​? By Wendy Sellers, The HR Lady

If you are in management, leadership or HR, you know the buzz is all about having engaged employees. So, what the heck does this mean and why should you care? Definition: Employee engagement is the emotional commitment the employee has to the organization and its goals. (Forbes.com) Ok, so why is it important for your employee to have this emotional commitment? Can’t they just do their #$%**! job? Sure, they can do the minimum requirements of the job to avoid being fired. But let’s be honest, almost everyone is doing more with less time and less employees since the economy tanked. The

flourish brought a crunched operating budget with revenue flow that is tight. For some industries the budget is flowing and so is the revenue - yet experienced, loyal and dedicated employees are no longer a dime a dozen. See, this is where the emotional commitment comes in. When your employee is dedicated to the job and to you, they will be less likely to be swept away by a competitor, they will be more likely to stay late/come in early and put in extra (paid or unpaid) hours to make sure the job is not only done - but done right, and they will be much more likely to tell their experienced, loyal and dedicated friends to come work for you and alongside them.

• Satisfied employees come to work and do the job. • Satisfied employees gladly take the pay and benefits and even participate in the employee pool table tournament. • Satisfied employees do not always go the extra mile or take successes/losses personally. • Satisfied employees recommend their friends who want to be “just satisfied.”

According to Towers Perrin research, companies with engaged workers have 6 percent higher net profit margins, and according to Kenexa research, engaged companies have five times higher shareholder returns over five years. (Forbes). Call an HR consultant (such as The

HR Lady) for advice to analyze and develop an engaged workforce. Wendy Sellers has a master’s degree in Human Resources, a master’s degree in Health Care Administration, is a passionate HR Consultant, Leadership Coach, author, and speaker. She has worked with hundreds of corporations and associations conducting management training, leadership development, and HR advisory services. She has experience as an HR Executive and Practitioner, an HR Advisor, a Board Member, and an adjunct faculty member. In additional to her formal education, Wendy is HR certified as an SHRM-SCP and SPHR, is health/life insurance licensed, is a Dale Carnegie course graduate, and is an active and past board member and volunteer for multiple non-profits and a National Speakers Association professional member. She also teaches the SHRM certification course. Visit www.thehrlady.com

Retention/turnover was the top workforce management challenge cited by 47% of HR professionals in the SHRM/Globoforce survey Using Recognition and Other Workplace Efforts to Engage Employees.

Employee Retention Affects Productivity

Management Training Affects Employee Retention

Wendy Sellers, The HR Lady®

with 25 years of experience, a Masters in Healthcare Administration and a Masters in Human resources, is an energizing and relatable management workshop facilitator

Productivity Affects Revenue

Wendy Sellers, MHR, MHA, SHRM-SCP, SPHR • 407.493.1582 • wendy@thehrlady.com • thehrlady.com 9

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Small Fiber Neuropathy By RAMI PACKARD

Small Fiber Neuropathy, sometimes referred to as Autonomic Neuropathy, is caused by damage to the small nerves that supply feeling to the body, assist in breathing, regulate heart rate, control perspiration and aid with digestion. Neuropathy is defined as a collection of disorders that occur when nerves or the peripheral nervous system (the part of the nervous system outside the brain and spinal cord) are damaged. Small Fiber Neuropathy is a common neuromuscular disorder associated with many medical conditions, including diabetes mellitus, amyloidosis, HIV infection, connective tissue diseases and pharmacological neurotoxicity. In many cases, particularly in elderly patients, no specific cause is found. The clinical presentation usually consists of cutaneous pain, sensory loss and autonomic dysfunction, which can lead to functional impairment. Some patients may present with pain as the primary or the only symptom, but pain is inherently subjective and difficult to measure or quantify. A sensitive and specific diagnostic tool is thus essential for making a correct diagnosis and providing appropriate subsequent management. Skin Biopsies are a safe procedure with minimal discomfort that allows somatic fibers carrying temperature and pain sensation to be differentiated from autonomic fibers. Loss of epidermal nerve fibers correlates with increased severity of neuropathy and a higher risk of developing neuropathic pain. Skin nerve fibers can regenerate, and their regrowth rate could be a marker of early axonal damage in patients at risk of developing peripheral neuropathy. A skin biopsy can be repeated in close proximity to a previous biopsy to assess the progression of neuropathy and the response to neuroprotective treatments - and can be used as a measure of outcomes in clinical trials. Small caliber nerve fibers consist of somatic and autonomic fibers. They play key roles in cutaneous nociception, thermoreceptor and autonomic function. Autonomic function can be assessed by specializing tests which quantify sweat output and assess cardiovascular regulation. However, not all patients with Small Fiber Neuropathy have autonomic involvement, so a test that will assess the somatic fibers may be useful. These fibers are small, and many are unmyelinated with very slow conduction velocities, and therefore, their conduction responses cannot be captured and evaluated by routine nerve conductor studies. This gap has been filled by a histological method to evaluate cutaneous nerve fiber density. The most common causes of small fiber neuropathy are diabetes, pre-diabetes, and metabolic syndrome. Studies have shown that up to 50 percent of patients with 10

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Fibromyalgia suffer from Small Fiber Neuropathy. There are a multitude of clinical papers stating that punch biopsies should be routinely used to diagnose Fibromyalgia. Additional papers and studies also state that Small Fiber Neuropathy is the first finding for neurological sequel from diabetes. Another chronic pain clinic that treats patients not only for Fibromyalgia, but also chronic back and neck pain found that 50 percent of their patients are suffering from Small Fiber Neuropathy as well. The implications from this are stunning. There is currently a general feeling that all the patients on chronic opioids are opioid addicts and do not have a real diagnosis or problem warranting treatment. This test will allow providers to screen for Small Fiber Neuropathy and diagnose up to 50 percent more patients. There are many options available for treating Small Fiber Neuropathy. The most effective ones address the underlying cause. Most often, the focus of treatment is on symptom control. If the cause is diabetes, pre-diabetes, or metabolic syndrome, papers have shown the symptoms improve by treating the insulin resistance, de-conditioning and vitamin deficiencies. Some people are also helped by physical therapy, well balanced diets, avoiding exposure to toxins, exercise, vitamin supplements, limiting or avoiding alcohol, prescription drugs or other complementary and integrative therapies.

All providers know how well patients do in comprehensive functional restoration programs. Now we know why. Studies also show the nerves regenerating and growing back with the proper managed treatments. A punch biopsy is done with a circular blade ranging in size from 1 mm to 8 mm. The blade, which is attached to a pencil-like handle, is rotated down through the epidermis and dermis, and into the subcutaneous fat, producing a cylindrical core of tissue. An incision made with a punch biopsy is easily closed with one or two sutures. Some punch biopsies are shaped like an ellipse, although one can accomplish the same desired shape with a standard scalpel. The 1 mm and 1.5 mm punch are ideal for locations where cosmetic appearance is difficult to accomplish with the shave method. Minimal bleeding is noted with the 1 mm punch, and often the wound is left to heal without stitching for

the smaller punch biopsies. The disadvantage of the 1 mm punch is that the tissue obtained is almost impossible to see at times due to small size, and the 1.5 mm biopsy is preferred in most cases. The common punch size used to diagnose most inflammatory skin conditions is the 3.5 or 4mm punch. Rami Packard and her husband have owned several businesses, all in the customer service industries. After owning a home care agency, serving as a resident director at an assisted living facility, and being a small business consultant for years, she found RX2Live. She is currently serving as the Regional Developer for the Northern Florida and Southern Georgia markets. Rami keeps busy assisting medical practices as they grow their practices and keep their patients well. She also assists with senior and corporate wellness programs. She has a passion for health and wellness and loves sharing this with the community. To learn more about how your practice can benefit from implementing this Medically Necessary procedure into your daily routine contact rpackard@rx2live.com or visit www.livewell.RX2Live.com

LOWE & EVANDER, P.A. MICHAEL R. LOWE, ESQ., BOARD CERTIFIED IN HEALTH LAW BY THE FLORIDA BAR 407.332.6353 | LOWEHEALTHLAW.COM 707 MONROE ROAD, SANFORD, FL 32771

Nothing is ever as it seems. Hide in plain sight. Perception becomes reality. If you’ve had one or more of these thoughts today, you may want to give us a call. Florida-based Law Practice Representing Physicians & Physician Group Practices

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Pain & Suffering By ROBERT HALL

Many have written about it; the lament that history repeats itself. When I was a younger man, in 1994, I started my career as the managing agent for a national medical malpractice insurance carrier. It was a rather cool gig for a twentysomething. They empowered me with a lot of authority for a young man with limited experience. During that time period before 2003, we underwrote medical malpractice insurance coverage beneath a Sword of Damocles; because we understood a jury verdict was unlimited regarding pain and suffering. My direct report was a lot older and wiser, and he pounded that point into my fertile brain. In basic terms, a judgement from a medical malpractice case breaks down into two components: The economic loss calculated based on the plaintiff’s personal situation, and the non-economic damages, known as pain and suffering. Since 2003, in the state of Florida, until about June 8, 2017, the legislature has capped damage awards for pain and suffering in medical malpractice cases at $500,000. I know there is legal wiggle room, but for this article I’ll keep it simple. If you’d like to know the case, N. Broward Hosp. Dist. v. Kalitan, Fla., No. SC15-1858, 6/8/17 One of my duties on the carrier-side was analyzing, underwriting, the information submitted to us from an insurance broker or directly from a physician or hospital. The submission was a paper application with supporting data. In those days, we had a lot of dead trees dropped onto my in-box. At the peak renewal season, I often wondered if I was playing a tiresome game of Jenga. My job was to unscramble the data looking through the company underwriting guide’s prism, and hopefully from on-thejob training, and instruction, I would have learned to have developed good judgment. I had no place to hide if the insurance coverage that I had signed off on blew up in my face. The underwriting file had my reasoning, my analysis, and the policy form had my name and signature at the bottom of the declaration page for all to see. I’ll share one of my real a world experiences from the late 1990s, and what as a practical matter, it means for the pain and suffering caps being struck down, and how that has quietly impacted carrier financial exposure. I had underwritten a physician, and I had added him to our book of business. Unfortunately, a year later he got sued for medical negligence by a young woman with a terrible medical and personal history. (The information I’m sharing is vague on purpose.) To put it mildly, she was in severe pain. Our physician’s therapy efforts had not eased her pain. But the medical records showed that the physician had tried his best. I read the records; we had talked with our insured. From our perspective, our physician had not committed medical malpractice by any textbook measure, and our medical experts agreed to back up our legal response. 11

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We thought the plaintiff’s lawyer was being unreasonable. As time passed, it was clear we could not resolve the dispute, so; We took the case to trial. In reality, the plaintiff made a compelling witness. The lawyer understood what he had in her, and also understood our reliance on the cold, hard facts, and the fact we had a mountain of money behind us. Unfortunately for me, looking back twenty years, I think the jury felt what her pain and suffering meant. She swayed the trial in her eyes. Unfortunately, for me, my claim manager, and our lawyer, we were not paying close attention to what mattered to the jury; her suffering. Remember, when an insurance carrier or other takes a case into a trial arena, as the saying, all bets are off. It’s not just about quality care or breaching the standard of care. They do not compose a jury of clinical risk managers, physicians, and hospital executives. We got our pride handed back to us with a $5 million plus verdict, and we paid our legal fees. It was an expensive lesson. And I should point out, our insured’s insurance policy had a $250,000 per occurrence limit. We had not offered the policy limits timely; we got caught in bad faith. For the next year, it was not comfortable sitting in my office chair, wondering if I needed to work on my resume. I understood it would take a lot of new insurance premium to cover up a $5 million sin while simultaneously not adding more liability claim files. Fast forward to 2019. It has been well over a decade since the

medical malpractice insurance business has, for what the insurance industry labels, a hardening market. If I were to share a graph starting in 2005, it would show a consistent downward line in premium cost relative to time. The reason for this premium trend moving downward year-over-year, in part, related to the pain and suffering caps working, and having provided a downward pressure on carrier aggregated losses. I know there are other contributing factors that have influenced a softer market. In the meantime, this healthcare delivery era has ushered in value-based payment models and the need for quality metrics driven from data aggregation. The data impacts provider decision making and hospital system and practice revenue. These systemic shifts occurred, while the medical malpractice insurance market has mostly remained soft. But my instinct is that in Florida the trend is to a hardening period. And I sus-

pect there will be a cascading effect on all commercial insurance lines and alternative financing models. If so, and I hope I’m wrong, my recommendation going forward is pay closer attention to the financial rating for medical malpractice insurance carriers and reinsurers. Inquire insurance brokers and insurance carrier representatives about loss trends, and if to expect upward rate pressure. Be prepared to manage the inherent conflict. As we all know, history repeats itself. Robert Hall, a broker in Healthcare products for ARCW Insurance in Pinellas Park, has over twenty-four years of experience in the healthcare, life sciences, and long-term care liability insurance and risk management business. He holds the ARM designation and has developed an expertise in healthcare, having placed complete insurance programs for hospital systems and large physician groups. He has also created captive feasibility studies and other alternative risk models. He has a strong understanding of HMO Reinsurance and Provider Stop-loss. Contact him at robert@arcwinsurance.com

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Medical Cannabis Use Continues to Increase with Senior Citizens By MICHAEL C. PATTERSON

In the United States, cannabis use is growing faster with seniors than any other age group. A 2016 study from the National Survey of Drug Use and Health showed a ten-fold increase in cannabis use among people 65 years or older. However, according to researchers, a lack of communication with their doctors and the continued stigma of cannabis keep barriers higher to getting this natural medicine. In Florida as of July 26, 2019, there were over 330,000 patients who have qualified to use medical marijuana (MMJ). The average age of a MMJ patient is 50 years old. Florida has one of the oldest populations in the United States. As more Seniors become familiar with the benefits of MMJ, more will use it, with or without physician involvement. A recent study published in May 2019 in the Journal of Drugs and Aging looked at how older Americans use cannabis and the outcomes they experience. The study was conducted at the University of Colorado School of Medicine. The goal of the study was to understand how older people perceive cannabis, how they use it, and positive and negative outcomes associated with cannabis use. “Older Americans are using cannabis for a lot of different reasons”, said Hillary Lum,

MD, PhD, co-author and assistant professor at the Colorado School of Medicine. “Some people use it to manage pain while others use it for depression or anxiety.” The research team held 17 focus groups in multiple settings (senior centers, health clinics and cannabis dispensaries) in 13 Colorado counties. These focus groups included more than 130 people over the age of 60, which included some non-cannabis users as well. Lum verbalized that participants identified “five major themes” which are as follows:

• Lack of research and education about cannabis • Lack of provider (physician) education about cannabis • Lack of access to medical cannabis • Lack of outcome information about cannabis use • Reluctance to discuss cannabis use Some participants in the study told researchers that they were nervous talking to their physician about questions regarding the use of medical cannabis, which Lum said points to a “failure of communication between health care providers and their patients.” Other participants told researchers that they bypassed their physician and went straight to buy recreational cannabis (since it is legal in Colorado), because their physician would not

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provide them a recommendation for cannabis, or they did not feel comfortable asking their physician for a recommendation. “I think (doctors can) be a lot more open to learning about it and discussing it with their patients,” said one focus group respondent. “Because at this point, I have told my primary care I was using it on my shoulder. And that was the end of the conversation. He didn’t want to know why, he didn’t want to know about effects, didn’t want to know about side effects, didn’t want to know anything.” The study adds to the growing literature on the diversity of marijuana use patterns in older adults, said co-author Sara Honn Qualls, PhD, ABPP, professor of psychology and director of the Gerontology Center at the University of Colorado Springs. “Older adults who use marijuana are ingesting it in a variety of ways for multiple purposes,” she said. “This and other papers from the same project show growing acceptance of marijuana use for medical purposes by older adults, and a clear desire to have their primary health providers involved in educating them about options and risks.

Hillary Lum agrees. “From a physician’s standpoint this study shows the need to talk to patients in a non-judgmental way about cannabis,” she said. “Doctors should also educate themselves about the risks and benefits of cannabis and be able to communicate that effectively to patients.” In the very near future, all physician practices will be affected by medical cannabis in some way. Based on mounting evidence, patients will seek out MMJ with or without physician involvement. The physician groups who provide cannabis recommendations, or at least an openness to discuss using MMJ as a medicine, will maintain and increase the number of practice patients and patient satisfaction. The physicians who continue to leave their “head in the sand” and ignore MMJ as a treatment will lose patients and ancillary services (lab, x-ray, anti-aging treatments, etc.) associated with those patients. 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

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Keeping Up with Orlando’s Medical Real Estate Needs By TAMARA KHAN

With Millennials being the largest living generation of 74 million (based on U.S. Bureau of Statistics projections from 2016 Census), Orlando is becoming and is establishing itself as a startup and corporate destination. It is evident in Orlando’s median age being 36.5 years old. This is in part due to Florida’s steady sunshine, but also the low state and local taxes. The Orlando metropolitan statistical area (MSA) is comprised of Osceola, Orange, Seminole and Lake counties - one of the largest in Florida with a population of more than 2.3 million. It is expected to grow 1.8 percent annually for the next five years. Furthermore, the nonimposition of personal income tax is quite attractive for employers to recruit and retain skilled labor in the region. Orlando recognized 75 million tourists in 2018, for which the $2.1 billion dollar expansion at Orlando International Airport is necessary. Aside from being a vacation hot spot, the city is becoming a medical destination due to its research and facilities. Adjacent to UCF are Lake Nona Medical City, Central Florida Research Park, and the Quadrangle Office Park. The latter of which is recognized as one of the top research parks in the world. Notably, Lake Nona

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Medical City is a 650-acre health and life sciences hub where medical care, research, and education are the primary emphases of businesses located there. University of Central Florida offers top-ranked programs for engineering and computer sciences. In addition, the Technology Incubator provides the tools, training, and infrastructure that help facilitate smarter, faster, startup growth. Over the past 10 years, Florida has created nearly 150,000 jobs in the education and health service employment sector. This is indicative of the need for services to the growing population as evidenced by the number of practicing physicians per capita - 260/100,000 people, just below the national average of 271.6, ranking Florida #24. Combined, the two major hospitals in Orlando employ about 50,000 people and continue to be a destination for world-class healthcare. In addition to several current downtown projects, Orlando Health will be prominent in Winter Park by occupying 20,000sf of medical office space - becoming highly accessible to its surrounding community. Two freestanding ER’s (Waterford Lakes and Oviedo), and the commencement of 3 others, are among the projects in AdventHealth’s pipeline. The short-term and long-term expansionary construction plans are strong for both hospitals.

Florida’s warm climate, attractive assisted living facilities, and amenitized senior luxury communities, are among the top reasons many Baby Boomers, choose the Sunshine State. National Health Expenditures accounted for 17.9 percent of GDP ($3.5 trillion or $10,739 per person), of which, Medicare spending contributed $705.9 billion to the total. Health care spending is projected to rise by 4.8 percent in 2019 and is expected to grow at an average 5.5 percent per year through 2027 - as stated by actuaries at the Centers for Medicare and Medicaid Services. The effects of demand for primary care and elective services in relation to population growth are highly correlated. As such, medical offices are willing and able to pay higher rents, increasing the value on the properties, and making them not only attractive, but necessary investments. As people are consistently on the quest for youth preservation, more and more physicians offer (or are co-located with) synergistic services like medical spas. Med-spas can be found in luxury shopping centers and professional office parks alike and offer a range of services from Botox and non-surgical procedures, to dermatological rejuvenation. After several years of practicing, many physicians are realizing the benefits of own-

ing their own practices. Albeit, running a business can be challenging in and of itself, they are recognizing less time constraints and operational decision-making freedoms to adapt as they see fit – compared to work-life in hospitals alone. Aside from the medical expertise, understanding their community and patients allow for more personalized health care, which is essential to any business. Summarizing, not only are medical offices and surgery centers well valued, but they often are under long term leases (compared to retail). They tend to renew and are one of the few asset classes that is (nearly) recession proof, as confirmed by the Bureau of Labor Statistics study on Healthcare Jobs and The Great Recession. Tamara is an investment and owner’s representative at Lamm & Company Partners, working as a land development and site consultant. Specializing in “Build-ToSuits”, she assists in taking projects from due diligence and investment analysis, to program design and permitting. Alongside her Senior, she collaborates to manage design and budgetary constraints, while maintaining investor required return, and achieving specific client needs. She holds a masters from Dr. Phillips School of Real Estate at the University of Central Florida. She can be contacted at mailto:khantamara@yahoo.com

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What’s New in the Use of Restrictive Covenants by Florida Medical Practices and Healthcare Businesses? By DON WEINBREN

It is expensive to own and operate a medical practice or healthcare business - the costs of electronic health records technology, medical and office equipment, and building and maintaining business relationships is significant. Physicians and healthcare business owners justifiably want to protect their investments. One protective method is to prohibit a departing owner or employee from competing or soliciting and accepting business from existing patients and referral sources through non-competition and non-solicitation/nonacceptance agreements (collectively, “restrictive covenants”). So, what is new in the enforceability of Florida restrictive covenants? The discussions below on Florida law updates apply the general rule, stated in §542.335, Fla. Stat., that a restrictive covenant, which is in writing and signed by both parties, can be enforced to protect one or more proven “legitimate business interests,” as long as the restriction is “reasonable in time, area, and line of business.” For this purpose, “legitimate business interests” include, among other things, trade secrets and substantial relationships with specific prospective or existing customers, patients, or clients.

New §542.336, Florida Statutes The 2019 Florida Legislature passed, and the Governor signed, CS HB 843, section 10 of which added new §542.336, Fla. Stat. Effective July 3, 2019, a restrictive covenant entered into with a licensed physician who practices a specialty in a county where one entity employs or contracts with all physicians who practice that specialty in that county is not supported by a legitimate business interest, and thus is void and unenforceable. Furthermore, the restrictive covenant remains void and unenforceable until three years after a second entity employs or contracts with one or more physicians to practice that specialty in that county. Although the application of §542.336 is limited to counties in which only one entity employs all of the physicians in a specialty, the impact of §542.336 could be much broader, and questions remain unanswered. For example, what happens if Group A operates in County 1 and County 2 with specialists who practice in both Counties, and Group A employs all of the specialists only in County 1, but Group B also employs physicians in the same specialty in County 2? While not free from doubt, it appears that Group A might be able to enforce a restrictive covenant to prohibit competition by a departing physician, but only in County 2; the restrictive covenant would be null and void in County 1. However, if there is no legitimate business interest, then could a court be persuaded also to ignore the restrictive covenant in County 2? Also, it is not clear whether §542.336 14

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applies only to contracts entered into after its effective date, or whether it applies to existing contracts for which enforcement is sought after the effective date. There is an acknowledgment of this issue in a “Bill Analysis and Fiscal Impact Statement” published by the staff of a Senate Committee with respect to a similar predecessor bill (S 882), but the analysis neither states the Committee’s intent in this regard nor reaches a conclusion. Ultimately, the courts will decide.

Referral Sources as Legitimate Business Interests Section 542.335 is silent on whether referral sources constitute a “legitimate business interest” on which a restrictive covenant can be enforced. For a number of years, the Florida District Courts of Appeal were split on this question, with the Fourth District ruling that referral sources are a legitimate business interest (see, Infinity Home Care, L.L.C. v. Amedisys Holding, LLC, 180 So.3d 1060 (Fla. 4th DCA 2015) and the Fifth District ruling that referral sources are not included because a referral source provides unidentified prospective patients, which are not a legitimate business interest (see, Florida Hematology & Oncology v. Tummala, 927 So.2d 135 (Fla. 5th DCA 2006). The Florida Supreme Court finally resolved the conflict in White v.

Mederi Caretenders Visiting Services of Southeast Florida, LLC, 226 So.3d 774 (Fla. 2017), at least in the specific factual circumstances raised in the case. In White, which was a consolidation of two separate cases (one from the Fourth District and one from the Fifth District), former marketing employees of two home health agencies (“HHAs”), neither of whom had worked as marketers in the HHA industry prior to their employment and brought no relationships with existing referral sources to the HHAs, solicited the referral sources of the HHAs on behalf of their new employers. Each HHA sought to enforce a written restrictive covenant signed by its former employee to prohibit solicitation of its referral sources. The Court ruled that §542.335 does not preclude referral sources from being legitimate business interests. In rejecting the reasoning in Tummala, the Court stated “[a]ttempting to protect identifiable referral sources is distinct from claiming an interest in an unidentified patient base.” The Court also noted that referral sources are an HHA’s “most important business asset,” and thus, based upon appropriate facts, can be protected under §542.335. The Court then went further, providing guidance to the lower Florida courts on how

to apply the White ruling, stating “the determination of whether an activity qualifies as a protected legitimate business interest under the statute is inherently a factual inquiry, which is heavily industry - and contextspecific.” It also stated that a specialist physician’s referral sources could constitute a legitimate business interest, if the facts support that conclusion. White clarified the issue of referral sources, but not all questions have been answered. For example, it is not clear that a practice could prohibit a withdrawing specialist from soliciting or accepting business from referral sources with whom the physician had relationships prior to joining the group. The answer likely will depend upon the facts of each case.

Federal Activity There occasionally are federal attempts to limit the use of restrictive covenants. For example, Senator Marco Rubio introduced a bill on January 15, 2019, the “Freedom to Compete Act,” S. 124, 116th Congress. The bill currently has no co-sponsors, and its likelihood of passage is unknown. If passed, it would add new Section 8 to the Fair Labor (CONTINUED ON PAGE 15)

What’s in your Lobby?

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Physician & Healthcare Professional’s Guide to Capital By MARISSA IGNATOWICH

A business owner’s personal credit score can seal the fate of the business by determining access to capital, cash flow, and its ability to grow. Healthcare Professionals who own practices rely on this marker of financial fitness as much as other entrepreneurs. Most medical practice owners need access to credit, whether it is to purchase or expand a practice, acquire equipment, upgrade technology, or temporarily cover cash flow shortages.

What are the “Perks” of a Good Credit Score?

Maintaining a good credit score is a key step to ensuring access to the best lending opportunities. “If you have bad credit as an individual, and especially as a business owner, you are missing out on amazing opportunities, and you are paying more for everything you do,” said Toya Lambeth of Fortress Credit Professionals. Lenders base their decisions on multiple factors, but personal credit scores often play the biggest role in their decision-making. A high score increases your chances of approval and your negotiating power and may get you approved for higher amounts or limits. Moreover, a good credit score translates to low interest rates on loans and lines of credit. Lower interest expenses can be a breath of fresh air for medical practice own-

What’s New in the Use of Restrictive Covenants, continued from page 14

Standards Act of 1938 (the “FLSA”) to prohibit any employer from enforcing an existing or imposing a new “non-compete agreement” on any employee who does not qualify for the FLSA’s minimum wage and overtime exemption for bona fide executive, professional and outside sales employees. In his introductory press statement, Senator Rubio noted “agreements that arbitrarily restrict entry-level, low-wage workers from pursuing better employment opportunities are egregious.” The scope of the bill is limited to nonexempt employees, so it would not prohibit restrictive covenants with most licensed health care or marketing personnel. Also, it only specifically prohibits “non-compete agreements,” and it recognizes an employer’s right to protect trade secrets. Thus, it might not prohibit non-solicitation and non-acceptance covenants (which do not actually prohibit employment). Don B. Weinbren is a shareholder with Trenam Law in Tampa, Fl. His practice focuses on healthcare, including matters involving healthcare mergers and acquisitions, managed care contracts, medical reimbursements, provider contracts, as well as state and federal regulation of healthcare industries. He may be reached at DWeinbren@trenam.com.

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ers, who typically deal with significant overhead expenses and irregular revenue cycles.

How can you Improve a Less than Ideal Score?

Stay on top of it The first step in assessing your borrowing power is to find out your credit score. Check your report periodically to track your progress and spot any potential problems. Physicians have busy schedules that can make it challenging to manage financial issues. A trusted personal assistant or spouse can ease the burden by keeping track of your accounts, making payments, and alerting you to credit changes. Correct errors “When you have negative items on your report, they can hold you and your business back for 7 to 10 years,” Lambeth notes. “But the good news is that anything can be deleted as long as there is a mistake.” Look for red flags on your credit report and dispute incorrect information promptly. Removing incorrect or outdated negative marks will help your score recover faster. Start over   If your credit history contains negative items, the best strategy is to start repairing your credit. Some steps you can take are to open new accounts and pay them on time. Even partial payments can be beneficial,

leading to a higher credit score in the long term. Establishing accounts periodically will increase your credit availability, resulting in higher borrowing power. However, avoid having your credit report checked too often, as this can bring the score down. Make efforts to reduce the amount of debt you owe. Keeping credit card balances under 50 percent (ideally under 30 percent) of the total credit limits will provide a boost to your credit score. Your credit score will benefit from having a good mix of credit cards and loans as part of your active credit history. Some creditors close credit cards that go unused for several months. It is important to use your accounts from time to time, to keep them open. Patience and caution are key factors in this equation because there is no quick way to fix a credit score. Rebuilding your credit history will take time, but your efforts and patience will pay off.

Are Alternative Funding Options Available?

The high burden of student loan debt

that most physicians carry, particularly early in their careers, can make it difficult to qualify for SBA loans or other conventional loans that offer low monthly payments and interest rates. If your credit history is less than perfect, you may need to consider alternative lending options, such as short-term funding with higher interest rates. Access to capital for your business enables you to start or expand your practice while you are still building your credit history. Short-term funding may be available even with a poor personal credit score (600 or even lower), especially for financing medical practices, which are known for their high revenue potential. According to healthcare business underwriter Kristen Friszell, if you are using the funds to grow your business and the resulting revenue exceeds the cost of the capital over time, then the higher-cost funding is a prudent investment in your business and your future. In 2013, Marissa Ignatowich began her mission, to bring a personalized alternative source of funding to the healthcare industry. As a family owned private lender, she has been instrumental in advancing the growth of many practitioners. Med Direct Capital is located in the heart of Delray Beach, Fl. and continues to strive to help other business owners.

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Bending the Trend in Healthcare Costs By DARREN REYNOLDS

As healthcare costs continue to rise in the United States, companies are scrambling to find solutions that will drive down expenses without putting employee populations at risk. More than ever, industries are moving toward building high performance health plans, utilizing community-based healthcare models, and turning their attention to Third Party Administrators (TPAs) who can offer more than claims management. The need for the healthcare industry to “bend the trend” and get these costs under control for its own employee populations has never been more important. With more than 100 rural community hospital closures across the U.S. since 2010, it is easy to see the crippling effects these costs have had on the industry’s ability to deliver critical care to the communities it serves.

Here’s how it works

Traditionally, TPAs manage and process claims for clients. It’s the core of what we do, but over time it has become clear that in order to truly help our clients, we need to do more. It has become the responsibility of TPAs to turn an employer’s health insurance program from an operating expense into a performing asset. Over the two decades we have been working within the healthcare system environment, we have been exposed to popula-

tion health management in its original form. We have also been able to work with scores of data in the process. We began to question are there services that can be provided to close the gap in increasing claims cost? Is there a way to consolidate this data and analyze it in a way that could help healthcare systems reduce their costs by keeping their employees healthier—thereby reducing claims? Fifteen years ago, the data that TPAs had access to was simple, static reports. The reports made it possible to tell clients how much money they spent, but we could not identify where costs were increasing. For example, was it attributable the top 10 chronic patients in their employee mix, or were there significant gaps in care? We discovered that by having better data and using data as a tool, clients could better understand the story behind their top patients, and in many cases isolate what was driving up their individual healthcare costs. Over the last decade, our industry has been able to “bend the trend” and use comprehensive data to decrease a company’s overall healthcare costs while at the same time providing better, more meaningful care. Now, we are able to take medical data and claim data, including biometric and phlebotomy results, and embed them in a tool that provides a HIPAA-compliant, population health virtual medical record. This allows an employer’s partner health system or case

management vendor to quickly access a member’s entire health status, gaps in care and willingness to change care record, at the touch of a button.

Knowledge is power

Healthcare costs are typically the second or third largest expense in most companies, and entrepreneurial employers today are participating more than ever in the management of their own health plans. TPAs who partner with healthcare systems to help manage employee populations for those systems, or the communities they serve, will be able to provide valuable information to their clients. Many insurance carriers are not set up to share data with hospital systems, but to be able to do that in a scalable, accessible manner makes an important difference in the level of service and engagement a TPA can offer. Using this “data first approach” helps healthcare decision makers identify gaps in an employee’s care and increase important preventative care methods such as screenings and checkups to keep employee populations healthier and shrink long term healthcare costs. Today, these tools can predict healthcare costs to a 90 percent accuracy rate. In systems with two years of data, TPAs can share – down to the “bellybutton level” – what each employee is expected to incur in healthcare costs over the next 12 months. It allows employers to identify claim issues and members

whose healthcare costs may be significantly higher than the standard. Then, we can not only try to find solutions to manage those higher costs through preventive care but help identify and develop programs that encourage those individuals to lead a healthier life. Many TPAs have access to this type of information. The value however, lies in how it is analyzed and packaged for clients. Employers should be asking their TPA what resources they have and if those tools can better help manage their healthcare costs. Is your TPA helping you develop a high-performance health plan? Just processing claims alone is no longer enough. To make change, we need to impact utilization and intensity within a population. Using this data is a huge step. Using metrics just as you would in other aspects of your business, will help control costs and provide a happier, healthier workforce. Darren Reynolds is president of Consociate Health, an innovator in integrating population health analytics with health care systems for the management of their employee populations. They integrate data and tools into health care systems’ Accountable Care Organizations (ACO’s), Clinically Integrated Networks, wellness programs and direct to employer initiatives. The deployment and integration of data and these support tools in improving the health of the communities they serve was a key factor in earning this award. For more information visit https://consociatehealth.com/

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Federal Cannabis Policies are Hurting Veterans – Here’s How to Fix Them By MAX SIMON

Military veterans face a number of challenging issues on the cannabis front, all thanks to outdated federal laws and regulations. The most painful of these is the fact that cannabis is still classified as a Schedule I controlled substance, which means that it has no currently accepted medical use and is classified similarly to substances like heroin and meth. Because of this, the United States government does not support military veterans having access to medical cannabis. Per the Department of Veterans Affairs (VA):

• VA clinicians may not recommend medical cannabis • VA clinicians may only prescribe medications that have been approved by the U.S. Food and Drug Administration for medical use, such as opioids and other pharmaceutical drugs that are more harmful than cannabis • VA clinicians are prohibited from helping veterans with their state medical cannabis program paperwork • VA pharmacies may not fill prescriptions for medical cannabis • VA will not pay for medical cannabis for veterans from any source • Any use of cannabis on VA grounds is strictly prohibited • Veterans who are VA employees are subject to drug testing under the terms of employment As you can see, cannabis is not tolerated in any way, shape, or form by the VA -- which can have a very damaging impact on veterans.

To claim that cannabis has no medicinal value is ludicrous.

To address the absurdity of this issue head on, there is significant research in well-published journals about how cannabis helps veterans:

• Studies have found that cannabis can help treat pain, which a great deal of veterans suffer from on a daily basis (veterans are 40% more likely to suffer from pain). • Cannabis has been found to help those who suffer from post-traumatic stress disorder, which as many as 1 out of every 5 military veterans suffer from. • Roughly 20 veterans commit suicide every day, according to the VA, and medical cannabis access has been associated with lower suicide rates, especially among young men. More research needs to be done, but the claim that cannabis has no medical value whatsoever is a hard pill to swallow. Speaking of pills, many veterans are encouraged to take harmful pharmaceutical drugs including opioids, which are highly addictive with harsh side effects. If veterans can consume alcohol for recreational purposes, then they should be able to consume

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cannabis, which is exponentially safer, for medical purposes.

The Current Administration Is Not Doing Much to Move the Issue Forward

The Trump administration recently sent officials from the VA to Congress to directly oppose three bills aimed at helping veterans access medical cannabis and allowing better research. They also reportedly denied VA home loans and GI Bill benefits to veterans that work in the cannabis industry. A provision that would have helped veterans access medical cannabis was removed from a spending bill in Congress recently due to staunch opposition from the VA. Regardless of your political beliefs, this is clearly unacceptable. Military veterans have served our country proudly, and the least we can do for these brave men and women is help them access a proven medicine that is safer than the pharmaceutical drugs they are so often prescribed. Plus, no military veteran should ever have to deal with being denied a VA home loan or GI Bill benefits simply because they make a living and support their families via a career in the cannabis industry.

What can the federal government due to improve federal cannabis policy for veterans?

The most thorough way for the federal government to make federal cannabis policy more favorable to veterans is to de-schedule cannabis. That would take cannabis off the Schedule 1 list, which could either be achieved through Congress or through direct action from the Executive Branch. The VA made it clear when it recently opposed previously mentioned federal cannabis legislation aimed at helping military veterans. “Marijuana is illegal under federal law, and until that changes, VA cannot prescribe or recommend it,” a VA spokesperson told The Washington Times. De-scheduling cannabis would remove the illegal status around cannabis and thus would make the VA’s current stance on cannabis policy moot. Historically, de-scheduling has been too heavy of a lift. So the next best option would be for the Executive Branch to direct federal agencies to make exceptions for VA clinicians to be able to recommend medical cannabis if they think it will help patients. Meaning, if the Trump administration wanted to make exceptions to the policy, it could. At the same time, we’d like to see the federal government cease the practice of denying VA home loans to veterans that work in the cannabis industry. The same is true for denying GI Bill benefits. This is discrimination at its worst. Finally, Congress could pass measures that help improve federal cannabis policy for veterans by increasing access and research.

If there’s enough political will in Congress, the effort could even overcome a presidential veto, should one occur. Federal cannabis prohibition and the issues that it causes for military veterans are unacceptable. The fixes to these issues are straightforward. It’s not science that’s getting

in the way. It’s not compassion for suffering veterans. Its politics, and we’d love to see that change. Max Simon is CEO/founder of Green Flower Media—the world’s largest cannabis education platform.

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GrandRounds Burnett School Awards Highest Number of Graduate Degrees The 36 students — 29 master’s and seven Ph.D. students – are the largest number to graduate from the Burnett School in a single commencement ceremony. Only 14 biomedical sciences graduate students crossed the stage at the last commencement ceremony in spring. In addition, 88 undergraduates will receive bachelor’s degrees in the biomedical sciences. During their time at UCF, the graduate students investigated medical solutions for a range of health issues including aging, cancer, tuberculosis and Crohn’s disease. They co-authored 58 peer review articles with their faculty research mentors and presented their findings at numerous scientific conferences.

Silvana Sidhom graduates with a master’s in biotechnology. Among the graduates is Silvana Sidhom, a Bill and Melinda Gates Foundation scholarship recipient, who earned

an M.S. degree in biotechnology. This is Sidhom’s second UCF commencement ceremony as she graduated in 2017

with a bachelor’s in biotechnology and biomedical sciences. “At UCF, I’ve been afforded several opportunities, from conducting nationally recognized research to serving the university and Orlando community,” Sidhom said. “Thanks to these experiences and my mentors at UCF, I am equipped for the next chapter of my life and am proud to be part of this Knight Nation.” At UCF, Sidhom investigated the correlation between sex hormones and aging with faculty researcher Dr. Michal Masternak. In a study, funded by the National Institutes of Health, they found that female hormones injected into male mice reduced metabolic abnormalities and potentially extended their lifespan. Sidhom’s research earned her a student award at the 2018 Ameri-

can Aging Association Conference, an honor usually reserved for doctoral candidates. After graduation, she plans to attend medical school. Ahmad Qasem will continue postdoctoral studies at UCF after receiving his Ph.D. in biomedical sciences. Several Ph.D. graduates, like Ahmad Qasem, will pursue post-doctoral careers here at UCF. Qasem came to UCF after completing his doctor of pharmacy degree because he wanted “to make a difference through finding better treatments for chronic diseases.” As a masters and doctoral student, he worked with the College of Medicine’s Dr. Saleh Naser investigating therapeutics for Crohn’s disease, a debilitating inflammatory bowel disease. He coauthored several journal articles with Dr. Naser and their research is now part of an ongoing clinical trial to treat Crohn’s with an antibiotic they created.   As a post-doctoral investigator, Qasem will continue researching better treatments for Crohn’s. “UCF led me to believe in myself and to strive for lifelong excellence,” said Qasem, who came to UCF from his native Jordan. “The innovative environment and the productive collaboration UCF creates, encourages students from diverse backgrounds to implement unique initiatives. Ebraheem Naser will attend pharmacy school after collecting his bachelor’s in biomedical sciences. Some Burnett School graduates will go on to pursue careers in healthcare fields such as medicine, dentistry

Central Florida Regional Hospital Launches Comprehensive Spine Care Program Central Florida Regional Hospital has announced the opening of the Spine Care Center, providing a comprehensive range of solutions for patients suffering from back pain. “We’re focused on treatments that provide life-changing solutions for our patients,” said Trey Abshier, CEO of Central Florida Regional Hospital. “Many adults are immobilized by back pain at some point, making it one of the most common reasons people go to the doctor. With the launch of our Spine Care Center, our patients are able to address these issues from diagnosis to treatment and rehabilitation in one place.” The Spine Care Center provides 18

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the latest surgical techniques, including minimally invasive surgery that leads to smaller incisions, reduced blood loss, less pain, lower risk of infection and minimal downtime. In addition, the availability of robotic technology helps to ensure safety and quality. Using the Mazor X™ Robotic Guidance Platform, the surgeon can develop a comprehensive surgical plan and visual outline of the procedure prior to and during surgery. This ensures accuracy and limits the amount of radiation to the patient as well as the surgical team. To guide patients through the treatment process, the hospital recently added Spine Nurse Navigator Gwen

and veterinary science. After collecting his UCF bachelor’s in biomedical sciences, Ebraheem Naser will pursue a doctor of pharmacy degree at the University of Florida as he hopes to work for a health regulatory agency. His passion is providing care to underserved communities and while at UCF, he studied risk factors for hypertension among the homeless and found that the longer a person was homeless the higher their risk was for the disease. Inspired to keep working with the homeless, he formed Project Downtown Orlando, a non-profit organization that supplies meals and hygiene kits to the homeless. “After a year and a half going out to downtown and just listening to the stories that people had, that motivated me to go and do my part,” said Naser, whose father, Saleh, is the College of Medicine faculty member.  “I hope to use the results of my study to help advocate for more healthcare resources for underprivileged communities.”

Northrup, RN, to its team. She serves as a central point of contact to guide patients through the surgical process as seamlessly as possible while also helping to streamline communication among the care team. The Spine Care Center at Central Florida Regional Hospital will treat a wide range of conditions, including herniated discs, spinal stenosis, myelopathy, compression fractures, facet osteoarthritis, spondylolisthesis, degenerative scoliosis, kyphotic deformities and spasticity. For more information on The Spine Care Center, visit https://www. centralfloridaregional.com/service/ spine-care.

YOUR SOURCE FOR LOCAL HEALTHCARE NEWS JKelly@orlandomedicalnews.com

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GrandRounds U.S. News & World Report names AdventHealth Orlando No. 1 Hospital in Florida AdventHealth Orlando has been recognized as the No. 1 hospital in Florida and the top in Orlando by U.S. News & World Report, which released its 2019-20 Best Hospitals ratings. The annual Best Hospitals rankings and ratings, now in their 30th year, are designed to assist patients and their doctors in making informed decisions about where to receive care for challenging health conditions or for common elective procedures. The hospital was also recognized as having seven nationally ranked specialty programs: diabetes and endocrinology; gastroenterology and GI surgery; geriatrics; gynecology; nephrology; neurology and neurosurgery; and urology. In addition, AdventHealth was recognized for having four “high-performing” programs: cancer; cardiology and heart surgery; orthopedics; and pulmonary and lung surgery. Just last month, AdventHealth for Children was also honored by U.S. News, when its neonatology program was ranked among the nation’s best in the annual “Best Children’s Hospitals” issue. And with these most recent rankings, AdventHealth for Women is now recognized as providing the best women’s care in Florida. For the 2019-20 rankings and rat-

ings, U.S. News evaluated more than 4,500 medical centers nationwide in 25 specialties, procedures and conditions. In the 16 specialty areas, 165 hospitals were ranked in at least one specialty. In rankings by state and metro area, U.S. News recognized hospitals as high performing across multiple areas of care. The U.S. News Best Hospitals methodologies in most areas of care are based largely on objective measures such as risk-adjusted survival and discharge-to-home rates, volume, and quality of nursing, among other carerelated indicators. Best Hospitals was produced by U.S. News with RTI International, a leading research organization based in Research Triangle Park, N.C. For more information about the 2019-20 rankings and ratings, please visit the FAQ. The rankings will be published in the U.S. News “Best Hospitals 2020” guidebook (ISBN 9781931469937), available for preorder now from the U.S. News Online Store and for purchase at other bookstores in mid-September.

Study Examines Cannabis’ Effects on Brain Neurochemistry A new Addiction Biology study provides the first evidence of a blunted response to stress-induced dopamine signaling in the brain’s prefrontal cortex in individuals at high risk for psychosis who regularly used cannabis. Little is known about the effects of cannabis on brain neurochemistry, and specifically about its impact on dopamine signaling. Of note, a recent analysis found a dose-response relationship between higher cannabis use and increased risk for schizophrenia, a condition associated with abnormal dopamine synthesis and release in the brain. This latest study’s results are important given the global trend to legalize cannabis and the growing

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evidence of the increased risks for psychosis in vulnerable youth. “Regular cannabis use has a profound effect on cortical dopamine function, in particular in relation to the stress response, which is critical for young adults at risk for psychosis,” said senior author Romina Mizrahi, MD, PhD, of the Centre for Addiction and Mental Health, in Toronto. “These results highlight the need for further research on the impact of cannabis on brain neurochemistry, especially in populations at risk for psychosis.”

Poinciana Medical Center CEO Chris Cosby and hospital staff recently welcomed Sen. Victor Torres to discuss healthcare. During the visit, Cosby and his team thanked Sen. Torres for his continued commitment to serving the community.

Grandkids Trying to Save Nana’s Life BOYNTON BEACH - To build awareness of their Nana’s need for a live kidney, four grandkids have created Kidney4Nana.org. Susan Ruchman of Boynton Beach Florida, who is blood type O+, needs a live kidney soon. Since none of her immediate family members are compatible/ eligible, Susan’s son Jonathan will pay it forward by donating one of his kidneys to someone else who needs one. Ali Ruchman, Maya Ruchman, Jessie Ruchman, and Ari Ruchman--ages 1722 and who live in Nashville, TN, and Livingston, NJ, are leading the effort to get the word out. From PTAs and School Boards to the patients she’s served throughout her career and still does as a Medical Assistant, Susan’s entire life has been committed to giving back to others. “My Nana has spent her whole life giving to others and making them feel loved and special, whether it be her family, her friends, her patients, or complete strangers. My Nana has never asked for anything in return, and

that is why we have this website and initiative,” said oldest grandchild Ali. “She would never try to steal the spotlight from those she loves, but right now we need to shine the light on her. The most selfless woman in the world needs your help and it would mean the world to us if you could help give us the ability to make more memories and produce more love every day.” This is a pay it forward story in the works-- one live donor can save two lives--it is just a matter of getting the word out. “We need to find an angel who can give a kidney and also find someone who needs a kidney. My mom has always instilled the importance of giving back. Since I am not compatible to donate one of my kidneys to Mom, I want to pay it forward by donating to someone else who needs one,” said son Jonathan. “And the grandkids are doing whatever they can do to help as well.” Kidney4Nana.org is a website created by four grandchildren hoping to find a live kidney for their Nana.

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GrandRounds VITAS® Healthcare Expands Hospice Care Services with New Office in The Villages VITAS Healthcare, the nation’s leading provider of end-of-life care, is accepting hospice-eligible patients in Lake and Sumter counties through its new office located in The Villages. This is the second VITAS location serving Lake and Sumter counties. The company’s first office in Eustis, Florida, opened in January 2018 to meet the growing need for quality end-of-life care services in the area. “We are honored to be welcomed by the residents of The Villages and to partner with ‘Florida’s friendliest hometown’ to provide patients and their families with the physical, emo-

tional, social and spiritual support they need at the end-of-life,” said Jillian Madsen, RN, general manager of VITAS in Lake-Sumter. Madsen oversees each hospice team which includes a physician, nurse, hospice aide, social worker, chaplain, bereavement specialist and volunteer. VITAS services available for hospice-eligible patients include: • Admissions personnel available 24/7/365—at the convenience of the family or upon the request of the physician • Physical, emotional and spiritual care provided by a hospice team

that visits the patient at home, in their nursing home or assisted living community, an average of five-plus times per week • 24/7 access to trained clinicians who can dispatch a team member to the home when necessary • Continuous care at home for up to 24 hours when symptoms demand it Additional therapies and patientfocused programs: • Lavender Touch: A gentle hand massage administered by trained volunteers  that offers added comfort, support, and one-on-one attention  • Paw Pals®: Loving animals and their

owners who volunteer to visit patients to provide comfort • VITAS’ award-winning veterans program • Massage therapy provided by a state licensed massage therapist As part of its commitment to bring value and educational resources to the communities it serves, the VITAS office at The Villages offers community outreach and education about end-of-life care and options, support groups, and other valuable resources. For more information about end-oflife care options, contact VITAS Healthcare at 352.800.5170 or visit VITAS.com.

Audience Engagement Spurs Orlando Medical News’ Digital Expansion A newly released analytics study reveals Orlando Medical News is engaging its digital readership at a robust rate, spurring the expansion of the publication’s digital footprint in Central and North Central Florida. “Digital economics allow us to deliver high-value local and national healthcare content beyond our core

of Orange, Osceola and Seminole counties and to better serve Brevard, Lake, Marion, Sumter and Volusia counties,” said John Kelly, publisher of Orlando Medical News. Audience engagement (18.3 percent open rate), coupled with significant desktop (57 percent) and tablet (37 percent) readership accelerated

Kelly’s digital expansion plans. “I’m a print guy, having grown up in the industry, but validation of rapidly changiang dynamics in the publishing industry demands ‘we feed the monster,’” joked Kelly. Established in 2005, Orlando Medical News will continue publishing around 4,000 print editions in

its Orange, Osceola and Seminole county core monthly. It remains the only B2B publication of its kind covering local, state and national news for physicians and healthcare professionals. Its editorial team, led by Pepper Jeter, has covered the Orlando-area business of healthcare since the publication’s inception.

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GrandRounds Unique at Home Care Program Opens in Orlando Lives have been saved, hospital admissions and readmissions reduced, and the number of elderly who remain living in their own home has increased based on evaluation of a unique at-home care program now operating in Orlando, Florida. CareA-Medix℠ uses a team of community paramedics to extend the physician care plan into the home enabling individuals living with chronic health conditions to age-in-place. Care-A-Medix℠ is a relatively new model of community-based health care in which paramedics are utilized outside their standard emergency response and transportation roles to improve population health. Community paramedics assist with home-based patient care for high-risk, high-utilization, and chronically ill patients to prevent acute care episodes requiring emergency medical care. “They con-

duct a lengthy initial assessment covering vital signs, home safety, medication reconciliation, falls and depression risk, pantry supplies, and social needs” said Marcus Prevot, chief community paramedic with Care-A-Medix℠. “Each home visit is documented for the referring medical office. Additionally, CareA-Medix℠ uses portable tablet computers to offer the physician or case manager two-way HIPAA-compliant face-to-face communication with their patient during the home visit.” “What sets this program apart from the many EMS community paramedicine programs is that while their primary focus is on reducing the number of repeat 911 emergency calls, Care-A-Medix℠ extends physician care into the home with scheduled visits over time” said Ken Peach, program founder. “Our paramedics get to know and care for individuals living with congestive heart failure, chronic obstructive pulmonary disease, hypertension, chronic kidney disease, diabetes, and other ongoing health conditions.” Care-A-Medix℠ uses Florida-certified paramedics with hospital experience because their extensive training

and board scope of capabilities enables them to monitor, manage, and provide self-care disease management education. Specialized training extends care for children with asthma and dialysis patients. Accountable care organizations, medical offices participating in Medicare Advantage health plans, a home care agency, and independent physician practices are current clients. The chronic care management program is expanding into additional counties in Florida. Care-A-Medix℠ Company Paramedic program lets self-insured employers offer a low cost per-employee-per-month health care service that includes wellness education, health risk screening, and chronic care management at both the worksite and employee homes. Care-A-Medix℠ is a service of The Local Health Council of East Central Florida, Inc., a not-for-profit health organization with offices in Winter Park. For information about Care-A-Medix℠ visit www.Care-A-Medix.org.

First Large-scale DNA Study in Florida Aims to Unlock a Secret

Can we crack the code to a healthier life? Researchers at AdventHealth are giving consumers potentially lifesaving information about their heart health with a first-of-its-kind DNA study in Florida — “WholeMe.” Ten thousand people will have the opportunity to join the WholeMe study, in which personal genomics company Helix will sequence the participants’ DNA. Every participant will be screened for the genes linked to familial hypercholesterolemia, known as “FH.” FH is a life-threatening genetic condition that causes high cholesterol. If left untreated, it can lead to cardiovascular disease, including heart attacks, even in young adults. “Genomics is core to our mission as we seek to redefine health care and create a consumer-centered system that’s built on the principles of whole(CONTINUED ON PAGE 22)

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GrandRounds person health, prevention and wellness,” said Daryl Tol, president and CEO of AdventHealth’s Central Florida Division. “From disease prevention to diagnosis to treatment, genomics is the future of medicine. It will be an essential component of health care in the years ahead and AdventHealth is proud to partner with Helix to bring this opportunity to Florida.” While the study is open to all adults who live in Florida, the enrollment sites are based in the Orlando area. Researchers will check-in with participants six months after they receive their DNA results. Thanks to generous community support through AdventHealth Foundation Central Florida, there is no cost for participants to join the study. AdventHealth is launching WholeMe in partnership with California-based Helix, which uses proprietary next-generation sequencing technology, called Exome+, to enable health systems and research institutions to deliver scalable and impactful genomic services to their communities. Helix is also a partner in the Healthy Nevada Project, a study similar to WholeMe. To date, of the nearly 30,000 people tested for FH, more than 115 have learned they are at high-risk. More than 90 percent of those participants would not have been diagnosed under current medical practice. “We believe everyone benefits from knowing more about their genetics, with actionable insights that can lead to people living healthier lives,” said James Lu, co-founder and senior vice president of Applied Genomics at Helix. “Our partnership with AdventHealth, and in particular the WholeMe study, will empower individuals with information about how their genetics could impact their heart health. AdventHealth is at the leading edge of offering these insights to the community. By leveraging Helix’s population health solutions together, we will be able to provide individuals with insights about how their DNA impacts their overall well-being.” WholeMe will do more than help Floridians learn about genetic conditions that impact their health. Researchers will also gain insight on how consumers respond — short- and long-term — to knowing their genomic information. “Genomics stands to have as great an impact on medicine as penicillin and radiology in earlier decades,” said Dr. Steven Smith, chief scientific officer of the AdventHealth Research Institute. “These genomic insights will be essential to how people live and the decisions we make. We are not only learning important information from participants; we’re also empowering them to change 22

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their behaviors and hopefully mitigate their risks for disease.” Earlier this year, AdventHealth Orlando began laying the foundation for its comprehensive genomics program — AdventHealth Genomics & Personalized Health — which will ultimately provide comprehensive genomics testing, analysis, interpretation and genetic counseling services. To register for WholeMe, visit wholemeflorida.com.

Curaleaf Opens Sanford’s 1st Medical Marijuana Dispensary Curaleaf has celebrated the grand opening of Sanford’s first medical marijuana dispensary in partnership with the Greater Sanford Regional Chamber of Commerce. Curaleaf is providing Sanford area patients with access to premium quality medical marijuana products in its 3,000 square foot full-service dispensary that includes spacious retail and reception areas, plus two private consultation rooms. This is the company’s 25th dispensary in Florida. Having successfully completed Curaleaf’s extensive and rigorous employee training program, the dispensary’s team of associates offer all patients best-inclass customer service and educational resources. Medical marijuana products are available in the forms of capsules, oils, distillates, concentrates, vaporizer pens, pre-rolls, smokable flower, and topical creams. Most recently, the company introduced its newest product, Curaleaf Shatter, in Sanford. Curaleaf at 610 Lake Minnie Drive is open Monday - Friday, 10:00 am 7:00 pm; Saturday, 10:00 am - 5:00 pm, with select locations open until 7:00 pm; and Sunday, Noon - 5:00 pm. In an effort to provide patient accessibility to medical cannabis, Curaleaf offers a wide range of standing discounts. The company offers all patients free statewide delivery as well as online ordering for pick-up or delivery through http://www.curaleaf.com.

New Primary Care Physicians Join Heart of Florida Physician Group Two new primary care providers have joined the Heart of Florida Physician Group and will be practicing together in Lake Wales.  Rodolfo S. Fernandez, M.D., an internal medicine physician and Amber Y. Shepard, M.D., a family medicine physician will be seeing patients at their office located at 1255 State Rd 60 E., Suite 500 in Lake Wales. To make an appointment with either Dr. Fernandez or Dr. Shepard visit HeartOfFloridaPhysicianGroup.com.  “We are very excited to have welcome these two physicians to our group,’’ said Sabrina Robinson, director for the physician group. “Dr. Fernandez had practiced in Winter Haven and is well-known in the area and Dr. Shepard, who is a Lake Wales native, is returning to the area to begin her practice. They are both wonderful additions to our group of physicians.’’  Dr. Fernandez believes in taking a holistic approach to treating

his patients. He also believes in making sure his patients are comfortable with their treatment plan. He sees patients 18 years and older. “My goals are to listen to their needs and help resolve their issues and make them feel at home with me,’’ Dr. Fernandez said.  Dr. Shepard is excited about being back in her hometown to start her practice.  “I am exactly where I need to be,’’ Dr. Shepard said. “This is home for me and there is no place like home.’’  Dr. Shepard said she listens to her patient’s concerns and forms a comprehensive care plan to help them take control of their health. She sees patients ages 2 and older.  Both physicians see patients for treatment of diabetes, high blood pressure, COPD, wellness visits, immunizations and sports and school physicals as well as sick visits and injuries.

Dr. Amber Y. Shepard,

Dr. Rodolfo S. Fernandez

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SERVING PHYSICIANS & HEALTHCARE PROFESSIONALS IN LAKE, MARION & SUMTER COUNTIES

DOH-Marion County Releases Latest Community Health Assessment Full report available online OCALA —Through collaboration among local officials and organizations, a county-wide assessment has produced the latest data needed to help direct health planning policy for the next several years. Marion’s assessment was based on the nationally recognized “Mobilizing for Action through Planning and Partnerships” process. Through this process, local health and community leaders completed three assessments to identify common themes to uncover key community needs. First, a facilitated discussion was used to identify events, trends and local factors that have the potential to impact health and quality of life. Second, focus groups and community surveys helped collect further information for analysis. Third, participants looked at secondary data highlights and trends for Marion County as compared to the state of Florida. “We thank each of our partners for their

contributions in completing this assessment. The end result will ultimately be more successful programs locally that will have a greater impact on our residents,” said Florida Department of Health in Marion County Administrator Mark Lander. “It’s vital that we had a wide-range of partners to collaborate on the assessment, so we understand the full scope of local challenges.” What issues stood out as priority items for the county to address? “Mental and behavioral health (including substance abuse), adult and child dental care, access to primary and preventative healthcare, and community infrastructure (specifically, safe and affordable housing and transportation),” Lander said. “The report shows that our residents have a decreased life expectancy compared to other counties and that our population continues to skew older than the state overall.

We’ve also seen an increase in mental health hospitalizations and opioid use.” Lander said that poverty continues to be a challenge in Marion County. “Our rate is higher than the state’s, and our children under age 18 living in poverty persists at a rate well above the state’s. Related to this, our median household income is 8,000 below the state average. On the positive side, unemployment is down overall, which brings good momentum to other areas we would like to see change. The department and community leaders worked with Well Florida Council to compile data and materials to complete the assessment. Now that the assessment is complete, local leaders are working on Marion’s Community Health Improvement Plan, or CHIP. Using the assessment when creating the CHIP allows for informed community decision

making and prioritizing of health challenges to ensure health issues are addressed strategically. “The data will be used to create a road map for initiatives and programs in the community to address areas of need. Through having this objective data readily at hand, community agencies will be better able to understand, assess and develop needed interventions. Importantly, this can also serve as a foundational document to help organizations when they are seeking funding for interventions meant to strengthen areas where our community is weak,” said Lander. The DOH-Marion County has published the 2019 Community Health Assessment. Interested individuals can review the document online by visiting: http://

marion.floridahealth.gov/programsand-services/community-health-plan-

MARION COUNTY ORGANIZATIONS THAT CONTRIBUTED TO THE REPORT. The Centers

Ocala Police Department

Marion County Hospital District

CareerSource Citrus Levy Marion

FreeD.O.M. Clinic USA, Inc.

Marion County Health Alliance

Marion County Children’s Alliance

AdventHealth

Suwanee River Area Health Education Center

Marion Senior Services

Quit Doc Foundation

Marion County Community Services Heart of Florida Health Center Marion County Parks and Recreation

Alternative Courts

Healthy Start of North Central Florida

College of Central Florida

Marion County Public Schools

United Way of Marion County

Hospice of Marion County

UF Health

Langley Health Services

Marion County Chamber and Economic Partnership

Ocala Health

Marion County Board of County Commissioners

Ocala Housing Authority

Kids Central, Inc.

Cradling Hands Hands of Mercy Everywhere

GrandRounds The Villages® Regional Hospital Announces New Administrative Director of Nursing The Villages® Regional Hospital (TVRH) is pleased to welcome a new Director of Nursing to its administrative team. Brian Arndt, MBA, BSN, RN joined TVRH in June 2019 and is responsible for the hospital’s overall nursing care and patient perception of care. “I am very passionate about providing exceptional, patient-centered care,” says Arndt. “I came to The Villages because of the great environment here and the amazing hospital team. The depth of knowledge of the staff and huge volunteer group is nothing short of extraordinary.” Arndt’s career in healthcare spans more than 20 years. He has held several leadership positions, most recently at Medical City in Fort Worth, a 320bed medical center in Fort Worth, TX where he held

the role of Director of Transplant Services. Arndt holds a Master of Business Administration degree from DeVry University in San Antonio, TX as well as a Bachelor of Science degree in Nursing from the University of the Incarnate Word in San Antonio, TX. With a professional certification in Nursing Leadership from the American Organization of Nursing Executives, Arndt is eager to exceed the already improved overall patient experience at TVRH. “It is of the utmost importance to me that every patient under our care feels like a member of our family,” concluded Arndt. When not at work, Arndt enjoys spending time on the water and serving as a clown for the Shriners International group offering fun and distraction for the children they serve.

Ocala Health Begins Expansion Project at Summerfield ER Ocala Health has released details on an expansion project at Summerfield ER. This $5 million project will add eight emergency room bays, bringing the total to 19 emergency rooms at the freestanding Summerfield ER location. This project will add an additional 5,100 square feet onto the existing facility. Construction is already underway and is expected to be completed by the end of the year. “We are committed to creating an exceptional patient experience and at Summerfield ER, we saw an opportunity to expand this facility so we can continue to provide patients with a more convenient, higher level of quality care,” said Chad Christianson, CEO, Ocala Health. This announcement comes during the addition of multiple access points and expansions across Ocala Health. Ocala Regional Medical Center is currently ex(CONTINUED ON PAGE 24)

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GrandRounds continued ... panding and renovating its emergency department along with a recent announcement of a $31M expansion in which 34 beds will be added to the facility. This project is expected to begin in July. Plans were also announced in May of a $27M expansion at West Marion Community Hospital in which a second cath lab will be added along with a dedicated 10-bed, prepost cath lab recovery unit as well as two large operating suites, bringing the total to 10 operating suites. Ocala Health has also recently announced plans to build a third freestanding emergency department off 466A in Wildwood. Ocala Health’s

second freestanding emergency department, Maricamp ER will open in August of this year.

Department of Health in Marion County Announces Upcoming Mobile Health Unit Site Visits The Florida Department of Health in Marion County’s Mobile Health Unit has scheduled its site visits for the remainder of 2019. The bus will provide immunizations and other department services on: • Aug. 20: Brother’s Keeper Soup Kitchen (435 NW Second St., Ocala) from 9 a.m. to 2 p.m. • Aug. 24: Saving Mercy (3601 W. Silver Springs Blvd., Ocala) from 10 a.m. to 1 p.m. • Sept. 6: AMEX Food and Deli (125 NW 110th Ave., Ocala) from 4:30 to 8 p.m. • Sept. 14: Tuscawilla Park (300 NE Sanchez Ave., Ocala) from 10 a.m. to 2 p.m. • Sept. 17: Brother’s Keeper Soup Kitchen (435 NW Second St., Ocala) from 10 a.m. to 2 p.m. • Oct. 4: AMEX Food and Deli (125 NW 110th Ave., Ocala) from 4:30 to 8 p.m. • Oct. 15: Brother’s Keeper Soup Kitchen (435 NW Second St., Ocala) from 10 a.m. to 2 p.m. • Nov. 1: AMEX Food and Deli (125 NW 110th Ave., Ocala) from 4:30 to 8 p.m. • Nov. 19: Brother’s Keeper Soup Kitchen (435 NW Second St., Ocala) from 10 a.m. to 2 p.m. • Dec. 6: AMEX Food and Deli (125 NW 110th Ave., Ocala) from 4:30 to 8 p.m. • Dec. 17: Brother’s Keeper Soup Kitchen (435 NW Second St., Ocala) from 10 a.m. to 2 p.m. • Dec. 18: St. Theresa Catholic Church (11528 SE US Highway 301, Belleview) from 10 a.m. to noon.

Schedule and services are subject to change. For the most current list of Mobile Health Unit dates, locations, and services, please visit Marion.FloridaHealth.gov.

DOH-Marion Offering Free Hepatitis A Vaccinations Thru August 30 The Department of Health in Marion County is offering free hepatitis A vaccinations to area residents MondayFriday during normal business hours (8 a.m. to 4:30 p.m.) through August 30, at the department’s Ocala location or at Mobile Health Unit stops throughout the county. There has been an outbreak of hepatitis A in our state, and Marion County is sixth in the state for the number of hepatitis A cases that we have seen. Vaccination is the best form of prevention for this virus, so to help fight the spread of hepatitis A, we are encouraging people who are at risk and anyone who would want to be protected from hepatitis A to get the hepatitis A vaccination.

What is Hepatitis A, and how is it spread? Hepatitis A is caused by a contagious virus that infects the liver, and it can lead to serious liver problems. The virus spreads through the feces of people who have the virus. If a person with the virus doesn’t wash his or her hands well after going to the bathroom, feces can transfer to objects, food, drinks or drugs. When these objects, food, drinks or drugs are then shared or touched by others, other people can unknowingly swallow the virus. If a person who has the virus comes into close contact with others (like during sex), the virus can also spread. People most at risk for the spread of hepatitis A include: • Individuals in direct contact with someone who has hepatitis A • People who use drugs (whether injection or non-injection) • Individuals experiencing homelessness or unstable housing • Travelers to countries where hepatitis A is common • Household members or caregivers of a recent adoptee from countries 24

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AUGUST 2019

where hepatitis A is common

Symptoms Someone can have hepatitis A for up to two weeks without feeling sick but during that time be spreading the virus to others. Symptoms typically start two to six weeks after infection and last fewer than two months. However, symptoms can last for up to six months. Symptoms include: • Fever • Fatigue • Loss of appetite • Nausea • Vomiting • Jaundice (yellowing of skin/eyes) • Abdominal pain • Dark urine • Clay-colored bowel movements • Joint pain

Prevention Get the hepatitis A vaccine and wash your hands regularly to stop the spread of the virus. In particular, be sure to wash your hands before you prepare food or work with food that isn’t already packaged, and after you you use the bathroom, touch people or public surfaces or change a diaper.

For more information on Hepatitis A Call the Department of Health’s tollfree information Line, 1-844-CALL-DOH (1-844-225-5364), Monday through Friday from 8 a.m. to 5 p.m. or email HepA@flhealth.gov. You can also find out more information about hepatitis A by visiting floridahealth.gov/HepA. Central Florida Health Announces New Corporate Director of Quality Sonya M. Zeller, DNP, MBA, RN, has been appointed director of corporate quality at Central Florida Health. Zeller is a graduate of Indiana Wesleyan University where she earned a doctorate in nursing practice, Master of Business Administration and

bachelor’s degree in nursing. She also earned a master’s degree in nursing, management and leadership from the University of Southern Indiana. Prior to relocating to Central Florida, Zeller was vice president, chief operating officer and chief nurse executive, physician practice administrator and cancer service line administrator at the local and system level for Indiana University Health. During that time, she also held a number of other leadership roles. “We are excited that Dr. Zeller has joined our team to lead our clinical quality efforts,” says Phyllis Baum, vice president and chief quality officer for Central Florida Health. “Excellence in clinical quality and patient experience are two of our organization’s main priorities and are consistent with Dr. Zeller’s long track record of success in leading teams in these efforts during her illustrious career in executive leadership.” As the system director of quality, Zeller will lead and direct all quality management activities for the hospital including infection control, accreditation compliance and readiness, performance improvement, patient safety, and the cancer program. “I’m confident that Dr. Zeller will facilitate ongoing improvements to the overall patient experience and assist our organization in achieving its vision of being the area’s safest hospital,” concludes Baum. Ocala Health Units Recognized for Nursing Excellence Ocala Health has earned three 2018 Unit of Distinction Awards in an annual program that recognizes and rewards exemplary nursing units at HCA Healthcare affiliate facilities. These units include the Intensive Care Unit at West Marion Community Hospital, the Ortho/Med-Surg Unit at West Marion Community Hospital, and the Progressive Care Unit at Ocala Regional Medical Center. The “Unit of Distinction” designa-

tion is achieved through measurable, exemplary performance in the strategic areas of advocacy and leadership, consistency in nursing practice and operations, and leveraging scale to drive performance. During 2018, approximately 1,200 HCA Healthcare nursing units participated in the program. Using specific criteria, nursing units are evaluated and scored based on performance. Recipients of the 2018 Unit of Distinction honor are considered to be in the top 5 percent of all HCA Healthcare medical-surgical, critical care, emergency services and surgical services nursing units. In addition to the UOD recipients, 67 additional units achieved scores ranking them within the Top 6 percent to 10 percent of all HCA Healthcare units, earning each an “Honorable Mention” designation. An important component of the program is HCA Healthcare’s sponsorship of nurses to obtain national certification through programs accredited by the American Board of Nursing Specialties. This year, more than 2,600 HCA Healthcare-affiliated nurses expanded their professional knowledge and advanced their individual and professional skills to earn certification. “The Unit of Distinction Award recognizes and celebrates excellence in nursing and acknowledges that it takes a high-performing team of nurses demonstrating a high level of commitment to achieve results like these,” said Jane D. Englebright, PhD, RN, CENP, FAAN, HCA Chief Nurse Executive and Senior Vice President. With more than 1,800 sites of care, HCA Healthcare-affiliated nurses have abundant opportunity to choose work across a wide spectrum of clinical and non-clinical settings. Launched in 2015, the Unit of Distinction program is a driving component of HCA Healthcare’s multi-year nursing strategic plan.

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Profile for Orlando Medical News

Orlando Medical News August 2019  

Orlando Health’s Center for Proton Therapy Reaches a Milestone Center has seen “strong growth” and “worldwide recognition”

Orlando Medical News August 2019  

Orlando Health’s Center for Proton Therapy Reaches a Milestone Center has seen “strong growth” and “worldwide recognition”