February 2019 Orlando Medical News

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February 2019 > $5

Orange County and Seminole County Medical Societies Setting Priorities for Upcoming Legislative Session OCMS, SCMS have concerns about legislation regarding scope of practice issues and telemedicine Fraser Cobbe, Executive Director of the Orange County Medical Society and Seminole County Medical Society, expects to see scope of practice matters, telemedicine and a proposal by pharmacists to diagnose and treat flu and strep throat to be issues likely to come up during the current session of the Florida Legislature. “We do know that the Speaker of the House has some ideas about expanded roles


PHYSICIAN SPOTLIGHT Dr. Raza Ali ... 3 Florida Pain Management Clinic Registration and the Opioid Crisis ... 2


Peek Into Orlando’s Healthcare Startup Scene ... 6 Fintech And Biotech Are Coming Together to Transform Drug Development ... 6

INDEPENDENT PHYSICIAN High Acuity Urgent Care Close to Home, at Less Cost ... 8





for non-physician practitioners which have us a little bit concerned,” Cobbe said. “Definitely there are some scope of practice bills that have been filed that we’re going to be expressing our concerns about over patient safety.” Advanced Registered Nurse Practitioners (ARNPs) and Physician Assistants (PAs) are likely to go after independent practice again. Cobbe said the medical societies want to make sure there are patient safeguards in-

cluded in that. “In general, we oppose them working totally independent and without adequate physician oversight to make sure the medical diagnosis, treatments and follow through are applied appropriately,” Cobbe said. “We know the pharmacists are coming after the ability to diagnose and treat strep and flu. We do have some concerns about their inability to do a history and a physical on a

patient. And they’re utilizing new tests that aren’t 100 percent foolproof, so we have some concerns with misdiagnosis of flu and strep if patients start to use the pharmacists as their only caregiver.” It is also likely that the governor will support passage of a telemedicine bill. While the medical societies are supportive of telemedicine, it needs to be done in an appropriate (CONTINUED ON PAGE 5)


Helping Others Achieve Their Dream Corey Burke of Cryos International may be the best in the world at what he does Corey Burke could conceivably be the best in the world at vitrifying eggs, the process of freezing collected oocytes to allow for future fertility. But Burke, tissue bank director for Cryos International, quickly points out that his success depends on others. Cryos International, a company with U.S. headquarters based in Orlando, is the world’s largest sperm bank, and the first free-standing, independent egg bank in the U.S. “We’re in a unique business,” Burke said. “We currently have 48 reference clinics we work with and 10 non-reference clinics that use our eggs in the U.S. These are egg clinics. The number of clinics we sell sperm to is much higher, 100 or more. We have also

distributed eggs to several European countries.” Burke, who has helped thousands achieve their dream of becoming parents, has worked in the reproductive industry as an andrologist and embryologist for more than 18 years. When he started in the industry in 2002, the technology of vitrification of oocytes and embryos was relatively new. Developments since that time have produced increased survival rates and for the first time allowed oocytes to be effectively

• • • •

and efficiently cryopreserved. Over the past ten years, Burke has launched several successful egg freezing programs in partnership with in vitro fertilization (IVF) clinics and worked as a training consultant. At Cryos, Burke is responsible for the safety and quality of donors and donor products, as well as the scientific direction of the laboratories and worldwide egg banking. Cryos has done work in more than 100 countries, and works to ensure a wide selec(CONTINUED ON PAGE 23)

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Florida Pain Management Clinic Registration and the Opioid Crisis By MICHAEL R. LOWE, Esq.

a physician will have to worry about this Pain Management Clinic Certificate of Exemption is if their practice meets the definition of a Pain Management Clinic. Here is the basic and pertinent statutory framework and definition:

In 2018, the top health story capturing the news headlines was the opioid crisis. These headlines encapsulated the pulse of the nation with regard to the opioid epidemic. In direct reaction to the opioid crisis and its effect on Florida’s citizens, the Florida Legislature adopted HB 21. Fraser Cobbe’s November 2018 Orlando Medical News article, “What Physicians Need to Know Concerning Pain Management Clinic Exemption Applications?” is a pertinent insight into what is now required for Pain Management Clinic exemptions by the Florida Department of Health to combat the opioid crisis through legislation passed in 2018, HB 21. Building on that article, this article further addresses the impact of both HB 21 and the opioid crisis on Central Florida’s health care community. As noted by Mr. Cobbe, HB 21 imposes a number of requirements on health care practitioners who prescribe or dispense controlled substances. The new law, which took effect on July 1, 2018, limits prescriptions for acute pain and holds those prescribing opioids more accountable. Moreover, HB 21 requires clinics that were previously exempt from the requirement to register under Section 458.3265, Florida Statues, also known as the Florida Pain Management Clinic Act (the “Act”), to now obtain and maintain a certificate of exemption from the Florida Department of Health (the “DOH”). Those provisions took effect January 1, 2019. HB 21 is a direct result of the opioid crisis and the government’s action to combat the opioid epidemic. Based on HB 21’s changes to Section 458.3265, Florida Statutes, the reason

Under Florida Law, a pain management clinic is any facility (public or private) that: (i) advertises for any type of pain-management services; or (ii) where in any month a majority of patients are prescribed opioids, benzodiazepines, barbiturates, or carisoprodol for the treatment of chronic, non-malignant pain.

In reviewing that definition, it is important to note that the two (2) separate grounds for qualifying as a “pain-management clinic” are disjunctive and not conjunctive, meaning that if the Practice met either of those two (2) grounds, the DOH would take the position that the Practice is a pain-management clinic under the Act, thereby requiring it to register as a clinic with the DOH. With regard to the definition regarding advertising in any medium for any type of pain-management services, it is important to note that the term “medium” although not defined in the Act, would be interpreted broadly by the DOH and/or the Board. In our experience, our firm would anticipate that the DOH and/ or the Board would interpret the language “any medium” to include radio, television, brochure, internet/website, telephone books, on-line listings, LinkedIn listings, billboard, email solicitation, business cards, and other similar materials and mediums. In reviewing the definition’s second basis for determining whether a practice or entity is a “pain-management clinic” your prescribing practices and statistical information are critical pieces of information that must be

analyzed in further depth to determine whether your practice or entity meets the definition of a “pain-management clinic” under the Act. Specifically, you must focus on whether in any given month you prescribed opioids, benzodiazepines, barbiturates, or carisoprodol to the majority of your patients for the treatment of chronic nonmalignant pain. Notably, the term “majority” is not defined in the Act, and therefore, the DOH would likely interpret that term in a general, common-sense approach, meaning that if you prescribe those pain-management medications to more than fifty percent (50%) of your practice’s patients in any given month for the treatment of chronic nonmalignant pain, then you would be prescribing those medications to a majority of your practice’s patients. Simply stated, the DOH would use a fifty percent (50%) threshold when interpreting the term “majority” in determining whether the Practice meets the definition of a “pain-management clinic”. Consequently, it is critical for you to keep pertinent information and data regarding your patient demographic, prescribing practices, pain management prescriptions, and the number of patients for whom you prescribe one of the four medications listed in the Act for patients with chronic, nonmalignant pain if you are in anyway trying to determine whether your practice, entity or facility meets the definition of a “pain management clinic” under the Act. If you do not meet that definition above, then you do not have to worry about the Pain Management Clinic Certificate of Exemption requirement. However, if you determine you do meet this definition, then you must


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register as a Pain Management Clinic or claim one of the Exemptions by completing the Certificate of Exemption. Failure to comply with the registration or Certificate of Exemption requirements in the Act can result in severe penalties including, but not limited to, disciplinary action being taken against the medical doctor’s or other licensed health care professional’s Florida license, investigation by the DOJ and/or the Florida Attorney General’s office for failure to comply with a statute which carries with it potential criminal implications and penalties, fines, and/ or collateral actions being taken by 3rd-party payors including the federal Medicare program and/or medical staff and peer review entities for hospitals and ambulatory surgical centers where physicians and health care professionals may perform pain management care and treatment. Consequently, it is imperative that you carefully analyze the Act’s provisions and how they may apply to your practice, and if you have any doubts or confusion, then to contact qualified health care legal counsel for further advice and guidance. Additionally, and equally applicable and important to Central Florida’s health care community is the fact that in August 2017, the U.S. Attorney General announced the formation of the Opioid Fraud and Abuse Detection Unit, a new Department of Justice pilot program that utilizes data to identify and prosecute individuals who are contributing to the prescription opioid epidemic. The pilot also funds 12 experienced Assistant U.S. Attorneys in opioid “hot-spots” for a three-year term to focus solely on investigating and prosecuting health care fraud related to prescription opioids. According to the U.S. Department of Justice, former Attorney General Jeff Sessions, these “hot-spots” are Central Florida, East Tennessee, Southern West Virginia, Western Pennsylvania, Southern Ohio, Eastern Michigan, Northern Alabama, Nevada, Eastern Kentucky, Maryland, Central North Carolina and Eastern California. As one of the 12 “hot-spots” that will be focused on for the 3-year term by the DOJ, Central Florida health care providers need to be aware and cognizant of this increased focus and scrutiny that will be applied to the Central Florida area, and in doing so should (CONTINUED ON PAGE 8)

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Orlando Pediatrician Advances Shepherd’s Hope’s Multi-faith Mission Providing Healthcare, Hope and Healing for Uninsured Families Shepherd’s Hope was founded in 1997 by Dr. William S. Barnes, senior pastor of St. Luke’s United Methodist Church, who was driven by the notion that “none of us knows how to do it all, but all of us know how to do some of it.” Since then, the faith-based organization has provided more than a quarter million primary care and specialty care patient visits to uninsured men, women and children across Central Florida with support from more than 20 multi-faith congregations in the region. One of them is the Tazkiah Foundation of Lights in Ocoee. In 2008, the mosque opened its doors to provide space for Shepherd’s Hope to expand its hours of operation with a new Saturday morning clinic. The Tazkiah Shepherd’s Hope Health Center was the brainchild of Dr. Raza Ali, a pediatrician who began volunteering at the organization’s downtown location in 2003. Five years later, he approached the Tazkiah Foundation of Lights about providing space for a Saturday clinic and launched it with the help of his wife Zenaida and Zamona Bacchus, one of Shepherd’s Hope’s health center managers.

“The various religions are like different roads converging on the same point.” – Mahatma Gandhi In 2012, Dr. Ali was named associate medical director for the clinic to work as a liaison between Shepherd’s Hope management and the volunteer staff. His responsibilities include supervising coordination of the Tazkiah clinic’s medical activities to ensure that quality patient health care is implemented in a professional manner consistent with current medical practice standards. He is joined in delivering on this mission by volunteer internal medicine physicians Dr. Jaseem Khan, Dr. Muhammad Awan, Dr. Abid Rasool, and Dr. Shazia Nasir. “Dr. Barnes has done heavenly work for the community and we are pleased to be among the faiths who are working with Shepherd’s Hope to continue to advance his mission,” Dr. Ali said. Dr. Ali holds a Bachelor of Science degree in Pharmacy from Texas Southern University in Houston and received his medical degree from Universidad Tecnologia de Santiago (UTESA) in Santo Domingo, Dominican Republic. He completed his resi-

dency, including serving as chief resident for the Department of Pediatrics, at Methodist Hospital in Brooklyn, New York. In 1994, he moved to Orlando and established his private practice in West Orange County. Here, he shares additional thoughts about his volunteer involvement with Shepherd’s Hope. Talk about the volunteer work you do with Shepherd’s Hope.

“I began volunteering at the downtown clinic in 2003. I would go there once or twice a month in the evening after seeing patients at my private practice. It was a very enjoyable and satisfying experience.” “Then, in 2008, I suggested to Shepherd’s Hope the idea of approaching the Tazkiah mosque in Ocoee about sponsoring a Saturday clinic there. My wife Zenaida, who is a critical care nurse, was instrumental in getting the clinic up and running.”

Is there a memorable patient encounter that is especially meaningful to you?

“There was a woman who brought her young child to the clinic. I remember her because she was wearing a very nice business suit and mentioned to me that she was also a physician who had just moved to Orlando because of her husband’s health issues. She told me she had just left a job interview and came straight to the clinic because her son needed medication they could not afford. It was heartbreaking for me to realize that hard times can come to anyone. The patients we see at Shepherd’s Hope are not always who you would expect.” What would you tell other physicians who may be interested in volunteering at Shepherd’s Hope?

“When I first started volunteering at the downtown clinic, there were times at the end of the day when I was so tired and just didn’t feel like going. But, then I learned that there are times when people start lining up outside the clinic hours before it opens with the hope of seeing a doctor, and sometimes there are not enough providers to see everyone. That (CONTINUED ON PAGE 6)

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Orange County and Seminole County Medical Societies, continued from page 1 way where the State of Florida still has the ability to regulate the quality of medicine delivered through telemedicine including that potentially provided by outof-state providers. “We feel strongly there needs to be some way to hold those medical professionals accountable for their recommendations and care that they give through that telemedicine Fraser portal,” Cobbe said. “The state should not abdicate their responsibility for quality of care in those instances. On a positive note on telemedicine, I think we’re ready for Florida to receive parity, like a number of the other states have, where if you’re a physician in Florida providing telemedicine services, then those services would be reimbursed similar to what an in-person visit would be.” The Orange County Medical Society and Seminole County Medical Society are supportive of the expansion of needle exchange programs. There has been a successful pilot program at the University of Miami with a needle exchange program that proved to help reduce rates for HIV, hepatitis and other blood-borne diseases. “We’re going to be active in trying to get that pilot program expanded to other communities,” Cobbe said. Insurance reform is another hot button issue. “Organized medicine has been going

after insurance reform for the past several years in ways which are pro-patient and prophysician, as well,” Cobbe said. “We’re hoping at some point to continue to push those forward. The fail first protocols require patients to try certain medications first and fail on those medications before they get to the medication that the physiCobb cian wanted to prescribe in the first place. We want to make sure there’s a way for a physician and patient to opt out of those fail first protocols if they know those medications are going to be ineffective.” Another issue is retroactive denials where physicians verify the eligibility of the patient. The care authorized by the insurance carrier is given only to find out later that the patient had fallen delinquent on paying their premiums. In cases like that, insurance carriers have historically denied reimbursement. Cobbe said physicians shouldn’t be saddled with that debt for a service being provided in good faith. There’s also a bill that’s going to be filed that prevents insurance carriers from changing formularies in the middle of a contract year for a patient. “Many patients will shop for their insurance coverage based on what drugs are in their formulary, and what tiers all those drugs are on,” Cobbe said. “We’ve got concerns with insurance carriers that sell a product to a patient and then a month later they change

the drug formularies, or change the tiers, and all of a sudden the patient is stuck for that full year with a policy or benefit that they did not anticipate when they purchased that product. I’d like to see some patient protections in there that they shouldn’t be able to switch that formulary until the end of the contract year.” The medical societies also favor a state system that mediates disputes between insurance carriers and physicians. Currently, the state requires physicians and insurance companies go through Maximus, which is the third-party dispute resolution contractor used by the state. Cobbe said since it is not mandatory for either party to go through that process, the vast majority of the time insurance carriers have opted not to participate. “We think we need to come up with a better regulatory scheme to hold insurance carriers accountable,” Cobbe said. Another consideration is surgery center legislation. What surgeons would like to see is that the length of stay in the surgery center be 23 hours from the start of the procedure. Current Florida law says that the patient has to be discharged by midnight. “Most states in the country allow 23 hours from the start of the procedure,” Cobbe said. “Florida is somewhat handcuffed in our ability to use surgery centers because you’ve got to discharge the patient by midnight. We think that arbitrary midnight deadline is something that jeopardizes quality of care, and potentially increases cost if the patient has no other option but to then get admitted at midnight.”

Workers comp is another issue under consideration. Cobbe said the workers comp system is full of delays and is often not meeting its core objective of returning an injured worker back to work as soon as possible. He said currently business owners have no idea what quality of care they are purchasing through workers comp. “We think it would be a good idea just to have some transparency by having the state publish a list of each carrier, and how they perform against each other on similar types of injuries,” Cobbe said. “With that transparency, then those who are doing a good job obviously will shine on those reports. Those who are not doing a good job will be more incentivized to work with the treating physicians to get better results.” Physicians are encouraged to get involved with the legislative proposals. “The state makes decisions on appropriate coverage, quality of care and access to care for patients,” Cobbe said. “It’s really important that physicians are involved in that process to have a positive impact on the system.” Cobbe expects this to be a year of transition because of a new governor, as well as new leadership in both the Florida House and Senate. “It’s a little different in the fact that everybody is still kind of feeling out the process with the new leadership,” he said. “But we are already laying the groundwork for the issues that are important to us.”

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Peek Into Orlando’s Healthcare Startup Scene (ORLANDO, FLORIDA) Pink Lotus Technologies LLC, the startup technology solutions company of the POMM™ wearable tech device, exhibited at the coveted Consumer Electronics Show (CES) in Las Vegas. It’s founder, Marianne Kilgallon, showcased the wristband tech device, designed to protect children by safeguarding them from threats like negligence and accidental death. The company is seeking investment and strategic partnerships. Learn more at www.pommconnect.com

(TAMPA, FLORIDA) TSOLife, the startup company that built a mobile platform for capturing and preserving the stories of elders, has moved into its $1.2M Series A round of funding which is expected to close this month. David Sawyer, CEO, is on a personal mission to enable Senior Living Organizations to easily capture and store the real life voices and stories of their residents on family-facing online platform so that they can be preserved for future generations. You can learn more about TSOLife at www.tsolife.com

(JACKSONVILLE, FLORIDA) Resility Health, a personalized biofeedback platform founded by Sarah Davidson, was selected to present at the first “pitch-in” event at Mayo Clinic’s new Life Sciences Incubator in Jacksonville. The company is also launching its new Resilience for High Performing Teams program this month. The new stress management program is designed to help teams in high pressure environments to improve concentration, interpersonal relationships, and focus to achieve peak performance in safety and productivity. Learn more at https://resilityhealth.com

Disclosure: Readers, please take note that the companies featured in the Health Innovators section have not paid for or bartered for these acknowledgements. All companies are selected based on merit, intrigue, and their potential to move healthcare forward towards the Quadruple Aim. In a noisy and biased market, we believe this to be a valuable distinction.

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If there’s one thing that I am passionate about, it’s being a witness to someone having an “a-ha!” moment. When you see someone’s mind firmly connect to a concept - their brows instantly lifted with light bulbs beaming bright from their eyes - that’s a pure and magical moment. In healthcare today, we have too few of those magic moments. Patients and families find the systems and language overwhelming and confusing. We tell patients that they should or could, take this or do that, or else this, that, or the other will happen. But how often do you see the light bulb of understanding turn on in their eyes? It should go without saying that these eureka moments do not apply to all situations, such as a life-ending diagnosis. What it does apply to, however, is in the way we help each other, our patients, and caregivers to better understand and relate to the patient’s condition. It’s in those opportunities that we need to create more lightbulb moments. Over time, I’ve collected a small toolbox of very simple interactive learning and simulation activities that help people experience a condition without consequence. For example, a mobile virtual reality app that helps “normal” people understand what it’s like to be a person with ADHD. Another is helping a parent with an asthmatic child to experience

the symptoms of asthma themselves using drinking straws and a coffee stirrer while running in place for 30 seconds. Recently, my fearless 6-year old daughter fractured her right humerus at the shoulder. Despite a long career in healthcare, as a mom I found the journey daunting. My first priority was to get her seen by a highly reputable emergency care provider and pediatric orthopedic specialist. Equally important however, was that I felt equipped to confidently and properly care for her at home. Like many people, I enjoy games and riddles. But I found that the puzzle of getting her in and out of a t-shirt (without cutting it off), safely bathing her without the brace for support, cleansing her clenched underarm and getting it completely dried to thwart that stinky, itchy rash, and managing her pain for restful sleep, were all things I was ill-prepared for. Even worse, I hadn’t really stopped to acknowledge what her experience must be like having her dominant arm and hand rendered unusable. Wearing the slightly oversized sling she got from the ER, I tried to do all the things

she had become highly frustrated with -- writing with my opposite hand, getting my seatbelt on, pulling my jeans up, washing my hands, even opening the peanut butter jar to make a sandwich. It was a series of “A-ha, I get it now!” moments that helped me experience her experience without the added downside of having to break my arm. Ultimately, my fearless wonderchild and I teamed up MacGyverstyle and, minus a few tearful and apologetic trials and errors, we puzzled and solved our way to experience many “a-ha!” moments together. Regardless of disease or condition, we know that gaps of awareness, knowledge and skills are finely intertwined in the layers of accountable care. Interactive experiences and demonstrations allow providers, patients and caregiver alike to close those gaps and expand their understanding and empathy. Unfortunately, it’s a significant element missing in today’s healthcare settings but also a great opportunity to level up meaningful engagement. If you have an interactive tip or activity you’d like to contribute, please email me at kelli@medspeaks.com or Tweet it @ Med_Speaks.

Fintech And Biotech Are Coming Together to Transform Drug Development By JOHN NOSTA, Forbes Contributor and Founder of NOSTALAB

Today, fintech and biotech are coming together to create a new, targeted financing option that is intended to drive efficiencies and advantages in drug development. Agenus, Inc. has announced the launch of the Biotech Electronic Security Token (BEST), a new, blockchain-based digital security to finance a single biotech asset alongside traditional financing for institutional and individual investors. The initial asset to be tokenized is AGEN2034, a PD-1 inhibitor and a member of a class of drugs generating over $15 billion in revenue in 2018. Not only a bold step, this is fundamental change for the bio-pharmaceutical industry that can have broad-reaching implications. The allocation of capital invested in drug development is estimated to have ex-

ceed $150 billion in 2017. Yet development remains problematic on many fronts. In the traditional model, the valuation of an individual asset remains a function of the entire company’s portfolio and the resulting dilution. Further, frequent restriction of promising investments to institutional inventors came limited access to a variety of parties from payors to patients. The resulting inefficiencies in investments can complicate, obstruct and impede multiple aspect of drug development. However, this new approach taken by Agenus establishes unique solutions to “tokenize” a portion of future US asset sales and offer key advantages: • Direct investment in a lead compound now in clinical trials. • A higher potential level of liquidity and tradability. • Valuation based on “revenue per dose.”

A broader reach to potential investors ranging from businesses to patients. Simply put, the depth and breadth of financing has changed by this new mechanism. And interestingly, this evolving “democratization” of drug development financing mirrors today’s health tech environment where clinical control is shifting to a more collaborative dynamic. Leveraging blockchain, Agenus can not only target a single biotech asset, but can establish new and powerful advantages from risk mitigation to a sharpened strategic focus. The establishment of this “open source” financing can become a fundamental shift to a more open and inclusive option across socioeconomic barriers. Further, the intrinsic security and organizational infrastructure may create a higher level of trusted, end-to-end financing. Originally published here on Forbes.com. You can follow John Nosta on Twitter @JohnNosta.

PHYSICIANSPOTLIGHT | Orlando Pediatrician, continued from page 3 really impacted me. I cried so much and felt guilty knowing that the times I did not show up, there might have been patients who were turned away.” “Volunteering at Shepherd’s Hope makes you feel spiritually good, even on your most tired of days. Any time you can

spare is very beneficial to both the patients and yourself.” The number of uninsured and underinsured patients who seek medical care from Shepherd’s Hope increases with every passing year. And, each year, some have to be turned away because there are not enough

volunteer medical professionals like Dr. Ali. To learn more about how to become a Shepherd’s Hope volunteer, contact Volunteer Program Manager Abby Seelinger at (407) 876-6699, ext. 233, or abby.seelinger@ shepherdshope.org, or visit www.shepherdshope.org/volunteers. orlandomedicalnews


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We Need Your Help! Shepherd’s Hope, the largest free and charitable clinic in Florida, is seeking Family Medicine Physicians to provide volunteer care for our patients (one three hour shift per month) at one of our five convenient locations in Central Florida. For volunteer information contact Abby Seelinger, Manager of Volunteer Programs (407) 876-6699, ext. 233 | abby.seelinger@shepherdshope.org or visit www.shepherdshope.org/volunteers.

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High Acuity Urgent Care Close to Home, at Less Cost David Harbour, DO, keeps patients and their care providers top of mind Eager to get the word out to the Orlando healthcare community, David Harbour, DO, and Eric Mason, DrPH, stress the value their high acuity urgent care centers for patients, insurance providers, and practices looking for an alternative for emergent patients who do not need immediate admission to the hospital. First Choice Urgent Care, founded in 2008, is privately owned with a mission to keep patients out of the hospital. “The decision to open a high acuity urgent care came from both of us working in Emergency Rooms and seeing how the vast majority of cases we saw were a tremendous waste of resources, and of patients/insurance/ ACO’s time and money,” said David Harbour, DO, medical director at First Choice, who is trained and board certified in Emergency Medicine. The entire staff is emergency medicine trained, experienced and hand-picked to ensure satisfaction for adults and pediatric patients. Labs, and radiology studies are handled by both locations; Oviedo, at 1945 West County Road 419, Suite #1101 and Maitland at 110 North Orlando Ave., Suite #14. Plans are for further expansion in central Florida. Dr. Eric Mason has been practicing emergency medicine for over 25 years. He graduated medical school as a physician assistant before earning a doctorate in public health.

He is also a consultant who astime, schedule or resource levels sists private medical practices of private practices. We can increase their value to the tend to most of these patients next levels in both a patient and save them time, money, care and probability aspect, and exposure,” Mason said. while minimizing risk. This is a win for insur“We do 90 percent of ance companies as well, since what hospital ER’s do for they can provide emergency patients not needing admislevel care in many cases, at a sion. Unlike hospital run urgent fraction of the cost. cares, we do not have the conflict Dr. Eric Mason “We work closely with any proof interest to feed the hospital viders who want to utilize our pracERs, but to reserve them for the more signifitice for emergency care, supplemental care, cant and appropriate cases. We are also not a and then ensure patients’ seamless follow up primary care office that acts as an urgent care back with their provider. Patient care is first, to increase walk in visits. We work with specialand while we do not replicate the hospital ER, ists to get patients directly admitted and have we can provide many services which virtustaff and resources in place to see higher acuity ally all other urgent cares will not do, and it medical care, then return patients to their own wouldn’t make business sense in my opinion healthcare providers. We want our patients to for hospital owned urgent care chains to NOT keep their provider, and us work with them as regularly refer patients out to their respectively an alternative to the ER for those many emerowned ER,” according to Harbour, “It does gent cases which require emergency medical make sense for the model of First Choice Uror traumatic care,” said Mason. gent Care to treat higher acuity patients and us Operating as independent cares benefits direct admit, or disposition patients back to the all aspects of the healthcare industry. referring provider as appropriate. This is best “Independence means that we only have for the patient, insurance carriers, Medicare, our patients to answer to, and not administraand physician offices that realize the trementions who must keep hospitals profitable. Hosdous savings potential.” pitals have a great role in healthcare but are Visit First Choice Urgent Care at www. grossly over-utilized in cases which are above firstchoiceurgentcare.net.




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Florida Pain Management, continued from page 2

ensure that they take all possible steps to maintain prescribing, medical record keeping, pain management clinic and billing/claims submission compliance in their daily practices of treating pain management patients or patients with chronic or even acute pain. A health care provider or professional does not need to necessarily meet the definition of a “clinic” under the Act to draw scrutiny or enter other attention from the DOJ task force that is monitoring Central Florida. Any potentially untoward or non-compliant prescribing, billing or pain management treatment practices could result in an audit, investigation or even criminal action by a host of Florida or federal government and health care regulatory agencies. Thus, if you are a healthcare provider professional that treats pain management or chronic pain patients, and/or prescribes any type of opioid or narcotic pain medications for patients, it is advisable to conduct a review of your prescribing, record keeping, billing, and treatment practices. But, perhaps the most significant federal legislative development came late in 2018 when President Trump signed into law the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act. The SUPPORT Act is wide-ranging legislation that touches on almost every aspect of the epidemic including treatment, research, funding, and reporting. Notable provisions of the SUPPORT Act include: • Expanded telehealth coverage and reimbursement for treatment of substance disorders; • Authorization of an alternative payment model demonstration project to increase access to outpatient treatment for Medicare beneficiaries; • Expansion of existing programs and create new programs to prevent substance use disorders and overdoses; • Provision of measures to prevent illicit flow of opioids into the United States by mail; and • Funding to encourage research and development of new non-addictive painkillers and non-opioid drugs and treatments. WHAT DOES ALL OF THIS MEAN FOR YOU? THE KEY TAKEAWAYS ARE THE FOLLOWING: 1. Know the definition of a “pain management clinic” under Florida law and whether or not your clinic meets the definition or is exempt and must file for a Certificate of Exemption. 2. Be careful with your prescribing practices and habits. 3. Always have a written pain management contract with your patients. 4. Be vigilant with tracking your prescribed (CONTINUED ON PAGE 10)




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Healthcare Industry Still Facing Crises By ANDREW COLE

According to Dongmin Kim, PhD (Orlando Medical News, January 2019) the healthcare industry is growing exponentially, impacting the quality of life for patients, through predictive analytics, finding cost effective solutions and adapting to extended life expectancies. Despite the improvements seen through predictive analytics and improved medicine, there remains a health insurance crisis across the country effecting both patients and physicians. According to Sara Collins, economist at the Commonweath Fund, Americans’ confidence that they can afford health care is slipping. “Even for conventional treatments covered under most health plans, the copays and high deductibles leave many people with health insurance they can’t afford to use.” Her organization found that underinsured people are nearly as likely to report problems paying medical bills as people with no insurance. She added, “they also report not getting needed health care at rates that are nearly as high as those who are uninsured.” Is it any surprise that many are raising funds through crowdsourcing? How concerned are our policy makers and providers over this alarming matter? Health insurance is expensive, complicated and difficult for the small business owner. For the business to grow, attracting and retaining better employees, increase productivity keeping everyone healthy and benefiting from health credits and deductions, offering health insurance is critical. Of course, if you have 50 or more full-time employees you are legally bound to offer health insurance. The Kaiser Family Foundation conducted a survey in 2017, finding that annual group health insurance premiums for businesses with fewer than 200 employees totaled between $6100 - $7200 for single coverage and between $17,000 - $20,500 for family coverage annually depending on the industry. With costs on the rise, often faster than inflation, it is no wonder so many small businesses dropped coverage. Since most small businesses have far fewer than 50 full-time workers, the good news is that they are exempt from the provision of the law mandating employer-sponsored coverage. However, small business owners and their employees are generally re-

quired on an individual basis to have health insurance coverage that meets the requirements of the Affordable Care Act. This typically means that they either buy coverage on their own in the individual or family health insurance market, or purchase or enroll in small business group health insurance to meet their requirements under the law. Without coverage they often forego well visits to the doctor opting to seek help in critical situations which can be extremely costly. What is the alternative? Offering nothing is not the solution. Nearly one-third of employees turned down job offers because of poor or non-existent health benefits. In fact, about 60 percent valued it so highly, they were willing to accept lower salaries. To combat the issue, many have turned to providing personalized health benefits. While the entire situation appears rather bleak, the East Orlando Chamber is addressing this issue for its members. To “stop the bleeding” the EOCC is offering three “Member Benefit” options for members and their employees who have nothing in place. The first is MDLive Telehealth providing an entire family living under one roof

CALENDAR: an opportunity to see a Florida Board certified doctor addressing 70 percent of typical doctor visits and 40 percent of urgent care and ER visits quickly from the comfort and convenience of their home, phone, tablet or PC. Additional packages available include the Allstate Accident, Allstate Cancer (including 23 specified diseases) and the WellCard Saving Plan. Each provides a reimbursement for doctor visits and other out of pocket medical expenses. Taking it one step further, the EOCC and Advocacy Advisory Council (led by Martha Santoni, Government Relations Coordinator at Nemours Children’s Hospital) is adopted Association Health Plans as a key initiative in 2019 so it may be able to offer full insurance programs to Chamber members and their employees. Currently only 10 states have enacted or presented a bill to address the critical needs of their constituents. To date, Florida has nothing on the books or language proposed. It is the mission of the East Orlando Chamber and its Advocacy Advisory Council to lead the fight on behalf of small business throughout Central Florida and the communities we serve such as Lake Nona

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Please visit www.EOCC.org for a complete listing of January’s 18+ Events

LAKE NONA DOCTOR RECOGNITION AWARD Last month the East Orlando Chamber of Commerce held their annual awards ceremony to recognize the most outstanding members from 2018. Dr. Colin Bartoe of Functional Neurology Chiropractic Center was the recipient of the “Rising Star Award.” This award is given to the member who made the most impactful contribution to the Chamber during their first year as a member. Dr. Bartoe joined the East Orlando Chamber in 9



2018 and has since become an Ambassador, Coffee Club Leader and sits on various committees. Dr. Bartoe is a perfect example for new members. He became engaged the day after he joined and has taken advantage of every opportunity presented. He is a model member who understands the benefit of the Chamber, helping his business prosper. Congratulations to Dr. Colin Bartoe, the East Orlando Chamber 2018 Rising Star recipient. orlandomedicalnews


Florida Pain Management, continued from page 8

numbers each month. If you are audited or investigated, you will need backup to show the percentage of patients prescribed opioids, benzodiazepines, barbiturates, or carisoprodol for the treatment of chronic, non-malignant pain. 5. Telemedicine – use it in your practice if applicable, but ensure you have the required licenses and permits to engage in a telemedicine practice. 6. Make sure you understand how to properly bill 3rd party payors for pain management and substance abuse care and treatment. 7. Back up information and control data securely. As with any overview, this information is general and intended to help you make informed decisions. The Healthcare Law Team at Lowe and Evander, P.A. understand the hard work and sacrifices it takes to become a health professional or provider and aggressively defend health professionals regarding protecting their license, practice, career, assets and reputation. Using our experience and expertise, we navigate the obstacles our clients face, serving not only as their attorneys, but also as their legal strategists, trusted advisors and protectors of their rights and interest against government investigations and lawsuits when necessary, and we help chart a course through the maze of state and federal health care laws, rules and regulations. Michael R. Lowe, Esquire is a boardcertified health law attorney at Lowe & Evander, P.A. Mr. Lowe and our law firm regularly represent providers, physicians and other licensed health care professionals, and facilities in a wide variety of health care law matters. For more information regarding those health care law and such matters please visit our website www.lowehealthlaw. com or call our office at (407) 332-6353.

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Meet Karen Jensen EEOC Board Chair Medical Community’s Marketing Needs

Poinciana Medical Center CEO Chris Cosby and Osceola Regional Medical Center CEO Davide Carbone recently met with Rep. Mike La Rosa, Rep. John Cortes and Sen. Victor Torres as part of HCA Good Government Group’s Day on the Hill in Tallahassee. The Good Government Group is HCA Healthcare's employee-based grassroots team engaged in state and national political issues. Pictured (left to right): Chris Cosby, CEO, Poinciana Medical Center, Florida Representative Mike La Rosa, Davide Carbone, CEO, Osceola Regional Medical Center.

Karen Jensen is vice president of Orlando Health Foundation. She has served in progressive leadership roles since joining the organization in 1995. Before joining Orlando Health, Karen led fundraising efforts at St. Joseph’s Hospital (Tampa), Burrell Behavioral Health (Springfield, Missouri), East Tennessee State University (Johnson City), Bradley University (Peoria, Illinois) and the University of Tennessee (Knoxville and Chattanooga). Karen holds a Certified Fund Raising Executive (CFRE) credential. She is a longstanding member of American Fundraising Professionals and the Association of Healthcare Philanthropy. She is a board member and officer for Variety Florida – the Children’s Char-

ity, a volunteer for the Girl Scouts of Citrus, a past president of the Kiwanis Club of East Orlando and a lifetime member of the Women’s Resource Center of Florida. She also is a board member and 2019 chair of the East Orlando Chamber of Commerce. Karen earned both her bachelor’s and master’s degrees in history from the University of Tennessee.


Jamie McMurray Racing the AdventHealth Camaro in The Clash at DAYTONA AdventHealth announced today that 2010 DAYTONA 500 champion Jamie McMurray will run the No. 40 AdventHealth Chevrolet Camaro ZL1 in the Advance Auto Parts Clash at DAYTONA during the 2019 DAYTONA Speedweeks Presented by AdventHealth. “Daytona International Speedway and Chip Ganassi Racing provide us with a national platform to amplify our new brand as AdventHealth,” said David Banks, AdventHealth chief strategy officer. “In almost all of our AdventHealth markets, there is a race track within a few hours. This allows our entire system of nearly 50 hospitals in almost a dozen states to not only participate in the NASCAR program, but hopefully benefit from it as well.” In addition, AdventHealth has partnered with Chip Ganassi Racing to develop a robust Human Innovation and Development Lab (HIDL) to focus on unique training to prepare drivers both mentally and physically. Located at the Chip Ganassi Racing shop in Concord, North Carolina, the HIDL is a human performance enhancement project that has been headed-up by former NASCAR driver Josh Wise. The HIDL features tools and technology that Wise and the team use to develop and improve the performance of drivers and pit crew members. “Our HIDL isn’t just producing bet-




ter athletes through fitness, it is looking at the whole person – how the mind and body connect to produce fast decision-making, better handeye coordination, balance, and overall mental toughness,” said Banks. “These are all things that we focus on with our patients – not just treating the diagnosis, but really looking at the whole person to ensure the mind, body and spirit are in alignment.” For the past three years, AdventHealth (formerly known as Florida Hospital) and McMurray have had a partnership. McMurray initially made his first Monster Energy NASCAR Cup Series (MENCS) start in the No. 40 car and now he returns to his roots in the No. 40 car for the kickoff of the 2019 MENCS season. McMurray has a long history of racing and winning at Daytona International Speedway. He has experienced winning in nearly every type of event that he has competed in at the “World Center of Racing” including go-karts, Sports Cars and NASCAR. McMurray is one of only four drivers to have ever won the DAYTONA 500 and Rolex 24 At DAYTONA, joining a list of racing legends that includes Mario Andretti, AJ Foyt and Jeff Gordon. “Jamie McMurray has proven to be successful at Daytona International Speedway,” Banks said. “As a person, Jamie aligns very well with the AdventHealth brand. He is a family man,

AdventHealth_Clash Car (1) & (2) & (3): Jamie McMurray, 2010 DAYTONA 500 champion, will run the No. 40 AdventHealth Chevrolet Camaro ZL1 in the Advance Auto Parts Clash at DAYTONA during the 2019 DAYTONA Speedweeks Presented by AdventHealth.

into staying active and maintaining a healthy lifestyle, wholesome, and an all-around good guy.” In Oct. 2018, AdventHealth also announced an expanded partnership with the Daytona International Speedway and the DAYTONA Speedweeks is now referred to as “DAYTONA Speedweeks Presented By AdventHealth,” which is highlighted by the 61st annual DAYTONA 500. AdventHealth began a relationship with the Daytona International Speedway in 2014, when Florida Hospital was named a Founding Partner and the Official Healthcare Partner of Day-

tona International Speedway. “I am looking forward to getting back in the car at Daytona and to have AdventHealth onboard with us for this race,” McMurray said. “We have had a great relationship with everyone at AdventHealth over the last several years. It means a lot to have them partner with us on this special event, especially with everything that they have going on at Daytona International Speedway throughout Speedweeks, as presenting sponsor and with their fan injector to greet fans coming to the races”.



GrandRounds Attorney George Indest Recognized For AHLA Top Honors In 2018 Attorney George F. Indest III, President and Managing Partner of The Health Law Firm, was recently recognized by the American Health Lawyers Association (AHLA) for Top Honors in 2018. Every year, AHLA recognizes the organizations that stand behind members; the law firms, organizations, health plans, businesses, and govern-

ment agencies that consistently and enthusiastically encourage and sustain their members’ and employees’ affiliation. Mr. Indest was also recognized in the Honor Roll of Donors for the "50th Anniversary and Beyond Campaign," which raised money in support of the Associations educational mission.

Doug Flutie Jr. Foundation for Autism Awards Nemours Children’s Hospital Grant to Expand Innovative Care Model The Doug Flutie Jr. Foundation for Autism has awarded Nemours Children’s Hospital over $19 thousand to expand the REACH Program. REACH (Respecting Each Awesome Child Here), originally developed by Nemours for children with Autism Spectrum Disorder (ASD) in the emergency department, will now expand to the surgical care department. According to a recent Nemours study, REACH reduces the use of medication administered to kids who are prone to stress and sensory overload in this care setting. “We are honored to continue our partnership with Nemours, and so grateful for their careful attention to the diverse needs of all patients, including children and families affected by autism,” said Doug Flutie Jr., founder of the Doug Flutie Jr. Foundation for Autism. The Flutie Foundation helped build out two REACH rooms currently in the emergency department. This grant will fund two new designated REACH rooms – one in pre-operative and another in the post-operative area of the hospital. The room will incorporate the use of sensory-friendly equipment, tools and resources to reduce an ASD child’s anxiety level caused by stress and/or over stimulation. Both rooms will be equipped with appropriate calming and engaging resources for a wide age-range and skill levels. Anesthesia inductions before surgery can become traumatic for children with ASD and pose a challenge for the care team, that often needs to use pharmaceutical and/or anesthetic interventions to prepare a child for surgery. “Our program was designed to help prevent escalation of anxiety and agitation in children with ASD, therefore leading to the reduced use 12



of sedatives and restraints,” said Kelly Bradley, Surgical Nurse at Nemours Children’s Hospital. “Since many of our ASD patients experience frequent hospital visits causing stress and anxiety, the ability to minimize the use of sedative medications, which do have side effects, is an added benefit for our patients and their families,” said Bradley. Nemours’ REACH Program, now in its third year, accommodates children with ASD, sensory disorders, mental health disorders and similar conditions. The care teams receive ongoing training regarding ASD, REACH concepts, procedure planning, and recognizing and managing anxiety and agitation. There is limited comparative research, but one study, not employing the REACH model, found that sedation or restraints were used in nearly one fourth of ED visits by children and adults with ASD. An evaluation of two years of electronic health records at Nemours Children’s Hopsital identified 860 pediatric ED visits in which the REACH model, was used for patients with ASD or similar conditions. With this approach, fewer than six percent of these patients needed an anxiolytic (anxiety medication). None needed an antipsychotic (for aggressive behavior) or an alpha-agonist (for hyperactivity and anxiety). Fewer, than one percent needed physical restraints.

Local Entrepreneur Caters to the Medical Community’s Marketing Needs Di-Anne Elise founder of Media Resources Enterprise has been a contributor in the medical field by revolutionizing marketing at its best. She has helped not only hospital medical groups but also health professionals educate the public in order to get a better understanding on how they could improve their patients’ lives. Di-Anne has been able to impact the medical community by providing business communication and marketing creative services in order to inform and make a difference in the medical health community. Di-Anne Elise, is an author, a speaker and a business communication coach and trainer, specializing in Public Relations, Marketing and Social Media Marketing strategy. She has been the National Association of Professional Woman (NAPW) Public Relations Women of the Year, Mrs. Corporate America 2012 and the reigning Mrs. Corporate America Lifetime Queen 2108. Di-Anne has the expertise: professionalism, and people skills to help businesses communicate to the public. Di-Anne obtained a bachelor’s degree in Communication with concentration in Public Relations, and Marketing, graduating Magna Cum Laude from Ashford University; she

has a professional broadcasting certification for Radio/TV from the Connecticut School of Broadcasting, has been a news contributor for local TV stations and a Marketing and Advertising expert for ehow.com. She assists in communication campaigns to promote her client's interests in the areas of public relations, marketing, social media, and video production. To contact Di-Anne Elise email her at dianne@mediaresourcesenterprise. com or call at 407-579-9903. For more information visit her website at: www. mediaresourcesenterprise.com

Orlando Health plans additions to downtown Orlando campus Orlando Health has announced plans for two new additions to its downtown Orlando campus. This week, plans for a new building located at 1800 S. Orange Avenue were submitted to City of Orlando’s planning division to begin the review and approval process. The one-story, 6,800 square foot facility will become home to a new Orlando Health Imaging Center. The new site will include state-of-the-art MRI, Open MRI, Radiology, CT Scan, Interventional Radiology and Mammography. “We’re excited about bringing this new flagship imaging center to the heart of the Downtown South district on Orange Avenue,” said Matt Taylor, AICP, vice president of asset strategy for Orlando Health. “In addition to serving patients with the most technologically-advanced equipment in a welcoming setting, we are providing convenient patient parking adjacent to the building. The new location offers patients easy access to imaging services near their work or home.” Construction on the new Orlando

Health Imaging Center is planned to begin this spring with completion by fall 2019. Orlando Health also submitted land development plans to the City this week for a new building located on West Copeland Drive between Sligh Boulevard and Lucerne Terrace. The facility will feature a nine-level visitor and team member parking structure with 895 parking spaces. The structure will also include just more than 12,000 square feet of medical office space on street level facing Copeland Drive and a five-level, 42,000 square foot office building facing Sligh Boulevard. “The new parking structure and office building is located at the western gateway to our downtown campus,” said Mr. Taylor. “The modern, timeless architecture will be a strong complement to the historic train station and Sun Rail platform, welcoming visitors to our campus.” Once permitted, construction of the new structure is expected to begin in spring 2019 with completion scheduled for nine months later. orlandomedicalnews


GrandRounds Orlando Health’s heart care earns highest quality rating from The Society of Thoracic Surgeons Orlando Health earned an Overall 3 Star Rating from The Society of Thoracic Surgeons for providing excellent care to patients undergoing coronary artery bypass surgery (CABG) and aortic valve replacement with coronary artery bypass surgery (AVR+CABG). The current rating is the eighth consecutive 3 Star Rating for CABG, and the fifth consecutive 3 Star Rating for AVR+CABG. The 3 Star Rating, the highest achievable, is based on STS Adult Cardiac Surgery Database participant outcomes. The most recent evaluation period is January 2018 through June 2018. Historically, approximately 6 percent to 10 percent of participants receive the three-star rating for isolated CABG surgery; and approximately 4 percent to 7 percent of participants receive the three-star rating for AVR+CABG surgery. “Our Heart Institute team remains committed to providing the best cardiovascular surgical care to our patients,” said Jeffrey Bott, MD, a cardiothoracic surgeon at the Orlando Health Heart Institute. For patients choosing our program, achieving the highest quality rating demonstrates our successes in cardiac surgery performance. For our staff, it is a privilege to be recognized by peers for the ongoing, day-to-day initiatives to deliver excellent outcomes.” The Heart Institute’s success in cardiac surgery performance is the result of expertise, experience, collaboration, and a voluntary, self-run quality council. The council — comprised of surgeons, nurses, pharmacists, respiratory therapists, infection control specialists, risk managers, administrators, doctors and other team members — works diligently on various quality improvement initiatives and care reviews for each of our processes including pre-surgical preparation, surgical management, avoidance of complications and death and postsurgical medical management. The composite measure for isolated CABG surgery consists of four quality domains over a twelve month period: 1. Absence of mortality (Deaths) 2. Absence of major morbidity (Complications) 13



The Orlando Law Group Continues to Grow with Addition of Three New Attorneys

The Orlando Law Group is continuing on their path as one of the top 500 fastest growing law firms in the country with the addition of three new attorneys to their team. Cameron White is an experienced business and real estate attorney who was a golf professional prior to law school. White has a broad transactional background with a focus in business and real estate transactions, including commercial and residential sales, purchases, leases, financing, and loan workouts and restructuring, as well as experience with intellectual property including licensing and trademarks.

3. Use of Internal Mammary Artery graft(s) (Arteries located in the chest and commonly used in bypass surgery because they have been shown to have the best long-term results.) 4. Receipt of required perioperative medications (Appropriate perioperative (before, during and after) medication usage.) The composite measure for AVR+CABG consists of two quality domains: Absence of mortality, and Absence of major morbidity. “The Society of Thoracic Surgeons congratulates STS National Database participants who have received threestar ratings,” said David M. Shahian, MD, Chair of the STS Council on Quality, Research, and Patient Safety. “Participation in the Database and public reporting demonstrates a commitment to quality improvement in health care delivery and provides patients and their families with meaningful information to help them make in-

Representative clients include private investors, golf course owners/ operators, developers, lenders, and business owners. He continues to build his practice by fostering and nurturing meaningful, congenial relationships. Mary Zogg has been a practicing attorney for over a decade. She has a multidisciplinary background which helps to provide a unique experience for her clients. She has an undergraduate degree in psychology and a Masters in Business Administration in addition to her law degree. This allows her to provide her clients with a full vision of the

formed decisions about health care.” The STS National Database was established in 1989 as an initiative for quality improvement and patient safety among cardiothoracic surgeons. The STS Adult Cardiac Surgery Database, a component of

financial, emotional, and legal aspects of their cases. Jessylin Polo Wiederhold has always been an active member in her community with a passion for making a difference in the lives of others. Originally from Miami, Florida, Jessylin is fluent in both English and Spanish. She began her legal career as a paralegal in personal injury for eight years. Jessylin now brings her passion for serving others to The Orlando Law Group in the areas of personal injury, PIP, and business law. She is an active member of the Florida Bar and Central Florida Association for Women Lawyers.

the STS National Database, includes more than 6 million surgical records, representing an estimated 90 percent of all adult cardiac surgery centers across the United States.



407.701.7424 orlandomedicalnews


GrandRounds Florida Heart & Lung Institute Welcomes New Cardiothoracic Surgeon Hiep C. Nguyen, M.D. Hiep C. Nguyen, M.D., Cardiothoracic Surgeon, recently joined the Florida Heart & Lung Institute of Osceola (formerly Cardiac Surgical Associates of Osceola) and the cardiothoracic surgical team at Osceola Regional Medical Center’s Heart and Vascular Institute. Dr. Nguyen brings significant experience in cardiothoracic and vascular surgery to Osceola Regional Medical Center. His expertise includes minimally invasive and robotic surgery, such as robotic Coronary Artery Bypass Grafting (CABG), Mitral Valve Repair (MVR), Aortic Surgery, Mini MVR and Tricuspid Valve Replacement (TVR), Transcatheter Aortic Valve Implantation (TAVR) and Endovascular Stent Grafting for Aortic Aneurysm and Aortic dissection. Most recently, Dr. Nguyen served as the Surgical Director of the TAVR program and Surgical Director of Minimal Invasive Cardiac Surgery at Christus Trinity Mother Frances Health System in Texas. Prior to that, he spent 10 years at Christian Care Health Systems in Delaware where he served as Director of the Cardiac Surgical ICU, Director Aortic Program, and Surgical Director of the TAVR program. “Dr. Nguyen brings a dynamic skillset and tremendous experience to our cardiovascular team, complementing our other surgeons and our program, aligning with the hospital’s future care goals,” said Davide M. Carbone, Chief Executive Officer of Osceola Regional Medical Center. A graduate of the University of Texas Medical Branch School of Medicine, Dr. Nguyen also holds a B.A. in Biochemistry from Rice University. He completed his fellowship at New York University, is certified by the American Board of Thoracic Surgery and is a diplomat of the American Board of Surgery. “Osceola Regional Medical Center’s Heart and Vascular Institute offers top-notch care, and I am thrilled for the opportunity to be a part of it,” Dr. Nguyen said. “I look forward to working with this experienced team to continue to offer the best cardiac care to our community.”




AdventHealth plans Lake Nona ER AdventHealth is expanding its care network in southeast Orlando, with plans for an emergency room in Lake Nona. The ER will have 24 patient rooms (including two pediatric-friendly rooms to make visits less stressful for young patients); respiratory therapy; diagnostic imaging, including CT scans, X-ray and ultrasound; and a full-service laboratory. The one-story, approximately 19,000-square-foot facility will be staffed by a comprehensive clinical team including board-certified emer-

gency physicians and emergency nurses. The ER will employ a team of approximately 100 people. The ER is part of a larger effort to bring emergency care close to home for residents across Central Florida, no matter where they live. Construction began in 2018 on AdventHealth ERs in Waterford Lakes and Oviedo. Both facilities are expected to open later this year. “We are excited to announce we will be adding this ER to our expanding network of care,” said Jeff Villanueva, CEO of AdventHealth’s East

Orlando market. “The Lake Nona area will be expanding quickly in the years ahead, and we want to keep pace with the needs of the community. Placing an ER in Lake Nona will give residents an easy, convenient way to access the entire AdventHealth network.” The emergency room will be located at Lake Nona Boulevard and Narcoossee Road. A groundbreaking is planned for this summer, with the ER expected to open in spring 2020.

Federal Court Rules in Favor of Parrish Medical Center, Against Seven Oncologists Who Sought Injunction to Restore Hospital Practice Privileges A federal judge has ruled in favor of Parrish Medical Center (PMC) and against seven oncologists who sought an injunction to restore their privileges to practice at the Titusville hospital. The seven physicians—Blaine Germain, Cynthia Bryant, Juan Castro, Ashish Dalal, Firas Muwalla, Brendan Prendergast, and Richard Sprawls, had sought a preliminary injunction against PMC, claiming their due process rights had been denied and that PMC’s bylaws were breached. The court found that neither situation had occurred and denied the physicians’ request. The ruling was issued Feb. 4, 2019, by U.S. District Judge Roy B. Dalton, Jr. The dispute centered on the physicians’ refusal to provide patient care data to PMC. Having received what the court said was a “full panoply of due process protections,” the seven physicians’ privileges were not renewed by PMC due to the physicians’ consistent failure to provide PMC with essential patient care data.

The court noted that “…PMC found that the Plaintiffs’ failure to comply with PMC’s request for patient data hindered the cancer program.” This failure constituted “relevant considerations” for PMC. The court cited the findings by the PMC Medical Staff Ad Hoc Committee that examined the physicians’ failure to turn over the requested patient data. The Court’s Order cited that “the Ad Hoc Committee found that the Medical Executive Committee could rightfully recommend denial of Plaintiffs’ reappointment applications,” and that such “…decision could rightfully be upheld following a hearing before the Ad Hoc Committee, a review by the CEO, and ultimate disposition by the Board. And at this stage, the Court finds no fault in this course of action—rather, the Bylaws contemplate denial of reappointment on such grounds so long as the reappointment process is followed.” The court also noted that, “Each reviewing body at PMC found that

Plaintiffs’ failure to comply with PMC’s request for patient data hindered the cancer program and the delivery of quality of patient care and could cause the loss of accreditation in the future,” the court said. The court’s decision validated the actions taken to not renew the physicians’ privileges, said Joseph Zumpano of Zumpano Patricios the Miami, Florida-based firm representing PMC. “The court found that PMC’s board of directors, and administration did the right things, the right way, according to policies, bylaws, and the law.” PMC has Brevard County’s longest continually accredited program by the American College of Surgeons Commission on Cancer (CoC). First accredited in 1989, PMC’s is one of only two CoC-recognized programs in Brevard County. The federal district court order can be read here: https://ecf.flmd. uscourts.gov/cgi-bin/show_public_ doc?2018-00487-94-6-cv



Reputation Management – Why Your Online Presence is Affecting Your Business By JOHN SINGLETON, Red Fang Marketing

Looking around you’ll probably notice most people’s gaze affixed to their smartphone or tablet. This is a fact of society that can no longer be ignored. With this fixation on technology, trends are emerging. Approximately 95% of consumers search for businesses and services online when they are trying to figure out where to spend their income. Retail giants, such as Amazon, have by and large trained the consumer space on the importance and reliance of reading reviews. This behavior has bled over into the rest of the consumer space, and impacts all businesses online from dentists to lawyers, and doctors to surgeons. According to a study conducted by Bright Local, and online business listing service, nearly 85% of consumers today now trust online reviews as much as a personal recommendation from a family member or friend. These statistics should be eye opening. Consumers now have the choice to read reviews online from unending sources. Major review platforms are Google, Facebook, and Yelp. Other important platforms include websites such as Citysearch, Judysbook, and Foursquare, as well as other tried and true establishments such as the Better Business Bureau. Drilling down further, there are now a plethora of specialty review sites based on specific industries. These are ever-present in the medical community and include sites such as WebMD, Vitals, Zocdoc, Healthgrades, RateMDs, and so on. In total, there are at least 16 medical specific review sites where patients can go to learn of the reputation of the physician they’ve been referred to or are now having to choose from due to an insurance change. This doesn’t just stop at the medical industry. There are also four dentist specific review sites and six specific eldercare review sites.

What does this all mean for you?

It means that patients, more than ever before, can learn about what their community at large thinks about a practice before ever picking up the phone to schedule an appointment, or step foot in a waiting room. As mentioned above, if 85% of those patients are treating these reviews with equal weight as a family or friend referral, then every medical practice needs to make sure they manage how they are being perceived by the public.

How it really works.

Most business owners believe that




reviews, but nothing is working. They ask their customers for reviews and even ask friends and family to help, but nothing works. There is a reason for that, in fact there are three reasons. Most people don’t leave reviews because they simply forgot, didn’t have time, or didn’t know how to properly leave one.

Can this be fixed?

whatever advertising and marketing they are doing results in patients walking through the door after responding to an advertisement. The same for those family or friends that have told people they know about how great a time they have had at a facility. What really happens, though, is that those advertisements and word of mouth referrals take a detour to online review sites first. If a company’s reputation is stellar or reputable, things end with an appointment being scheduled. When the reputation is mediocre or poor? Well, then those hard-spent marketing dollars and/or goodwill has resulted in people choosing a competitor at worst, or perhaps doing nothing at all.

Key Review Factors

When looking at reviews, there are a number of factors that must be taken into account. The first and most obvious is the average star rating. After that, consumers look at how many reviews a business has. A 5-star rating is nice, but few reviews hold less weight than others with a large volume of reviews. Other factors that go unnoticed but are just as critical are the frequency at which reviews are being posted. Is a business only getting a new review once or twice a year? They look irrelevant. Does a business have plenty of reviews, but that last one is older than three months? Well, that too, is a factor. 73% of consumers think that reviews older than three months aren’t relevant. Does a business respond to negative reviews? If yes, then that’s a positive thing. If no, then that just shows further apathy and gives the impression that a business just doesn’t care what their customers think.

You’ve already tried everything?

Many business owners feel like they have done all that they can to get

The short answer is yes. Thankfully there are companies and services out there that can help businesses get a handle on their online reputation, and bolster it where needed, or repair it if it’s in poor shape. Much like getting a poor grade in school, negative reviews take longer to overcome as you need 10 “A’s” to overcome that “F” that came through. With the right service in place, business owners now have the ability to reach out to their customers and prompt them for reviews when the time is convenient for the customer to leave one. Through email and text campaigns, now you can reach your audience on their time and ask them to tell their community at large about

the great service they were provided. For medical practices, this is just as important as businesses at large. One key factor the healthcare industry is PHI information. This has already been accounted for, and services, such as the one Orlando Medical News is offering, is fully PHI compliant. This critical factor allows medical practices and medical related services to have peace of mind when implementing a review service.

Interested in solidifying your online reputation?

Contact John Kelly and his staff at Orlando Medical News. John can be reached at jkelly@orlandomedicalnews. com or by calling 407-701-7424 John Singleton founded Red Fang Marketing in 2015 while in the midst of a highly successful corporate marketing career for multiple household brands including The Home Depot, Dish Network, and New York Life. Red Fang Marketing was born out of the desire to bring high caliber marketing strategies and techniques to everyday business owners, giving them an edge in their marketplace and helping them achieve their goals and dreams. VISIT REDFANGMARKETING.COM



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Considering Adults with Undiagnosed CHD By Jamil Aboulhosn, MD and Arwa Saidi, MB, BCh, MEd, FACC

Congenital heart defects are the most common birth defect, affecting one percent of babies. More than 90 percent of these children are now surviving to adulthood; consequently, there are now almost 1.5 million adults with congenital heart disease (CHD) living in the United States. This is one of the great success stories in the history of medicine. Before the advent of the heart lung machine in the 1950s, which allowed surgeons to operate on defects within the heart, most babies born with complex CHD did not survive to reach adulthood. It was through the creativity, diligence, and commitment of physicians, researchers, nurses and surgeons that this miraculous change in outcomes occurred. These heart defects range from mild (such as a small hole in the heart) to complex (such as a blue baby with three instead of four heart chambers). The majority of patients with complex forms of CHD have symptoms and are diagnosed early in infancy or childhood. Those with mild defects may not develop symptoms or be diagnosed until later in life. These symptoms usually include exercise intolerance, shortness of breath, irregular heart rhythm, or lower extremity swelling. Unfortunately, the vast majority of adult CHD (ACHD) patients are not under the care of an ACHD specialist. There are numerous reasons for this, which include lack of access to specialized care, lack of awareness of specialized care, loss to follow-up after the pediatric period, or being under the care of a non-specialist. So when these patients develop symptoms, they usually present to their primary care providers, emergency room physicians, obstetricians and gynecologists or other non-ACHD physicians. Recognition of signs and symptoms of CHD by these medical providers allows for timely and appropriate delivery of care. There are numerous acceptable ways to classify CHD but one can simplistically group ACHD patients into one of two categories:

Patients with Known CHD:

In the United Sates, the majority of ACHD patients were followed by a pediatric cardiologist during




childhood. However, most patients, especially those with mild forms of CHD, do not end up transitioning to an ACHD specialist after aging out of pediatric care. Over the years, many have been lost to care and their cardiac follow up often becomes sporadic because they are feeling well, did not have insurance, relocated or did not establish cardiac care in adulthood. Although many patients consider themselves “cured” because of their prior surgery, unfortunately that is not the case. They are still at risk of developing arrhythmias, progressive valvular disease and heart failure symptoms, and may need further medical or surgical intervention. Greater awareness and recognition of the importance of ACHD followup will reduce the preventable complications associated with loss of care. It is essential that patients have a basic knowledge and understanding of their CHD, what surgeries they have had, what medications they take, and what signs or symptoms to watch out for. Some adult CHD patients have low circulating oxygen levels and are “cyanotic,” meaning their lips and fingers have a bluish discoloration. These patients are at increased risk of having a brain abscess, stroke, clots in the lungs, and heart valve infections. Others have normal oxygen levels but suffer from heart rhythm instability and suffer from heart failure. Many are living healthy, productive lives and are under good sub-specialized ACHD care. All patients with CHD are at risk for developing acquired medical problems such as diabetes, cancer, hypertension, etc.; they are just like the rest of us in that respect.

undiagnosed atrial septal defect, partial anomalous pulmonary venous return or Ebstein’s anomaly in patients presenting with heart failure symptoms, right atrial or ventricular dilation or atrial arrhythmias. Consider a diagnosis of CC-TGA in patients with heart failure, slow heart rates due to complete heart block or a type of electrical abnormality called the Wolf Parkinson White syndrome. Patients with coarctation of the aorta may present with difficult to control hypertension despite the use of multiple antihypertensive medications. A cardiac echocardiogram, CT or MRI can help make the diagnosis. If congenital heart disease is considered or diagnosed, further evaluation and imaging by a CHD specialist is necessary. This evaluation and management is guided by the 2018 AHA/ACC Guidelines for the Management of Adults with Congenital Heart Disease and takes the anatomical cardiac defect and the patient’s symptoms into consideration. After a diagnosis is established, collaborative care between the primary care provider and ACHD cardiologist is recommended. Patients and providers can access the Adult Congenital Heart Association website at www.ACHAHeart.org to find the adult congenital heart disease center that is closest to them, as well as a list of board certified specialists, including details about the care the center provides. In conclusion, whether you are seeing a patient who is presenting

with new symptoms or who has known CHD and has been lost to care, we urge you to think about CHD. So many patients in this country are lost to the specialized care they need.

About the Adult Congenital Heart Association

The Adult Congenital Heart Association (ACHA) is a national not-forprofit organization dedicated to improving the quality of life and extending the lives of adults with congenital heart disease (CHD). ACHA serves and supports the more than one million adults with CHD, their families and the medical community—working with them to address the unmet needs of the long-term survivors of congenital heart defects through education, outreach, advocacy, and promotion of ACHD research. For more information about ACHA, contact 888-921-ACHA or visit www.ACHAHeart.org. Jamil Aboulhosn, MD, FACC, FSCAI, is the Chair of the Adult Congenital Heart Association Medical Advisory Board. He is the Streisand/American Heart Association Chair of Cardiology and Associate Professor of Medicine and Pediatrics at the David Geffen School of Medicine, University of California Los Angeles, as well as Director of the Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles. Arwa Saidi, MB, BCh, MEd, FACC, is the Vice Chair of the Adult Congenital Heart Association Medical Advisory Board. She is the Director of the Adult Congenital Heart Disease Program and Professor of Medicine and Pediatrics at the University of Florida, Gainesville.

Patients With Previously Undiagnosed CHD:

Because of the more favorable natural history of several heart defects, some patients may not have symptoms and thus go undiagnosed until adulthood. These defects include atrial septal defect, partial anomalous pulmonary venous return, coarctation of the aorta, Ebstein’s anomaly and congenitally corrected transposition of the great arteries (CC-TGA). Patients with these defects may present with symptoms during or after a pregnancy or even later in life with symptoms of heart failure and decreased exercise tolerance. Consider a previously

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Tips for Hiring the Right Worker, the First Time By WENDY SELLERS, The HR Lady The war for talent is stronger than ever. Finding qualified, effective people is difficult, expensive and exhaustive. Hiring right is fundamental. How do you do this? First, train hiring managers on how to interview. This starts with clearly defining the job. Having the right employees in the right roles for the right amount of time simply cannot be downplayed. It does seem like a pretty easy concept, right? Then why do so many companies get it wrong? During the hiring process, one major reason companies inadvertently hire the wrong people is because it is not clear what skills or attributes they are looking for. Creating basic job descriptions for every role in the company will save time, money and painful experiences for all involved. Second, take the time to find the right person. Hire a recruiter if you have not successfully done this before. Another major reason that companies inadvertently hire the wrong person is that there is a lack of time allocated to find and screen and interview qualified candidates. Often the manager tasked with filling the position is stressed, carrying a heavy workload and feels rushed to fill the position with any warm body. Any manager put in this position may hire the person who may be “good enough” and end up with him/her not being able or willing to meet company expectations. In order to avoid hiring the wrong candidate, time must be allotted to hiring managers so that they can take an appropriate amount of time to find the right types of candidates, ask the right questions, get the right people involved in asking those questions and to finally give realistic job previews to the top candidates. Supply and demand drive the availability of qualified candidates; therefore, every position will take a




different amount of time to properly fill. For some positions, this may take twelve hours over two weeks; for other positions, this may take ten hours a week over two months. Third, set the new hire up for success. Unless your culture is punitive, do not have a probationary period. As leaders, we want our employees to do their job, take responsibility, be accountable and act like an adult. Then why the heck would you start new work relationships off with “Welcome to the team, you are on probation.” This is not how to start a trusting, positive relationship. You are now inferring, yes, I may have chosen you as the best candidate, but I do not trust you to do the job but maybe, just maybe, I might trust you are the right person in 90 days, 6 months or a year. This is ridiculous. At will employment spells out that every employee is on probation every, single day (unless there is a contract, and even then, the terms often allow for termination for cause). If you are worried that you chose the wrong person for the job, hold the hiring manager accountable not the new hire. If you are worried that they may not “catch on” to your processes, improve your systems and training programs. If you are worried that they may file unemployment, again hold the orientation process and the hiring manager accountable for not conducting better interviews. In most states, new hires cannot file until after 90 days of employment, so get your act together and make sure your team is doing everything possible during those first 90 days for a successful new hire experience. Please note this is a leadership and operational duty, not an HR responsibility. If your policies are outdated change them. Use positive verbiage and policies. An introductory period is appropriate, but it shouldn’t be negative or punitive. Culture is key. Your policies should reflect your culture.

Considering how difficult it is to recruit employees, keeping them is vital. Developing your managers into true leaders should be CEOs’ number one concern. After that is developing all employees, from the receptionist or maintenance staff to your executives and board members. Why? A recent Gallup report states employees desire engagement and if they do not get it from their management team, they will be looking for a new job. The same report states employees leave due to lack of career growth opportunities. Employee and leadership

development is a now a cost of doing business and is no longer avoidable. Hire right the first time, because who has time to do it over? Wendy Sellers “The HR Lady” 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. Wendy is authentic and transparent - above all, she keeps it real. She is honest, loyal and direct - there is never any sugar coating! VISIT WWW.THEHRLADY.COM


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MACRA 2019 Changes Address Physician Concerns Centers for Medicare & Medicaid Services (CMS) is taking steps to ease regulatory burdens by removing process measures, developing more outcome measures, changing the fee schedule to support telemedicine technology, and focusing on EHR interoperability. That’s because CMS listened to stakeholder input before releasing the final changes to the Quality Payment Program (QPP). The changes were effective on January 1, 2019. This marks the third year of the QPP, which was established in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA repealed the sustainable growth rate (SGR) formula for reimbursing physicians and other clinicians participating in Medicare. The QPP encourages value-based care through two tracks, the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). With these new changes, CMS vows to continue using the Patients over Paperwork framework so that physicians may focus more on taking care of patients and less on redundant documentation. Other changes are that CMS has renamed the EHR Incentive / Meaningful Use / Advancing Care Information category to “Promoting Interoperability,” placing a strong emphasis on sharing healthcare data between providers and providing full access to patients of their healthcare records. Highlights of the changes made to MIPS for 2019 that will affect clinicians include: 1. Category weights have changed for two categories. The categories are fundamentally the same. The category changes include: • Quality: 45 percent (down from 50 percent in 2018). 25 percent.

• Improvement Activities: 15 percent. • Cost: 15 percent (a 5 percent in-

crease from 2018).

• Hospital-based or facility-based clinicians have some flexibility in 2019.

Eligible clinicians may use facility-based reporting for MIPS Quality and Cost categories based on the hospital value-based program. Eligibility will be published on the QPP website in quarter 1 2019.

2. Important general MIPS changes for performance year 2019 include:




• The performance threshold increases in 2019 from 15 MIPS points to 30 MIPS points to ensure a neutral payment adjustment, and greater than 30 points for an increase. • The exceptional performance bonus increased to 75 points (up from 70 points in 2018). • The total amount of Medicare reimbursement at play for 2019/2021 has increased. Practices scoring between zero and 30 total MIPS points will see up to a -7 percent adjustment. Practices scoring over 30 points could see up to a 7 percent increase. (Note: Any positive payment adjustments will be multiplied by a scaling factor to ensure budget neutrality, so the maximum positive adjustment will likely be below 7 percent.) • The five bonus points added to the final score of clinicians in small practices (TINs with fewer than 15 associated NPIs) increases to six points. The points will be added to the numerator of the Quality score rather than the overall MIPS score. • Eligibility has been adjusted to allow more clinician participation in MIPS, even by providers excluded based on the low-volume threshold criteria.


• Promoting Interoperability:

• The performance period for the third year of the QPP/MACRA is the calendar year 2019. Performance for 2019 will affect payment in 2021.



• Options include: (a) voluntary participation without a payment adjustment, or (b) choosing to opt in and be subject to the performance requirement and payment adjustment. • Eligible clinician types have expanded. These will include the five categories that were included in the two previous years, plus clinical psychologists, physical therapists, occupational therapists, speechlanguage pathologists, audiologists, and registered dieticians or nutrition professionals. 3. The MIPS Quality category has: • Separated collection types from submission types, clarifying some of the confusing language. • Added eight measures, with four being patient-reported outcomes, and removed 26 measures that didn’t add value, were process measures, or were topped out. • Made claims-based measures available only to small groups with fewer than 15 physicians. 4. MIPS Advancing Care Information category changed in 2018 to Promoting Interoperability. In this category, it is much more difficult than it has been in the past to achieve maximum points. The Promoting Interoperability changes for 2019 include: • Four aims clinicians must meet: ePrescribing, Health Information Exchange, Provider to Patient Exchange, and Public Health and Clinical Data Exchange. Clinicians would be required to re-

port certain measures from each of the four objectives, unless an exclusion is claimed. • Any unreported measure or no answers to a yes/no measure will result in a zero Promoting Interoperability score. • MIPS-eligible clinicians are required to use the 2015 Edition of Certified Electronic Health Record Technology (CEHRT) if they report in this category, and must submit evidence to CMS. • The Promoting Interoperability reporting period will remain a minimum of a continuous 90day period. • Scoring is now solely based on performance and the base. Bonus and performance scores are eliminated. (CONTINUED ON PAGE 19)


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MACRA 2019 Changes Address Physician Concerns continued from page 18 • Security risk analysis is still required, but no points will be assigned. • Two new measures are added for the e-Prescribing objective: Query of Prescription Drug Monitoring Program (PDMP) and Verify Opioid Treatment Agreement as an option to earn bonus points. 5. MIPS Improvement Activities category changes include: • Removal of the 10 percent Promoting Interoperability bonus for using a CEHRT to complete the Improvement Activity. • Clarification of the criteria for “high-weighted” classification.

Healing Our Healers: Healing Our Healers: Healing Our Healers: 6. MIPS Cost category changes include:

• Eight episode-based Cost measures have been added. The same two core measures for Medicare Spending per Beneficiary and Total Per Capita Cost remain.


Healing Our Healers: Healing Our Heale Healing Our Healers: Healing OurHeale Healers Healing Our

• All cost measures have the same weight.

7. Alternative Payment Models: More specialty-related models will be developed. Practices that are looking to achieve top scores should review past performance, especially the Cost and Promoting Interoperability categories, as the Cost weight increases, and the Promoting Interoperability measures will be more difficult to achieve. For more information: 1. Calendar Year 2019 Updates to the Quality Payment Program 2. Quality Payment Program Year 3 (2019) Final Rule Overview webinar 3. 2019 MIPS Quick Start Guide

Practices that find these changes overwhelming may want to reach out for expert help with industry-leading best practices to maximize Medicare payments. Visit Medical Advantage Group (medicaladvantagegroup.com) for more information. For resources on MACRA and success in optimizing reimbursement, go to MACRA Resources for Medical Practices (thedoctors.com/MACRA).

LL O V II N G Y O U R LL II FFFebruary EE A S A DOCTOR Thursday, 28 S A D O C T O R O V N G Y O U R A L O V I N G Y O U RLightLrefreshments, I F E AcashSbar and A reception D O- 6CPMT O R

Thursday, February 28 Presentation - 6:45 PM Thursday, February 28 Museum of Arts and Sciences, Daytona Beach Thursday, February 28 Light refreshments, cash bar and reception - 6 PM 352 S. reception Nova Road Light refreshments, cash bar and 6F PM PMA S A D O C T O R O V Iand N Greception YFebruary O U R 24L--I6 E Light refreshments, cashL bar Presentation - 6:45 PM RSVP by Presentation -- 6:45 6:45 PM PM Thursday, L O V Iphysicianwellness386@gmail.com N G Y28O U R L I F E A S A D O C T O R February Presentation L O V I Y OorYreception UORU R- 6LPMLIIFF EE AAS SA DAO D Museum of Arts and Sciences, Daytona Beach LNOG Vcash IN Gand C TO O Light refreshments, bar 386-255-3321 (talk text) Museum of Arts and Sciences, Daytona Beach L Thursday, O V IFebruary N G28cashFebruary Y OU R - 6LPMI F E A S A D O Museum of Arts Daytona Beach Presentation - 6:45 PM 352 S. Nova Roadand Sciences, Light refreshments, bar and reception Thursday, 28 352 S. Nova Nova Road Road Museum of Arts andPM Sciences, DaytonaWible, Beach MD Thursday, February 28Pamela Keynote Speaker: - 6:45 352 Light refreshments, cash bar and reception - 6 PM RSVPS.by February 24 Presentation 352 S. Nova Road Museum of Arts and Sciences, Daytona Beach Thursday, February 28 Special Panel Guests: Clayton Wittman, Wittman -Legal RSVP by February 24 Light refreshments, cash bar and reception 6 PM Presentation - 6:45 PM February 24 RSVP by February 24 RSVP 352 S.by Nova Road Haynes, physicianwellness386@gmail.com Delicia MD, Family First Primary Care Museum of Arts and bar Sciences, Beach - 6 PM Light refreshments, cash andDaytona reception physicianwellness386@gmail.com Presentation 6:45 PM physicianwellness386@gmail.com RSVP by February-24 physicianwellness386@gmail.com 352 Nova 386-255-3321 (talk or text)Road 386-255-3321 (talk orPresentation text) physicianwellness386@gmail.com -S.by 6:45 PM Museum ofRSVP Arts and Sciences, Daytona Beach 386-255-3321 (talk or text) February 24 386-255-3321 (talk or text) 386-255-3321 (talk orMuseum text) Keynote Speaker: Pamela Wible, MD ofphysicianwellness386@gmail.com Arts and Sciences, Daytona Beach 352 S. Nova Road Special Panel Guests: Clayton Wittman, Wittman Legal Keynote Speaker: Pamela Wible, 386-255-3321 (talkMD or text) Keynote Speaker: Pamela Wible, MD 352 S. Nova Road RSVP by February 24 Delicia Haynes, MD, Family First Primary Care Keynote Speaker: Speaker: Pamela Pamela Wible, MD Clayton Wittman, Wittman Legal Special Panel Guests: Keynote Wible, MD Special Panel Guests: RSVP Clayton Wittman, Wittman LegalMD by February 24 Delicia Haynes, MD, Family First Primary physicianwellness386@gmail.com Keynote Speaker: PamelaCare Wible, Special Panel Guests: Clayton Wittman, Wittman Legal Special Panel Guests: Clayton Wittman, Wittman Legal physicianwellness386@gmail.com Delicia Haynes, MD, Family First Primary Care Special Panelor Guests: Clayton Wittman, Wittman Legal 386-255-3321 (talk text) Delicia Haynes, MD, Family First Primary Care Delicia Haynes, MD, Family First Primary Care Delicia Haynes, MD, Family First Primary 386-255-3321 (talk orCare text) Keynote Speaker: Pamela Wible, MD Keynote Speaker: Pamela Wible, MD Wittman Legal Special Panel Guests: Clayton Wittman, Special Panel Guests: Clayton Wittman, Legal Delicia Haynes, MD, Family First PrimaryWittman Care Delicia Haynes, MD, Family First Primary Care

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Forty Percent of Medical Marijuana Patients Quit Taking Other Prescription Drugs By MICHAEL PATTERSON

As of January 2019, 200,000 patients are taking medical marijuana in Florida, and a lot of them are not taking other prescription drugs or telling their physician. A new study by the University of Michigan defines the magnitude of this issue. The study found that 42 percent of patients using medical marijuana stopped taking at least one prescription drug. In fact, about a third of the respondents hide their use of medical marijuana from their primary care doctor. Within the study, it was noted that most patients perceived medical marijuana as more cost-effective than traditional pharmaceuticals and most do not receive their recommendation from their primary care provider. Currently, there are 2,000 Florida physicians who have received the mandatory two-hour training on certifying patients for medical marijuana. Chuck Wright, President of MOROF (Medical Office Resources of Florida), has seen the topic of medical marijuana use expand dramatically over the last 6

months. “Our members from across the state are asking a lot more questions on how to deal and manage this new legal drug but stay compliant with Medicare and other insurance plans,” he said. While the numbers of patients taking medical marijuana is increasing 3,0005,000 per week, Wright knows it’s a topic that needs to be addressed. “With more patients using medical marijuana every day in Florida, physician groups will have to address it in their practice sooner rather than later,” said Wright. Some tips for medical companies looking to incorporate medical marijuana

data into the health record: • Open up a dialogue with your staff - For some reason, healthcare workers feel as if they say anything about medical marijuana, they will be drug tested immediately or type casted as a marijuana smoker. Let your staff know that you want to have an open conversation, without judgement, about medical marijuana and find out what they are hearing from your patients. • Explore how collecting medical marijuana information from your patients can provide better care and decrease costs - Imagine if you are a Skilled Nursing Facility Administrator and you discover your patients who use medical marijuana go home 3 days quicker than other patients and need less care? Would that interest you? With the adage “do more with less” rampant in health care today, any and all ways to save costs and increase care should be evaluated. • Develop a policy on how to discuss medical marijuana with patients

- Patients are coming to your staff right now asking questions, and you may not know what they are telling them. It is important to have a unified message from your practice and staff on medical marijuana. Your staff want direction on this issue. It is up to you to provide it. • Be a resource on medical marijuana for your patients - Most patients want to talk to their physician about medical marijuana because they are curious. Your patients trust your judgement. Even if you don’t write medical marijuana certifications, they will appreciate you pointing them in the right direction to learn more about it. As healthcare professionals, it’s time to take the lead and bring medical marijuana into mainstream healthcare. It is in the best interest of your patients and your practice. 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.

Innovation in VoIP Taking Charge in Phone Systems By CURTIS PARTRIDGE

VoIP (Voice over Internet Protocol) systems and the ability to transmit telephone calls via the Internet have been evolving since their inception in the late 90’s. The quality has improved greatly, and it has become the standard for business telephone communications. Traditional telephone system providers have either pivoted to VoIP or left the market entirely. Cost is a large advantage of VoIP saving companies sometimes as much as 60 percent on their telephone bills, but like everything involving technology, innovation is now winning the day. Unified communication is now the buzzword involving mobile devices, voice-to-text, team messaging, video conferencing, conference calling, and advanced call routing. A VoIP strategy can save much more than just phone bills. Some of the advantages for a modern medical practice include… • For multi-location practices you can




operate across all your sites with one telephone system. This means all inbound calls can be answered for all locations at one office, or you can distribute calls across multiple users no matter which office they work in. • Promotes collaboration and interaction because doctors and medical staff can communicate in real time using features such as video conferencing, instant messaging, and more. • Patient data can be managed more efficiently by integrating the VoIP telephone system with your current electronic medical records to show patient data on inbound calls. • Features such as auto attendant and Find Me enhances service and productivity because doctors can easily connect with patients, staff, and other healthcare providers when they are on the go. • Automated attendants can lower inbound call volume by allowing general information to be relayed to callers.

• Integrated mobile applications allow doctors and staff to call patients without revealing their personal cell phone numbers. • Cloud-based VoIP telephone systems offer improved business continuity because calls can be routed anywhere including multiple mobile phones. • Automated call routing can allow your staff to live answer calls, but when they are busy or unavailable an automated attendant can automatically take over answering calls. • Voice to text features now allow doctors and staff to read voicemail transcripts as text messages without taking the time of listening to each message. • For transient staff members that do not have a desk they can enjoy the features of the telephone system by utilizing a mobile application. • Call reporting can instantly show average hold times for callers and where you may need to increase resources to cover inbound telephone calls.

• Cloud-based VoIP telephone systems easily grow and contract as the needs of a practice changes. A good telephone system provider can consult with your team on the best solutions that fit your practice. This more than just saving money on your monthly phone bill. They can provide an overall structure and strategy to improve customer service and your staff productivity. They can possibly also integrate elements of your current telephone system to save the practice money during the transition to a cloudbased telephone system. Curtis Partridge has over 20 years of experience in information technology focused on small to medium businesses. He has been a corporate IT manager as well as a consultant. He is currently Senior Systems Engineer for Lotus Management Services consults with businesses to implement and manage technology solutions. VISIT LOTUSMSERV.COM/



Israeli Researchers Believe They Will Have A Cure for Cancer in a Year Promising research with multi-agent toxins By JOSHUA MANSOUR, MD

According to the WHO/ International Agency for Research on Cancer, 18.1 million cancer cases are diagnosed worldwide each year. Cancer is now the second leading cause of death behind cardiovascular diseases. It is imperative now, more than ever, that we continue to seek new methods to treat this devastating illness. Recently, Accelerated Evolution Biotechnologies did an interview where they stated they believe that they will “offer, in a year’s time, a complete cure for cancer.” Although it grabs headlines, that is a momentous statement to make. Let’s dig a little deeper into the work that they are currently doing. The premise behind their treatment involves using a multi-agent target toxin. In the past, this type of therapy targeted toxin treatment has involved the introduction of DNA coding for a protein (can be an antibody) into a bacteriophage - which is a virus

that infects bacteria. These proteins can then be displayed on the surface of the virus and interact with its surroundings. The company’s therapy involves a similar phenomenon, but with the use of peptides instead of proteins. Peptides consist of two or more amino acids linked together in a chain. They are smaller than proteins, can serve biological functions, and in many ways are less expensive to reproduce. Most cancer therapies aim at attacking a target in a cell, on the surface of a particular cell, or in one of its internal pathways. However, a mutation in one of these targets can make the therapy ineffective. What is being done here, with multi-target toxin therapy, is that several peptides of the cancer cell are being targeted with a peptide toxin to avoid mutations rendering a therapy ineffective. The more targets used, the less likely that a series of mutations will occur simultaneously that will make the therapy ineffective. This will help in not

allowing the cancer cell to evade the treatment and continue to replicate, even with some mutations occurring. This may have the ability to reduce side effects as well, given that the peptides will aim to attack specific targets on the cancer cells that are typically not overexpressed in other healthy cells. In addition, since the peptides are small (the ones they have developed are about 12 amino acids long) and lack a rigid structure, it allows them access to regions of the cell that may be blocked if a larger protein was used. Overall, they are using a “combination modality” in a very specific manner for an attack of each cancer cell in this therapy. Combinational therapy has been successful before with cancer, HIV, and autoimmune disease among others. The goal of the company is to eventually personalize this to each patient by having a biopsy sent and analyzed for the receptors that it overexpresses. The

patient would then be administered an individualized concoction developed to treat the disease. This is exciting and has potential, but more data needs to be presented. Thus far they have concluded mice experimentation and found inhibited human cancer cell growth that did not affect healthy mice cells. They are currently working on beginning a round of clinical trials, which many people will be eager to see the conclusions. Recently, Accelerated Evolution Biotechnologies has been writing patents on a variety of different specific peptides. While their work thus far is enthusing and making headlines, their claim to “offer in a year’s time a complete cure for cancer” is likely premature. Yet, I don’t know a single person, including myself, who wouldn’t hope for that. Joshua Mansour, M.D. is a board-certified hematologist and oncologist in Stanford, California. He is currently doing additional work in the field of Hematopoietic Stem Cell Transplantation and Cellular Immunotherapy.

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How Hospitals Can Reduce Healthcare Associated Infections and Stay Competitive By JEFF FEUER

When you think of an operating room, you imagine a room where everything is clean and sterile. Patients go to a hospital with the full intention to get healthy and feel safe; however, that is not always the case. While hospitals work really hard to ensure patient safety, there are some dangers that can be hard to regulate without the proper processes in place. In fact, one in 25 patients will acquire a healthcare-associated infection (HAI) during their stay in a hospital. Because these infections develop within the hospital where antibiotics are frequently used, HAIs and their resistance to antibiotics are different from the traditional bacteria outside of the hospital. Scrubs worn by nurses and surgical sales representatives contribute largely to patients being exposed to HAIs. A study in the American Journal of Infection Control, by the University of Arizona, found following a standard eight-hour work shift, 92 percent of scrubs worn by hospital personnel are carrying dangerous bacteria including antibiotic-resistant strands of MRSA, VRE and C-Diff. In American hospitals alone, the Centers for Disease Control (CDC) estimates that HAIs account for an estimated 1.7 million infections and 99,000 associated deaths each year. The infections cannot only harm or kill patients, they are also costly; HAIs lengthen hospital stays, cause readmissions and eat up valuable hospital resources. HAIs remain one of the predominant threats to beneficiaries receiving the highest quality of care, improved outcomes and reduced cost. The largest expense-driven contributor to the high cost of HAIs and the risk to quality patient outcomes are surgical site infections. While hand-washing is often seen as the front-line defense, most of the public isn’t aware of the dangers associated with contaminated surgical scrubs. Aside from hand-washing, there is an equally important risk from contaminated scrubs aiding in the transfer of these infections to patients and the general public. These deadly 22



strands can live for up to 90 days and cannot be killed unless the contaminated fabrics are professionally laundered. Unfortunately, no home-laundry system can meet these requirements. The issue arises when workers leave the hospital wearing their scrubs after a shift or come in after laundering their scrubs in a home washer. On any given day, there are hundreds of surgeons, nurses and sales reps entering and leaving an operating room. While scrubs worn by health care professionals are part of the problem, scrubs worn by traveling surgical sales representatives can be even more of a risk. Often unknown to the public surgical sales representatives are present during 35-40 percent of all patient surgical procedures, and 68 percent of large bone orthopedic procedures. They can be seen wearing their own home-laundered “street-scrubs” visiting multiple hospitals throughout their

day. A concerning trend, by wearing their own scrubs, vendors may not be changing into clean scrubs provided by the hospital before entering an active operating room. Frequently seen in restaurants, coffee shops, gas stations and airports wearing these potentially contaminated “street-scrubs,” surgical vendors may be expanding the potential risk to both patients and the public. The newest option is for hospitals to implement a new vendor management system altogether, tracking a vendor’s access to restricted areas, and providing clean disposable scrubs that expire after eight hours. RepScrubs® LLC., a company providing time-sensitive vendor attire for infection prevention in hospitals, disposable scrubs and secure vendor management through its web-based kiosk or ScrubPort®. The ScrubPort dispenses clean scrubs at a small fee to the vendors. The system helps track and regulate sales

reps entering and leaving the building. Not only does RepScrubs eliminate contaminated scrubs from being used again, it reduces costs for hospitals and increases vendor security. Reducing HAIs is a body of work with many contributing factors. Creating a system to regulate traffic to and from an operating room is a good place to start. If a vendor is offered the same access to sterile zones in a hospital, they should be held to the same standards and protocols as a surgeon. Jeff Feuer is the CEO and president of RepScrubs, a national company providing healthcare facilities with time-sensitive vendor attire that improves infection prevention and vendor management protocols, while reducing costs. The RepScrubs system includes real-time vendor tracking reports for hospital staff about who has been to the operating room. For more information, visit http://www.repscrubs.com

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HEALTHCARELEADER | Corey Burke, continued from page 1 tion of high-quality, extensively screened donor sperm, and donor eggs from all races, ethnicities and phenotypes for tailored fertility treatments. Some women may not be able to produce their own eggs,but achieve pregnancy with a donor egg. And there can be a number of reasons for women seeking to freeze their eggs to preserve fertility for a later date. It could be plans to forego being a mother until later in life because of career goals, or it is an option when women are scheduled to undergo cancer treatments that might damage future fertility. While in 2012 the American Society for Reproductive Medicine made vitrification the standard of care, it’s still a fairly new science. “There are a few important aspects of using frozen donor eggs,” Burke said. “One is collecting the eggs and vitrifying them. And, of course, that’s highly important. It is one of those things like anything else, garbage in, garbage out. So, it has to be done correctly with the proper eggs to actually survive the freeze.” They usually collect 20 to 30 eggs from a woman. Not all are top quality. They only freeze eggs that are absolutely perfect. Burke said they can’t look at them genetically at this point in time, but there are certain measurements to see if the different components of them are perfect. What is more challenging than freezing the eggs is the warming of the oocytes once they are collected and shipped to a clinic. Although this has been the standard of care for about six years now, there are clinics unfamiliar with the process of warming eggs. “Every embryology lab warms embryos just about daily or at least weekly because that’s a standard procedure we do in the laboratory,” Burke said. “But eggs are different from embryos. Embryos are generally 60 to 80 cells when there are frozen. When they freeze an egg, it’s one single cell. And that one

single cell can be damaged by ice crystal formation. As you’re warming the eggs, you have several places where ice crystals can re-form.” The eggs are frozen to about minus 196 degrees centigrade. The special tanks used to ship the eggs absorb liquid nitrogen to maintain that temperature. The tanks they are shipped in will hold the temperature for about three weeks, although the eggs are all shipped overnight. “We also put temperature trackers on them because if something happened and they reach that minus 130-degree mark, that could mean problems for them,” Burke said. “We make sure they stay absolutely frozen.” It is technically challenging to warm eggs. You have to pay great attention, and be exact and very precise. “So, we partner with good clinics,” Burke said. “We don’t work with every clinic out there because, in all honesty, there are good clinics and there are bad clinics. To make them successful, we provide training where I’ll go out to the clinic and teach everyone in the laboratory how to do the precise method.” To be successful, Burke counts on the success of the IVF clinics. If they’re not successful at getting people pregnant, they’re going to be out of business. “We have this real symbiotic relationship going on where they have faith in what we’re doing and we have faith in what they’re doing,” Burke said. “We’re just trying to build relationships between us and them so they know we’re giving them a good-quality product, and we know they’re providing a good quality use with our product, by working together in our best interest. We offer a guarantee with our eggs. So, if a clinic buys six eggs, we guarantee that they’ll get one good-quality blastocyst to transfer on day five.” A blastocyst is the best grade an embryo can be grown to before being implanted. While it takes only about ten minutes for the eggs to be warmed up, it takes about six days

from the day they are warmed to actually grow them to a transfer-quality embryo. If the first effort to create a blastocyst is unsuccessful, they replace the batch of eggs and the IVF clinic gets to try again. Burke said a good relationship with the clinics is also helpful because if there is a failure for some reason, the lab will be honest and perhaps say, “This failed, but it wasn’t your eggs. This guy had absolutely horrible sperm.” If it’s a sperm issue, before they go on, that issue must be taken care of. Cryos has a high rate of success. Right now, they have about a 70 percent clinical pregnancy rate. A clinical pregnancy rate is defined as a heartbeat and ongoing pregnancy. This is usually confirmed at about six weeks of pregnancy. Their delivered rate right now for the clinics that are reporting is around 50 percent. “If I had all the numbers, I think it would be a little bit higher,” he said. “But still, 50 percent is a very respectable delivery rate. That means basically half the people who tried have delivered. That’s actually even a little more impressive because, again, of the newness of frozen donor eggs. There’s a learning curve to it. And the rates across the board are getting better and better. Actually, frozen donor eggs are at the very least equal to fresh donor eggs. For years all we’d been able to do is fresh, because we didn’t have the technology we now have to do frozen.”


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