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July 2019 > $5

2019 Health Law Issues Crystalizing What to look out for now with 2020 on the horizon By MICHAEL R. LOWE

As we approach the second half of 2019, the biggest health law issues facing health care professionals and providers have crystalized during the first half of this year. With the 2020 elections on the horizon, and nearly every poll listing health care as one of the top three issues on the minds of the American voters, health care professionals and providers must be aware of health law issues which will be driven by and will drive seismic changes in the health care delivery


Joseph Stewart, MD ... 2


How to Respond to Social Media Likes, Followers & Comments ... 3


Telehealth - An Expanding Wave in Healthcare ... 4

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and reimbursement systems. We all know that the U.S. health care system is a mess, but most of us don’t fully understand how all of the pieces interact with one another, or the forces which shape the relationships between what I like to refer to as the three Ps, which are patients, providers and payors. Currently, 4 major changes are driving the health care sector and significant trends and changes in health law. Those 4 changes are technology and innovation, health insurance and payment models, alternative therapies, and in particular medical marijuana, and disruption in the health care delivery and payment systems including increasing penetration and ownership by private equity interests and strategic mergers and consolidations such as the Amazon, Berkshire Hathaway and J.P. Morgan Chase joint venture. Here’s a look at the resulting top 10 health law issues fac-

ing providers and professionals as a result of these 4 major factors causing seismic shifts in the health care delivery and reimbursement systems. 1. The Opioid Crisis In 2018 and the beginning of 2019, the opioid epidemic has dominated news headlines and resulted in increasing government fraud and abuse enforcement activities, rapid legislative developments at both the federal and Florida levels, and the formation of a federal Opioid Fraud and Abuse Detection Unit as a new DOJ pilot program. That program utilizes data to identify and prosecute individuals who are contributing to the prescription opioid epidemic, and the pilot program funds 12 experienced Assistant U.S. Attorneys in opioid “hot-spots” for a 3-year term to the end of 2020 to investigate and prosecute health care fraud related to prescription opioids. One of those “hot-spots”

is Florida, and we have seen a significant increase in the investigation and prosecution of prescribing physicians and pharmacies/ pharmacists over the past 12-18 months. And make no mistake, even well-intentioned and honest physicians who prescribe opioids for their patients could be under scrutiny. The collateral effects of these investigation and prosecutions include State licensure investigations, potential medical malpractice lawsuits, peer review actions and third-party payor/managed care company scrutiny. It is critical for Florida prescribing physicians to be aware of and comply with new laws that have gone into effect such as the 3-day limit on opioid prescriptions which went into effect in March 2018. The totality of the new federal and Florida laws and regulations going into effect are too numerous to list in this article, but are certainly something (CONTINUED ON PAGE 5)


Looking Out for the Uninsured

Ryan Schott, OD, contributes to Shepherd’s Hope vision of care “Everyone deserves to see better, and thus live better,” said Ryan Schott, OD. Owner and operator of Kindred Optics in Maitland, he’s also a passionate volunteer for Shepherd’s Hope, providing vision solutions for uninsured and under-insured patients in Central Florida. “Corrected vision and eye health play such a vital role in a person’s ability to function at their best every day,” said Schott. “In 2017, I learned about the incredible collective impact area doctors were making in people’s lives through Shepherd’s Hope and I volunteered immediately. I was surprised when I learned that I was the only optom-

etrist in their Community Referral Provider Program. Alongside general practitioners, specialists in every field can make such a difference in our community by volunteering just one evening a month,” he said. “I grew up abroad, in a US Air Force family. I met so many different people and experienced a lot of different cultures. A common trait I found in so many people the world over is the willingness to help others who need a helping hand. As an optometrist, I can help people see their worlds better,” he said. Schott carries on his family’s tradition of giving back to the community. His

•• •• • •

mother, Michele H. Schott, MSHA, MBA, FACHE, introduced him to Shepherd’s Hope. A retired U.S. Air Force Lt. Colonel and hospital administrator, she began her work with the non-profit as a volunteer; she is now a part-time team member, serving as health information management coordinator at the Longwood Health Center. Dr. Schott sees patients at the Shepherd’s Hope downtown location as well as at his practice in Maitland. He helps patients with primary vision care as well as ocular diseases including dry eye syndrome, glau(CONTINUED ON PAGE 2)


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Looking Out for the Uninsured,


coma, macular degeneration and diabetic retinopathy. As a volunteer provider, he has treated over 150 patients for Shepherd’s Hope. By applying for and obtaining grants, he has expanded his impact even further. He obtained a grant from SALT Optics, a Californiabased eye glass company, for 100 pairs of eyeglasses for patients. “When others hear the tremendous impact that Shepherd’s Hope is making in our Central Florida community, many are compelled to contribute in ways they can help, even from different geographic regions. It’s truly people who make the difference in providing better health for everyone, including those down on their luck, facing a life crisis or combatting a disease. Together, we can change lives,” he said. “The work of Shepherd’s Hope is impressive statistically – they have provided over 250,000 primary care and specialty care patient visits to uninsured men, women and children in Central Florida. But what drives me to do more are the individuals I meet, seeing how my volunteering makes them see better, feel better and be a little better prepared to improve their lives,” said Schott. “It’s heart-breaking to know that people in our community are suffering with ocular diseases just because they are uninsured or under-insured. Whether they just need their corrective vision prescription adjusted or they’re experiencing a rare eye disorder, improving their vision improves their lives. I feel part of a bigger ‘vision’ with Shepherd’s Hope, contributing my abilities to help people,” he said. Schott graduated from Nova Southeastern College of Optometry. He is a member of the American Optometric Association and the Central Florida Optometric Society. He completed a residency focusing on primary care and ocular disease at the Orlando Veterans Affairs Medical Center. He holds a BS in biology from Florida State University. He served in the Florida Air National Guard as a Structural Apprentice with the 125th FW in Jacksonville. He has received the VOLK Excellence in Ocular Disease Award and the Essilor Excellence in Dispensing of Ophthalmic Materials Award. With the idea that “none of us knows how to do it all, but all of us know how to do some of it,” Dr. William S. Barnes, senior pastor of St. Luke’s United Methodist Church, founded Shepherd’s Hope in 1997. The non-profit depends on volunteer physicians, nurses and other licensed health care professionals to provide quality health care for people in the community. It has grown to include service facilities in Longwood, East Orlando, Downtown Orlando, Ocoee and Winter Garden.

Joseph Stewart, MD reinvigorated with PMC robotics program

continued from page 1

To learn more about volunteering with Shepherd’s Hope, contact Abby Seelinger, volunteer program manager, at (407) 876-6699, ext. 233; abby@seelinger@shepherdshope. org; or visit



JULY 2019

A Purposeful Life

On a particularly cold night in Illinois last December, Joseph Stewart, MD, and his wife, Shelly, discussed the possibility of moving to a warmer climate. Having recently become empty nesters, they agreed they would move only if Stewart found the perfect fit. Stewart, a board-certified gynecologist with more than 20 years of experience, connected with Poinciana Medical Center (PMC) and their visions for gynecological care aligned. “We looked at each other, realized the entire upstairs of our house was empty, and decided it might be time to regroup and move,” remembers Stewart. “I was looking for a hospital where I could be part of launching a robotics program to help the community, and that’s what I found at PMC.” At PMC, Stewart is providing the full spectrum of surgical gynecologic care for women in Poinciana and the surrounding area, including well-woman exams, contraception, hormonal therapy, in-office procedures and major gynecologic surgery. “The PMC mission resonated with me, especially with so many people out here and a strong need for full-time local doctors,” he admitted. “I’m looking forward to the great things we’re going to do for patients.”


Stewart realized he wanted to study

medicine when he was a high school senior. He describes this epiphany as a lightbulb that came on and never went off. He studied biology at the University of Akron, attended medical school at Wright State University in Dayton, Ohio, and completed his residency in Obstetrics and Gynecology at the Akron General Medical Center. His practice in Illinois included obstetrics and the delivery of approximately 4,000 babies over his career. Today, Dr. Stewart’s special interests include pelvic support work, cancer risk assessment and risk reduction, menopause, bleeding problems, minimally invasive surgery, and treatment and correction of severe pelvic organ prolapse. Stewart executes complex gynecologic surgery using robotic technology, which allows him to perform surgery with less trauma to the patient. “When we can perform surgery more easily, it translates into less time in the hospital, a faster return to work and less pain,” he explained. “With robotic technology, 80 percent of women who have hysterectomies go home the same day. They simply feel better faster.” In 1993, when Stewart was finishing his residency, laparoscopy was new, and performing surgeries through small ports was in its infancy. The evolution of this technology has been transformational for Stewart, reinvigorating his career and steering his focus toward more complex surgeries with robotics.

“The platform for many major surgeries either already is or will be robotic,” he asserts. “We’ll continue to have the whole realm of tools at our disposal, but as we move forward, robots are here to stay. Building our robotic program now is a good thing for the Poinciana community.”


Stewart and his wife live in the community of Solivita in Poinciana and enjoy an active lifestyle. Notably, they have twin sons who are both in medical school and a daughter in her first year of dental school. Every time Stewart thinks about this, he can’t believe it’s true. “I remember them as little kids, seeing me in scrubs leaving for the hospital,” he recalled. “They saw me take thousands of phone calls while we were out at dinner, and through most of their childhood they took that for granted, but when each entered high school, the significance of practicing medicine kicked in for them, kind of like it did for me.” Stewart, who’s looking forward to seeing where his children’s medical careers take them, notes that physicians are all on the same journey to help patients with quality of life. “Something like pelvic organ prolapse can interfere with quality of life if it is not addressed, but it’s curable,” he concluded. “We can fix these things and make patients more comfortable; it’s part of a mission I’m proud to be a part of.”

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- Dr. Brian

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


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How to Respond to Social Media Likes, Followers & Comments By QUINTIN L. GUNN, SR.

Patient-focused Cardiothoracic Surgeons Caring for Greater Orlando The Florida Heart & Lung Institute has several locations extending from Orlando to Pensacola. Through this partnership, we are able to deliver a patient-focused experience in which every provider is dedicated to excellence. We offer a comprehensive range of services specializing in heart and lung surgery, including minimally invasive and robotic surgical interventions. Wade Fischer, MD Cardiothoracic Surgeon Medical degree: Tulane University Residency: Cleveland Clinic Cardiothoracic Sugery Fellowship: SUNY Downstate, Brooklyn, NY Board Certified, American Board of Thoracic Surgery Diplomat, American Board of Surgery

Hiep C. Nguyen, MD, FACS Cardiothoracic Surgeon Medical degree: University of Texas Medical Branch Residency: New York Medical College Cardiothoracic Sugery Fellowship: New York University Board Certified, American Board of Thoracic Surgery Diplomat, American Board of Surgery

Hello Sally, Thank you for visiting our page. We love hearing from our followers and clients. I saw you liked our recent post about, stem cells, beauty product, regenerative medicine information, arthritis treatments etc. Please feel free to let me know if we can be of assistance to you in any way. If you have a medical question or concern, our staff and doctor have been helping patients for many years. We’d love to hear from you, so I’m leaving our office number just in case: (example 444-366-9966) Kindest Regards and I look forward to speaking with you soon.

Responding to social media prospects is just as important as answering calls or email. In fact, because consumers took the time to visit your profile and or business page it indicates you have what they need, like or want. Fortunately for you, your marketing company is creating the kind of content that is driving brand awareness and interest from new patient prospects. These are Warm Leads and should be treated as such. And your goal is to reach the prospects where they are and when they indicate a need or desire. Some marketing systems have an autoresponder, which is good, but may not be as personable. We recommend that your Front Desk or Patient Care Coordinator send a brief email or note to induce further engagement. This is the critical step to increased business and sales. Some prospects may not respond but if you can close two to four likes, follows, or engage with comments, just imagine the impact on the practice bottom line. And yes, most are just browsing or what we call Looky Lous, but others are just waiting for a friendly and gentle nudge to check out your services. and or product. Social media is just what it says. Be social, talk, make friends. This is the easiest way to grow clients. Connecting with them while they’re hot! So, thank them for visiting your page and ask if they had a particular need or question that someone at the office can answer. It might go something like this:

By the way, this same response can be used with MailChimp or Constant Contact responses. The closure rate for internet leads should be no less than 70 percent for scheduling a consult, and even higher once they come into the office. This is because, in most cases, prospects have already done their research, they are just trying to validate if the doctor is qualified to perform the procedure(s). Also, tracking your lead results is pivotal to your practice success. A system we have found to be most effective in lead nurturing, tracking and lead closure is www. Marketing analytics helps the practice monitor and measure results and set profit goals. In conclusion, how quickly you respond, and what you say has the biggest impact on your practice. So, make sure your staff is well trained and can book the consultation after the questions from the prospect are answered.

Quintin L. Gunn Sr. is a Practice Development Consultant with Social Media Solutions for Doctors. Visit

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JULY 2019





East Orlando Chamber of Commerce Calendar: La Crema de Nona Every Tuesday 8:30 – 9:30AM DICKEY’S BBQ PIT

9368 Narcoossee Rd., #101, Orlando, FL 32827

EOCC Educational Series “EXPO Ready” with our panel of Experts Wed, July 10, 2019, 11:30AM – 1:30PM EAST ORLANDO CHAMBER OFFICE 12301 Lake Underhill Rd., Ste 245, Orlando, FL 32828

Chamber Luncheon Featuring Mayor Buddy Dyer Conversation with the Mayor re: Vision for the next four years and working with the New County Mayor” sponsored by AdventHealth

Wed, July 17, 2019, 11:30AM – 1:15PM LAKEHOUSE LAKE NONA 13623 Sachs Avenue, Orlando, FL 32827

Coffee Club Semoran at Bonefish Grill Orlando Gateway Thurs, July 18, 2019, 8:30 – 9:30AM BONEFISH GRILL ORLANDO GATEWAY 5463 Orlando Gateway Vlg. Cir, Orlando, FL 32812

EOCC Connect 4 Property Professional Networking Kyle Quackenbush, Orange Co. Comptroller information on Property Fraud Alert Service

Thurs, July 18, 2019, 4:30 – 6:00PM BONEFISH GRILL LAKE UNDERHILL


presented by

Telehealth - An Expanding Wave in Healthcare

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

Telehealth is an evolving component of healthcare today, but certainly not a new concept. Healthcare in the home setting has a long history beginning in the late 1800’s when the telephone was used to reduce unnecessary office visits. NASA introduced physiologic monitoring over a distance during the Mercury space program, expanding the technology developing the Rural Papago Advanced Health Care project offering healthcare in rural settings. For some it may seem impersonal, but the care management program developed by the VA offering education, monitoring and feedback at home from a remote disease management support team resulted in fewer hospitalizations, readmissions, length of stays and costs. Patients reported a higher rate of satisfaction with the process and were found to adhere better to medication regimens. With a serious shortage of physicians and populations in rural communities older, sicker and poorer than at any time in recent history, telehealth and strong recruitment may fill the rural gap. According to the National Rural Health Association, “family physicians comprise 15 percent of the US outpatient workforce by handling 23 percent

of those outpatient visits overall,” 42 percent of which are in rural areas. Utilizing telemedicine is becoming more mainstream, especially in remote areas but works best when providers in the community have access to specialists in metropolitan areas. The goal of telemedicine is to substitute in-person doctor or hospital visits with online consultations offering a great way to help reduce escalating health costs. For lowincome families, it offers much promise delivering medical attention when they would often neglect care due to cost and access oth-

erwise. To prove the point, Health-E-Access set up by the University of Rochester coordinated care between child daycare centers and a local hospital. Through hospital video conferences, physicians were able to conduct a variety of medical examinations on children focused on those suffering acute illness. Over more than a decade, “in over 95 percent of the cases the telehealth conference led to a primary diagnosis later supported.” For low-income parents, the benefits of this type of system (CONTINUED ON PAGE 5)

Free for EOCC Members - $10 for non-members

Amazing Explorers Academy Waterford Lakes Ribbon Cutting Wed, July 24, 2019, 6:00 – 7:00PM

We are looking forward to providing care to patients in Osceola County

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Coffee Club Nona at Sam’s Club Thurs, July 25, 2019, 8:30 – 9:30 AM SAM’S CLUB LAKE NONA

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Upcoming Chamber Luncheons Wed, Aug 21, 2019, 11:30AM – 1:15PM Dr. Sandy Shugart – “Valencia College Public Safety Village” Sponsored by Orlando Health


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The Business of Women’s Health Panel Sponsored by AdventHealth

Wed, Oct 16, 2019, 11:30AM – 1:15PM RIO PINAR COUNTRY CLUB

8600 El Prado Avenue, Orlando, FL 32825

Please visit for a complete listing of January’s 18+ Events 4


JULY 2019

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EOCC MEDICAL CITY 2019 Health Law Issues Crystalizing, continued from page 1


continued from page 4 offered scheduling flexibility and time commitment as well as money saved. It has alleviated barriers to transportation and the need to schedule appointments during work hours. The Journal of Telemedicine and Telecare studied the benefits of using telehealth in pre-hospital emergency medical services. The intervention consulted remotely between the patient and an EMS physician determining the need for hospital transport. For those with non-urgent conditions patients were transported to an affiliated primary care clinic. “The program saw a 6.7 percent reduction in potentially medically unnecessary ED visits and a 44-minute reduction in ambulates back-in-services times resulting in a cost savings per averted ED visit of nearly $2,500. Locally many insurance plans are introducing Telemedicine as a cost saving alternative. Nemours Children’s Health System introduced its CareConnect, Telemedicine designed just for kids offering the expertise of Nemours pediatricians and the convenience of technology. Fees are based on the patient’s insurance carrier. For those taking advantage of this option, they report that it is quick and easy, with care you would expect from an inoffice visit, but from the comfort of home. To increase access to and reimbursement opportunities for telehealth diagnosis, Governor Ron DeSantis signed HB23 into law. This newly-signed legislation would allow insurance companies and HMO networks to cover out-of-state providers, a practice in place in Washington D.C. and 39 states. For the small business, offering benefits such as health insurance, pensions and paid vacations can be quite costly. Payroll is the largest line item on most employer’s balance sheets and recruiting and training new employees cost time and money, making attracting and retaining the best talent a priority, especially in competitive fields with multiple options. The East Orlando Chamber of Commerce (EOCC) understands and works diligently to further the interest of businesses providing valuable benefits, industry focused programs and networking and connections to encourage growth in and around East Orange County. Identifying this critical need to support small business, the EOCC offers health benefits to its members including Telehealth for $14 per month per household. EOCC members can offer our health benefits package of Telehealth, Allstate Accident, Allstate Cancer (& 23 specified diseases plan) plus Wellcard to their employees. Our insurance representative with Avalon Insurance Services does all the administration of the plan(s) selected by you &/or your employees. Are you an independent physician seeking ways in which to increase exposure, revenue, and attract talent to grow with your practice? Joining the East Orlando Chamber, becoming actively involved in all it has to offer is the perfect way to start. Give us a call at 407-277-5951 or visit our website at Your Business is Our Business.



JULY 2019

that physicians should focus on when structuring opioid prescribing compliance programs, policies and procedures for their practices and also selecting and taking continuing medical education courses particularly in the required areas of laws and rules and prevention of medical errors. If you are an opioid prescriber, it is imperative that you know and understand the regulatory and legal framework for prescribing these medications in a compliant manner in order to protect yourself from legal and regulatory liability. 2. Value-Based Payment Models/ Clinically Integrated Networks CMS has been revamping the Medicare Shared Savings Program since August 2018. In doing so, it has not only proposed a new direction for accountable care organizations (“ACOs”), but also renewed its focus on the development of clinically integrated networks (“CINs”). While CMS delayed the start of new ACO participants from January 1 until July 1 of this year, it has been aggressively pursuing value-based payment systems such as MIPS and encouraging the development and implementation of provider-driven, patient-centered models with significant opportunity for innovation. CINs provide an excellent model for provider-driven, patientcentered models driven by clinical integration and improvement in communication and coordination of care between multiple treating providers across the spectrum of a patient’s treating professionals and providers. However, it is important to note that with its renewed commitment to these types of models, CMS is recognizing that the move to value-based payment models has not occurred and expanded at CMS’ expected and hoped for pace. The obstacles which have slowed it down include anti-trust, federal Anti-Kickback Statute, federal Stark Law, and HIPAA laws and regulations that are in need of reform in order to facilitate the growth and expansion of value-based payment models and CINs. Consequently, we will continue to see a major push to reform these laws, and in particular the federal Stark Law and the federal anti-trust regulatory framework as they apply to value-based payment models, CINs and ACOs. Providers and professionals considering joining these types of payment-models and networks must be aware of the application of these health care regulatory laws to them and how to properly structure their relationships with a CIN, ACO or value-based payment model so as to comply with these laws and avoid the risks and penalties which accompany violations of them. 3. Technology Innovation Continues to Outpace the Law Artificial intelligence, the internet of things, and innovations in medical devices and surgical procedures such as robotics and remote monitoring of patient information and data are rapidly maturing and being adopted and implemented in the health care delivery system. However, federal and Florida health care regulatory laws are not keeping pace in areas such as cybersecurity risk management, privacy, accountability features and safety. As providers and professionals continue to turn more to technology innovations and the care and treatment of their patients, they need to be aware of such security and

safety risks and ensure that they have proper ing and marketing rules promulgated by the licensing boards, consumer protection laws, insurance coverage for these risks and potenand balance-billing and transparency laws tial liabilities such as cyberliability insurance and regulations when developing their marand riders for amendment to their profesketing materials, fee schedules and payment sional liability insurance policies to cover adstructures. This will require not only a keen vanced health care technological innovations awareness and understanding of those laws such as artificial intelligence and the internet and regulations, but also an ability to imof things. It is critical for health care profesplement them, and by necessity the retensionals and providers to have a thorough retion of qualified legal counsel, marketing view of their insurance coverage and policies consultants and billing staff and personnel and procedures (in particular their cyberseto advise on them. curity, HIPAA, and risk management policies and procedures) as they continue to expand 5. Medical Marijuana/ their use of such health care technological inAlternative Therapies novations in the care and treatment of their While both applauded and criticized, patients. Health care professionals and promedical marijuana is certainly here to stay viders need to be aware that multiple federal and increasingly becoming part of the and Florida agencies such as the FDA, FTC, health care landscape in Florida. Recent HHS/OCR, AHCA, and DOH, as well as federalized legislation such as the STATES the applicable licensing boards in Florida, Act and the SAFE Act have gained support will all be scrutinizing and regulating the use and will provide more freedom for States to of advanced technological innovations and regulate cannabis and medical marijuana potential cybersecurity, privacy and safety use and also permit banks to allow medirisks and breaches. The confusing jumble cal marijuana businesses to open accounts of laws, jurisdictions, and standards are not and use them as depositories for their bankeasy to navigate, and therefore, health care ing and cash transactions. Patients are beprofessionals and providers must assemble a coming more aware of the advantages of team of legal counsel, risk management, inmedical marijuana and CBD products and surance professionals and privacy/security/ will be demanding and requesting them on IT system experts to advise them on these a regular basis in the future. The potential areas. Ultimately, the risks versus reward of uses of medical marijuana spans multiple using these health care technological innovamedical conditions including pain managetions will tilt highly in favor of the rewards ment, epilepsy, cancer, and other severely and benefits outweighing the risks for both debilitating and potential life-threatening patients and providers/professionals. Addidiseases. Florida has established a regulatory tionally, patients, and frankly their third-party framework for medical marijuana practitiopayors, will be demanding increased use of (CONTINUED ON PAGE 6) these health care technological innovations Your Host andto Presenter: at a rapid pace. Thus, the time analyze and prepare for this wave of innovative “This is a s results spe change is now. 4. Pricing and Transparency As I am writing this article, the Trump Administration announced the promulgation of an Executive Order establishing criteria for transparency in the pricing of health care goods and services including Dr. DeArcy Vaughan procedures and pharmaceuticals. At first PharmD, MBA, BCACP, CDE, CTTS glance this Executive Order appears to place another overwhelming compliance burden on health care professionals and providers, it also presents a tremendous opportunity for them. Specifically, transparency and pricing presents an opportunity for health care professionals and providers to connect with their patients and discuss the costs and benefits of a recommended procedure, drug therapy, course of treatment, etc. This in and of itself is a tremendous marketing opportunity for health care professionals and providers to distinguish themselves from the competition, and a keen understanding of a patient’s health insurance/third-party payor programs, goals and desires for their care and treatment, and ability to pay represents a chance to build stronger physician-patient relationships and foundations for trust by eliminating surprise bills and obtaining a clear understanding of the patients desired goals and outcomes and achieving them within their ability to pay. It also presents an opportunity for the development of innovative fee schedules and payment structures. However, providers and professionals must be aware of applicable federal and Florida laws and regulations including the advertis-

- Dr. Brian

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


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



2019 Health Law Issues Crystalizing, continued from page 5 ners, and for any provider or professional looking to enter that space it is critical for them to understand that framework and comply with it. While in its infancy, medical marijuana has the potential to grow to one of the largest and most disruptive health care sectors not only in Florida but across the nation. Getting in on this tidal wave in advance and doing so in a compliant manner will present tremendous clinical, professional and business opportunities for health care professionals and providers, but doing so will require a strong working knowledge and application of the Florida legal and regulatory framework. Failure to comply with that framework could result in not only professional licensure risk and penalties, but also legal and criminal action and enforcement. 6. Florida House Bill 843 While the Florida Senate indefinitely postponed its consideration of Florida House Bill 1243, which would impose certain reporting requirements when a Florida hospital or group practice contemplated a transaction that would result in a material change to the health care market, the Senate did pass Florida House Bill 843. This legislation includes provisions which would invalidate certain restrictive covenants, and in particular non-competes, in certain situations. It becomes effective July 1, 2019, and has the potential to invalidate certain noncompete provisions in physician employment agreements between physicians and hospital-owned physician group practices and/or mega-group practices. This could present a seismic shift and disruption in the physician employment landscape and affect the ability of physicians to leave mega-group practices and/or hospital-owned group practices and remain in their geographic area and continue practicing. However, this new law is complex and untested, and like all the non-compete matters will be very fact sensitive and require careful analysis. So, physician employers and physician employees facing transitional issues involving non-competes would be wise to seek legal counsel when evaluating the application and potential enforcement of a non-compete provision in an existing employment contract. And, House Bill 1243 will be on the Florida legislator’s agenda again in the future. The intent of these laws is clear – to increase the ability of physicians to practice independently and prevent market actors such as large health care systems, hospitals and mega-groups from obtaining too much control of and power over the health care delivery system and marketplace. 7. Disruptor and Disruption Following the passage of the ACA, financial capital was readily available to fund health care start-ups. Many entrepreneurs, including physician entrepreneurs, sought alternative delivery and payment models in the years following the ACA’s passage. In 2019 and 2020 disruptors will again seek to reform the health care marketplace through new delivery models, structures and services. Driving these disruptors are a renewed focus on technology and the consumer experience. The most visible disruptor on the horizon is the Amazon, Berkshire Hathaway and J.P. Morgan Chase joint venture. In recognizing and preparing for these disrup6


JULY 2019

tors, health care providers and professionals are well served to ask the question of what do these disruptors have in common? The answer to that question is that the disruptors view the current health care delivery system as one of “disorganized care” and are seeking to redefine it into more organized care through alternative delivery systems, valuebased payment models, patient-centric and consumer-satisfaction driven focus and the implementation of technology such as artificial intelligence, blockchain, robotics surgery and the internet of things. Like it or not, these disruptive forces are definitely needed within our broken health care system and present tremendous opportunity for those health care professionals and providers who embrace it and understand how to implement it in a compliant manner. Federal and Florida health care regulatory laws such as HIPAA, the federal Stark Law, the Florida Patient Self-Referral Act, the Florida Health Care Clinic Act, and federal and Florida anti-trust laws, among others will all apply to these disruptions and must be understood and complied with by those health care professionals and providers seeking to adopt and implement these disruptive changes in their practices. 8. Private Equity Investment in Health Care Since the enactment of the ACA, private equity companies have increasingly become interested in the health care industry. We have seen a large influx of private equity investment in healthcare, and in particular in physician and provider practices. However, when considering a potential private equity transaction, it is highly advisable to be aware of state law restrictions in Florida such as the Florida Health Care Clinic Act, the Florida Patient Self-Referral Act, Florida anti-trust laws, and applicable rules for the various licensing boards including the Florida Board of Medicine. Ownership of physician and provider practices implicates all of these laws and must be assessed well in advance of any substantive discussions, much less any transaction documents being finalized and executed, and transactions being closed by the parties. Failure to do so can result in severe penalties including professional licensure actions against health care providers and professionals. Additionally, health care providers and professionals must be aware of the fact that they will be relinquishing much of their

ability to govern and direct the business and scope of their practices once they complete a private equity transaction and turnover the governance and ownership of those practices to the private equity investors’ management and administrative team. Consequently, Florida health care professionals and providers considering private equity transactions should carefully evaluate them with the assistance of health care legal counsel, tax and accounting consultants and business/financial consultants prior to entering into a private equity transaction.

10. HIPAA FIPA, Privacy & Security Hardly a day goes by without another headline about a cybersecurity breach, many of which have been occurring in the health care sector. Both federal and Florida health care regulatory agencies are increasing not only their investigation of reported breaches but also their audits of health care professionals and providers under HIPAA and FIPA (the Florida Information Protection Act). If your entity or practice does not have a privacy and security compliance program, cyberliability insurance, and regular training on cybersecurity, privacy and security issues, you need to implement all of these as soon as possible. Privacy and security in the health care industry will continue to be top ten issues for the foreseeable future, in compliance with them must permeate all aspects of your practice or entity. Failure to implement appropriate privacy and security compliance measures could result in disciplinary action by your licensing board, HHS/OCR, and the Florida Attorney General’s Office. Cyberliability insurance is still relatively inexpensive, and the development and implementation of an effective HIPAA/Privacy/Security compliance program can be done relatively quickly and inexpensively.

9. Fraud and Abuse Activity and Enforcement Thus far, 2019 has seen a continued escalation of fraud and abuse enforcement efforts including those designed to address the opioid epidemic and CMS program integrity activity such as the Targeted Probe and Educate Program being implemented by CMS. This escalated enforcement activity has included expansion into targets beyond just traditional professionals and providers such as hospitals and physician groups including Medicare Advantage plans, electronic health record companies, and private equity owners. For the foreseeable future, both federal and Florida health care regulatory agencies will continue to closely monitor potential fraud and abuse matters in the federal Medicare program, the Florida Medicaid program and opioid prescribing. Additionally, we are seeing an increased amount of pseudo-enforcement activity by third-party payors such as commercial and private health care insurers, PIP insurers and managed care entities. Thus, health Host and care providersYour and professionals willPresenter: be well served to ensure that they have active monitoring and auditing policies, procedures and processes in place to help ensure that their providers’ and professionals’ quoting, documentation, billing and claims submission are complaint with not only the applicable federal and Florida health care regulatory laws, but also managed care and third-party payor contracts. If youDr. have not performed DeArcy Vaughan PharmD, CDE, CTTS a recent compliance andMBA, billingBCACP, audit within your facility, group practice or provider entity, doing so is strongly recommended as third-party payor government regulatory agencies and entities continue to increase their scrutiny and seek recoupment of perceived overpayments and improperly paid or fraudulent claims.

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Michael R. Lowe, Esquire is a Florida board-certified health law attorney at Lowe & Evander, P.A. Mr. Lowe regularly represent providers, physicians and other licensed health care professionals, and facilities in a wide variety of health care law matters. For more information visit

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- Dr. Brian

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


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Deconstructing Cerebral Aneurysms: To Treat or Not to Treat? By RAVI H. GANDHI, MD

Imagine your patient has had an MRI or CT scan for a simple headache. The radiologist report reads, “4mm un-ruptured intracranial aneurysm arising from the supraclinoid internal carotid artery.” You send an office referral to see your trusted neighborhood neuro-endovascular surgeon and proceed to call the patient. The patient begins to ask you a million frantic questions in a state of shock and despair. If that patient does not ask you those questions, they immediately turn to Dr. Google. A Google search for brain aneurysm returns images of ruptured aneurysms and alarmist messages encouraging people to seek emergent care. The patient may feel compelled to go to an emergency room. If that patient’s sensibilities enable them to refrain from the emergency room they begin to wonder, “Is it ok to drink coffee or will that rupture my aneurysm? Is it ok to work out? Is it ok to shower? Should my kids get tested?” The answer to all of these questions is that everything is ok. The prevalence of un-ruptured intracranial aneurysms is estimated between 3-4%. There are millions of people who have undiagnosed aneurysms. A new diagnosis should not drastically change a patient’s behavior. In realty, 6 million Americans have brain aneurysms and there are only 30,000 ruptured aneurysms per year. An aneurys-



mal rupture carries a mortality rate of 40%. A high mortality and morbidity rate associated with rupture makes deciding which aneurysms to treat of paramount importance. A majority of aneurysms identified incidentally are treated with careful observation. Observation entails annual non-invasive imaging such as an MRA or CTA. If the imaging remains stable then continued observation is considered. “To Treat or not to treat?” begins with determining the patient’s lifetime risk of rupture. Size is the first selection criteria. Initially, it was felt all aneurysms less than 10mm had an approximately 1% risk based on a population study in Helsinki, Finland. Later the controversial, ISUIA I and II studies suggested a lower risk. The flaws of the latter study include selection bias, crossover and incomplete follow-up. The risk of rupture is accepted to range from .85% to 1.7% ISUIA I

for aneurysms less than 10mm. Aneurysms greater than 10mm have a much higher rate of rupture and are usually recommended for treatment. Other patient specific factors include personal history of rupture, family history of ruptured aneurysms, aneurysm shape, or smoking history. So now you have a patient with an aneurysm. The number one lifestyle modification needed is smoking cessation. The patient may resume all other normal activities including exercise. Smoking is the number one patient-controlled risk factor. I spend a great deal of time trying to convince patients recently diagnosed with an UIA to quit smoking. In patients and families with two first-degree relatives with intracranial aneurysms, screening is recommended. The aneurysm has been identified and now the decision must be made. The patient should be referred to a neurovascular spe-

<10mm 10-24mm <25mm GROUP 1


0.05% 0.5% 1% <7mm ISUIA II



7-12mm <13-24mm<25mm


Anterior circulation 0 0.3% 0.5% 2.9% 8% Posterior circulation (including Pcom) 0.5% 0.7% 2.9% 3.7% 10%

cialist. The choice to treat or not to treat the aneurysm would be a careful consideration and discussion of aneurysm specific risk factors such as size, shape, and patient’s medical conditions. If the risk of rupture is greater than the risk of treatment then treatment is usually recommended. In the modern era of minimally invasive endovascular treatments, more aneurysms are amenable to treatment with minimal side effects.


The intracranial aneurysm diagnosis often produces anxiety for both the patient and provider. The article discusses the considerations for any provider who has a patient recently diagnosed with an un-ruptured intracranial aneurysm. Dr. Ravi Hemant Gandhi joined Orlando Neurosurgery following a cerebrovascular and skull base neurosurgery fellowship at Goodman Campbell Brain and Spine in Indianapolis, Ind. and a neuroendovascular fellowship at Albany Medical Center in New York. A neurosurgeon with nearly a decade of experience and a wide variety of peer-reviewed articles and oral presentations he has a special interest in the detection and treatment of complex brain and spinal tumors, blood vessel disease of the head and neck, and emergency treatment of neurological trauma and stroke. Visit

Notes: Patients with unruptured aneurysms were separated into two cohorts: those with no history of subarachnoid hemorrhage (group 1), and those with a history of subarachnoid hemorrhage from another aneurysm (group 2). For larger aneurysms, the studies noted no significant differences in rupture rates between groups 1 and 2. Although the two studies stratified aneurysm size differently, ISUIA II reported rupture rates that were generally higher than ISUIA I. ISUIA, International Study of Unruptured Intracranial Aneurysms; Pcom, posterior communicating.

Board Certified Neurosurgeon Fellowship trained cerebrovascular, endovascular & skull base neurosurgery Leveraging traditional & minimally invasive technology in detection and treatment of complex brain & skull base diseases


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JULY 2019

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Neuroplasticity: Movement is a Medicine By BRITTANY GIAMMALVO

Not long ago, it was believed that our brains were incapable of change throughout our entire lifespan. It was thought that our brain’s structure and development was mostly permanent following infancy and childhood. Decades of research have revolutionized our comprehension of the human brain, allowing for better recovery outcomes for patients with neurological injuries. Our central nervous system (CNS) is comprised of our brain and spinal cord. Those who experience injuries to the CNS, such as a Traumatic Brain Injury (TBI) and Spinal Cord Injury (SCI), principles of neuroplasticity are now incorporated as a key to recovery. We are familiar with exercising our body to increase strength, endurance, and power. However, we also have the capability to work out our brains. When our brain is stimulated through therapeutic interventions, it will adapt and change to the demands placed upon it.

What is Neuroplasticity?

Neuroplasticity is the ability of our brain and spinal cord to continuously rewire new neuron pathways to enhance motor learning following an injury. Our brain is the command center of our body, and neurons are different cells which specialize in commu-

nicating feedback from your body to your mind. Our brains have the capacity to form new neural circuits in response to ongoing activity. These connections are constantly becoming stronger or weaker in response to stimulation, learning, and experience. Our brain’s flexibility for change allow for new networks to enhance our movement and regain functional independence. “Neuroplasticity is also the mechanism by which damaged brain relearns lost behavior in response to rehabilitation” - Kleim & Jones 2008. We now understand our brains ability to adapt and change can occur at any stage of life. Neuroplasticity can increase the speed of communication from brain cells to our body. If we experience a catastrophic event, our brain will detect the injury and rapidly attempt to rebuild neuron pathways. Through skilled physical therapy, occupational therapy, and speech therapy, patients can make remarkable recoveries, and return to normalcy.

How can Neuroplasticity be enhanced?

Therapy model of care is based on patient-centered focus. Intensive, focused rehabilitation helps restore function and maximize feedback/feedforward mechanisms to promote long term memory. Research shows the earlier the care, the better the outcome. Neuroplasticity is best targeted by intense

repetitious training that challenges the body appropriately. Thera pists should focus not only on repetition, but properly dosing activity to the skill level of the individual. Rehabilitation services help drive CNS reorganization through task specific interventions. Movement is a medicine because continuous practice enhances our brains ability to relearn patterns and form new pathways to return to independence. Movement and exercise can enhance motor learning and motor control. Motor control is the ability to regulate mechanisms that are essential to movement patterns that allow us the freedom to perform activities of daily living (ADLs) and navigate our environment. There are three factors that influence movement: task, individual, and environment. Therapists will manipulate and challenge the factors of movement to assist a patient to accomplish a particular action. Our brain is constantly integrating perception of tasks and sensory information to give our movement a meaningful outcome. Variables that influence neuroplasticity: • Aerobic exercise and resistance training: improve brain health,

improve spatial learning, and decreased DNA damage • Intensity: frequency, duration, and difficulty • Repetition • Use it or lose it:

failure to influence movement can lead to functional decline • Mood: mental health plays a vital role because stress, depression, and fear can negatively influence recovery • Experience (Activity) • Age: young brains are

to change

• • • • •

more plastic

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Brittany Giammalvo, PT, DPT, CLT, of NeuLife Rehab holds a doctorate in Physical Therapy and is a Certified Lymphedema Therapist. She graduated Summa Cum Laude from the University of Central Florida. NeuLife rehabilitation provides specialized care through a multidisciplinary approach for individuals who have experienced a catastrophic event. Our certified therapists are experienced in the techniques and principles to support neuroplasticity. Our therapists challenge clients to progress toward their goals through fun and novel interventions that enhance motor learning, sensory input, and cognitive reintegration to increase overall independence and return home. Visit

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Why Good Employees Leave By WENDY SELLERS, The HR Lady®

Why do good employees leave? This is a hot topic in the business world right now and will continue to be so while the economy is doing well and even when the economy is shaky. Why do good employees leave? Two reasons (1) poor management and (2) because the can. They can leave your workplace due to a good economy that brings them job options elsewhere. So that brings us to choose between having poor or effective management on our teams. I used to refer to everyone as a “leader” not management, but let’s be honest, most managers (and even business owners) are not true leaders. Sure, they might have a fancy title and possibly even a decent salary but that does not make them a leader. A leader is someone who others follow willingly – not because they have to in order to get paid, obtain health insurance and/or (in the case of the military) – to simply stay alive. I’ll get back to military leaders in a moment. What is poor management? Poor management is simply the inability to properly manage project or teams of people. Most companies use metrics to measure success (such as sales revenue, KPIs, net profit margin, customer retention/repeats, sales revenue, overhead costs, etc.). When those metrics are not met, one cause may be poor management. Although it is important to note that if the metric is new, it may be a faulty metric. A few signs of poor management can be defined by the following: higher than normal turnover (voluntary and involuntary), low productivity, increased accidents in the workplace, increased call outs, increased negativity, a toxic work environment and secret/hush hush conversations. The root cause of poor management is not easy to define but it usually starts from the top, works its way into processes and then becomes the culture of the organization. Here is an example: I had a client the other day ask a management candidate how many years’ experience they had as manager. The candidate responded: 8 years. My client was thrilled while I stopped the interview to ask more specific questions such as: What is FMLA; explain the FLSA overtime law to me; Give me an example of a time you had to put an employee on a performance improvement plan and what was the result; Have you handled a harassment incident; How many people have you super9


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vised in the past 18 months; What was your turnover rate; etc. The candidate was unable to clearly show that he had true management experience. It turned out that he was managing projects not the people assigned to the projects. The moral of this story is, if he was hired, he would have failed, and it would have been the leader’s fault as she was responsible for the hiring. Now, back to working with former military personnel – I come from a family with veterans and active duty military members. Many of my clients have former military personnel and I volunteer with veterans to help them find jobs in the civilian workforce. I can’t stress this enough – if you are not currently in the military your rank and title mean nothing – zero, zip, nada. Giving orders to employees might actually get you laughed at! Sure, you can fire a few people who laugh but eventually you will figure out that the good people will leave, and you will be stuck with the poor performers. Regardless of your background, how to you get good employees to do what you want them to do? You need to inspire and motivate. You

People are more willing to be open about problems around an authentic leader, which means that those problems are more likely to get fixed, instead of being ignored. Authentic leaders inspire those they lead because they stay true to their own values: they know who they are, and they don’t let anyone keep them from making a decision that they know is right. Finally, authentic leaders have integrity and firm moral codes, and they manage to stay sensible and stable even during the most difficult times.

need to engage. And above all, you need to not be a jerk. I know this is tough to hear especially if you are not a “people person” but just keep thinking about productivity, the bottom line and your (soon to be reduced) stress level. How can you inspire and motive in your workplace? 1. Bring out the best in others (Do not focus only on their weaknesses) 2. Set the vision (Where are we going, together?) 3. Provide accountability and constructive feedback (No excuses; do not delay; Osmosis does not work) 4. Provide opportunities for growth utilizing their knowledge, skills and abilities (Actively engaged in your career growth plan means they want to stay) 5. Empower through delegation (You are probably not the smartest in the room, sorry) 6. Protect, not cover up (fairly and consistently, no favoritism) 7. Recognize and reward appropriately (a sincere Thank You is free) 8. Strive to be an authentic leader Finally, what is an Authentic Leader? Authentic leaders inspire trust in their teams.

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

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With the passage of the 2018 Farm Bill, Hemp and all by-products from hemp including CBD are now 100 percent legal… sort of. Congress passed the 2018 Farm Bill and President Trump signed it into law in December 2018. However, the regulations have not been written or approved regarding the cultivation of hemp and the sale of CBD by the Federal agencies charged to oversee the process. The US Department of Agriculture (USDA) will be in charge of writing the rules on how hemp can be grown from seed to harvest. The USDA has come out publicly stating that they will have final regulations approved in the third or fourth quarter of 2019. The FDA is in charge of the manufacturing, distribution, and sale of CBD and CBD infused products. The FDA had their first public hearing on regulating CBD in Washington, DC on May 31, 2019. The FDA has publicly stated that regulations could take up to two years to approve and implement. However, in the interim, they have provided guidelines on how to proceed with sales of CBD products until final regulations are enacted. The guideline is very simple, if companies do not market or advertise anything regarding CBD and its medical benefits (i.e. cures cancer, eliminates colitis, etc.), then the FDA will not shut your business down. However, if CBD companies advertise CBD as a “cure-all” or in any way promote unproven benefits, the FDA will

shut down your operation. The current strategy of FDA of regulating CBD is to create a “demarcation line” to delineate pharmaceutical grade CBD and food grade CBD. FDA Commissioner Gotlieb, prior to his resignation in May 2019, testified in front of Congress that the FDA wants to incentivize pharmaceutical manufacturers to continue to research CBD and find more benefits the cannabinoid can offer patients. Also, the FDA does not want to disrupt the current CBD market by requiring all CBD to go through FDA clinical trials. Therefore, the FDA is looking at a percentage of CBD or concentration of CBD within a product that would determine whether a product is pharmaceutical grade or food grade. For example, if the FDA comes out with regulation that any CBD product containing more than 100mg of CBD per dose would be classified as pharmaceutical grade CBD requiring FDA clinical trials. However, if the CBD product has less than 100mg of CBD per dose, then it would be considered food grade and would only have to pass a food grade certification process (remember, this is only an example). This “demarcation” strategy is comparable to OTC medications and pharmaceutical medications. A person can take OTC ibuprofen and purchase it anywhere if the ibuprofen is 200mg or less per pill. However, if they want pharmaceutical grade ibuprofen (800mg per pill), they must go to a physician and get a prescription.

Florida CBD legal Update

The Florida legislature just passed SB 1020 in June 2019 regulating the production of hemp in Florida. It was signed into law by Governor Desantis last month. Based on this new law, the Florida Department of Agriculture will be in charge of regulating CBD sales within Florida. At a press conference in June 2019, Ag Commissioner Nikki Fried stated, “I think I have made it very clear along the way that I have a concern about what’s on the marketplace right now. We have no idea what is in those products. We have no idea if there is THC or CBD, if there are other types of chemicals.” “There’s going to be a window of time where everybody in the state of Florida will have to be compliant and bring in products that have the right labeling and the right testing standards. “said Fried. “For all of the other stuff that is on the shelves that does not comply, then they are outside the law.” If you are a physician and you would like to sell CBD in your office, based on the FDA policy of no enforcement as long as you do not advertise benefits of CBD, you can sell it legally. However, based on the comments from FL Ag Commissioner Nikki Fried, you must be selling lab tested consistent product. Therefore, follow these steps prior to selling CBD at your practice: 1. Only work with reputable brands. If you have an individual coming into your store and wants to distribute CBD, and they

are not from a reputable company, do not meet with them. Reputable companies can be verified online and from references. 2. Ensure the CBD you are selling has lab tested results available at any time. Reputable CBD companies are now putting QR codes on individual bottles which allow anyone to check the lab results of each bottle in real time! This is extremely important during a spot inspection or complaint inspection by FL Dept. of Ag or potentially the FDA. 3. Seek legal counsel with a licensed Florida healthcare attorney. Selling CBD at your practice can be beneficial for your patients and your practice, but you want to ensure you are following the law. Michael C. Patterson, founder and CEO of U.S. Cannabis Pharmaceutical Research & Development of Melbourne, is a consultant for the development of the medical marijuana industry nationwide and in Florida. He serves as a consultant to Gerson Lehrman Group, New York and helps educate GLG partners on specific investment strategies and public policy regarding Medical Marijuana in the U.S. and Internationally. He can be reached at

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

Formerly known as Best of ASCO®

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

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

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

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

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JULY 2019

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


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

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A Legitimate Revenue Stream with High Grade CBD By STACY BIRNBACH

CBD is quickly emerging as a potential drug target for a variety of immune-mediated central nervous system diseases. CBD targets the endocannabinoid system (ECS), interacting with ECS’s receptors and helping to restore homeostasis. The endocannabinoid system, discovered in the early 1990s by Dr. Raphael Mechoulam, the “father of cannabis research,” is crucial to human health. The endocannabinoid system is a lipid signaling system, composed of “cannabis-like ligands,” also known as endocannabinoids, including anandamide and 2-arachidonoylglycerol. These are Endogenous Cannabinoids that bind to cannabinoid receptors. These endocannabinoids bind to a specific group of G-protein-coupled receptors (CB1 and CB2R). CB1 receptors are located in centers of the brain associated with motor control, emotional response, motivated behavior, and energy homeostasis. Secondary to areas of the brain, CB1 receptors can be found in tissues of the pancreas, liver, GI, skeletal muscle, heart and reproduction system. CB2 receptors mostly serve a regulatory purpose in the immune system. A number of health problems are attributed to ECS dysregulation, such as obesity, metabolic syndrome, and more. Additionally, it is important to note that endocannabinoids are receptor-dependent. CBD is a safe and effective nutrient found in the hemp plant. CBD Oil and Hemp Oil both come from the same plant, the hemp plant. However, Hemp Oil typically comes from the seeds of the hemp plant, and thus does not contain the same quantity of cannabinoids found in CBD Oil or Hemp Extract, which are extracted from the entirety of the plant. Therefore, CBD Oil and Hemp Extract have more powerful medicinal effects. Unlike marijuana, CBD has no psychoactive effects. It is natural, non-toxic and has a favorable safety profile. The medicinal effects of CBD come from it acting upon CB1 and CB2 receptors throughout the body. Some of the benefits of CBD activating CB1 receptors include relief from depression, lower intestinal inflammation, lower blood sugar, reduced anxiety, reduced fear and paranoia, and increased myelin formation. CBD also activates CB2 receptors which target a substantial number of diseases in the human body, including cardiovascular, gastrointestinal, neurodegenerative, psychiatric and autoimmune. For these reasons, according to the National Institute of Health, targeting the endocannabinoid system through external cannabinoids such as CBD could be useful in treating a number of ailments such as pain, epilepsy, multiple sclerosis, Parkinson, acne, psoriasis, ADHD, diabetes, schizophrenia, bacterial infections, substance abuse, withdrawal, and more. CBD has the potential to vastly improve people’s quality of life. In addition to the substantial research on CBD, testimonials have flooded the in11


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ternet, attesting to its life-changing benefits. Because of CBD’s notable medicinal effects, targeting a large variety of ailments, and its favorable safety profile, CBD should not be ignored. Not only does CBD offer promising health benefits for patients but additional revenue opportunities for those involved in the CBD market. The CBD product marketplace is global and rapidly growing. Initially, the Industrial Hemp Farming Act of 2015 excluded hemp from the Drug Enforcement Administration’s controlled substances list, effectively legalizing and opening market opportunities for hemp-derived CBD products. President Trump’s recent signing of the 2018 Farm Bill is thought to restore industrial hemp to nationwide legal production for the first time since World War II. The total U.S. hemp industry now looks to expand at 18.4 percent rate through a 5-year combined annual growth rate (CAGR) from 2018-2022. Hemp Business Journal estimates that, in all leading hemp product categories, the hemp-derived CBD market will grow from a $390 million-dollar market in 2018 to a $1.3 billion market (3.3x) by 2022, representing a 27.2 percent, 5-year CAGR. For years, experts have predicted that if the cannabis industry expands at its current rate, the American market will reach $20 billion by 2020. But it is now estimated that the hemp-CBD market alone could reach $22

ence improvements from the recommended CBD products, then they will continue to purchase such products and as a result, the physicians will both be helping their patients and earning an additional revenue stream. Patients who see results will additionally recommend the product to their family and friends, and as this network expands, so will the doctor’s revenue stream, with minimal additional effort. Because of CBD’s endocannabinoid target, making it an extremely exciting new treatment, and leading to the development of an expansive CBD product market, the CBD industry is especially valuable to doctors. It could potentially change lives both medically and financially. billion by 2022, and the overall market for Cannabis products could reach $80 Billion. Considering these market statistics and the research on the benefits of CBD, offering CBD to patients, could provide an additional revenue stream for physicians as well as offer effective medicinal treatment. For instance, becoming a brand ambassador with a quality CBD company included in the PDR, could allow physicians to benefit from an additional CBD related revenue stream by promoting and recommending this safe and effective medication. If patients experi-

Stacy Birnbach, a top executive recruiter and successful business woman, suffered from clinical bipolar depression for 30 years. After 3 decades of therapy and drugs, she cured herself naturally and discovered CBD, specifically Kannaway products, the only CBD company included in the PDR. Stacy, CEO and Founder of CBD for Total Health, started the company to educate people about the overall health benefits of CBD and the importance of using effective, quality products. For questions or more information, email Stacy at or visit

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Playing Political Games Does Not Improve Patient Care By MARILYN M. SINGLETON, MD, JD

Now that it is the political season where divisiveness rules the day, the bevy of President wannabes’ interest in maternal health is suspect. After all, none of them have joined the many maternal health advocates who praised the President for signing into law the Preventing Maternal Deaths Act which gives grants to the states to help identify the causes of maternal mortality. According to the Centers for Disease Control and Prevention, black and American Indian/Alaska Native women are about 3 times as likely to die from a pregnancy-related cause as white women. These politicians are neither epidemiologists nor medical personnel, yet they have diagnosed differences in maternal outcomes of black women as a product of racism. Their racial pandering serves to foment disharmony rather than initiate an honest examination of the problem. Of course, those vying for political real estate will not preface their theories with some medical facts: uterine leiomyomas (fibroids), a cause of post-partum hemorrhage, are present in three times as many black women as white women. Or that the higher rates of high blood pressure in black Americans may be due to a gene that makes them more salt sensitive. Perhaps this contributes to the 50 percent higher incidence of hypertension of pregnancy (pre-eclampsia/eclampsia) in black women than in any other racial or ethnic group. White and Hispanic women have substantially the same rate of the disease and Asian and Pacific Island women have the lowest rate of any ethnic group. As a noted black female obstetrician patient safety and risk management expert called the cause of pre-eclampsia a “mystery” and noted, “older schools of thought attempted to use socioeconomic status as a reason to explain the problem, but it doesn’t hold up under statistical analysis.” Do these politicians who label medical personnel as racists also tell you that 11 percent of obstetrician-gynecologists are black women (same as the general black population) and they were more likely than white or Asian ob-gyns to practice in federally funded underserved areas and areas with high poverty levels? Are these physicians racists? Health problems are multifactorial and must be rigorously researched. While bias and social factors cannot be ignored, painting medical care personnel as racists will not advance the conversation. Nor will depriving medical personnel of their religious rights eliminate discrimination in the delivery of medical care. Right of conscience laws have been on the books since the 1970s but the rules had been weakened and medical personnel began reporting workplace retaliation and harassment for their beliefs. Thus, the recently finalized Protecting Statutory Conscience Rights in 12


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Health Care rule ensures that medical personnel have the right to abstain from delivering certain medical services on the basis of religious beliefs or moral convictions. The ink was barely dry on the final rule when San Francisco filed a lawsuit claiming it was “discriminatory.” The lawsuit alleges that the rule “prioritizes providers’ religious beliefs over the health and lives of women, lesbian, gay, bisexual, or transgender people, and other medically and socially vulnerable populations.” First, as far as vulnerable populations, it appears black women have no trouble finding abortion providers: 49 percent of abortions are performed on white women and 40 percent on black women despite the fact that black women of childbearing age make up 14 percent of the population. Second, the lawsuit assumes that many physicians will wantonly begin to discriminate against LGBT patients. No one in the emergency room is asking the sexual history of a hemorrhaging patient. Physicians who abide by the Oath of Hippocrates pledge to do no harm to their patients. Many physicians in their medical judgment do not believe that, for example, assisted suicide, sex-change surgery, and hormone blockers are harmless. Additionally, some surgeons simply have no desire to perform certain procedures just as breast cancer surgeons have no interest in bowel surgery.

The lawsuit contends that it is “the fundamental obligation of the medical profession and the right of patients to receive quality patient care.” The best care will come from physicians familiar and comfortable with the treatments sought. Certainly, in San Francisco with a major medical school and several large health systems, competent physicians who are well-versed in transgender surgery, sterilization, pregnancy termination, and euthanasia are available. The lawsuit is a political stunt. No doubt some patients have experienced professionally unacceptable treatment. Fortunately, the universe filled with ethical professionals that this U.C. San Francisco-trained black female physician inhabits

is more common than not. I have taken care of thousands of patients in public and private hospitals across the country. I’ve worked with hundreds of medical personnel, some of whom were not particularly warm and fuzzy with any of their patients. I cannot tell you what was in their hearts, but they always behaved professionally and competently. Dr. Singleton is a board-certified anesthesiologist. She is President of the Association of American Physicians and Surgeons (AAPS). She graduated from Stanford and earned her MD at UCSF Medical School. Dr. Singleton completed 2 years of Surgery residency at UCSF, then her Anesthesia residency at Harvard’s Beth Israel Hospital. While still working in the operating room, she attended UC Berkeley Law School, focusing on constitutional law and administrative law. She interned at the National Health Law Project and practiced insurance and health law. She teaches classes in the recognition of elder abuse and constitutional law for non-lawyers.

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Will Anti-Vaccinators Object to the New Cancer Vaccine? By JOSHUA MANSOUR, MD

Will Anti-vaccinators also be against these new breakthrough vaccines that can improve odds for a type of cancer once thought to be a death sentence? With the continued outbreak in measles and other illnesses that were once thought to be essentially eradicated with the concurrent use of vaccines it is interesting enough that vaccines again have made yet another improvement, this time to treat cancer. Will this be something that anti-vaccine individuals would turn down if now their life now depended on it? Pancreatic cancer is many times not diagnosed until it has metastasized (spread throughout the body from its initial origin) and by then is many times uncurbable. Initial symptoms are many times vague, therefore mistake it for a simple illness. That is until this cancer spreads beyond the pancreas, this organ that is located deep in the abdomen. Dr. Elizabeth M. Jaffee an international leader in immune-based therapy and Co-Director of the Cancer Immunology Program and the Gastrointestinal Cancers Program at Johns Hopkins and the Sidney Kimmel Comprehensive Cancer Center has focused recently on the development of vaccines that overcome immune tolerance to cancers. She has focused on testing a pancreatic cancer

vaccine in patients who are eligible for complete surgical resection but are at high risk for disease recurrence. The initial studies have demonstrated the safety of the vaccine and identified a dose that allows for activation of the immune system. Thus far it has been associated with improved disease-free survival. In addition to the vaccines mentioned above oncolytic virotherapy has been an emerging treatment, with major institutions investing research and time into finetuning this therapy. There has been a wide array of viruses that have been used, including measles, polio, herpes, and the adenovirus. MD Anderson has genetically modified the adenovirus, which can cause the common cold, to help treat Glioblastoma Multiforme, a very aggressive brain tumor. Malignant gliomas are both the most common and most lethal type of central nervous system tumors, with glioblastoma being the most aggressive subtype. The current standard of care involves a combination therapy that consists of surgery, radiation, and chemotherapy. Even with this treatment, these tumors remain incredibly fatal. After second-line therapy, there is currently no standard of care. Duke University has used an oncolytic virus to treat Glioblastoma Multiforme. In this manner, a live genetically modified polio virus is imparted in the brain tumor via a catheter. The adapted virus, without the part that causes

the viral disease, can then penetrate the cancer cells and surmount an immune response to attack the cancer cells. The rate of overall survival of patient’s treated with this at 24 months was 21 percent compared to 4 percent in the general population group. Another instance where a different virus is being used is with Talimogene Laherparepvec (also known as TVEC), which is used to treat melanoma and is currently FDA approved. It is a herpes virus that is genetically engineered to help shrink the tumor and then activate the immune system to continue to recognize and destroy cancer cells. Similar to the others, the herpes virus also has the ability to invade the cancer cells. However, this treatment differs from the others previously mentioned, as this oncolytic virus is genetically engineered to include granulocyte-macrophage colony-stimulating factor to help draw immune cells to the tumor. This can further enhance the response of our immune system to fight these once unrecognizable cells. The measles vaccine, used to prevent measles, contains a weakened but live version of the measles virus and causes the immune system to produce antibodies against the virus without causing you to contract the illness. In this manner, if exposed to measles, these developed antibodies will work to protect from the disease.

In a different manner, Mayo clinic has used a large dose of measles virus for treatment of multiple myeloma after patients failed multiple lines of conventional therapy. The dose used for this vaccine contains about 100 billion units, enough to inoculate approximately 10 million people. While some of the previously mentioned treatments will inject an oncolytic viral therapy locally, in this particular case the engineered measles virus was injected intravenously in order to help treat metastatic disease instead of localized disease. Above, there are several methods described in which vaccines and viruses are being used to treat cancer. Some of these are in the investigational phases and others are FDA approved. These treatments have been described as immune therapy, viral oncolytic treatment, or “cancer vaccines”, even when referring to the same mechanism. A person who favors one type of “name” versus the other may choose the one that they find suitable to their personal beliefs. Whichever you choose though, there is no denying that these vaccines can be used to help fight cancer. Dr. Joshua Mansour is a board-certified hematologist/ oncologist working in the field of hematopoietic stem cell transplantation and cellular immunotherapy in Stanford, California. Recently he has had over 10 abstracts and over 10 manuscripts published in esteemed journals and given countless presentations at conferences and other institutions. He has helped design and implement clinical studies to evaluate current treatment plans, collaborated on grant proposals, and lead published multi-institutional retrospective studies.

Wednesday August 21 Topic:

MEDICAL MARIJUANA & THE PRACTICE OF MEDICINE Michael Patterson, NHA,OTR/L, CEAS , CEO, US Cannabis Pharmaceutical, Research, and Development






JULY 2019



GrandRounds Physicians Transform Care for ChestPain Patients, Dramatically Reducing Admissions and Costs The clinical transformation and emergency room teams at AdventHealth have transformed the way chest-pain patients are treated in the emergency room, leading to dramatic reductions in admissions and overall costs. Physicians and the clinical transformation team collaborated to create a written algorithm that was used to categorize patients into high-, medium- and low-risk populations. The results have been published and recognized in EClinicalMedicine, the online publication of The Lancet, the world’s leading independent international medical journal. The project was spearheaded by Dr. Jeffrey Kuhlman, chief of quality and safety at AdventHealth. Prior to joining AdventHealth, Kuhlman served as a Navy physician for three decades, including as personal physician to President Barack Obama. “All of us as Americans agree health care is too expensive,” Kuhlman said. “One way to change that is to remove direct cost while ensuring the highest quality of care.” Chest-pain patients account for 10 percent of adult visits to the ER. But of those patients, only one percent are actually having a heart attack. Despite the statistics, many chest-pain patients were historically admitted to the hospital, leading to unnecessary costs to the consumer and organization. For the majority of chest-pain patients, physicians use the HEART score — History, EKG, Age, Risk factors and Troponin, a cardiac enzyme that rises when heart muscle is being damaged. Kuhlman explained AdventHealth’s process: Chest pain patients at high risk for a heart attack are admitted for further evaluation and care. Patients at intermediate risk are functionally or anatomically evaluated with stress test or heart scan in observation status. Patients who are low risk are watched for three hours, connected to follow-up, and discharged

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JULY 2019

safely after another troponin test. All 200,691 patients in the study were tracked for 30 days after discharge, and none suffered major adverse cardiac events during the tracking period. Connecting patients with appropriate follow-up care is also a key component of the initiative. Depending on their diagnosis, the care team arranges an appointment within 72 hours, either with a cardiologist or a primary-care physician. The study concluded the algorithm resulted in avoided health care costs of over $31 million. The initiative also led to a: • 99 percent increase in patient discharges • 63 percent drop in admissions • 20 percent decrease in patients being put on “observation” status The clinical transformation team and physicians are piloting similar algorithms for patients with abdominal pain and fainting, which also account for substantial numbers of ER visits.

Free Back to School Physicals for Uninsured/Underinsured Families The free back-to-school physicals will include general health assessments and sports physicals (minus immunizations) with a Nemours specialist. Following the completion of their physical exam, they will receive the required Florida Department of Health form (DOH 3040) which meets the state requirement for enrollment in public or private school. Children up to 18 years of age are welcome and must be uninsured. Appointments are required. Those without an appointment will be seen on a limited basis and must arrive one hour before health centers open. Please call 407876-6699 ext. 265 to schedule your appointment today! West Orange Medical Clinic 455 9th Street, Winter Garden, FL 34787 Wednesday, July 24, 9 a.m. to noon Miércoles, Julio 24, 9 a.m. hasta noon Thursday, August 1, 1 p.m. to 4 p.m.

Jueves, Agosto 1, 1 p.m. hasta 4 p.m. Tuesday, August 6, 9 a.m. to noon Martes, Agosto 6, 9 a.m. hasta noon Longwood Shepherd’s Hope Health Center The Sharing Center Plaza 600 N. US Hwy 17-92, Suite #124, Longwood, FL 32750 Thursday, July 25, 9 a.m. to noon Jueves, Julio 25, 9 a.m. to noon Monday, August 5, 4 p.m. to 7 p.m. Lunes, Agosto 5, 4 p.m. hasta 7 p.m. Dr. Diebel, JR. Memorial Shepherd’s Hope Health Center Samaritan Resource Center 9837 E. Colonial Dr., Orlando, FL 32817 Tuesday, July 30, 4 p.m. to 7 p.m. Martes, Julio 30, 4 p.m. hasta 7 p.m. Downtown Shepherd’s Hope Health Center Orange County Medical Clinic 101 S. Westmoreland Dr., Orlando, FL 32805 Wednesday, July 31, 6 p.m. to 9 p.m. Miércoles, Julio 31, 6 p.m. hasta 9 p.m.

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GrandRounds CollaborateMD Recognized as One of the Best Places to Work in Healthcare in 2019 ORLANDO - CollaborateMD, a leading provider of cloudbased medical billing and practice management solutions, has been selected by Modern Healthcare as one of the 2019 Best Places to Work in Healthcare. The complete list of this year’s winners, in alphabetical order, is available here. “Despite the political headwinds that the industry faces, healthcare organizations continue to be dominant economic engines in their communities,” commented Aurora Aguilar, editor of Modern Healthcare. “Organizations recognized on this year’s list have also weathered mergers and reorganizations and have come out stronger. As evidenced every month by the Bureau of Labor Statistics employment numbers, the industry shows little sign of slowing down when it comes to creating jobs. And that puts pressure on employers to create not only robust compensation and benefits packages, but to create

a sense of loyalty in the competitive labor market. We congratulate the Best Places to Work in Healthcare for going above and beyond to create fulfilling environments for the nation’s professional caregivers.” “We are proud to be selected by Modern Healthcare as one of the best places to work in healthcare. We understand our employee’s time investment and dedication, so it’s our responsibility to foster an environment that’s positive and fun; a place they enjoy coming to. At CollaborateMD, we are more like family and I think that’s what translates to building effective relationships with our customers.” – Douglas Kegler, Founder & President This award program identifies and recognizes outstanding employers in the healthcare industry nationwide. Modern Healthcare partners with the Best Companies Group on the assessment process, which includes an extensive employee survey.

PONTE HEALTH Welcomes Robert Szafranski as Director of Construction for Vertical Medical City Robert Szafranski, has been actively engaged in construction for 40 years, and in healthcare construction specifically for over 37 of those years. His approach to construction management has been “boots on the ground” for the majority of his career, which has allowed him to strategically address construction and logistics issues. Szafranski joins PONTE HEALTH after a long run with Orlando Health, in the management of all new construction and renovation projects for all eight hospital campuses as well as freestanding emergency departments, clinics and doctors’ offices. The addition of Szafranski to the Vertical Medical City - Orlando team “is priceless to the project” says Ponte, who built a relationship with him through serving the Hospital as a professional services firm.

Vertical Medical City - Orlando, a development by PONTE HEALTH PROPERTIES, has plans to mobilize construction by the end of the year. For more information visit online

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GrandRounds The Orsini Way Launches to Bring Compassion to Medical Communication ORLANDO - The Orsini Way has launched a groundbreaking program and digital platform that shows healthcare professionals a completely new way to communicate, dramatically enhance patient satisfaction and improve outcomes. Anthony Orsini, a Board-Certified Neonatologist for more than 20 years, developed the program to help professionals practice compassion when interacting with patients. “Communication is the number one factor influencing the patient experience, and one interaction can change the course of someone’s life,” said Anthony Orsini, D.O., neonatologist and founder of The Orsini Way. “There are ways to teach relationship building, empathy and trust, and making simple changes to daily interactions can dramatically impact the culture of an entire hospital and help patients feel at ease. Hospitals

using our program have reported a 60 percent increase in overall patient satisfaction since employing these methods.” Originally founded as BBN, The Orsini Way’s initial goal was to help doctors effectively deliver tragic news to patients and their loved ones. This program uses professional actors to put physicians through real-life scenarios and help them learn the most empathetic ways to interact. Now, the company has expanded to include all aspects of patient communication through its all-encompassing flagship program, “It’s All in the Delivery.” It’s All in the Delivery uses compassionate communication to change healthcare culture, including topics such as breaking bad news, professional burnout, conflict resolution and body language. The powerful communication methods involve experiential role playing via professional actors, interactive workshops, and a digital learning experience to reinforce adherence and build positive habits. “Seventy-one percent of malpractice claims are initiated due to poor communication,” continues Dr. Orsini. “Healthcare professionals are experts in their fields, but sometimes, we forget how to speak the language

Axiom Bank Appoints Scott Leitner VP, Commercial Relationship Manager Axiom Bank N.A., a Maitlandbased, leading community bank, recently named Scott Leitner as VP, Commercial Relationship Manager. In this role, Leitner will develop commercial relationships and drive revenue growth. “Scott’s diverse background in law and business brings a wealth of knowledge to our team,” said Ted Sheppe, Executive Vice President, Commercial Banking of Axiom Bank. “His experience helping small businesses reach and exceed their financial goals through innovative solutions is a valuable asset as we continue expanding our services.” As a licensed Florida Bar attorney, Leitner boasts nearly a decade of legal experience, including real

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AdventHealth, Dr. Phillips Center Receive $85,000 Grant for Caregiver, Memory Loss Study The National Endowment for the Arts (NEA) awarded AdventHealth and the Dr. Phillips Center for the Performing Arts an $85,000 grant to support a groundbreaking study that evaluates how the performing arts impacts those with memory loss and their caregivers. The grant was one of just 15 grants totaling $724,000 the NEA awarded to support research projects that investigate the value and impact of the arts. The local study, launched earlier this year, may enhance or even change the way the health care community treats anxiety disorders and other conditions associated with dementia in the aging population. Led by veteran AdventHealth researchers and educators at the Dr. Phillips Center, the study follows memory-loss patients and their full-time caregivers through an eight-week, fun and interactive class incorporating theater games, movement exercises and performances. The NEA grant will benefit both researchers and participants. “Caregivers have unique burdens and stressors, and this grant will enable us to further our research in developing programs and interventions with the aim of reducing these factors and providing whole-person care,” said Dr. Steven Smith, chief scientific officer of the AdventHealth Research Institute. “We hope this research will result in expanded support and resources for caregivers, innovative treatment for

Rommel De La Rosa, a registered nurse at Poinciana Medical Center, was recently honored with the DAISY Award for his commitment to providing exceptional healthcare to all patients. Presented by the DAISY Foundation, the award recognizes nurses who make special connections with patients and are outstanding role models in the nursing profession.

people with memory disorders, and show how unique partnerships can be used to advance medicine and help our neighbors heal.” The funds will help participants in areas such as transportation, as getting to and from the arts center can be a significant stressor for a caregiver. Researchers have already discovered promising early results with the study. Classes have proven to be a source of needed social interaction, reconnection with loved ones and additional social support from fellow caregivers. Ninety-two people, or 46 pairs, participated in the first round of classes, and researchers are working to recruit 68 pairs for the next session, which begins in September. “What’s exciting about this study is that it has the potential to improve communications and quality of life for people facing all kinds of health challenges,” said Dr. Phillips Center President and CEO Kathy Ramsberger. “Our hope is that it will serve as a road map for similar programs throughout our region, and spur arts centers and health systems in other cities to expand our collective work in the future.”

AdventHealth and the Dr. Phillips Center for the Performing Arts launched an innovative partnership in 2014 to create a nationally-leading center of excellence for performing arts and wellness education.

FCC Commissioner Advances $100 Million Telehealth

Initiative FCC Commissioner Brendan Carr has announced that the FCC will vote at its July 10th meeting to advance a $100 million Connected Care Pilot Program to support telehealth for lowincome Americans across the country, including those living in rural areas and veterans. At the clinic, two patients with diabetes demonstrated how they are using remote monitoring technolo-


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GrandRounds gies to improve their health. “With advances in telemedicine, health care is no longer limited to the confines of traditional brick and mortar health care facilities,” said Commissioner Carr. “With an Internet connection, patients can now access high-quality care right on their smartphones, tablets, or other devices regardless of where they are located. I think the FCC should support this new trend towards connected care, which is the healthcare equivalent of moving from Blockbuster to Netflix. That’s why the FCC will vote to advance my $100 million pilot program at our July 10 meeting. It will focus on ensuring that low-income Americans and veterans can access this technology. Particularly in rural communities like Laurel Fork, where the nearest hospital is in a different state, access to telehealth can make a life-saving difference.” “…telehealth is already delivering results,” continued Carr. “Diabetes patients that participated in a remote telehealth program saw their A1C levels decline by 2.2 points on average, which significantly reduced their risk of renal disease, heart disease, and death caused by those conditions. Through the Connected Care Pilot Program, the FCC can build on the success of projects like these,


which are helping create a model for the adoption of connected care technologies and bridging the doctor divide in rural America.” The FCC will vote on a Notice of Proposed Rulemaking at its July Open Meeting that seeks comment on: Budgeting for $100 million in USF support for health care providers to defray the qualifying costs of connected care services for low-income patients, including people in medically underserved areas and veterans. Targeting support for innovative pilot projects to respond to a variety of health challenges, including diabetes management, opioid dependency, high-risk pregnancies, pediatric heart disease, and cancer. Providing an 85% discount on qualifying services for a three-year period with controls in place to measure and verify the benefits, costs, and savings associated with connected care technologies. Collecting relevant data to enable stakeholders to better understand the impact of telehealth and consider broader reforms that can support the trend toward connected care. Connected care has resulted in substantial savings, particularly in the management of chronic diseases, which account for over 85% of direct health care spending in the U.S. A study of 20 remote patient monitoring trials found a 20% reduction in all-cause mortality and a 15% reduction in heart failure-related

Orlando Health Announces New Executive Holly Muller is the new Chief Nursing Officer of Orlando Health Orlando Regional Medical Center and Assistant Vice President of Orlando Health. In this role, Muller will provide leadership and coordinate activities, processes and policies for high quality patient care and work closely with the Vice President of Nursing for Orlando Health to provide leadership and direction. Most recently, Muller served as the vice president of patient care services at Lee Health Gulf Coast Medical Center. She was responsible for the patient care services division and hospital operations within a 356bed acute facility. Some of her accomplishments within this role include successfully merging two facilities to one new replacement facility, leading a system wide conversion of Large Volume Infusion Pumps within four acute care facilities and outpatient center and promoting leadership alignment for advancing professional nursing practice. . Currently, Muller is a member of the American Organization of Nurse Executives, the Florida Organization of Nurse Executives and

the Central Florida Organization of Nurse Executives. In 2014, she was the chapter president for the Southwest Florida Organization of Nurse Executives. She received a Bachelor’s degree in nursing from LaSalle University in Philadelphia and a Master’s in nursing from Kaplan University in Chicago. Also, she completed the Wharton Nurse Leaders Program in Philadelphia and is board certified as a nurse executive. Currently, Muller is enrolled in the Doctor of Nursing program at the University of Central Florida.


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GrandRounds hospitalizations. The VHA’s remote patient monitoring program resulted in a 25% reduction in days of inpatient care and a 19% reduction in hospital admission for more than 43,000 veterans with conditions like hypertension, congestive heart failure, chronic obstructive pulmonary disease, depression, and PTSD. One remote patient monitoring initiative showed a 46% reduction in ER visits, a 53% reduction in hospital admissions, and a 25% shorter length of stay.

AdventHealth for Children Ranks 31 in Neonatology in U.S. News & World Report 2019-20 Best Children’s Hospitals U.S. News & World Report, the global authority in hospital rankings and consumer advice, has ranked AdventHealth for Children’s neonatology program in the new 2019-20 Best Children’s Hospitals rankings published online today. AdventHealth for Children ranked No. 31 nationally and No. 1 in Florida for neonatology. The 13th annual Best Children’s Hospitals rankings recognize the top 50 pediatric facilities across the U.S. in 10 pediatric specialties: cancer, cardiology and heart surgery, diabetes and endocrinology, gastroenterology and gastrointestinal surgery, neonatology, nephrology, neurology and neurosurgery, orthopedics, pulmonology and lung surgery, and urology. “AdventHealth for Children is committed to providing the highest quality, most advanced and compassionate whole-person care to the children and families we serve. Being ranked among the top 50 programs for newborn care for two consecutive years is a recognition of that steadfast commitment,” said Dr. Rajan Wadhawan, senior executive officer of AdventHealth for Children and a boardcertified neonatologist. “Delivering a baby prematurely or having a critically ill child is a very difficult time for parents. Our stellar team of talented nurses, physicians and volunteers — who care for more than 2,000 babies in our neonatal intensive care units each year — demonstrate their compassion and unmatched skill every day.” The U.S. News Best Children’s Hospitals rankings rely on clinical data and on an annual survey of pediatric specialists. The rankings methodology 19


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factors in patient outcomes, such as mortality and infection rates, as well as available clinical resources and compliance with best practices.

Poinciana Medical Center to Open Full-Service Emergency Department in Championsgate Poinciana Medical Center, an affiliate of HCA Healthcare’s North Florida Division - Orlando Market, will bring state-of-the-art emergency care to the ChampionsGate area in 2020 with the opening of a freestanding emergency department near the intersection of ChampionsGate Boulevard and Ronald Reagan Boulevard. A groundbreaking ceremony will take place at a later date. The facility will measure approximately 11,000 square feet, feature 12 private patient care rooms, and employ emergency medicine physicians and staff. It will operate as a full-service emergency department, providing comprehensive, 24/7 care for pediatric and adult patients, including a dedicated trauma room as well as laboratory and imaging services. “Poinciana Medical Center is committed to providing residents of ChampionsGate and the surrounding area with access to high-quality emergency care,” said Chris Cosby, CEO of Poinciana Medical Center. “Every minute matters in an emergency – and having a facility nearby will provide treatment to save lives and enhance patient recovery.” The facility will be the fifth freestanding ER in the Orlando market for HCA Healthcare’s North Florida Division. It joins similar facilities in Hunter’s Creek (opened in 2014), Heathrow and Baldwin Park (both opened in 2019), as well as an upcoming facility in the Millenia area of Orlando which will open later this summer. Each facility operates as a department of a nearby HCA Healthcare hospital. The North Florida Division’s Orlando Market is slated to open its fifth hospital in the region, UCF Lake Nona Medical Center, fall 2020.

Poinciana Medical Center Opens Expanded ER Poinciana Medical Center’s expanded emergency room is now open. In response to the growing healthcare needs of Osceola and Polk counties,

AdventHealth Performs First Central Florida Procedure with Innovative Single-Port Surgical Robot

Surgeons at AdventHealth are the first in Central Florida to use a next-generation surgical robot that requires only a single incision to perform minimally invasive procedures. The da Vinci SP at AdventHealth Celebration is the first of its kind in Central Florida — and one of only 15 in use nationwide since it was cleared for use by the FDA in 2018. The first procedure at AdventHealth Celebration was a robotic prostatectomy, performed by Dr. Vipul Patel and his surgical team. “Robot-assisted surgery is much less invasive than open or traditional laparoscopic surgery, which can mean better outcomes and quicker recovery times for patients,” Patel said. “As a single-port system, the SP has the potential to increase these benefits to our patients.”

the hospital’s $10.1 million project added 14,000 square feet and nine beds to the ER, increasing capacity from 22 beds to 31. The project also included the renovation of the hospital’s lab, emergency department waiting room and entrance. This is the facility’s third expansion since its opening in 2013. Poinciana Medical Center will celebrate the completion of this latest expansion as part of its Six-Year Anniversary Community Celebration in July.

AMA Adopts Policy to Prevent Further Spread of Vectorborne Diseases With an increasing number of people in the U.S. becoming ill from vector-borne diseases—or infections spread through mosquito, tick and flea

Most surgical robots in use today require multiple entry points into the body, with each incision accommodating a robot arm that holds a single instrument. The SP requires only a single incision that is about 2 inches wide. Through a thin tube called a cannula, surgeons can control three separate instruments, plus a high-definition, 3D camera to provide a clear view of the procedure. “The single-port approach has the potential to be beneficial to patients,” Patel said. “This is an exciting development for the field of robotic surgery.” In addition to urology procedures, the FDA recently cleared the da Vinci SP to perform lateral oropharyngectomy procedures (commonly known as radical tonsillectomy) and tongue base resection.

bites—the American Medical Association (AMA) today adopted policy to further its efforts to address this emerging health care concern. Due to the increasing threat and limited capacity to respond to vector-borne diseases in the U.S., the AMA’s new policy calls for the AMA to advocate for improved surveillance for vector-borne diseases to better understand the geographic distribution of infectious vectors and where people are at risk. The policy also calls for the development and funding of comprehensive and coordinated vector-borne disease prevention and control programs at the federal, state, and local levels, investments that strengthen our nation’s public health infrastructure and the public health workforce, and education and training for health care professionals and the public about the risk of vector-borne diseases. Under the new policy, the orlandomedicalnews


GrandRounds AMA will support prevention efforts as well as the dissemination of available information. Additionally, the policy calls for increased and sustained funding to address the growing burden of vector-borne diseases in the U.S. “Our country currently has limited capacity to properly control mosquitoes, ticks and other sources of vector-borne disease that are causing more and more people to become ill. In fact, approximately 80 percent of vector control organizations lack the resources they need to prevent and control vector-borne diseases,” said AMA Board Member E. Scott Ferguson, M.D. “In order to protect our citizens from illness, we must ensure that health departments and other vector control organizations are equipped with funding and resources necessary to prevent and control vector-borne diseases. It is also vitally important that we educate health professionals and the public about existing and emerging vector-borne diseases as it will be critical to addressing both prevention and treatment efforts.” Furthermore, the policy acknowledges that clinical research will be needed to improve the diagnosis and treatment of vector-borne diseases, noting specifically that Lyme disease should be an area of focus. Additionally, because no licensed vaccines for humans are currently available for any vector-borne disease pathogen present in the U.S., the new policy calls for vaccine development for vector-borne diseases. According to a May 2018 report by the Centers for Disease Control and Prevention (CDC), cases of vectorborne disease tripled across the country between 2004 and 2016, and nine new germs spread by mosquitoes and ticks were discovered during this same time period. According to a May 2018 report by the Centers for Disease Control and Prevention (CDC), cases of vectorborne disease tripled across the country between 2004 and 2016, and nine new germs spread by mosquitoes and ticks were discovered during this same time period.

New Mental Health App “Nothing But Advice©” Launches in Florida Those struggling with mental health issues now have access to help in real-time 24 hours a day seven days a week through a new app called Nothing But Advice©. The app has launched in Florida with a nationwide



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roll-out planned for this summer. The Nothing But Advice app allows Florida residents to connect with qualified mental health professionals in the state through an easy-to-use platform via audio, video or text communication. The more than 250 trained Florida-based mental health professionals on the app have been thoroughly vetted. A licensed mental health and certified rehabilitation counselor, CEO Elise S. Gates founded Nothing But Advice after a culmination of years of professional training, observing health care trends and working within an outdated mental health system. “People today need and deserve immediate access to mental health professionals to help guide them through issues big and small. Stressed students, struggling new moms, lonely seniors and others often do not know where to turn or cannot wait to receive the help they desperately need,” said Gates. “We are in a mental health crisis right now. The estimated cost in lost wages, lost productivity and the emotional, financial and physical toll on families and loved ones is a trillion-dollar crisis. Nothing But Advice is a solution.” Nothing But Advice provides a supportive environment where people can talk openly with a qualified counselor who is objective, neutral, non-judgmental, educated and skilled. All communications are anonymous, encrypted and confidential. “Nothing But Advice was created by mental health professionals, not serial entrepreneurs, to meet a very real need in our society. Our mission is to listen, collaborate and provide professional guidance and support in real time,” said Gates. “We want to ensure that users have critical and immediate access to competent, personalized mental health services beyond limited office locations and hours.” Initial funding for Nothing But Advice was provided by the Deberi Group, South Florida-based angel investors who are successful entrepreneurs and business executives investing in women-owned tech companies. “We are not doing psychotherapy; we are not diagnosing or building an on-going relationship and we are not a crises hotline. We offer immediate mental health advice to users at the exact time they need it,” said Gates. Nothing But Advice can be downloaded for free on a smart phone or computer via the App or Google Play store. On the app, users will find the degrees and specializations of all participating mental health professionals and a list of those

advisors who are available in real time. They can then choose to communicate with advisors via audio, video or text. The cost is $40 per 20-minute session or $80 per 40-minute session. Parents or friends have the option to share minutes to loved ones who are registered users on the site. There are no minimum commitments or insurance requirements.

The Bariatric Program at Orlando Health – Health Central Hospital Achieves National Accreditation The bariatric program at Orlando Health – Health Central Hospital recently received accreditation as a Comprehensive Center under the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP®), a joint program of the American College of Surgeons (ACS) and the

American Society for Metabolic and Bariatric Surgery (ASMBS). “The accreditation recognizes the quality care our team delivers,” said Wiljon Beltre, bariatric surgeon, medical director, bariatric program at Orlando Health – Health Central. “Everyone has a part and our team members are dedicated to their roles, and give their best to the program to ensure positive outcomes and improved lives for our patients.” The MBSAQIP Standards ensure patients receive care from a multidisciplinary program, not just a surgical procedure, which improves patient outcomes and long-term success. Beyond the traditional and robotic surgery options performed at Orlando Health – Health Central, a multidisciplinary team of surgeons, nurses, registered dietitians and other medical professionals with specialized training work to ensure positive, quality outcomes for patients before and after the procedures. Support prior to surgery includes comprehensive examinations. Ongoing care following surgery includes physician appointments, and monthly support groups to encourage healthy eating

Success Story! I am an RX2Live franchise owner. We were promoting a Physician & Practice Administrator event, Thursday, May 9th, at Ruth’s Chris Steakhouse introducing RX2Live’s exciting new revenue opportunities for physician practices. Despite investing in direct mail marketing campaigns, registration was low. One week prior to the event I reached out to John Kelly & the Orlando Medical News team. He smiled, then designed and ran Targeted Promotional Email Distributions in Central Florida & North Florida. Within 3-days we received RSVP’s maxing out the room! The revenue enhancers and steaks were HOT! Physicians requested follow-up appointments and RX2Live is becoming a component of successful Central Florida Physician practice.

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GrandRounds habits, exercise and other lifestyle changes. “Not only are we focused on excellent clinical results in the surgical procedures we currently perform, we review outcomes, and explore opportunities through clinical research (internal and external) and other continuous improvement efforts, for even better outcomes and potential new surgical options for patients,” said Dr. Beltre. To earn the MBSAQIP designation, the bariatric program at Orlando Health - Health Central met essential criteria for staffing, training and facility infrastructure and protocols for care, ensuring its ability to support patients with severe obesity before and after surgery. The center also participates in a national data registry that yields semiannual reports on the quality of its processes and outcomes, identifying opportunities for continuous quality improvement. The application process included an extensive site visit by an experienced bariatric surgeon, who reviewed the center’s structure, process, and clinical outcomes data. The prevalence of obesity was 39.8 percent and affected about 93.3 million of U.S. adults in 2015-2016, according to the Centers for Disease Control and Prevention. The CDC also reports obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer that are some of the leading causes of preventable, premature death. “Obesity is an epidemic, and unfortunately it isn’t getting better,” said Dr. Beltre. “Weight loss surgery isn’t only about the numbers on the scale. Weight loss surgery can end diabetes in as little as two days. In addition, high blood pressure and high cholesterol can also go away for patients. Weight loss surgery is about becoming a healthier person as a whole – being aware of health, living better, and doing things once unable to do.” In addition to the program accreditation, bariatric surgeons Dr. Beltre, and Lou Harold, MD, have been designated verified surgeons by the MBSAQIP. Also, the Orlando Health Bariatric & Laparoscopy Center at Orlando Health Orlando Regional Medical Center (ORMC) is accredited as a Comprehensive Center with Adolescent. The Orlando Health ORMC center’s bariatric surgeons Muhammad A. Jawad, MD, and Andre Teixeira, MD, have been designated verified surgeons by the MBSAQIP.



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Medical Students Less Likely to Choose to Become Primary Care Doctors By VICTORIA KNIGHT

Despite hospital systems and health officials calling out the need for more primary care doctors, graduates of U.S. medical schools are becoming less likely to choose to specialize in one of those fields. A record-high number of primary care positions was offered in the 2019 National Resident Matching Program -- known to doctors as “the Match.” It determines where a medical student will study in their chosen specialty after graduation. But this year, the percentage of primary care positions filled by fourth-year medical students was the lowest on record. “I think part of it has to do with income,” said Mona Signer, the CEO of the Match. “Primary care specialties are not the highest paying.” She suggested that where a student gets a degree also influences the choice. “Many medical schools are part of academic medical centers where research and specialization is a priority,” she said. The three key primary care fields are internal medicine, family medicine and pediatrics. According to the 2019 Match report, 8,116 internal medicine positions were offered, the highest number on record and the most positions offered within any specialty, but only 41.5% were filled by seniors pursuing their M.D.s from U.S. medical schools. Similar trends were seen this year in family medicine and pediatrics. In their final year of medical school, students apply and interview for residency programs in their chosen specialty. The Match, a nonprofit group, then assigns them a residency program based on how the applicant and the program ranked each other. Since 2011, the percentage of U.S.trained allopathic, or M.D., physicians who have matched into primary care positions has been on the decline, according to an analysis of historical Match data by Kaiser Health News. But, over the same period, the percentage of U.S.-trained osteopathic and foreigntrained physicians matching into primary care roles has increased. 2019 marks the first year in which the percentage of osteopathic and foreign-trained doctors surpassed the percentage of U.S. trained medical doctors matching into primary care positions. Medical colleges granting M.D. degrees graduate nearly three-quarters of U.S. students moving on to become doctors. The rest graduate from osteopathic schools, granting D.O. degrees. The five medical schools with the highest percentage of graduates who chose primary care are all osteopathic institutions, according to the latest U.S. News & 22


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E+/Getty Images World Report survey. Beyond the standard medical curriculum, osteopathic students receive training in manipulative medicine, a hands-on technique focused on muscles and joints that can be used to diagnose and treat conditions. They are licensed by states and work side by side with M.D.s in physician practices and health systems. Although the osteopathic graduates have been able to join the main residency match or go through a separate osteopathic match through this year, in 2020 the two matches will be combined. Physicians who are trained at foreign medical schools, including both U.S. and nonU.S. citizens, also take unfilled primary care residency positions. In the 2019 match, 68.9% of foreign-trained physicians went into internal medicine, family medicine and pediatrics. But, despite osteopathic graduates and foreign-trained medical doctors taking up these primary care spots, a looming primary care physician shortage is still expected. The Association of American Medical Colleges predicts a shortage of between 21,100 and 55,200 primary care physicians by 2032. More doctors will be needed in the coming years to care for aging baby boomers, many of whom have multiple chronic conditions. The obesity rate is also increasing, which portends more people with chronic health problems. Studies have shown that states with a higher ratio of primary care physicians have better health and lower rates of mortality.

Patients who regularly see a primary care physician also have lower health costs than those without one. But choosing a specialty other than primary care often means a higher paycheck. According to a recently published survey of physicians conducted by Medscape, internal medicine doctors’ salaries average $243,000 annually. That’s a little over half of what the highest earners, orthopedic physicians, make with an average annual salary of $482,000. Family medicine and pediatrics earn even less than internal medicine, at $231,000 and $225,000 per year, respectively. Dr. Eric Hsieh, the internal medicine residency program director at the University of Southern California’s Keck School of Medicine, said another deterrent is the amount of time primary care doctors spend filling out patients’ electronic medical records. “I don’t think people realize how involved electronic medical records are,” said Hsieh. “You have to synthesize everything and coordinate all of the care. And something that I see with the residents in our program is that the time spent on electronic medical records rather than caring for patients frustrates them.” The Medscape survey confirms this. Internists appear to be more burdened with paperwork than other specialties, and 80% of internists report spending 10 or more hours a week on administrative tasks. The result: Only 62% of internal medicine doctors said they would choose to go into their specialty again -- the lowest percentage on record for all physician specialties surveyed.

Elsa Pearson, a health policy analyst at Boston University, said one way to keep and attract primary care doctors might be to shift some tasks to health care providers who aren’t doctors, such as nurse practitioners or physician assistants. “The primary care that they provide compared to a physician is just as effective,” said Pearson. They wouldn’t replace physicians but could help lift the burden and free up doctors for more complicated care issues. Pearson said more medical scribes, individuals who take notes for doctors while they are seeing patients, could also help to ease the doctors’ burden of electronic health record documentation. Another solution is spreading the word about the loan forgiveness programs available to those who choose to pursue primary care, usually in an underserved area of the country, said Dr. Tyree Winters, the associate director of the pediatric residency program at Goryeb Children’s Hospital in New Jersey. “The trend has been more so thinking about the amount of debt that a student has, compared to potential income in primary care,” said Winters. “But that’s not considering things like medical debt forgiveness through state or federal programs, which really can help individuals who want to choose primary care.” KHN data correspondent Sydney Lupkin contributed to this report. Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.




Finding a New Home, Bridging the Americas

“I would hear people say, ‘someone Sheyla Zelaya Aragon, MD, President, Lake-Sumter Medical Society passed from being poor.’ As a young student, which discoveries Can you share insight into the challenges of Sheyla Zelaya Aragon, MD, was reThe truth was stood out the most? opening a practice as a young physician? cently installed as president of Lake-Sumter Medical Society. By itself, that’s not huge SZA: I saw first-hand how many diseases SZA: During the process of opening a pracvery upsetting to me.” news. But based on her journey from wartorn Nicaragua amid political changes to leader of the local medical society is very much newsworthy. North Florida Medical News asked Aragon what it was like growing up in Nicaragua, her adolescence filled with community medical mission work, her sometimes-difficult road to medical education completion, and how she landed in Leesburg. Tell us how growing up in Nicaragua impacted your interest in pursuing the practice of medicine.

SZA: Growing up in Nicaragua was key for me to realize I wanted to be a physician. I was raised in a rural town with little access to healthcare. The community health center had only an on-call nurse and a physician who was a sixth-year medical student fulfilling social medical service to graduate. Emergencies were transferred to the next hospital, which was 21 kilometers (13 miles) away. Instead, folk medicine was practiced in my hometown. Interestingly, a lady who owns a local general store would dispense medical advice and sell over-the-counter medications – plus or minus available antibiotics. When anyone spoke of feeling ill, even my father would say, ‘see what the general store owner can offer you.’ Living there facilitated benign advice. When their illness didn’t improve, they were rushed to the community health center and then the hospital when it became a life-threatening emergency. Even though you moved to the U.S. when you were a toddler, your family returned to Nicaragua after the revolution. Tell us about living in both worlds.

SZA: In the 1980s, I translated for my mom at doctors’ appointments in Florida at Jackson Memorial Hospital. After the revolution at the beginning of the 1990s, my family returned as the country was putting itself back together. Throughout my adolescence, I was exposed to both worlds and noticed the great need for medical professionals in Nicaragua. My vacation and spare time was spent rebuilding schools, buying books and distributing educational material and supplies. I participated with my church on health trips, where volunteer physicians and dentists visited our rural areas to provide services. But medicine was always scarce. For me to get up-to-date medical literature, I purchased books from the U.S. Those experiences shaped me to pursue the practice of medicine as my passion.



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could be prevented with safe and clean water, and how many deaths could be prevented with access to healthcare and medicine. I would hear people say, ‘someone passed from being poor.’ The truth was very upsetting to me. Tell us about your medical education and decision to specialize in internal medicine, and subspecialize in nephrology?

SZA: By the time I decided to pursue medical school, I wasn’t sure between pediatrics versus internal medicine until my third year in medical school with direct patient care. I enjoyed my internal medicine rotations. Then, it wasn’t until I came to the U.S. through the William Harrington Program at Jackson Memorial Hospital at the University of Miami that I fell in love with nephrology. My first classes focused on podcytes, glomerular diseases and dialysis. My Nicaraguan education hadn’t taught me in depth the biochemistry of electrolyte disorders and nephrology research. Nicaragua had one or two nephrologists that had studied abroad. Once again, the monetary barrier for dialysis wasn’t an option. The lifechanging event that made me realize I was meant to be a nephrologist occurred when a family member ended up in end stage renal disease. Unfortunately, he passed. What brought you to the Leesburg area and why did you choose to open a clinic?

SZA: I was idealistic. I wanted to create a bridge between the U.S. and Nicaragua to share medical knowledge. As I engaged with my studies for the U.S. medical license and ECFMG certification, much was changing in Nicaragua. Unfortunately, in 2007, political parties changed. Once I secured my medical residency in the U.S., the Nicaraguan Ministry of Health made it almost impossible for me to train until last-minute permission was granted to continue my education in the U.S. During my residency and fellowship years, returning to visit family in Nicaragua was becoming most uncomfortable with Nicaraguan immigration. That’s when I decided to pursue my medical career in the U.S. I ended up in Central Florida through the Conrad 30 Program that permits foreign medical graduates to work in underserved medical areas and offer healthcare to our most needed communities. I realized that no matter where I am, I can still do what I love with a purpose. There’s no better place than in this beautiful rural community where I have been welcomed. If you look at the statistics, we have poverty, illiteracy and social challenges to overcome.

tice, I wished for instructions. Not all the answers were available through Google searches. The greatest help came from engaging with community doctors. Unfortunately, one of the things I figured out on my own was that one medical provider is offered a standard fee schedule from the insurance companies. I realized that collaborating with other providers is equivalent to strength and gives young physicians like me the chance to succeed. (Aragon has hospital affiliations with Advent Health at Waterman, Central Florida Health Alliance: LRMC and TVRH, and Select Hospital: Promise at the Villages.) You were recently inducted as president of the Lake-Sumter Medical Society. What has moved you to become so involved in the medical community, and what are your goals and hopes during this two-year commitment?

SZA: My inspiration to open a practice came

– Sheyla Zelaya Aragon, MD.

from doctors in the community that I met through the Lake Sumter Medical Society. Patients are my motivation. My hope is that through the experience of our members, we can identify more potential physician members, including young physicians. Nonmembers who have questions or need advice are free to call us. We’ll direct you to the best person. Our goal is your success! What else makes Central Florida special?

SZA: Something very special that made Central Florida my home is that I’m close to my siblings and their children. They visit from the north, south, east and west of the state. We’re ensuring our future generations will see the importance of being raised with a sense of community and togetherness.

We Need Your Help! Shepherd’s Hope, the largest free and charitable clinic in Florida, is seeking an Endocrinologist 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 | or visit

SHARE YOUR PASSION: Help those in need of hope and healing in our community by joining our clinical and non-clinical volunteers at Shepherd’s Hope.

More volunteer doctors and nurses needed now more than ever to help fill the immense demand for healthcare services to the uninsured and under-insured men, women and children in Central Florida.



Profile for Orlando Medical News

Orlando Medical News July 2019  

2019 Health Law Issues Crystalizing What to look out for now with 2020 on the horizon

Orlando Medical News July 2019  

2019 Health Law Issues Crystalizing What to look out for now with 2020 on the horizon