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A Step by Step Path to Excellence Resources and culture key steady improvement at Health Central

Back in 2011, Health Central Hospital in Ocoee was one of the last independent hospitals in Central Florida, and its board was trying to decide whether to merge with a larger health care system. According to the Orlando Sentinel’s coverage at the time, board members agonized over which system had the clearest intentions and most capabilities to serve the community. Some members told a reporter they had changed their minds several times. They finally (CONTINUED ON PAGE 4)


Industry Focus Programming for Healthcare Professionals ... 7

Senator William Frist, MD, Talks Staying Current on COVID-19 and His Podcast, A Second Opinion ... 8 In Other Words…. The Case for Price Transparency ... 10

HEALTHCARE LEADER It's not Work if it's Your Passion ... 13

The Emotional and Psychological Struggle of Being a Doctor By SHANNON SOVNDAL, MD

I remember standing motionless in the doctors’ lounge, staring at my hands. Things had changed. I was someone different, someone my family and friends might not recognize if I let them in, really let them see my true soul. But that wasn’t possible. Not for me. I was too guarded, always guarded, always in control. It wasn’t just today that had changed me. It had been everything. All I wanted to do was see my kids. I wanted proof that they were safe at home; I wanted to see them alive and well, laughing and playing. Instead I was alone, feeling the frantic drone of a busy emergency department. There was no time for reflection or emotion; patients were waiting to be seen. Trauma Room 11 had just given me a cold taste of reality. No superhero saves or knights in shining armor – just the simple fact that sometimes really bad things happen. In the background, the TV mounted in the corner of the room played ESPN baseball highlights. With exaggerated ex(CONTINUED ON PAGE 6)




What’s in your Lobby? PRINTED ON



Happy Doctors’ Day


We thank our doctors for all that they do to help us feel whole.

20-SYSTEM-02246 Doctors Day 2020_F.indd 1



MARCH 2020

3/4/20 11:16 AM orlandomedicalnews




Responding to an Urgent Call Terry Su, MD, looked into the 9/11 sky and knew what he had to do Dr. Terry Su’s path to becoming a skilled head and neck surgeon was a winding one. A native of Northern California, Dr. Su enrolled at University of California Davis pre-med, but after shadowing a trauma surgeon, he wasn’t sold on the medical field. He completed his undergraduate degree and took some time to gain hands-on experience in another career that interested him – aviation. “I had always seen flight academy ads on the back of in-flight magazines and wondered what it would be like to fly local commuter jets,” Su said. “I gave a career in piloting serious consideration, but my mother ultimately urged me to go back to school.” Su listened to his mother and enrolled in dental school at New York University – but it wasn’t until the fall of his senior year that he felt the full weight of his decision. Sitting in his Lower Manhattan classroom on a crisp morning in September of 2001, Su and his classmates watched in horror as American Airlines Flight 11 and United Airlines Flight 175 crashed into the North and South towers of the World Trade Center. “Being so close to the tragedy reminded me how fragile human life is,” Su said. “After that day, I had a new passion and resolve to spend my days helping people.” A CAREER TAKING FLIGHT After receiving his dental degree, Dr. Su worked as a licensed dentist for nearly a year, yet the idea of being a surgeon was still in the back of his mind. He went on to receive his medical degree and completed his residency at the University of California, San Francisco. Su furthered his training in Jacksonville, where he completed a fellowship in head and neck surgery and microvascular reconstructive surgery. “As I was finishing my fellowship, I was

alerted to a job opening with Osceola Regional Medical Center,” he said. “They were looking for an oral and maxillofacial surgeon to help build their trauma program from the ground up. The early years of the program – and my career – were as rewarding as they were exhausting, with most surgeries lasting between 8 and 12 hours.” BECOMING A MENTOR Dr. Su left Central Florida for the University of Colorado in 2016 to teach residents while working as an oral and maxillofacial surgeon. Last year, he was offered the opportunity to rejoin Osceola Regional Medical Center. The hospital had since been designated a Level II Trauma Center by the Florida Department of Health and had added a two-year general surgery residency program. Su jumped at the chance to return to Florida to continue teaching and working alongside young physicians, handling a wide variety of trauma cases involving everything from car accidents to assaults to unusual cases, such as sinkhole-related injuries. “For this type of surgery, it is critical to understand the human mouth and what an individual’s bite is supposed to be,” Su said. “Trauma to the face and neck often results in big holes, which is much different than other areas of the body. Instead of patching, we must do our best to restore the original form and function so that our patients can eat, chew and speak again.” In addition to handling trauma cases, Dr. Su is appreciative that his employer, HCA Healthcare, allows him to tailor his practice to what he enjoys doing the most: head and neck cancer surgery and reconstruction. Su, along with his fellow surgeons, pathologists, radiologists and other experts, conference twice each month to present cancer cases and decide on a comprehensive

and individualized care plan. That collaboration helps Su communicate openly with patients and develop a level of trust critical to top-tier care. A CALL TO ACTION The most powerful tool Su has in delivering positive outcomes for his cancer patients, however, is the primary care physician. He urges his medical colleagues to remember the mouth and neck, and – when in doubt – to refer patients to a specialist for a better look. “Head and neck cancer and oral cancer are different from other cancers deep within the body, which makes one assume they’d be easy to diagnose,” Dr. Su said. “Dentists are on the lookout for ulcers or bumps and will often refer patients for further diagnostic testing. Primary care physicians, on the

other hand, aren’t generally accustomed to examining inside patients’ mouths. By identifying and referring patients at risk for head and neck cancer at an earlier stage, survival rates increase dramatically.” Now in his second year back in the Sunshine State, Su continues to raise awareness around early diagnosis of head and neck cancer. When he is not in the operating room, he enjoys spending time with his wife and three children. He looks forward to the opportunity to continue serving patients throughout Osceola County and Central Florida. Dr. Terry Su is an oral and maxillofacial surgeon at Osceola Plastic-Maxillofacial Cosmetic & Reconstructive Surgery in Orlando.


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MARCH 2020



A Step by Step Path to Excellence, continued from page 1 decided on Orlando Health, a not-for-profit system which was, at that time, composed of seven hospitals. Eight years later, Leap Frog, a widely cited hospital ratings organization, selected Orlando Health - Health Central Hospital as a Top 100 Hospital nationally, one of the most competitive quality awards in the U.S. How Health Central has steadily improved in quality is a story of a determined staff, an influx of new resources, and the creation of a culture that breaks information silos and embraces transparency of data. “They were a free-standing entity,” said Christina McGuirk, the Chief Nursing Officer at Health Central. “So, they just didn’t have the resources they needed,” she said. However, McGuirk said she quickly noticed that the nursing team “was very engaged and they had a real drive for improving quality of care.” She was so impressed with the team, she applied to become CNO as soon as the position opened. An immediate opportunity was to encourage the Health Central nurses and medical professionals to take advantage of the continuing education and whole-care classes that were already in place throughout the Orlando Health system, said McGuirk. Another immediate step was to call in nurses from other Orlando Health hospitals who were at the tops of their fields in certain specialties like Critical Care Nursing or Emergency Nursing to shadow Health Central team members and to develop recom-



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mendations for the education and training resources that could have the most impact. These nursing leaders encouraged the best practices they observed, and they were able to identify ways to align the education plan for the clinical team members, said McGuirk. “What that also did was to aid in building relationships across the Orlando Health system, in fostering collaboration between Health Central and the rest of the system they had just joined.” The resources were important, but the most pressing need at Health Central – as it is for any merger of organizations – was to ensure that the Orlando Health culture took root and flourished. This is one of the biggest challenges for any organization. The legendary business consultant Peter Drucker famously observed that in any organization “Culture eats strategy for breakfast.” That insight was central to the quality improvement strategy for Health Central from the point of view of both McGuirk and Antonio Velardi, MD, the Chief Quality Officer for Health Central. “We needed to create a culture of shared governance,” said McGuirk. “And we did that by nurturing the clinical team members to feel empowered to be part of that practice change, to be able to identify the outcomes we currently have and then to look at evidence-based practices and how we can improve the outcomes for our patients collectively.” “We must have a culture in which peo-

ple know they are not going to be punished for reporting mistakes,” said Velardi. “If you are afraid of repercussions, you tend to hide what you did that was wrong. If the organization is focused on improving its policies and procedures instead of punishing people, we have a much more open working environment.” In addition to these elements of shared responsibility and openness, is the desire to break the silos that tend to develop within highly technical organizations. “We really focused on being transparent with our leadership team and on bringing down those walls, so we made sure everyone understood how their specific jobs affected the overall outcomes.” “Every step of a patient’s time in care is carefully monitored,” said Velardi. “Even something seemingly as simple as a transporter taking a patient from their hospital room to radiology for an x-ray has multiple steps that are recorded and monitored. Any ‘variances’ – gaps between what should occur and what did occur get the attention of managers quickly.” McGuirk described that in daily meetings, not only would direct care team members review the previous day’s data, but that every department possible would be represented. This intense focus paid off in tangible improvements in patient outcomes. For example, Velardi used the example of sepsis statistics. Sepsis is a condition that arises

when an infection someone already has—in the skin, lungs, urinary tract, or somewhere else—triggers a chain reaction throughout body. If not treated rapidly and aggressively, it can lead to very serious problems for the patient, including death. In 2013, national hospital mortality rate for patients who developed sepsis was about 25 percent.  At Orlando Health-Health Central that rate has been cut in half to 12.5 percent. Health Central’s improvements have been receiving a lot of attention. In addition to the Leapfrog Top 100 designation, the hospital earned an “A” grade for patient safety. The hospital began earning recognitions for reductions in infections as early as 2014. And by 2018 it had earned the Florida Hospital Association Award for Most Improved Hospital. “I am so proud of the team and the work that is done here,” said McGuirk. Sometimes old data keeps getting reported in the community, so it’s really good when awards like this can help draw attention to all the progress everyone has worked so hard to achieve.”





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The Emotional and Psychological Struggle of Being a Doctor, continued from page 1 citement, the commentator extolled the virtues of Alex Rodriguez because he had hit yet another home run. He makes close to $58,000 every time he steps to the plate. I guess he deserves it, the pressure and all. I didn’t take note of who won the game, I can only recall Alex. I stood like a zombie in the middle of the lounge, numb, like the poor zebra you see on Animal Planet after having one of its legs chomped off by a hidden crocodile during a compulsory river crossing in Tanzania. The look, that look, on the zebra’s face always struck me as a bit misplaced, because it was devoid of any apparent emotion or concern. Moments from death, tripodding on the far shore, the zebra appeared totally detached and dissociated from its dire predicament. As I stood there, I felt the same as that zebra, vacant of any emotional content. I understood the look. I shouldn’t have been able to push my emotions aside, not if I possessed some small fleck of compassion or empathy. Because this wasn’t normal. This wasn’t what people experienced day to day. At least not normal people. But I had been trained to be this way. No panic, just a calm approach to a problem, like a mathematician working an equation. Years of preparation, acquiring a skill set, building up my vault, had readied me to stand in the lounge like a zebra. And so, I stared at my hands to see if I was actually here, to see who I was. Maybe I was hoping to see something different. Anything, really. A tremble, a shake. But I saw nothing. Just my hands. Steady. Solid. Quiet. Even though it didn’t look like it, deep down, the last thirty minutes had kicked my ass. From the outside I was calm, but some-

where inside, the hideous reality of death and suffering screamed and rattled in my well-guarded cage. There was a picture on the internet that went viral not too long ago. A photographer had caught a shot of a doctor in scrubs and a white coat, crunched down with one hand on the wall and the other on his face. The doctor had just lost a patient. He clearly was shaken and had availed himself of a quiet moment outside. The image went viral was because it showed compassion, feeling, and the emotions of a doctor. People, seeing the picture, were not only moved but surprised. Moved for obvious reasons, but surprised because the doctor was showing such despondence and pain. This should not be surprising. Doctors are affected. It’s hard to be around death. It’s hard to be around the uncertainty, the randomness and the reality that anything can happen on any given day. And once it happens, there’s the magnitude of loss and devastation that follows. Out of necessity I had been trained to deal with anything that walked through the ER doors. And I can remain calm, zebra like, in almost any situation. But that isn’t real. It’s fake. A con job I pull on myself. Because when the exhaustive day is done, and I come home to a quiet and dark house, I am left with my experiences. Sometimes these experiences can become demons. Hovering around death is like hovering around a black hole. Sometimes you can’t escape. It draws you in, too far if you let it. At times it asks too much, like gravity relentlessly pulling away every photon of light. This is why medicine can be so costly. It is why divorce, depression, PTSD and suicide

affect so many providers. But there is hope. Life’s fullness is created at the extremes. The good, the bad and the ugly. What I’ve come to realize, is that I need it all. Medicine has been a gift rather than a curse. I’ve been given an exclusive and extreme spectrum that is beyond anything I could have ever imagined. Right there, on the cusp, the event horizon opens everything. Devastation or exhilaration. You need to tiptoe on the edge of despair to know life. The fear and loss open up joy and amazement. It’s like one leads to the other. Let me rephrase that: one allows the other. So, I may seem cold at times, dealing with an unimaginable situation. But truly, I am moved. And if I manage it correctly, I’m moved to be a better person, father and husband. I’m moved to hug my kids a little longer and kiss my wife with a little more passion. Life is fragile. And because life is fragile, the spectrum is immense. It allows me to see beauty in chaos, grace in tragedy and the hope that lives in between.


Shannon Sovndal, MD, is the author of Fragile: Beauty in Chaos, Grace in Tragedy, and the Hope that Lives In Between. Dr. Sovndal is a board-certified doctor in both emergency medicine and emergency medical services (EMS) and serves as a physician and medical director for multiple EMS agencies and fire departments. Dr. Sovndal has a wide range of career experience, working in tactical medicine (TEMS) with the FBI, as a team doctor for the Garmin Professional Cycling team, and as a flight physician. As the producer of the podcast Match on a Fire: Medicine and More, he is the founder of 3Hundred Training Group, which focuses on educating and training prehospital providers.



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MARCH 2020

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EOCC Educational Series “On the Menu” Featuring “Advertising in a Digital World” with Mitchell Smith Wed March 11 | 11:30 AM – 1:30 PM



Industry Focus Programming for Healthcare Professionals

EAST ORLANDO CHAMBER OF COMMERCE 12301 Lake Underhill Rd, Ste. 245, Orlando, FL 32828

March Chamber Luncheon

“Innovations & Trends of the Coworking Spaces Revolution” Panel Discussion Wed, March 18 | 11:30 AM – 1:15 PM AVALON PARK COMMUNITY CENTER 13401 Tanja King Blvd., Orlando, FL 32828

Coffee Club Nona – Sam’s Club Lake Nona

(3rd Thursday of the month – NEW) Thu, January 16 | 8:30 – 9:30 AM SAM’S CLUB LAKE NONA 1920 Narcoossee Rd., Orlando, FL 32832

Your Pie Lee Vista Ribbon Cutting Tue, March 24 | 11:00 AM – 1:00 PM 6889 Eagle Watch Dr, Orlando, FL 32822

Non-Profit Council Roundtable – Member Nonprofit Benefit

Volunteer Appreciation Tabletop Exercise

Wed, March 25 | 8:30 – 10:00 AM EAST ORLANDO CHAMBER 12301 Lake Underhill Rd., Ste. 245, Orlando, FL 32828

East Orlando Scavenger Hunt University After Hours Thu, March 26

Check in opens at 4:00 PM at Fairfield Inn UCF Hunt: 5:00 – 7:00 PM

After Party & Prizes: 7:00 – 8:00 PM at Island Wing Company $10 per individual | $50 per team of five Complimentary appetizers, happy hour pricing, prizes & unique networking

Latte with Leaders – Member Benefit

(4th Friday of the month) Intimate conversation with your Orange County Political leaders Fri, March 27 | 8:00 – 10:00 AM EAST ORLANDO CHAMBER 12301 Lake Underhill Rd., Ste. 245, Orlando, FL 32828 REGISTRATION REQUIRED

Misters & Sisters Great Lunch Adventures Tue, March 31 | 11:00 AM – 12:30 PM PDQ WATERFORD LAKES 12195 E Colonial Dr, Orlando, FL 32826

Battle of the Businesses After Hour Team Fun Wed, April 1 | 5:00 – 7:00 PM BB&T WATERFORD DRIVE THROUGH 12301 Lake Underhill Rd, Orlando, FL 2828


REGISTER YOUR TEAM OF FOUR Recruitment Special of the Day! Sign up as a NEW EOCC Member & Pay between April 1-April 3 The $25 processing fee will be Waived! MARCH 2020


Dedicated Healthcare Council members greeting guests. Rosellen Kraus, Sleep Number DeMarco Prince, CERTUS Neesi Ross, Community Health Center


For the last few years the East Orlando Chamber of Commerce has carefully examined the specific needs of member businesses and how to effectively help advance their ideas, network and promotion of products and services. To achieve outcomes benefiting the various industries served, we started by developing Councils and Committees with unique industry focus. Recruiting member experts and asking what they needed was step one in helping each grow organically meeting the needs of specific industries. As a result, we have watched a slow and steady growth within our Technology team, Realty connections and now with our Healthcare Council Collaborative. Our Healthcare Council Collaborative incorporated medical professionals of every variety, complimentary programs, healthcare marketing, realty and the like. Each brought valuable insight to the collective for several months as we coordinated an event to introduce practice managers, referral coordinators, physicians and many more during a Meet & Greet event. Our goal was to be the connector helping to increase referrals, expand visibility within the community ultimately increasing revenue. The results were exciting as more than seventy people within the healthcare field joined us at CERTUS of Waterford Lakes for an early morning breakfast networking event. Physicians talked to peers, exchanging information, cards and setting up appointments with each other. Josh Freitas, Vice President of Program Development at CERTUS shared unique programs and engagement initiatives being developed with the patient of memory care loss in mind. He has taken an interest in the latest studies with hearing loss and dementia leading to several research opportunities. Hearing this made the introduction between Josh and Dr. Kyle Clifton with Ascent Audiology a natural choice. Dr. Clifton is also a champion for those with hearing loss and the link with memory issues and quite

Healthcare professionals representing various specialties found the interaction with peers valuable.

Networking their way around the room. Dr. Colin Bartoe, Functional Neurology Chiropractic Center Josh Freitas, Vice President of Program Development at CERTUS

excited to possibly work with them to help possibly close a gap for those in need. Andrew Cole, President and CEO of the East Orlando Chamber explained the purpose of the Healthcare Council Collaborative to guests, helping them to understand the value brought to those securing membership in the organization. In addition to connecting peer to peer through Meet and Greet opportunities, our May Job Fair, Health Benefits available for the practice, Business Expo and our Connect 4 Property Professionals events, the East Orlando Chamber has created a Healthcare Council Collaborative Member directory that will be distributed in our Community bags provided to more than 2,000 new residents throughout 35 communities. As with any event, hearing from attendees is important, so each was asked to complete a brief survey of their impressions and likelihood of participating in future opportunities. The feedback was priceless! Of the more than half returning feedback ALL said they found value, made valuable connections and would certainly attend another event. The East Orlando Chamber Healthcare Council Collaborative is

Please visit www.EOCC.org for a complete listing of March’s events

focused on the entire landscape with special attention to offering focused peer-to-peer networking to increase referral sources. Are you looking for an opportunity to mix and mingle among your peers? Join us for the next East Orlando Chamber Healthcare Council Collaborative, Thursday, June 25, 2020 from 8:30 – 9:30 AM at The Bridge at Orlando at 3201 Rouse Road in Orlando. We will introduce your neighboring physicians, more about the Healthcare Collaborative and how the EOCC is helping grow your practice through referrals, community outreach and new opportunities with increased revenue potential. If you are a physician or healthcare professional, register today. A continental breakfast will be provided. RSVP is requested. Want to know how else the Chamber can work with you to elevate your business? Give us a call at 407-277-5951. Let’s meet to discuss your business objectives and how the EOCC helps drive results making you a long-term member of one of the oldest established chambers in Central Florida. Dorothy Hardee is the Administrator for East Orlando Chamber of Commerce.


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Q &


Senator William Frist, MD, Talks Staying Current on COVID-19 and His Podcast, A Second Opinion

Senator William Frist, MD, is a nationally recognized heart and lung transplant surgeon, former U.S. Senate Majority Leader, founding partner of Frist Cressey Ventures and chairman of the Executives Council of the health services investment firm Cressey & Company. As a U.S. Senator representing Tennessee from 1994 -2006 (the first practicing physician elected to the Senate since 1928), Dr. Frist served on both the Health (HELP) and the Finance Committees responsible for writing all health legislation. He was elected Majority Leader of the Senate, having served fewer total years in Congress than any person chosen to lead that body in history. His leadership was instrumental in the passage of the 2003 Medicare Modernization Act that established the Medicare prescription drug benefit, and the historic PEPFAR legislation that provided life-saving treatment globally to 20 million people and reversed the spread of HIV/AIDS worldwide. Senator Frist graduated from Princeton University and Harvard Medical School. Dr. Frist completed surgical training at Massachusetts General Hospital and Stanford. As the founder and director of the Vanderbilt Multi-Organ Transplant Center, he performed over 150 heart and lung transplants, authored over 100 peer-reviewed medical articles, and published seven books on topics such as bioterrorism, transplantation, and leadership. He is board certified in both general and heart surgery. Dr. Frist annually has led medical mission trips to Africa and Haiti, and emergency response teams to disasters around the globe, including to Sri Lanka after the Indian Ocean Tsunami, Bangladesh, Sudan, New Orleans after Katrina, Haiti after the earthquake, and the horn of Africa. He is founder and chairman Hope Through Healing Hands, a humanitarian organization devoted to improving global health. As a leading authority on healthcare, Senator Frist speaks nationally on health reform, government policy, global health, education reform, and volunteerism. He is the Co-Chair of the Health Project at the Bipartisan Policy Center, and co-founder of Aspire Health, the nation’s largest nonhospice community-based palliative care company. His board service includes the Robert Wood Johnson Foundation, The Nature Conservancy, and three publiclytraded companies: AECOM, Select Medical, and Teladoc Health. Senator Frist is one of only two individuals to rank in the top ten of each of the five inaugural Modern Healthcare Magazine annual surveys of the most influential people in healthcare in the United States.



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OMN: You had experience dealing with the 2003 SARS Crisis by being on the ground in China with a U.S delegation of Senators. Can you give us a comparison of that experience with COVID-19 today? Dr. Frist: In April of 2003, I led a delegation of United States Senators at the height of the SARS crisis. That was four months into the crisis. At that time there was a cover up in China and it was obvious that they were not releasing information either within their country or without... That crisis grew globally. This time around China has been much more forthcoming and instead of being four months, this time it was three weeks, and about the third week in January, they began to produce useful information about the virus. They began to act much more aggressively this time around in terms of shutting down spread, warning the people of China. There’s still a question in terms of those first few weeks how much their central government control had kept things under wraps inappropriately, but only time will tell. They’re so much better this time around in terms of responsiveness. Their adherence to global standards were still short of what we need in order to contain viruses and pathogens. Pathogens don’t have passports and viruses don’t have visas. There are no barriers between China and the United States or China and any other country. Therefore, containment is the only real definitive action and in essence treatment that we have today. In speaking with policy makers, like I know you do, can you give me an idea of what projections and trends that you’ve been briefed on? Dr. Frist: I’m going to rely just totally on the CDC because we really don’t know. None of the models right now are sufficient to predict how big it will be. What we do know is that it’s going to have a severe economic impact and that is underway. That impact will worsen over the coming week in a global sense. The United States, hopefully, will respond and bounce back quicker if the virus does not increase, but globally the response will be months. As a physician, I know other physicians are going to want to hear from you, what should they expect as far as what should they expect in their practices and what impact is this going to have on their practices? Dr. Frist: For a physician clinical-based or hospital-based, you’d have to prepare for two things from a practical standpoint. Start by asking yourself, if your own workforce does not show, meaning half the people don’t show up, whether it’s your nurses or ancillary personnel, what are you going to do? How are you going to continue to deliver care? How are you going to be able to, if people are coming into the office, take care of them? I encourage people to think about supplies that they have; hospital gowns, ven-

tilators, masks, to make sure you have sufficient stocks. And if you’re a doctor, do you consider using more telemedicine than you had in the past? How much can you do in terms of managing your patients by the telephone or by video for those who have the infrastructure of teleconferencing? And then there’s your own safety. We learned from the SARS experience in 2003 that much of the morbidity was from people in the hospitals contaminating or infecting other workers, so you need to review your own infectious disease protocols for your own office and your own personnel to prevent transmission. Focus on waiting rooms. How would you isolate somebody who was in your waiting room if they have symptoms or even if you’re in an emergency room? Think of that person to person contact. I know it’s premature to ask, but if providers are overwhelmed, are we just going to be asking patients to stay home as long as they can? Dr. Frist: We have to be really careful, but I think you’re right. We have a fixed number of resources that we can dedicate and for the medical community, doctors, nurses and the hospitals, people are going to continue, irrespective of this virus, to become ill and to need a doctor’s care. Anybody who is looking for elective surgery, will probably be encouraged to postpone and delay. The second thing that people will look at is prevention. For people who are looking and doing their colonoscopies or routine mammograms for prevention, they will be at a pause. Mainly, it’s because we have fixed resources in the healthcare system. We have to think about the response to people who are acutely ill. If (the spread of this virus) did get large enough, it would mean a triage mechanism would have to go in place both in doctor’s offices and hospitals. The most current, up-to-date information is going to be coming from the CDC, and right now things are changing on an almost hourly basis. I know you want to tell us about what you are doing now in public healthcare information. Tell us about your podcast – what you are discussing and who your guests are. Dr. Frist: So, A Second Opinion Podcast with Bill Frist, M.D., is now about nine months old. It’s a podcast that captures a unique but very large audience who is interested in health and wellbeing. Our approach is to take the very best of health and wellbeing conversation, intersect that with policy conversation from Washington or at the state level or even local level. And the third big area that we intersect with is the area of innovation and creativity, which includes the small and mid-size businesses that are involved in health and healthcare, but also includes innovation in health services and payment mechanisms and new ways to diagnose and treat mental health issues. So,

we engage specifically at the intersection of policy, medicine and innovation. We broadcast every Monday, but for urgent issues we do bonus or special episodes like one we did yesterday on COVID-19 with the former head of the CDC, Dr. Tom Frieden, who was the long-acting director there until two years ago, and is now CEO of Resolve to Save Lives, a $225 million, five-year initiative to prevent epidemics and cardiovascular disease. Resolve to Save Lives was launched in September of 2017 with support from Bloomberg Philanthropies, the Chan Zuckerberg Initiative, and the Bill and Melinda Gates Foundation and partners countries around the world. Our goal is to be the most trusted voice in the issues around health and healthcare, not just in times of crisis, but in understanding the complexities of individuals getting health and healthcare today and the healthcare system, including the financing and organization and delivery of healthcare. We speak to individuals nationwide to provide information you cannot get elsewhere in a curated way. The podcast is available 24/7, so you can get to the information when you want it. The sort of people that we have as guests are anybody from the head of the CDC to Victor Dzau who runs the National Academy of Medicine, to directors and former directors of the food and drug administration and of NIH. Toby Cosgrove, from the Cleveland Clinic. We talk to guests like United States Senator, Lamar Alexander and those innovative in fields like payment reform to virtual reality companies in healthcare, a whole range of people. Visit our website, asecondopinionpodcast.com, We’ve been very successful in terms of reaching people. We’re on all the platforms, Apple, Spotify. Wherever people get their podcast.



THC Showing More Benefits Than Financial Doom Previously Known After Surviving VOLUNTARYBENEFITS: NOT SO VOLUNTARY


By Michael C. Patterson

Cannabis is now legal for medical purposes in 33 states and adult use is legal in 11 states. With more states legalizing cannabis, the ability to perform research on cannabis has increased. Cannabis has become more available, at a state level, to study and research its effects on the human body. Cannabis is made up of cannabinoids, a class of diverse chemical compounds that act on the human cannabinoid receptors, also known as the Endocannabinoid system. Until recently, it was widely believed that the cannabinoid, CBD or cannabidiol, had more health benefits than another well-known cannabinoid, THC. Tetrahydrocannabinol, or THC, is the cannabinoid which produces the “high” feeling and has been demonized for decades as a detriment to individuals and society. A research study published in the journal, Scientific Reports, May 2019, tracked almost 20,000 cannabis sessions from 3,400 patients. The research team from the University of New Mexico stated through their spokesman, Jacob Miguel Vigil, “Despite the conventional wisdom, both in the popular press and much of the scientific community that only (cannabidiol-CBD) has medical benefits while (tetrahydrocannabinol-THC) merely makes one high, our results suggest that THC may be more important that CBD in generating therapeutic benefits.” To come to this conclusion, researchers had 3,400 patients use an app called Releaf. On this app, participants would note a variety of details about their cannabis use sessions over the time span of nearly two years. The participants would record type of cannabis consumed (flower, concentrate, edible, etc.), the combustion method (joint, vapor, pipe, etc.), subspecies of the cannabis plant (Sativa, Indica, Ruderalis), and cannabinoid content of THC and CBD. The patients also rated the



MARCH 2020

severity of up to 27 health conditions or symptoms before and after self-administration of the cannabis product and tracked any side effects they experienced. Based upon the data, Vigil’s team concluded that “CBD appears to have little effect at all, while THC generates measurable improvements of symptom relief.” While this study is far from meeting the strenuous standard of an FDA clinical trial, it does give more data to ascertain that all parts of the cannabis plant can be beneficial. Many FDA prescriptions are not curing disease, but merely managing or limiting symptoms of diseases. Just because many think THC is bad for patients doesn’t make it an accurate assumption. Anecdotal evidence from thousands of participants is a standard metric for cannabis studies as of now. With the 2018 Farm bill becoming law in December 2018, CBD derived from hemp is now 100 percent completely legal. This new legal product will allow for federal research to be performed on CBD at a very high level in order to potentially develop new medications. More clinical studies on effects of all cannabinoids, including THC are needed. But one of the most important facts of cannabis use has never changed, which is cannabis has never caused a death in human history. As physicians begin to be exposed to objective information on cannabis, more of them are becoming advocates of medical cannabis. Florida now has over 2,600 doctors qualified to recommend cannabis as a medicine and the list of qualified physicians is increasing at approximately 15 per week. Michael C. Patterson, founder and CEO of U.S. Cannabis Pharmaceutical Research & Development of Melbourne, is a consultant for the development of the medical marijuana industry nationwide and in Florida. He serves as a consultant to Gerson Lehrman Group, New York and helps educate GLG partners on specific investment strategies and public policy regarding Medical Marijuana in the U.S. and Internationally. He can be reached at mpatterson@uscprd.com

Health insurance, whether group or individual coverage, has become essential for all Americans. While it is essential from a wellbeing perspective, it can be unattainable from a financial perspective. One of the main reasons for the astronomical cost of health insurance is the way in which we consume it. Often, individuals are going to the Emergency Room for something that could be easily handled by an urgent care clinic. Furthermore, our healthcare is one of the ONLY things we consume that we don’t know the cost of prior to the service. When it comes to the non-emergency ways we use our health insurance, there are absolutely ways we can be better consumers - but what about a health issue like a heart attack or a stroke? When faced with a critical illness, how to be a better consumer of healthcare is rarely top of mind; rather, getting aid quickly and returning to work is usually top of mind. The major advancements in healthcare have created an environment in which a critical illness is more survivable than ever before. While this sounds like a statement that should be celebrated, the lingering financial impacts are what can crush an individual and their family after a critical illness.

Two-thirds of the 1.5 million Americans who filed for Bankruptcy, do so because of Medical Costs, often associated with surviving a critical illness. When a patient survives a heart attack, they should be focusing on how to get better, not on how to pay their bills or how to avoid medical bankruptcy. How can this problem be addressed? One of the best ways to solve this problem is through a Critical Illness insurance policy. This policy is designed to pay a lump sum upon diagnosis of any named critical illness. The plans can pay out as little as $10,000 and as much as $50,000. This benefit pays the survivor directly and they can decide what to do with it. For example, many survivors will use this lump sum to negotiate and pay their medical bills, while some use it as a replacement for income while they take time off from work to focus on healing. The most attractive element to the Critical Illness policy is the affordability. Dale McMindes DALEMCMINDES@allstate.com https://agents.allstate.com/ dale-mcmindes-orlando-fl.html 407-290-5000

WHAT CAN BE COVERED BY A CRITICAL ILLNESS POLICY: Heart Attack Stroke Kidney Disease Alzheimer’s

Parkinson’s Cancer Organ Transplant And many more

Premiums can be as low as $4/ month and include a Wellness Benefit that reimburses annually for preventative tests like mammograms, chest x-rays, or colonoscopies.

This benefit is best offered in a group setting and can be made available to all employees either voluntarily through payroll deduction or via employer sponsorship. Sixty-two percent of employees, when given the option, say they would participate in a Critical Illness program to cover the out of pocket costs. Unfortunately, this is much greater than the number of employers who actually offer it. Critical Illness insurance is generally available to ages 18-65 and when offered through an employer, can be guaranteed issue. Most plans will have a 12 month look back period in which they will not cover any diagnosed critical illnesses for another 12 months. The rate will never change, even as the employee ages. Employees can also cover their dependents for a very minimal cost.

How big of a problem is Critical Illness really? Group Critical Illness policies are filling a financial void that exists within the current health insurance model. This group strategy is the best way to allow your valued team members to focus on getting better and can help prevent them from being one of the millions of Americans who declare medical bankruptcy after surviving a Critical Illness.

Every 34 seconds, an American will suffer a heart attack.* Every 40 seconds, someone in the US has a stroke.*

Chelsea Whalley chelsea@jdonovan.financial www.jdonovan.financial 407-840-4042




The Case for Price Transparency By PAULA M MUTO, MD FACS AND MARK R. MUTO

Editor’s note: This month’s spotlight is on an advocate of disruption in healthcare, who speaks passionately on many issues regarding transparency in healthcare, patient rights and ensuring patient access to the care they need and deserve in our forum format we call “In Other Words… where we enjoy giving providers the opportunity to discuss issues they would like to address with colleagues in the healthcare community. In Other Words….with Paula M. Muto, MD, and Mark R. Muto Healthcare is a mess. Sixty-four percent of Americans avoid or delay treatment because of not knowing the cost. The fear of surprise bills and the increase in deductibles have created, at best, a confused marketplace, at worst severely restricted networks that prevent patients access to critical services. Both patients and doctors have been held captive in a system that, by design, separates them, despite the natural alignment in priorities. Doctors want to take good care of patients and patients want to get better, but the current set of rules interfere with this fundamental relationship. We all know the reasons for the status quo, with healthcare accounting for nearly one fifth of the nation’s economy, the incentives are obvious, and the effects cascade through society as a whole. The true cost of care is skillfully hidden, and because we assume it will be high, with trepidation we dutifully pay our monthly premiums, and even swallow additional fees when actual service is provided. Healthy, organic economic trends are stymied by workers forced to stay in unsuitable jobs and employers strongarmed into managing benefits instead of production. Add to this the loss of productivity of workers forced to take multiple steps in pursuit of care, not to mention delays in treatment, and the costs extend beyond the individual. This scenario satisfies archaic insurance requirements for managed care but offers no value for the patient or doctor. From the insurance perspective, the needs of the patient are not paramount, because in most cases, the employer is the “customer.” Taking the patient out of the equation, makes it easier to negotiate price. As long as patients remain obedient and within the restrictions imposed upon them by their employer plan, the cost is controlled, even if that means having to travel to another state for a routine procedure. These policies may save money for a patient’s employer, but not necessarily for their spouse’s. The real price of a knee replacement goes well beyond the operating room and it is the patient, not the employer who incurs that cost. Despite this shift, there is little opportunity for the patient to decide what is best for them. 10


MARCH 2020

With the patients out of the equation, the response on the medical side has been a consolidation of services, shifting care away from individual practices to larger, often restricted and impersonal networks. Doctors struggling with increasing overheads and decreasing payments, have responded by retiring early or by selling their practices to hospitals or even venture capital. For the first time, over half of the physicians in the country are system employed, which means they are no longer allowed to work directly for the patient. With little autonomy, physicians have been silenced or worse, ignored. It’s no wonder 48 percent report burn out or “moral injury.” The doctor-patient relationship has been deemed irrelevant, even though 75 percent of patients consider it the most important factor in their healthcare. We have effectively separated doctors from their patients leaving them vulnerable to a standard of care determined by economics. But where do we go from here? Technology has created a world of convenience, where services of all kinds are directly accessible to the consumer and at lower cost, because there are no intermediaries. Isn’t medicine perfectly suited for this? Restoring a personal, peer to peer relationship realigns priorities and allows the patient both control over their own healthcare choices and holds physicians directly accountable for a good outcome. Bio-

technology is leading to targeted therapies and individualized care and we need a new paradigm that accommodates the future of healthcare – not its past. We can simplify the equation by eliminating the steps technology has made irrelevant and offer patients direct access to their doctor for a transparent price. But to change the system we have to prepare for an epic battle and doctors must lead the charge. We can no longer, in good faith, sit idly by as our hospitals and societies publicly oppose any initiative that challenges the status quo. Understood, there is a vast industry built around healthcare delivery that has led to an astonishing increase in administrative costs, but we now know it doesn’t work and is unsustainable. The cost of managing care has far exceeded the cost of delivering care. Medicare for all or other reforms would require more resources and we don’t have any to spare. We need to decide who is the best steward of the healthcare dollar and it is an undisputed fact that when the patient pays, the price comes down. Allowing the patient to choose what is best for them is a fundamental right, and depends on an autonomous doctor-patient relationship. Price transparency is an important step and one we cannot fear. Paying for care is finite, not everyone needs a billion-dollar cancer drug, advances in minimally invasive techniques have reduced the need for expensive postoperative management, and vacci-

nations have eliminated certain diseases all together. Bernie Sanders suffered a cardiac event, was treated, released and back on the campaign trail within a week. The price of his cardiac stent is irrelevant, because the cost of delivery was minimal. We are moving toward more efficient care, but are repeatedly being yanked backward by costly system requirements. At the very least those costs should be transparent. We do not need a complex hierarchy to practice good medicine. We have made it infinitely more difficult for no good reason. Physicians should not be held captive by a system that no longer serves their patients. We need to act together to put the patients first by offering direct access and price transparency. Doctors have a moral obligation to just say no, step outside the current system to take care of the patient, and we have the technology to do it. Paula Muto, MD, FACS, is a fellowship-trained vascular surgeon by specialty who also practices general surgery. Additionally, she is director of the Vein Center at Mutosurgical. She is an advocate of disruption in healthcare and speaks passionately on many issues regarding transparency in healthcare, patient rights and ensuring patient access to the care they need and deserve. Muto is the founder and CEO of UBERDOC, a direct-pay healthcare platform. Visit www.uber-docs.com. Mark R. Muto is the owner of Pace Systems, an IT consulting company specializing in medical information technology and patient privacy.



P C A N O R A N G E C O U N T Y . C O M


4 0 7 - 8 3 6 - P C A N

In Honor of

National Doctors’ Day MARcH 30, 2020 The Primary Care Access Network (PCAN) would like to thank all our gifted

Volunteer Physicians

for their commitment, sacrifice, and for the thousands of hours of hard work donated to the men, women and children of Central Florida.

PCAN’s mission is to improve the access, quality and coordination of health care services to the uninsured and underinsured populations of Orange County.

FO R V OLU NTEER OPPORTU NITIES, CO N TACT: Community Medicine Clinic at Advent Health 407-303-7298 | Dental Care Access Foundation 407-898-1525 | Florida Department of Health in Orange County 407-858-1400 Grace Medical Home 407-936-2785 | Healing the Children 407-877-9311 | Shepherd’s Hope, Inc 407-876-6699 | SpecialCare, Inc. 407-836-2519



MARCH 2020



Set Savings Goals Get on track money-wise by setting some savings goals. Here are some tips to get you started: START A BUDGET. Set a goal to create a workable household budget with the end in mind to bring in more than you spend and then save it. Use apps, spreadsheets, or plain pen-to-paper, but be sure to create line items for your savings goals and allocate funds for those areas. CREATE AN EMERGENCY FUND. Set a goal to establish a particular savings amount to have on hand for emergencies. The general rule of thumb among financial experts is to save three times your salary for emergencies. Remember, this fund is only for unplanned expenses.

from your paycheck, that you barely notice in the day-to-day, can pay off significantly once you’re ready to use these savings.

CREATE A SHORT-TERM SAVINGS FUND. Planning a vacation or a home renovation project? Need to budget for Christmas shopping? Don’t put those expenses on credit cards. Start a savings fund for shortterm spending plans or projects so you can afford them. CREATE A LONG-TERM SAVINGS FUND. Plan for the far-off future by putting a sum of money into an interest-bearing account and not touching it. You could use a windfall for this purpose, such as a tax refund or a bonus from work. Automating small contributions to this account straight

Martino Siciliano is a Senior Vice President and OSJ Advisor with 40+ years of Financial Services experience and has been with Primerica since 1981. He holds State Life, Health, Property Casualty, FINRA Securities Series 6, 26, 63, SEC Series 65 and Fedreal NMLS Mortgage Licenses. He is a PFS Investments Inc. Registered Representative, a Life Insurance Representative (US) and an Investment Adviser Representative Eric Perlman is a Senior Regional Leader with Primerica who brings over 20 years of investment experience. He holds FINRA Series 6, 26, 63 and 65 licenses. He is an American Veteran who spent four years in the Air Force serving a one-year tour in Vietnam, and is a graduate of Long Island University with an MBA in Finance and Economics. He currently lives in The Villages, Florida with his wife of over forty years and has a grown son who lives in Danbury, Connecticut.


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It’s not Work if it’s Your Passion Raegan Le Douaron found happiness where she began Growing up with a family-owned health insurance business, Raegan Le Douaron was expected to help out after school and later on, breaks from college. Spending her spare time filing case management reports and taking precertification information, her younger self vowed two things: To never work for her parents, or for her parents. “I used to say that to anyone who would listen,” Le Douaron recalled. “There was a much more exciting life to be lived and I was going to live it!” And she did, traveling the world, getting married, running several successful careers, and then returning home….to now run the family business! Raegan Le Douaron was promoted to President of WeCare tlc, the leading workplace healthcare company, in 2020. “Never say never!” Le Douaron laughed. “My journey to WeCare tlc and the healthcare industry is definitely an unconventional one. But I’m so honored by our company’s accomplishments and thrilled to lead the charge to change how healthcare is delivered across the United States. I can now look back and see how the steps of my path led me back here.” But Le Douaron could not see her path as a young student at Florida State University. “I was at a point in life where I was just drifting, with no idea of what I wanted to do,” she recalled. “I was just trying to live up to what was expected of me.” Then in her junior year, her brother, Dustin, died in an automobile accident. “Losing my brother completely shook me to my core. He was the most important person to me in the world. Growing up with our parents divorced, it was always him and me, Raegan and Dustin. We were each other’s biggest supporters and toughest critics. He was the best,” she said. Losing her beloved brother was heartbreaking, but in the aftermath Le Douaron was able to summon a sudden purpose. “Dustin’s death gave me the strength to trust myself. I suddenly knew that if I could survive this, I would be OK no matter what. It was shortly after this that I decided to follow my love of food and cooking and go to culinary school. I began to feel drive and ambition for the first time,” said Le Douaron. She moved to Rhode Island to study at the prestigious Johnson & Wales culinary school. She landed a job at the posh Castle Hill Inn in Newport, learning to survive in an uber-competitive, fine dining kitchen. “I was too short, so I became an expert at scaling any surface, so I didn’t have to ask for help. I carried pots and pans that were bigger than me and had burns up and down my arms from having to reach through flames on burners I was too short to reach over. I came in earlier, and worker harder. Every. Single. Day. I was not graceful, but I 13


MARCH 2020

was persistent. Eventually I became better, gained the Chef ’s confidence, and worked my way up.” Le Douaron traveled around Europe working with fine chefs and making wonderful food. But when she eventually returned home to Central Florida, she could not find the same fine-dining opportunities and so took a detour into hospitality industry sales. She found her kitchen skills translated well to sales, where she was able to multitask without stressing and deliver consistent results. Her success attracted the attention of some interesting business executives: her parents. “The day came when they saw the success I was having in my sales career, and they asked me to come work at their reinsurance company,” said Le Douaron. She agreed. But while reinsurance was financially rewarding, Le Douaron was more interested in her family’s newest venture, WeCare tlc, which manages healthcare centers for U.S. companies looking to cut costs while promote employee well-being. She began helping with brand development, the sales presentation and creating structure around processes. “I quickly became inspired by what WeCare tlc had to offer,” she said. “A dedicated health center for companies to offer their health plan members to use at no cost

to them? A health center totally devoted to improving the lives of people? Promoting health and wellness in a country that has a broken health care system? The chance to help grow a company that I believed in from the ground up? Yes, please!” Her parents were in turn inspired by her commitment to the fledgling company, and the success she delivered. In January they named her President. “Raegan has been instrumental in building the foundation of, and growing

WeCare tlc,” said Judy Garber, former President and new co-CEO. “She is a tremendous asset to the company and shares the same vision and principles WeCare tlc was founded on. I expect Raegan to keep pushing the company to new heights.” WeCare tlc now manages 54 near or on-site healthcare centers for companies across the nation. Patients who visit employee health centers have access to primary care services, chronic disease management and a formulary. “I get the chance to bring a product to market that is truly different,” Le Douaron said. “I’m passionate about health, diet, and how the two set the stage for a healthy life. I love that we are not only making changes in the lives of people, but because health care is local, we get to improve entire communities,” she said. The girl who wanted nothing to do with the family business is now excited to go to work each day. “My experience has been varied, and until recently I was unsure of how it tied together,” Le Douaron said. “But I now see that there was no other path for me to take. I am truly grateful for all of it, and I can’t wait to see what is next!”


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BEFORE MARCH 30TH orlandomedicalnews


Correct Use of CPT Modifiers to Maximize Reimbursement By CAREL VISSER

It is widely accepted that the national denial and rejection rate runs as high as 30 percent of all insurance claims submitted to insurance companies for adjudication. Rejected claims have data and/or formatting problems and can be resubmitted when corrected. Denied claims have been accepted for processing and had a negative determination outcome. These claims cannot simply be resubmitted and have to be sent back as appeals or reconsiderations. In both cases it is a costly and time-consuming exercise. One of the chief causes of rejections and denials is the incorrect use or lack of modifiers. Correct use of modifiers can speed up claim processing and reimbursement. WHAT ARE MODIFIERS Modifiers consist of two numbers, two letters or a letter and a number. They are appended to either a Current Procedural Terminology (CPT) code or a Healthcare Common Procedures Coding System (HCPCS) code to further explain the procedure or service, giving more detail to the code. This cuts down on the number of CPT and HCPCS codes required. There are two levels of modifiers. Level I modifiers are developed and maintained by the American Medical Association and consist of two digits. They can be applied to CPT and HCPCS codes. Level II Modifiers are developed and maintained by The Centers for Medicare and Medicaid Services and consist of two letters or a letter and a number. There are approximately 358 Level II modifiers. It is possible to use multiple modifiers. The correct order of modifiers is very important to ensure approval of the claim. A word of cau-

tion; overuse of certain modifiers, modifier 22 for example, can trigger audits. CPT MODIFIERS This article will deal with CPT modifiers only. Level II modifiers will be dealt with at a later stage. There are 36 CPT modifiers consisting of two digits each. A selection of these and their correct usage is explained below. Modifier 22 - Increased procedural services When a procedure requires more work than is typically required, modifier 22 can be appended to show this increase in work. Documentation must be added to support the extra work. Do not use this modifier with evaluation and management services. Modifier 24 - Unrelated evaluation and management (EM) service by the same physician or other qualified health care professional during a postoperative period There are three possible global periods for surgical procedures - Zero day Postoperative Period, 10 day Postoperative Period and 90 day Postoperative period. If a physician is required to perform an EM during the postoperative period of a procedure that is totally unrelated to the procedure performed, then modifier 24 is attached to the EM service to ensure payment. Modifier 25 - Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service If an EM service is performed on the same day as a procedure, then modifier 25 is added to the EM to ensure the EM and procedure are both paid instead of being regarded as a bundled service. Modifier 50 - Bilateral procedure

When an identical procedure is performed on both sides of the body in the same encounter, then modifier 50 is added to the procedure code. This negates the need to bill the procedure with modifier LT and then to repeat the procedure with the modifier RT. Caution must be taken that the procedure code does not already have a bilateral service in the title (CPT code 27158 – Osteotomy, pelvis, bilateral (eg, congenital malformation)) Modifier 51 - Multiple procedures Modifier 51 is added to CPT codes when multiple procedures are performed which are not components of the first procedure performed by the same physician at the same encounter. Code 51 is not used on EM services. Medicare does not recommend using modifier 51. Do not use modifier 51 on ‘add-on’ codes. This modifier should be used sparingly.

In cases where a procedure needs to be repeated by the same physician or other qualified health care professional, modifier 76 can be appended to indicate that the procedure needed to be performed again. Do not use this on EM services. Modifier 79 - Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period This modifier is used when a physician is required to perform a procedure or service that is not related to the original procedure carrying a global period during the postoperative period.

Modifier 95 - Synchronous Telemedicine service rendered via a real-time interactive audio and video telecommunications system Synchronous Telemedicine service is defined as a real-time audiovisual interacModifier 58 - Staged or related procedure or sertion between a physician or other qualified vice by the same physician or other qualified health care health care professional and a patient located professional during the postoperative period at a site distant from the physician or other If a procedure or service is planned to qualified health care professional. The nature be performed during the postoperative and time on the consultation must be • REDUCE Rejectionspe-& Denials fromspent Payors riod, is more extensive than the AR original pro- Follow-up comparable to the service if it was held face• REDUCE by Timely cedure or service, or• for therapyAdmin following a to-face. Modifier 95 may only be appended to REDUCE & Increase time with Patients surgical procedure the modifier 58 can be services listed in Appendix P of CPT. • PARTNERING with Office Administrator – Manager & Maximize Revenue appended to the staged or related CPT code. Modifier 99 - Multiple modifiers • Discover how 50 & 60 Yr. Old Physicians – Dentists… Modifier 59 - Distinct Procedural Service If multiple modifiers are required, Critical the Freedom Retire Modifier 59 is Take used the when thereSteps are to Enjoy modifier 99 may beto appended to the CPT 5Mistakes That Erode Retirement Dreams multiple distinct procedures other than EM code and the individual modifiers are listed services performed by the same physician as part of the description of the service. at the same encounter. Modifier 59 should Carel Visser, is the COO of Florida Busionly be used when there is no other modiness Systems Visser which provides medical Carel fier available that would better explain the billing and revenue management sercvisser@fl bsystems.com vices. He is a qualified medical biller and procedure. coder dealing directly with day to day


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business and providing training to companies in medical billing and revenue management skills. Email cvisser@flbsystems.com. Visit www.flbsystems.com



The Physicians Plan The PhysGame icians Game P MBA for Doctors*

MBAcceleration) A for Doctors* (Masters of Business (Masters of Busine ss Acceleration

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MARCH 2020



Math Behind Medical Malpractice Carrier Consolidation By ROBERT C. HALL

With the recent acquisition of Norcal Mutual by ProAssurance, the medical malpractice insurance market continues to consolidate. I think this Insurance Journal link paints a financial picture why Norcal’s board of directors voted in favor of the transaction to proceed and perhaps close the proposed deal toward the end of 2020. In fact, in my opinion, I think we will see more carrier consolidation in 2020 and beyond. I’ll try to provide a simple explanation as to why. Full disclosure, I know and am friends with many of the individuals working for both noted companies. I can assure you they are well-educated, seasoned professionals and this decision was evidence based. And if you have insurance coverage with them, understand both carriers have billions in assets and surplus and will be strong going concerns if the deal falls apart or does not get regulatory approvals. Further, what drives this type M&A activity is the acquiring insurance carrier seeks to expand their service menu, broaden their licensing footprint, and capture more overall market share while the acquired carrier’s board of directors - understanding their financial situation and liabilities on their book’s - seeks to protect their insureds and shareholders best interests and also shield themselves from a potential director and officers claim. I’ll write about the D&O market segment another time. A medical malpractice carrier survives based on conservative underwriting principals, its loss development and the actuarial mathematics - if not enough premium is charged and collected to off-set future losses and legal expenses, eventually the carrier goes bankrupt or worse goes into liquidation. As I wrote in January, the medical malpractice insurance market continues to deteriorate based on negative underwriting results that have generated poor combined ratios. A combined ratio is a basic measure of a carrier’s profitability. Since 2014, the overall medical professional insurance (MPL) industry has had a combined ratio over 100 percent - and we are now seeing an uptick in frequency (numbers of claims filed) and severity (claims paid) that

continues to climb year-over-year on average now well-beyond $300,000 per claim paid. Another contributing factor for Florida, has been the elimination of the pain and suffering caps that had been in place since 2003. But let me take you back to my point about combined ratios and add another often-overlooked insurance industry practice known as managing reserves. As I’ve detailed below, the overall MPL carriers combined ratios from 2014 to 2018 (we are awaiting 2019 results) and overall aggregate loss and allocated legal expense (ALE) reserves per AM Best. Anything over 100 percent indicates an underwriting loss and has to be offset the by better investment returns, cutting expenses and hope for future years having positive loss and claim development.

ings like A++ or A or B++. These ratings have a significant meaning. In simple terms, it provides the consumer with a third-party analysis and a rating measure as to the insurance carriers ability to pay their financial obligations. They are charged with annually reviewing insurance carriers and market sectors and sometimes warning consumers about a bad trend. At present AM Best has a negative market outlook for the Medical Professional Liability insurance sector. We have not experienced a hardening market in 15 years. The days when insur-

ance was an easy renewal are gone. I recommend taking a hard look at your insurance program and make the necessary preparations to manage this emerging problem. Robert Hall, a broker in healthcare products for ARCW Insurance in Pinellas Park, has over twenty-four years of experience in the healthcare, life sciences, and long-term care liability insurance and risk management business. He holds the ARM designation and has developed an expertise in healthcare, having placed complete insurance programs for hospital systems and large physician groups. He has also created captive feasibility studies and other alternative risk models. He has a strong understanding of HMO Reinsurance and Provider Stop-loss. Contact him at robert@arcwinsurance.com


2015: 118.2 -

2016: 118.6 $19,768

2017: 118.0 $19,490

2018: 117.8 $16,169

2019: ? ?

(Source: AM Best - May 6, 2019 - Best’s Market Segment Report)

I suspect readers are asking themselves a good question, excuse the cliche, but how can any business be profitable and keep the doors open spending about 18 percent more than they are bringing in the door? The answer, in part, comes from how a carrier manages their assets and surplus and decides how much premium it needs to reserve a way for future claims and claim management expenses (ALE). But did you note the big change in loss and ALE reserves from 2017 to 2018? The MPL industry had a $3.32 billion reserve reduction. Where did all that money go? The takeaway, in my opinion, not all, but there are medical malpractice carriers drawing from their prior year reserves to help fund business operations as they are being hit with new claims. And not properly reserving their current book of business – a dangerous game to be playing. I will be curious to see what result we get for 2019? The data I have shared comes from AM Best, the leading insurance industry credit rating agency. I suspect you’ve had insurance agents banter about AM Best rat-


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Taking on the Stairs: Life After A Double Lung Transplant Now entering its 13th year, the community will once again have the opportunity to get together to show support for the fight against lung disease by climbing up the 512 steps of 390 North Orange at the 2020 Fight For Air Climb. This annual event, held by the American Lung Association on March 28, helps raise funds for lung research, education, and advocacy. While the event attracts athletes, first responders, and all walks of life from throughout Central Florida, the mission comes to life with many participants. One remarkable story includes that of local yoga instructor, Dale Turner. Mr. Turner had suffered from COPD, pulmonary fibrosis and pulmonary hypertension which caused him to require a significant amount of oxygen. Dale was referred for a lung transplant at the AdventHealth Transplant Institute. “When we first met Dale, he had some reservations about lung transplantation. We made sure that we sat down and talked about all of his treatment options and made sure that lung transplantation was the right choice for him and his family,” said Dr. Cynthia Gries, the medical director of the lung transplant program. He completed his evaluation to make sure he was a suitable candidate and was listed for a lung transplant on October 5, 2018. Just three weeks later, Dale received

the call. His care team had identified a new set of lungs for him, and it was time for a double lung transplant. On November 1, Dale underwent a successful double lung transplant. Within 2 weeks, Dale went home from the hospital without oxygen to walking a mile a day. Within 5 months of receiving his new lungs, Dale participated in the Fight For Air Climb, successfully completing the 25 flights, or 512 steps, of one of downtown Orlando’s tallest buildings. “I think the best part of the last fifteen months hasn’t been anything earth shattering or monumental. It has been the ability to be able to do the simple things. Dinner with friends, coffee with my wife on a Sunday Morning or afternoon just a simple walk without struggling for breath after 50 feet. I am so grateful to the wonderful staff at AdventHealth and of course my donor and family for giving me a second chance at life,” said Turner. “This is truly a remarkable experience for both running and fitness enthusiasts, as well as our participants that are suffering from a lung disease,” said Janelle Hom, executive director of the American Lung Association in Florida. “And is a reminder that no one should have to fight for air on a daily basis. Dale’s story is inspiring and exemplifies why we do this work; he has given hope to people struggling to breathe.”

The American’s Lung Association local partner in lung health, AdventHealth, contains the first and only transplant program in Central Florida. Their one-year survival rates exceed the national average by more than 2 percentage points. With the average wait time of less than two months, patients have the shortest wait for a lung transplant at AdventHealth compared to any other center in the state of Florida. The lung transplant team aims to transform lives each and every day through innovative treatments and compassionate care with the patients and their family’s best interest in mind. As in Dale’s case, their median wait times are less than one-quarter of the national average, just 6.1 days. The one-year graft transplant survival rates are 100 percent with continued innovation within the program daily. The Fight For Air Climb event embraces participants with lung disease connections ranging from lung cancer, asthma, COPD, and the 28 lung diseases the American Lung Association touches. Consider these facts: • Lung cancer is the leading cancer killer of both men and women in the United States with nearly two thirds of people

diagnosed with lung cancer having never smoked or are former smokers. • COPD is the third leading cause of disease-related death in the United States. • Asthma leads to more than 13.8 million missed school days annually, and 14.2 million lost workdays in adults. Asthma results in 439,000 hospitalizations and 1.3 million emergency room visits annually. On average more than 200,000 people are hospitalized yearly from influenza complications. Funds raised through this event support lifesaving research and local lung disease education programs. Those wishing to participate can register as an individual or as a team. Registration costs $25 and includes a $100 fundraising minimum.

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MARCH 2020

616 E Altamonte Dr Suite 203 Altaonte Springs,FL 32701



Laser Therapy for the Treatment of Lymphedema and Diabetic Foot Ulcers By DR. NILMA ELIAS SANTIAGO

In recent years, there has been a lot of discussion about the benefits and efficacy of photobiomodulation, also known as lowlevel laser therapy (LLLT). Current research supports its benefits in the treatment of post-surgical and neuropathic pain, lymph vessel regeneration, lymphatic fluid motility, prevention of tissue fibrosis, fibroblast proliferation, and neovascularization 1,2,3. Though there is scientific evidence encouraging the use of LLLT, it is underutilized by healthcare practitioners. Some of the reasons for the underutilization of LLLT are lack of knowledge of this modality, lack of standardization regarding the treatment parameters for different conditions, and lack of reimbursement from Medicare. The United States Food and Drug Administration approved the use of LLLT as an adjunct treatment for chronic pain 4. However, as mentioned above, LLLT is beneficial for other medical conditions such as lymphedema and diabetic ulcers. These types of patients present pain, inflammation, edema, and fibrosis, affecting their functional status and quality of life. Using a contributory mo-

dality that facilitates their healing is not only beneficial but necessary to improve their quality of life and decrease health-related costs associated with ongoing treatment. WHAT IS LOW-LEVEL LASER THERAPY? LLLT is non-invasive, light intensity phototherapy providing a photochemical, not thermal effect on the tissue. This type of photobiomodulation uses wavelengths of light in the red or infrared region, which is between 650 and 905 nm triggering biochemical changes at the cellular level, specifically in the mitochondria. The way it works can be compared to the process of photosynthesis in plants; photoreceptors absorb light facilitating the chemical changes within the plant cell. LLLT wavelengths can penetrate the skin and soft/hard tissues promoting tissue repair, decrease pain, and inflammation. This modality has been used mostly for musculoskeletal conditions for its pain management benefits. Nevertheless, patients with other chronic diseases can be treated with LLLT. HOW DOES LLLT HELP PATIENTS WITH LYMPHEDEMA AND

DIABETIC FOOT ULCERS? Lymphedema patients present several impairments such as pain, increased circumference in the affected limb due to edema and decreased range of motion associated with the amount of fluid in the extremity. As reported in the literature 2, LLLT can be effective in the reduction of limb volume and circumference, movement in the affected limb, and pain relief. Diabetic foot ulcers are a serious complication in patients with diabetes. Statistics from the Department of Health indicate that 15 percent of these patients will likely develop foot ulcers during their lifetime and 6–40 percent of them may require an amputation 4. Since diabetic foot ulcers can result in such a burden for the patient, family, and the healthcare system as a whole, it is imperative that practitioners incorporate effective treatments to facilitate the healing of these ulcers. LLLT assists with diabetic foot ulcer healing by increasing granulation tissue formation, fibroblast proliferation, collagen synthesis, neovascularization, and early epithelialization 5. In addition, the healing time and wound contraction are improved with the use of LLLT as a supporting modality in

the treatment of these ulcers. Conventional lymphedema management includes compression treatment, manual lymphatic drainage, exercises, and skincare. In the case of diabetic foot ulcers, common treatments include debridement (as indicated), specialty dressings, and off-loading. Should practitioners incorporate LLLT in their toolbox as an added modality to treat lymphedema and diabetic foot ulcers, these patients will benefit tremendously with outcomes that possibly include faster and cost-effective results, since the patient will not revolve in the healthcare system for impairments and functional limitations related to these chronic conditions. We owe it to our patients to include evidence-based vanguard treatments that ultimately will improve their lives. Even if the LLLT treatment is not reimbursed by Medicare, the practitioner may find creative alternatives to cover the cost of this treatment. Having lymphedema and diabetic foot ulcers decrease the patient’s mobility, increase healthcare costs and affect their independence. Our goal should be to facilitate (CONTINUED ON PAGE 18)


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MARCH 2020



Non-Compliance with Pain Management or Substance Abuse Treatment/Programs: Could it be an Acquired Brain Injury (ABI)? By MICHAEL SAMOGALA, RN

As we know from multiple sources published over decades, many addictive substances act in the brain to produce their euphoric effects, however, some can also cause significant brain damage due to seizures, stroke, and direct toxic effects on the brain cells themselves. Repeated drug use leads to changes in the function of multiple brain circuits that control pleasures/reward, stress, decision-making, impulse control. learning and memory, and other functions.(1) As time and study progress, we are beginning to understand the mechanisms of this cellular damage or injury to the brain itself as being commonly related to the brain’s reaction to prolonged exposure to these substances and/ or the related hypoxia (deficiency in oxygen) that may occur on a cellular level. Researchers say certain club drugs trigger a chemical chain reaction in the brain similar to what occurs during traumatic brain injury, leading to cell death, memory loss and potentially irreversible brain damage.(2) In further discussion, definitive identification and diagnoses can be established utilizing modern imaging techniques. The central nervous system effects of these drugs include neurovascular complications, encephalopathy, atrophy, infection, changes in the corpus callosum, and other miscellaneous changes. Imaging abnormalities indicative of these complications can be appreciated at

both magnetic resonance (MR) imaging and computed tomography (CT). (3) Although many of us are not experts in these types of injuries or able to effectively analyze the latest research, we as healthcare or compensation/benefit providers must acknowledge those individuals we serve, that for no other apparent reason, continue to be non-compliant or fail to benefit from professional pain management or substance abuse treatment programs. Considering what we are now aware of as being a result of true impaired function (cognitive, decision making, impulsivity, behavioral or physical deficits) or injury causing at least in part a non-intentional pattern of behavior leading to ineffective treatment or unsuccessful productive outcomes including the ability to return to gainful employment. One of the most challenging questions we must address is how do we begin to determine if an individual may be experiencing the sequela of this type of acquired brain injury? Though determining the possibility of this type of brain injury is a multistep process, there are professionals that recommend the following with the guidance of an appropriately licensed healthcare provider; Identify the potential ABI client – This is not a diagnosis defined term as it consists only of the client’s history relating to their past substance use and the reasons given for non-compliance or failed treatment (subjec-

tive from the client as well as what was determined by the professional provider). Confirm there is an ABI – This is a medical diagnosis and may require medical imaging studies and/or supportive information such as a comprehensive evaluation by a neurologist, psychiatrist, neuropsychologist, and other members of an accredited neurorehabilitation/neurobehavioral team including a certified substance abuse licensed mental health counselor. Refer for appropriate care and services – Depending on the degree and effect of the injury, as all brain injuries are “individual injuries,” the referred neurorehabilitation/ neurobehavioral program must: • Be outcome-focused with an intensive concentration on community re-entry; • Have at least 24/7 neurobehavioral/ substance abuse support and immediate intervention protocols; • A drug free secure environment; • A care and treatment program and team that is trained and accredited as a brain injury specialty program. In summary, the success and final outcome of the individual with an acquired brain injury from a non-traumatic source will depend on many factors; one of the most influential being the identification of the substance induced ABI as well as the type and quality of the post-acute neurorehabilitation/ neurobehavioral program the individual is re-



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ferred to for care and treatment. The CARF accredited Brain Injury Specialty Program at NeuLife Post-Acute Rehabilitation (residential or outpatient) offers comprehensive neurorehabilitation/neurobehavioral services resulting in eighty percent discharge to home or community with maximal obtainable level of function, independence and return to employment potential, if applicable. REFERENCES:

National Institute on Drug Abuse University of Florida. “Club Drugs Inflict Damage Similar to Traumatic Brain Injury.” ScienceDaily. Neurologic/Head and Neck Imaging Your Brain on Drugs: Imaging of Drug-related Changes in the Central Nervous System, Benita Tamrazi, Jeevak Almast Michael Samogala RN, CRRN CBIS has been directly involved in providing professional nursing and education services to the healthcare community. Most notably receiving board certification in rehabilitation nursing and as a brain injury specialist, he continues to provide professional credited continuing education programs to multiple professionals across the country, and remains in the position of Director of Corporate Education, NeuLife Neurological Services. Visit www.neuliferehab.com

Laser Therapy for Diabetic Foot Ulcers, continued from page 17

a good quality of life for our patients. Lowlevel laser therapy improves these conditions and that my friends, is priceless. REFERENCES:

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1.Cotler HB, Chow RT, Hamblin MR, Carroll J. The Use of Low-Level Laser Therapy (LLLT) For Musculoskeletal Pain. MOJ Orthop Rheumatol. 2015;2(5):1-10. 2. Baxter GD, Liu L, Petrich S, et al. Low-level laser therapy (Photobiomodulation therapy) for breast cancer-related lymphedema: a systematic review. BMC Cancer. 2017;17(1):833. 3. Rashidi S, Yadollahpour A, Mirzaiyan M. LowLevel Laser Therapy for the Treatment of Chronic Wound: Clinical Considerations. Biomed Pharmacol J 2015;8(2):1121-1127. 4. The United States Food and Drug Administration. 510 Summary: (as required per 2LCFR; §807.92) Excalibur Light Therapy SystemSummary Report 2004. https://www.accessdata.fda.gov/cdrh_docs/pdf4/ k041530.pdf Published October 2004. Accessed February 26th, 2020. 5. Kajagar BM, Godhi AS, Pandit A, Khatri S. Efficacy of low-level laser therapy on wound healing in patients with chronic diabetic foot ulcers-a randomized control trial. Indian J Surg. 2012;74(5):359–363.


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Dr. Nilma Elias Santiago, PT, DPT, WCC, CLT, OMS, is the owner and Physical Therapist at Integumentary Physiotherapy Clinic. She is Board Certified in Wound Care, Ostomy Management and Certified in Lymphedema Management. She can be reached at nelias@integumentarypt. com. Also, visit http://www.integumentarypt.com



Beware of Third-Party Billing Systems By JAY CORN

Many organizations are starting to see large organizations add third-party billing systems. They want vendors to sign up with a third-party website in order to get paid. These systems may seem great for the customer but adding a third party to the transaction can add a whole array of complications, liabilities and costs. Before you agree to use a customer’s third-party billing and payment system, consider the additional complications and costs. VENDOR COST TO MAINTAIN USERNAMES AND PASSWORDS Each of the third-party payment systems will require the vendor to subscribe to a website using a user id and password. They might even use a more secure method called multi-tier authentication whereby you have to receive a text code just to sign in. If each customer implemented such a system, the vendor would potentially have hundreds of systems to track, update and maintain. Remembering that these systems often require the passwords to be changed periodically, a vendor would now need a software and a staff line to track all the different systems. That staff line is usually an accounting-based person of at least $30k per year. How does an accounting department share these usernames and passwords among staff? What happens when an employee leaves and all these passwords must be changed? ADDITIONAL THIRD-PARTY LEGAL AGREEMENTS Online systems and websites all include end-user agreements. These legal agreements attached to these online systems are all different and must be reviewed by an attorney. The agreements typically add additional terms of payment and regulation that were not available at the time of quote. They may not be acceptable to one or both parties. Any third-party legal agreement may also change the intent of the transaction or even change the liability of the products and services involved.

fees involved that are not a part of the original quote or transaction. When a vendor quotes a product or service without knowing about the third-party fees, it can change the cost to the vendor after an agreement has been made. Now the third party may have a claim against the vendor for fees. This would be unfair to all parties involved and would start the relationship off in a negative tone. Obviously, if the vendor anticipates additional costs, the cost of the product will be affected. GIVING A THIRD PARTY ACCESS TO YOUR BANK ACCOUNTS Often the third-party billing system wants to transact business using bank transfer. This means you must give a third party direct access to your bank account. Now with multiple third-party billing systems, how will you track who has access? Does access have to be renewed annually? Who at those billing companies has access to your account? Going a step further, when a transaction is made, a question of liability is introduced if the transaction is incorrect. If the third party deposits or withdraws the incorrect amount, who is going to correct the issue and in what time frame? Before you start agreeing to these systems, ask yourself how many of these systems will you have to agree to and at what cost. In the end, using a third-party billing system may seem good for one party but for the other it can be an absolute cost and liability nightmare. Jay Corn is Owner & Founder of Medical Check-In Systems. Contact him at: jcorn@medicalcheckin.com

Ergonomics in Your Office: A Quality Office Chair Matters By DOUG MINTZ

I know, I know, you’ve heard this before – about how many hours of an employee’s day are spent in an office chair. Well there’s a reason you keep hearing about this. It’s very important! Let’s consider another similar situation. If you’re taking care of yourself, then you spend almost a third of your life in bed sleeping – 29 percent to be exact. That’s right – 7 hours a day, 7 days a week, 52 weeks a year. There’s no disputing this fact. These days most people are making significant investments in this part of their life and purchasing quality mattresses and bedding systems to ensure they get the sleep they need. Now let’s go back to our original scenario. An admin employee spends 8 hours a day in their office chair. 40 hours a week x 50 weeks in the year (everyone needs a vacation). That’s 8 hours/day x 5 days/week x 50 weeks for 2,000 hours per year. What does this mean? Well, there are a total of 365 days x 8 hours/ day or 8,760 total hours in any given year. So, an admin employee spends 2,000/8,760, or 22.8 percent of their year in their office chair. This too is a significant portion of their life. So, when you break down this

analysis, just like sleeping, a very large portion of time is spent in that task chair in your office. The best way to deal with an admin employee that sits in their chair so long is to make sure they sit in one that provides good support and will hold up under these heavy-use conditions. A quality office furniture vendor should be able to assist you with task chair selection. There are passive-ergonomic chairs and active-ergonomic chairs. Chair mechanisms vary as well; swivel-tilt mechanisms, mutli-tilt mechanisms, and synchro-tilt mechanisms. There are also task chairs designed for 3 shift applications. Whatever direction you chose to go for your admin employee seating needs, be sure to test drive the product before you purchase. Have 2 or 3 demo chairs brought to your office and pass them around for a week so everyone gets to try them out and you can receive good feedback. Even in the world (CONTINUED ON PAGE 20)

ADDING A THIRD PARTY TO THE VENDOR/CUSTOMER RELATIONSHIP By adding a third party to the transaction, a whole set of legal ramifications are added. Having a transaction discrepancy or an issue with payment adds a third party to the legal side of things. If the product or service is not paid for in time, does the vendor take recourse on the third party or the original customer? Does the third party have any claim? Regardless, it will take additional time to identify the party responsible. ADDING COST TO INVOICE These third-party systems often have 19


MARCH 2020



Commercial Real Estate Terminology: Cold Grey Shell vs. Warm Vanilla Shell It can make a difference By DOUG PRICE

There is no shortage of interesting terminology in Commercial Real Estate. One specific area of interest is found in the descriptions between a Cold Grey Shell and Warm Vanilla Shell. The overall definitions have to do with how raw or unoccupied spaces can be delivered to new tenants prior to the space being built out for its specific use. This topic is especially important as the differences of how a space is delivered can affect the cost of a transaction by tens of thousands to hundreds of thousand dollars for the tenant. With this much at stake, understanding the various definitions of how a space is delivered is worth learning. While there are multiple synonyms for how spaces are delivered, an unoccupied or new space is often described as being a ‘Shell’ space. The two most commons types of unoccupied spaces or ‘Shells’ come with the terminology of either a ‘Cold Grey Shell’ or a ‘Warm Vanilla Shell’. Let’s take a further look. WHAT IS SHELL SPACE? Shell Space denotes the interior condition of a specific commercial real estate space that does not have substantial interior improvements or finishes. With a new development or new construction, most spaces are typically delivered in a Shell condition; which means the space is essentially four perimeter walls with a primarily open floor plan. The tenant then builds out the space to their specific parameters which makes it no longer a shell, but a finished or built out space. Additionally, a landlord or tenant may choose to demolish the interior finishes of an already built out space if the specific finishes are not beneficial or needed by the next tenant. This is considered returning a space to a Shell Condition and is often required prior to performing a new build out on a secondgeneration space. Shell construction typically denotes the floor, perimeter walls and roof of an enclosed premises and may include some HVAC, electrical or plumbing improvements, but not internal walls, interior space partitioning, individualized tenant finishes or fixtures. Essentially, a Shell Space is an open box that is ready for a tenant to build out or install their unique fixtures in. However, the difference of the ‘type of shell’ is where the details can make a significant impact on the cost for a tenant. Let’s take a look at the differences between a Cold Grey Shell and a Warm Vanilla Shell. WHAT IS A COLD GREY SHELL? A Cold Grey Shell is most often defined through understanding the two main de20


MARCH 2020

scriptor words before the word shell: Cold: typically means the space does not have HVAC (heating, ventilation and air conditioning) available or installed in the space; and hence, the space cannot be heated (or cooled) prior to the HVAC being installed. In this instance, an HVAC unit or units will need to be installed or supplied into the space in order to bring heating, ventilation and air conditioning to the space. Hence, the space is cold. Grey: typically means the space has no other improvements to it such as the walls being finished with drywall and painted, a drop ceiling grid and tiles or a drywall ceiling, appropriate lighting installed, flooring, or any other standard improvements such as a restroom, built out offices, etc. The word grey speaks to the fact the floor and any exterior walls are often the color grey because of the untreated concrete floor or walls. A Cold Grey shell is essentially a space with no HVAC or finishes of any real substance. Many times, landlords will also leave a portion of the floor or even the entire floor in dirt condition without pouring any concrete, if they assume the future tenant will need to install heavy plumbing. WHAT IS A WARM VANILLA SHELL? In comparison, a Warm Vanilla Shell is close to the opposite of a Cold Grey Shell, as defined by: Warm: the space does have an HVAC system connected and functional, or at least is attached to the premises and ready to be hooked up. Warm means the space can be heated and / or cooled without adding a new HVAC system. Vanilla: typically refers to the space having finished exterior walls with drywall, a drop-grid ceiling with ceiling tiles or a drywall ceiling, with lighting installed, HVAC that is distributed, and often also includes some level of additional build out such as a finished restroom(s) with running water, sewer, plumbing, fixtures, etc. The space may also contain some level of additional build out such as any amount of offices or additional walls and interior rooms. A Warm Vanilla Shell is essentially a space with HVAC and the four walls and ceiling being finished. Many landlords of both retail and office buildings will prepare a vacant space in the condition of a Warm Vanilla Shell delivery so that certain tenants might be able to immediately move in with very minor adjustments to the space or with simply the installation of their tenant specific furniture, fixtures and equipment. However, there are some tenants who prefer a Cold Gray Shell vs. a Warm Vanilla Shell if they have unique requirements for their mechanical systems, plumbing or other

finishes. A Vanilla Shell might require the Tenant to replace some of the improvements a landlord may have already performed such as relocating the restrooms or upgrading their finishes, selecting a different type of ceiling and light fixtures and more. Depending on the level of finishes in a Warm Vanilla Shell, it’s possible for a landlord to spend $50,000 to $100,000 in improvements that the tenant might immediately tear out or upgrade. Meaning, if the landlord spends money on a specific ceiling grid, lights and restroom location but the tenant wants something different, there can be a healthy waste of both time and money. That money would have been better slated for the tenant to use on the exact items and finishes they wanted verses what the landlord already put into the space. While many retail tenants or traditional office tenants may prefer the delivery of a Vanilla Shell to expedite their occupancy and lower their expense of build out, most healthcare providers are much better off taking a space in a Cold Grey Shell format. The reason is that a healthcare tenant can better utilize the equivalent of the money the landlord would have spent on a space and instead utilize that money for the exact upgrades the tenant wants. There are times when the landlord has already spent the money on delivering a Vanilla Shell, which in that case you simply get what the landlord has already decided. However, there are also

many situations, especially with new construction, where if you get to the property or landlord early enough in the negotiations that you can determine the type of delivery as part of your negotiations for the space. Understanding these unique terms when evaluating commercial real estate spaces will help you make the most informed decision and give you an advantage during your negotiations. Doug Price is an agent with CARR Healthcare, the nation’s leading provider of commercial real estate services for healthcare tenants and buyers. Every year, thousands of healthcare practices trust CARR to achieve the most favorable terms on their lease and purchase negotiations. CARR’s team of experts assist with start-ups, lease renewals, expansions, relocations, additional offices, purchases, and practice transitions. Healthcare practices choose CARR to save them a substantial amount of time and money; while ensuring their interests are always first. Contact Doug at Doug.Price@carr.us

Ergonomics in Your Office: A Quality Office Chair Matters, continued from page 19 of quality ergonomic seating, not all chairs are the same, and every employee may prefer something a little different. Again, an astute office furniture representative can help through this selection process. You may end up st andardizing on two models of task chairs to best take care of all your employees. Some features and benefits of quality ergonomic seating: FEATURE • Proper Lumbar Support • Back Angle Position • Arm Height Adjustment • Pneumatic Seat Height BENEFIT • Reduces Lower Back Strain • Reduces Disc Pressure • Prevents Neck and Shoulder Strain • Prevents Pressure Under Thighs – Eases Blood Flow There are also several features one doesn’t see that go into a quality task

chair. Denser foams, contoured foams, memory foams, thicker plywood seat pans and back supports, larger diameter mounting screws, load-rated pneumatic cylinders, heavier gage steel in the mechanisms, and key metallic components (vs. plastics or composites) are several such items. What I can assure you is after you make this investment in your employees, they’ll be happier, healthier, and very appreciative of your actions, which will also increase their productivity and decrease their down time out of the office. Happy chair hunting! Doug Mintz founded and is president of CPOF Inc – Cubicles Plus Office Furnishings, and has been in the office furniture industry for over 20 years. Mintz has had success in several vertical markets in his industry including Retail Auto Sales, Banking, Mortgage & Finance, and Medical Clinics. His focus is primarily on the patient’s waiting room experience, as well as the ergonomic health and wellbeing of clinic employees. He can be reached at doug@cubiclesplusof.com



American Lung Association Asks Florida to Do More to Prevent, Reduce Tobacco Use Our nation is facing a youth e-cigarette epidemic, setting up our kids to become the next generation hooked on tobacco, and continuing the cycle of tobacco addiction and the diseases that come with it. Is Florida doing enough to protect kids? By JANELLE HOM

Electronic cigarettes, or e-cigarettes, are tobacco products that have been sold in the U.S. for about a decade. They include epens, e-pipes, e-hookah, and e-cigars, known collectively as ENDS—electronic nicotine delivery systems. They’re also sometimes called JUULs, “vapes” and “vape pens.” E-cigarettes are the most commonly used tobacco products among kids—and it’s become an epidemic. While much remains to be determined about the lasting health consequences of e-cigarettes, there’s evolving evidence about the health risks of e-cigarettes on the lungs—including irreversible lung damage and lung disease. The American Lung Association’s “State of Tobacco Control” 2020 report found that in 2019 Florida earned failing grades on its efforts to reduce and prevent tobacco use, including e-cigarettes. Florida officials can take action to increase tobacco prevention and control funding while also regulating e-cigarettes as tobacco products to support public health and save lives in 2020. The need for Florida to act to protect youth from all tobacco products, including e-cigarettes, is more urgent than ever, with the youth vaping epidemic continuing its alarming rise to 27.5 percent or more than one in four high school students. This is a staggering 135 percent increase in high school e-cigarette use in just the past two years, and close to three million more kids started vaping in that time period, setting them up for a lifetime of addiction. One powerful tool to address the youth vaping epidemic is increasing the minimum age of sale for tobacco products, including ecigarettes, to 21. The U.S. Congress finished off 2019 with a huge victory passing a federal law to increase the national tobacco sales age to 21. This law will ensure that all states have a sales age of 21 in 2020. Virtually all adult smokers had their first cigarette before age 21, and most before the age of 18. Tobacco use remains the nation’s leading cause of preventable death and disease, taking an estimated 480,000 lives every year. The need for Florida to take action to protect youth from tobacco is more urgent than ever, with youth e-cigarette use reaching epidemic levels due to a 78 percent increase in high school e-cigarette use from 2017 to 2018, according to results from the Centers for Disease Control and Prevention (CDC)’s 2018 National Youth Tobacco Survey. This equals one million additional kids beginning 21


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to use e-cigarettes, placing their developing bodies and lungs at risk from the chemicals in e-cigarettes as well as a lifetime of addiction to a deadly product. The 17th annual “State of Tobacco Control” report grades states and the federal government on policies proven to prevent and reduce tobacco use, and finds that while Florida has taken significant steps to reduce tobacco use, including voters approving a constitutional amendment prohibiting e-cigarette use in public places and workplaces where smoking is prohibited, elected officials must do more to save lives and ensure all Florida residents benefit from reductions in tobacco use and exposure to secondhand smoke: • Funding for State Tobacco Prevention Programs – Grade [F] • Strength of Smokefree Workplace Laws - Grade [B] • Level of State Tobacco Taxes - Grade [F] • Coverage and Access to Services to Quit Tobacco - Grade [F] • Minimum Age of Sale for Tobacco Products to 21 – Grade [F] The American Lung Association encourages Florida to fully fund tobacco control efforts at levels recommended by the CDC, and in particular, this year’s report noted the need to legislatively extend protections from secondhand smoke and secondhand e-cigarette emissions to all workers

in Florida. Both the U.S. Surgeon General and the National Academies of Science, Engineering and Medicine have warned about the risks of inhaling secondhand e-cigarette emissions, which are created when an ecigarette user exhales the chemical cocktail created by e-cigarettes. The American Lung Association applauds Floridians for standing up for public health by overwhelmingly approving Amendment 9 and extending protections from secondhand smoke and secondhand e-cigarette emissions to workers in Florida. “Opportunities for better health begin where people work, live and play, and a person should not have to be exposed to the dangers of secondhand smoke and secondhand e-cigarette emissions to put food on the table,” said Janelle Hom, executive director of Central Florida’s American Lung Association. The real question is: Will lawmakers in Florida end their failure to act and take this opportunity to achieve lasting reductions in tobacco-related death and disease? As a community member, I urge Florida lawmakers to drive policies that have been proven to reduce tobacco use and save lives, especially when the health of kids is at stake. Janelle Hom is the Executive Director of the American Lung Association in Florida. Email her at Janelle. Hom@lung.org. Visit Lung.org



The Orlando Medical News "On behalf of the PCAN provides value added Board I would like to thank Advertising and Marketing you for the support you have solutions. Solutions provided throughout the including Print, Digital, years helping us recognize Social Media, Podcasts and ourVideo. wonderful volunteer All delivered with providers for the great work high levels of Customer they do in our community.ad Service at reasonable have leveraged Werates. really We appreciate Orlando the Orlando Medical News Medical News for the efforts throughout 2017 and to highlight the PCAN will continue to do so in 2018. collaborative and share I routinely encourage my with others the services we peers to meet the Orlando provide to the uninsured Medical News Team. Orange County residents. We wouldn’t be able to do it without your kind support."

Di-Anne Elise Torrente Rebecca Sayago PR & Marketing Executive Director Specialist Primary Care Access Network




Q &


Responding to COVID-19: What If You Had to Build a Hospital in Days? Q & A with Tony Cowan, Director of Emergency Response Technology, World Housing Solution, Inc.

Tony Cowan is a health care professional who spent over 25 years working with physician groups in the development of Ambulatory Surgery Centers. In 2014, he designed an EBOLA Response Hospital, and in 2017 he designed clinics that were delivered to Puerto Rico for the hurricane relief effort. Those clinics went on to become accredited medical public health facilities. Today, he is Director of Emergency Response Technology with World Housing Solution (WHS) and is discussing how they have created a rigid, modular Pandemic Response Hospital that can deploy in days. Q I understand that WHS designs and manufactures mobile shelters for the Department of Defense, how does that transfer into responding to a pandemic? T.C. Our manufacturing technology allows us to produce panels that are light enough to move by hand, durable enough to be flat-stacked, then deployed and set-up over and over. Our Rapid to Deploy Structures (RDS) are made of these highly insulated durable and reconfigurable panels. This ability to reconfigure a space allows us to design functionality as needed from use-case to usecase. When we deploy a Work Force Camp, the internal design is very different from a NATO base camp. We took advantage of the inherent versatility of our construction technology to grapple with the unique challenges of responding efficiently to a pandemic using 21st Century Shelter technology that provides equivalency of care that you could never get in a bouncy tent. This approach resulted in the creation of what we call the S.T.A.G.E.™ solution to pandemic response. It truly is a game changer for surge capacity and rapid deployment capability for isolation and quarantine facilities during a pandemic response. A S.T.A.G.E. ™ solution will dramatically improve how we isolate and treat people and ensure quality of care as well as continuity of care wherever it is needed, as we grapple with addressing pandemic care requirements. Q How does the S.T.A.G.E. ™ solution improve isolation efforts? T.C. First, it is a far more modern approach, but more importantly, it is rapidly deployable, sterilizable for reuse, and more effective at stopping the spread of the virus. The acronym S.T.A.G.E.™ stands for Separating, Transmission, As Gestation, Evolves. Basically, our facility allows for people to stay isolated in space-appropriate environments as the risk of infection and transmission are determined. Step one: a person who has been exposed is separated from every 22


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other person who has been exposed. This starts the risk clock counting down immediately. Compare that to restarting your isolation clock every time someone else you are housed with becomes a confirmed case. This is significant. Currently, if you are two days from leaving quarantine and two people you have been living with test positive, you have to start your isolation clock all over. Individual isolation is imperative to reducing the risk of repetitive exposures. Step two: the person is either released after testing negative or sadly they join those who are in recovery. Recovery is also segmented, as some people will only need to stay isolated while they are infected but show little symptoms. Others may need intensive care. The RDS S.T.A.G.E.™ system ensures the entire facility is served by HEPA filtered air at negative pressure. Maintaining negative pressure and HEPA filtration with ultraviolet germicidal radiation, secures that the virus does not escape the facility as a result of airborne contaminated particles. This pandemic response facility can have decontamination vestibules for entering and exiting the facility. It will be made up of several wards with increasing life support services, as they are needed up to and including full surgical suits. Ultimately, a person will exit the facility. Our hope is that STAGE™ isolation will reduce suffering and save lives, increasing the number of recovered individuals. It will, without question, be more humane than quarantining people in a hotel or on a cruise ship and waiting to see who gets sick in an environment where they will be constantly exposed - increasing the likelihood for infection as has already occurred. Q If the United States is confronted with an outbreak the size and scope of what China is dealing with, can this technology deliver a complete quarantine facility in a week? T.C. The quick answer is yes, if our building was a deployable asset ready to respond. However, that will require municipal or federal agencies to invest in having the asset ready to deploy. As it is, we have a manufacturing to deployment time of about 90-days depending on logistics. Logistics could be negatively impacted by the pandemic. If the demand was high enough, we could dramatically increase the volume of isolation and intensive care units we are manufacturing to meet the demand. The good and bad news is the COVID-19 pandemic is not going anywhere soon. There is a window of opportunity to invest in our domestic pandemic preparedness. The other good news about our solution is its versatility. These would be rapidly deployable assets to augment the medical/ public health infrastructure for

any type of medical surge event. This asset would be of immediate utility in any type of all-hazard event including: forest fires, earthquakes, hurricanes, or terrorist attacks. It is a medical surge asset that can be both positively or negatively pressurized, making it flexible for pandemics or chemical, and/ or radiological response.   Q According to the OSHA Influenza Pandemic Planning Guide, health care facilities may have more warning time and response time for pandemic influenza, especially if the initial outbreak develops in another country. Are you finding that to be true and why is that important? T.C. As we learned from other countries, the time to take advantage of that window of opportunity is now! The large hospital networks that the general public rely on to care for their medical public health must take immediate action. These health care facilities cannot wait until their locations, which are not designed to care for large volumes of highly contagious individuals, are inundated with infected patients. COVID19 patients would then be making the entire hospital complex the most likely place to contract the infection. If hospitals delay preventative measures, not only will they have unnecessarily exposed their own medical staff to the contagion, but they will have lost the chance to reduce suffering and save lives for the communities they serve. Q The report warns that because pandemics are not a contained or local event and by nature is widespread, there will be less federal or state support available to the individual health facility. How does your solution support a local health facility? T.C. Our Pandemic Response Solution (PRS) gives local hospitals the ability to have a facility that both supports a pandemic program and keeps the delivery of that program away from the primary hospital center. If a hospital uses the same patient capture system for both typical health issues and pandemic issues, they have turned the entire hospital into a hot zone of contagion. With the PRS the hospital will still have to decontaminate with vigilance. However, the day-to-day burden of being a hot zone is at a location where the staff always wears Personal Protective Equipment (PPE) and the patients are already infected, so they do not have to be shrouded in masks or kept in individual containment areas away from each other. 

Q The OSHA guide goes on to say that unlike a mass casualty or weapons of mass destruction event, emphasis on cohorting or grouping by condition practices, isolation practices, and sterilization procedures is more important for pandemic infection control than decontamination. Is this part of the reason you came up with the S.T.A.G.E.™ system? T.C. That is exactly why I came up with the S.T.A.G.E.™ system. Our PRS was designed to keep people separated until it is appropriate for cohorting to begin. Because the PRS is segregated using the S.T.A.G.E. ™ system, it reduces the risk of people being exposed to others who may be infected. It also maximizes staffing when medical monitoring is needed. The staff work in Green Zones when not in direct contact with patients. They work in Yellow Zones where logistics and transportation takes place, and finally in Red Zones when they are in direct contact with the patient. This helps everyone to know when they need to be protected and when they can “take a breather”. Wearing PPE is not pleasant: it can cause pain spots, can be claustrophobic, obscures vison, and is exhausting to wear. Working in PPE for a nonstop 8-hour shift would be torture, and is unsustainable for extended numbers of work days. This system gives both patients and staff a place they can be without the need of PPE. (CONTINUED ON PAGE 23)



Intimacy vs. Isolation:

The Importance of Developing Relationships in Healthcare


Back in the 20th century, Erik Erikson developed a psychosocial theory for human development which he split into 8 stages. The sixth stage, which he named ‘intimacy vs. isolation’ relates to the stage in our lives when we begin to form meaningful, loving relationships with others. One place where meaningful relationships are particularly important is within the healthcare industry. Yes, it can be a very rewarding industry to work in, but when patients die and the stress levels build, healthcare professionals really need strong, lasting relationships that they can rely on to get them through it. INTIMACY VS. ISOLATION Erikson believed that we learn to develop ‘intimate’ relationships between the ages of 19 and 40 – during our working age. In his eyes, success during this phase means being able to form strong, intimate relationships, whilst those who struggle with this can experience isolation and loneliness. According to Erikson, intimacy doesn’t refer to sexual relationships, but rather to relationships in which each person can share parts of themselves with each other and develop deeply personal connections. So, to find out if you’re developing ‘intimate’ and close relationships with others or not, you should ask yourself if the relationships you have are like this. You might feel isolation instead, especially if you feel that you avoid opening yourself up to others. It could be that you’re afraid of rejection, or you’re scared of being vulnerable. But regardless of why you isolate yourself, isolation often leads to loneliness, social isolation and in the worst cases can turn into a self-perpetuating cycle which can really affect your mental health. If you find yourself feeling really isolated, you should seek the advice of a therapist. WHY RELATIONSHIPS ARE IMPORTANT IN HEALTHCARE Humans have an innate desire to be close to one another. Close relationships are important for all of us, but especially for those working in the healthcare industry. In a high-stress healthcare job like nursing, you rely on your colleagues to be there when you need them both in surgery, on the wards and when you need emotional support. Here are some other reasons why close, intimate relationships are important for you. LESS STRESS Research has shown that having close relationships is linked to less production of 23


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cortisol – the stress hormone. So, the more close relationships you have, especially at work, the less stress you will feel. Of course, close relationships also give you an outlet for feelings of stress or sadness, so this helps to lower your stress levels, too. Here are some other ways to deal with stress in healthcare. GREATER SENSE OF PURPOSE Having close, intimate relationships can help you to feel like you belong and are part of something bigger. This is really important in healthcare, especially if you’re working in a role which saves or makes people’s lives better. Feeling like you are part of a bigger effort will make you feel more excited and committed to your job every day. BETTER TEAMWORK If you have close relationships with your team members then you will trust them more and vice versa. This is especially important in stressful situations, if you feel that you can rely on each other, then you will work better as a team and you will be able to do your job better. HOW TO WORK ON DEVELOPING INTIMACY The first way to choose intimacy over isolation is to learn to be open and to share with others. These are some ways to help you develop stronger relationships: • Share part of yourself with others. • Work on building a strong sense of selfidentity – i.e. work out what you like, what your hobbies are, what makes you happy, take yourself out on dates and work on your relationship with yourself. • Let others in and foster a sense of emotional intimacy and closeness with your friends and colleagues. • Make commitments to your friends and colleagues. Part of being able to form strong relationships involves being able to commit to others for the long-term. • Show that you care about those around you and their needs. Relationships are a two-way street. Getting love is important, but so is giving it. Dr. Sarah Müller is the Managing Director of kununu, Europe’s largest employer rating platform and only professional provider specializing in exclusive employer reviews and workplace insight. So far, employees and job seekers have left more than 3.7 million authentic experience reports on kununu.com on various criteria such as salary, working atmosphere or application processes. Dr. Muller’s work in both Europe and in the U.S. is focused on raising the bar on transparency between employees and employers.

Q &


Responding to COVID-19: What If You Had to Build a Hospital in Days? continued from page 22

Q Another point in the OSHA guide states that an influenza pandemic is a sustained crisis and you can expect the response to have a duration of up to 24-months or longer. Unlike an isolated mass casualty scenario, a pandemic may come and go in waves, each of which can last for six-to-eight weeks. Is your solution capable of a 5-year sustained deployment? T.C. There is no greater reason to acquire the PRS system than the possibility of a sustained crisis. Staff should not be expected to struggle in inadequate facilities for an ongoing, undetermined amount of time, as they deliver care to the suffering. In a PRS system, staff will have all the benefits of working in a brick and mortar facility with none of the issues that arise while working in a tent. COVID-19 may well become endemic and this pandemic could last for the foreseeable future. A system that is structurally capable of maintaining services during a hurricane with a reduced

power requirement up to 7-fold is vital. There is no long-term financial value for setting up pandemic response in a tent. Q Do you have any advice for the general public as fears grow over this possible impending pandemic?  T.C. Yes, I have good news and bad news. The bad news is that this is already a pandemic in all but political posturing and jargon. It is going to continue to spread and there is little the federal or local governments are going to be able to do to stop that. The good news is that you actually have a lot to do with your own risk of exposure. Read the literature available - it is actually as simple as it sounds: wash your hands, stay home if ill, and keep a respectable distance from others, while avoiding large crowded areas as much as possible. Shop during off hours, carry an alcohol-based hand sanitizer and use it regularly. We are going to have to keep ourselves safe and take care of each other during this event.

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GrandRounds CMS Announces Actions to Address Spread of Coronavirus The Centers for Medicare & Medicaid Services (CMS) is announcing several actions aimed at limiting the spread of the Novel Coronavirus 2019 (COVID-19). Specifically, CMS is issuing a call to action to health care providers across the country to ensure they are implementing their infection control procedures, which they are required to maintain at all times. Additionally, CMS is announcing that, effective immediately and, until further notice, State Survey Agencies and Accrediting Organizations will focus their facility inspections exclusively on issues related to infection control and other serious health and safety threats, like allegations of abuse – beginning with nursing homes and hospitals. Critically, this shift in approach, first announced yesterday by Vice President Pence, will allow inspectors to focus their energies on addressing the spread of COVID-19. As the agency responsible for Medicare and Medicaid, CMS requires facilities to maintain infection control and prevention policies as a condition for participation in the programs. CMS is also issuing three memoranda to State Survey Agencies, State Survey Agency directors and Accrediting Organizations – to inspect thousands of Medicare-participating health care providers across the country, including nursing homes and hospitals. “Today’s actions, taken together, represent a call to action across the health care system,” said CMS Administrator Seema Verma. “All health care providers must immediately review their procedures to ensure compliance with CMS’ infection control requirements, as well as the guidelines from the Centers for Disease Control and Prevention (CDC). We sincerely appreciate the proactive efforts of the nursing home and hospital associations that have already galvanized to provide up-tothe-minute information to their members. We must continue working together to keep American patients and residents safe and healthy and prevent the spread of COVID-19.” The first memorandum released today provides important detail with respect to the temporary focus of surveys on infection control and other emergent issues. Importantly, it notes that, in addition to the focused inspections, statutorily-required inspections will also continue in the 15,000 nursing homes across the country using the approximately 8,200 state survey agency surveyors. Surveys will be conducted according to the following regime: • All immediate jeopardy complaints (a situation in which entity noncompliance has placed the health and safety of recipients in its care at risk for serious injury, serious harm, serious impairment or death or harm) and allegations of abuse and neglect; • Complaints alleging infection control concerns, including facilities with potential COVID-19 or other respiratory illnesses; • Statutorily required recertification surveys (Nursing Home, Home Health, Hospice, and ICF/IID facilities); • Any re-visits necessary to resolve current enforcement actions;



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• Initial certifications; • Surveys of facilities/hospitals that have a history of infection control deficiencies at the immediate jeopardy level in the last three years; • Surveys of facilities/hospitals/dialysis centers that have a history of infection control deficiencies at lower levels than immediate jeopardy. The memorandum also includes protocols for the inspection process in situations in which COVID-19 is identified or suspected. These protocols include working closely with CMS regional offices, coordinating with CDC, and other relevant agencies at all levels of government. The agency is also providing key guidance related to inspectors’ usage of adequate personal protective equipment. The other two memoranda provide critical answers to common questions that nursing homes and hospitals may have with respect to addressing cases of COVID-19. For example, the memoranda discuss concerns like screening staff and visitors with questions about recent travel to countries with known cases and the severity of infection that would warrant hospitalization instead of self-isolation. They detail the process for transferring patients between nursing homes and hospitals in cases for which COVID-19 is suspected or diagnosed. They also describe the circumstances under which providers should take precautionary measures (like isolation and mask wearing) for patients and residents diagnosed with COVID-19, or showing signs and symptoms of COVID-19. Finally, the agency is announcing that it has deployed an infection prevention specialist to CDC’s Atlanta headquarters to assist with real-time in guidance development. Today’s actions from CMS are focused on protecting American patients and residents by ensuring health care facilities have up-to-date information to adequately respond to COVID-19 concerns while also making it clear to providers that as always, CMS will hold them accountable for effective infection control standards. The agency is also supplying inspectors with necessary and timely information to safely and accurately inspect facilities. To view each memo, please visit the below links: • Suspension of Survey Activities: https://www.cms.gov/ medicareprovider-enrollment-and-cer tificationsurveycertificationgeninfopol icy-and/suspension-survey-activities • Guidance for Infection Control and Prevention Concerning Coronavirus Disease (COVID-19): FAQs and Considerations for Patient Triage, Placement and Hospital Discharge: https://www.cms.gov/ medicareprovider-enrollment-and-ce rtificationsurveycertificationgenin fopolicy-and/guidance-infectioncontrol-and-prevention-concerningcoronavirus-disease-covid-19-faqs-and • Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in nursing homes: https://www.cms.gov/ medicareprovider-enrollment-and-cer tificationsurveycertificationgeninfopo licy-and/guidance-infection-controland-prevention-coronavirus-disease2019-covid-19-nursing-homes

Burnett Student Presents at State Research Conference The UCF biomedical sciences major presented research that he and three other students recently conducted at the Florida Undergraduate Research Conference, the nation’s largest multidisciplinary research conferences for undergraduates. Torres is one of 127 UCF students who attended the conference held Feb. 21-22 in Fort Myers. Torres’ research is focused on a cholera toxin, but it is only a starting point. He wants to dive into cancer research in the near future because he wants to become an oncologist and help people like his mother, Jackie Perez, who died from cancer last year. Torres’ mother was diagnosed with bladder cancer when he was a freshman in high school. Years of advocating for his mother in the medical system, combined with the hands-on experience that he has received through UCF’s Transfer-Student Research and Integration Program, set him on a path toward medical school with a focus on oncology research. “My mother’s experience is why I want to go into oncology research,” Torres says. “I’m not aiming to go into research to cure cancer, which is something that may or may not be done in my lifetime…I think that if I can just help one patient the way my mother’s doctor helped her, I’ll be satisfied.” Torres is one of 83 UCF students who presented at the conference. Aside from Florida Gulf Coast University which is hosting the event, UCF had the most students attending. Torres’ path to UCF went through

Valencia College, where he earned an associate degree while caring for his mother. He was introduced to research at UCF through the Transfer-Student Research and Integration Program, and worked in biomedical sciences Professor Ken Teter’s lab. Teter, has been recognized for his research excellence, and received UCF’s Reach for the Stars award. He is also well known among students for his guidance and mentoring. Torres calls his time at UCF conducting research as life-changing. “Going into a university, I didn’t even know what research was,” Torres says. “I barely knew that I needed research experience for medical school, let alone how to start research. Dr. Teter taught us about research, what science really is, scientific method, hypotheses, and we also learned about lab conduct before we got into a lab.” Torres believes his experience at UCF, combined with his steadfast commitment to his mother’s care, has prepared him well for a future in medicine. “I have a lot of time to make up for that I lost, especially near the end of my mother’s life,” Torres says. “I was always at the hospital and so I couldn’t do anything. So since then I’ve been really, at least for her, doing absolutely everything under the sun. I’m super busy now, but I prefer it to be that way.”

Florida-DOH Opens Coronavirus Call Center To better serve and assist residents regarding concerns about the 2019 coronavirus (COVID-19), the Florida Department of Health has established a Call Center to answer general questions residents and visitors may have. The Florida Department of Health’s dedicated COVID-19 Call Center is 1-866-779-6121. The Call Center is available Monday through Friday, 8:00am to 7:00pm. Residents can also send questions via email at COVID19@flhealth.gov. For additional information, visit the Florida Department of Health’s dedicated COVID-19 webpage at  www. FloridaHealth.gov/COVID-19.

In support of the state’s efforts, the Florida Department of Health in Orange County (DOH-Orange) has established a Coronavirus Call Center phone number for Orange County, Florida residents. The phone number is 407-723-5004.  The DOH-Orange Call Center is available Monday through Friday, 8:00am to 5:00pm. We want to emphasize. Despite the recent confirm COVID-19 cases in Florida, the overall immediate threat to the public remains low. DOH-Orange has been planning and coordinating with our community partners to address any cases that might occur in Orange County. The procedures and protocols are in place. 



GrandRounds Six UCFCOM Students Receive Order of Pegasus

Connect with Physician Colleagues at the PSCF Networking Social in Kissimmee

Five biomedical sciences undergraduates and one M.D. student are among this year’s 24 recipients of the Order of Pegasus — UCF’s most prestigious student award. The recipients will be honored at an April 6 ceremony. This year’s inductees also include seven LEAD Scholars, five President’s Leadership Council members, seven Student Government leaders, 11 Burnett Honors College scholars, three Greek members, two studentathletes and three transfer students, including one as a master’s degree student. Their collective GPA is 3.88. Undergraduate students are selected based on academic achievement, university involvement, leadership and community service. Graduate students are chosen based on the same merits as well as publication or research experiences. The recipients will also receive commemorative medals and scholarships from Student Government. The inductees’ names and pictures will be added to the wall show-The Orange, Osceola and Seminole County Medical Societies have The Orange, Osceola and Seminole County Medical Societies have casing past and present Order of Pegasus officially unified under a singular thePhysicians Physicians Society officially unified under a singularorganization, organization, the Society of of recipients in the Pegasus Lounge on the secCentral Florida. ond floor of the Student Union. Central Florida. This year’s College of Medicine recipients are: Yaser Ahmad, Biomedical Sciences Kyle Benkel, Biomedical Sciences Samuel Mikhail, Biomedical Sciences Victoria Millington, Biomedical Sciences Sirikanya Sellers, M.D. program George Walters-Marrah, Biomedical Sciences

We invite to join Sisters Speakeasy Speakeasy ininKissimmee on April 28, 28, We invite you you to join us us atat 3 3Sisters Kissimmee on April 2020. Our initial event in the region gives the physicians in Osceola County an an 2020. Our initial event in the region gives the physicians in Osceola County opportunity to connect with peers,make make new contacts, and and meetmeet opportunity to connect with peers, newprofessional professional contacts, PSCF leaders. PSCF leaders. Learn more about PSCF and our goal to provide physicians with a unified

The Orange, Osceola and Seminole Medical Societies have officially unifia edunified under Learn more PSCF and our goal to provide physicians with vision andabout strategic advantage asCounty we address the needs of our members and a singular organization, the Physicians Society of Central Florida. visionthe and strategic advantage as we address the needs of our members and future of our profession. the future ofyou our profession. We invite to join us at 3 Sisters Speakeasy in Kissimmee on April 28, 2020. Our initial event

No presentations, noMedical talks. The and County Societies have make new in the Orange, region givesOsceola the physicians inSeminole Osceola County an opportunity to connect with peers, Simply joinprofessional us for social and professional networking. officially unified under a singular organization, the Physicians Society of contacts, and meetno PSCF leaders. No presentations, talks. Central Florida. Simply join us for social and professional networking.

Learn more about PSCF and our goal to provide physicians with a unified vision and strategic advantage as join we address theSisters needs of Speakeasy our members and future of ouron profession. We invite you to us at 3 in the Kissimmee April 28,

PSCF Networking Social

2020. Our initial event in the region gives the physicians in Osceola County an No presentations, no talks.April Simply join2020 us for social professional Tuesday, 6:00and - 8:30 PM networking. opportunity to connect with peers,28, make new| professional contacts, and meet PSCF Networking Social 3 Sisters Speakeasy PSCF leaders.

Fayshonda Cooks Brings 20 years’ Experience in Healthcare Leadership to WeCare tlc as Chief of Clinical Services

PSCF28, Networking Tuesday, April 2020 | Social 6:00 - 8:30 PM 226 Broadway, Kissimmee, Florida 34741 | 6:00 -physicians 8:30 PM with a unified Learn more about Tuesday, PSCF and our 28, goal2020 to provide 3April Sisters Speakeasy https://pscfl.org/event/April2020 asSisters we address the needs of our members and vision and strategic advantage 3 Speakeasy 226 Broadway, Kissimmee, Florida 34741 the future of our profession. 226 Broadway, Kissimmee, Florida 34741 https://pscfl.org/event/April2020 Visit our website to register https://pscfl .org/event/April2020 No presentations, no talks.

Simply join us for social and professional networking. as collaboration between Orange and Seminole County Medical The PSCF was founded in 2019 Visit our website totheregister Societies. The PSCF represents allopathic and osteopathic physicians, residents, and medical students Orange, Osceola, and Seminole County. PSCF Networking Social The PSCF was founded inin2019 as collaboration between the Orange and Seminole County Medical

Fayshonda Cooks, DrPH, RN, BSN, MPH, has joined WeCare tlc, the leading The PSCF Societies. The PSCF represents allopathic and medical students in Medical was founded inTuesday, 2019 as collaboration between the Orange Seminole County Apriland 28,osteopathic 2020 |physicians, 6:00 - residents, 8:30and PM onsite and near-site healthcare provider as Orange, Osceola, and Seminole County. 3 Sisters Speakeasy Societies. The PSCF represents allopathic and osteopathic physicians, residents, and medical students its new Chief of Clinical Services. In her role, Cooks is a member of the Kissimmee, Florida 34741 Physicians Society of226 Central Florida Osceola, inBroadway, Orange, and Seminole County. Executive Leadership Team and provides https://pscfl.org/event/April2020 844-234-7800 vital input regarding the clinical services (CONTINUED ON PAGE 26)




Visit our website to register Physicians Society of Central Florida MARCH 2020




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

GrandRounds delivered in all WeCare tlc health and wellness centers. She oversees the development of clinical protocols and procedures relative to patient care along with ensuring consistency in implementation of those procedures throughout WeCare tlc. Cooks is also responsible for ensuring the clinical areas at all health centers meet WeCare tlc’s clients’ needs as well as state, federal and local regulatory requirements. “Fayshonda is an amazing addition to the WeCare tlc family,” said Raegan Le Douaron, president of WeCare tlc. “She is extremely intelligent and experienced, but most importantly she is passionate. Fayshonda will help us with our goal to help whole communities become healthier.” Cooks is one of the most renowned healthcare leaders and consultants in Florida. She has over 20 years’ experience in the industry and has a proven track record at developing and implementing strategies to optimize clinical operations and improve overall health care outcomes. Cooks was the first nurse in Florida to lead two counties’ health department networks from marginal performance to Joint Commission accreditation on the first attempt. “I’m so thrilled to take on this new role at WeCare tlc,” said Cooks. “Throughout my career, I have been a strong advocate for access to quality primary and preventive care. WeCare tlc is committed to providing these crucial services for affordable costs and I look forward to leading the charge on providing the best possible care to our 1,000,000+ patients.” In addition to her time as a leader and consultant, Cooks is also a Doctor of Public Health and a Registered Nurse. She holds a Bachelor of Science in Nursing from Excelsior College and a Master of Public Health from the University of South Florida. WeCare tlc operates 54 healthcare centers in 10 states and serves more than 100 clients. Health centers are available to individual employers or can be created through a cooperative effort of multiple companies. Healthcare services include primary care, chronic care management, laboratory testing, medication dispensing and negotiation for outpatient procedures. WeCare tlc has developed systems that streamline claims data, which is coupled with health center data in order to clarify how healthcare dollars are spent. The company has adopted best practices to mitigate medical risks. WeCare tlc was founded in 2005 in Lake Mary, Fla. and now has more than 200 employees nationwide. For more information, visit https://www.wecaretlc.com

Expanding horizons MagMutual isn’t just a malpractice insurer, we protect you from all the liability risks you face. Our visionary approach examines risk from all sides to offer you comprehensive insurance solutions for the practice, business and regulation of medicine. We see your whole picture – and that makes you even stronger.




MARCH 2020





GrandRounds UCF Researcher Finds New Signal to Predict Breast Cancer Growth

Healthy Children: Impacts on the Economy The first white paper of a series authored by R. Lawrence Moss, MD, FACS, FAAP, president and CEO of Nemours Children’s Health System, calls attention to the direct connection between healthy children and long term U.S. economic growth and security. The white paper, How Children Can Transform the Economy…And Health Care was released today at the 8th Annual Lake Nona Impact Forum in Orlando. “Strategic investments in children’s health and well-being can generate a significant return to the economic health of the United States,” said Moss. “We must seize the opportunity to change how we define health in children that will improve longterm workforce productivity for the next generation of adults and drive the American economy for years to come.” Moss describes how moving to a “payfor-health” system of care and addressing the social determinants of health in children, can have a dramatic impact on the nation’s entire health care system. Children account for only about 7% of total medical care spending yet will soon become 100% of the adult population. “The benefits of intervention in childhood are seen across a lifetime and even impact the next generation,” says Moss. “These are smart, strategic investments for the future of our country.” Recognizing that healthy children will lower overall health spending and improve the quality of the U.S. workforce, the paper outlines the actions Nemours is taking to have healthy children grow up to be healthy and productive adults. Specifically, Nemours has or has committed to the following: • Created a value-based services orga-

nization to support a culture shift in the payment model. • Adopted a population mindset to be accountable for children in the service area whether they seek medical care or not. • Partnered with organizations in addressing social determinants of health to apply each other’s areas of expertise and share the cross-sector rewards of improved child health and well-being. “We are partnering with payers to develop pediatric-specific value-based payment programs and have developed the necessary infrastructure to execute. Our efforts to date have shown significant progress towards a paradigm shift that will lead to lower health care expenditures and better care for children,” said Jamie Clarke, Chief Value Officer at Nemours. Making an effort through this paper to engage a broader set of private and public sector leaders to action, Dr. Moss paints a picture of a healthier and stronger America, “Our future is bright, just imagine a world where our economy is driven by the power of a truly healthy workforce. By making evidence-based changes in the way we “create” healthy children, we not only improve the quality of life for families, but we also improve workforce productivity and reduce health care-related costs to individuals, companies and governments/communities.” The white paper, How Children Can Transform the Economy…And Health Care can be accessed at https://www.nemours. org/content/dam/nemours/wwwv2/ childrens-health-system/media/ whitepaper-children-economy.pdf

Saturday, March 28th 10 AM - 6 PM @ the Oviedo Mall


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> MARCH 2020 Oviedo – Winter Springs – Medical City East

A tiny piece of a protein could be key to keep breast cancer from growing. A discovery at the University of Central Florida College of Medicine may in the future help detect cancer cells in patients before these cells have a chance to metastasize or spread through the body. Dr. Annette Khaled, a cancer researcher who has spent the last eight years studying ways to inhibit breast cancer metastases, published her lab’s results in last month’s Scientific Reports. Dr. Khaled leads the medical school’s cancer research division and is looking at how and why cells escape the primary cancer tumor and then spread to organs like the lungs, brain and bones, where they cause 90 percent of cancer deaths. Supported with funding from the National Institutes of Health (NIH) and the Breast Cancer Research Foundation, she previously was able to show that a molecular complex called a chaperonin or CCT for short, which helps proteins to fold into functional units, is especially active in cancer cells. Her team developed a peptide that blocks CCT and placed it in a nanoparticle for delivery to kill cancer cells. Although Dr. Khaled knew that the nanomedicine was disabling CCT she didn’t know how. Complicating the fact was that CCT is a giant cellular machine made up of eight different subunits, totally 1 mega Dalton in size – that is equal to 1 million hydrogen atoms. In her latest study, Dr. Khaled discovered that one of the subunits forming CCT, “Subunit 2” is the foundation that

helps the entire complex work. “Subunit 2 leads and the other units follow,” she said. Adding “Subunit 2” makes normal cells act like cancer cells.” Defining Subunit 2’s role took months of study. The UCF scientist discovered that adding more Subunit 2 caused cancer cells to grow and move; depleting it caused cancer cells to ultimately die. “Understanding cancer is like trying to solve a giant jigsaw puzzle,” Dr. Khaled explained. “And with this discovery, we feel like we’ve found some of the parts that make up the puzzle’s edge. We all have a little Subunit 2 in our cells and our levels go up and down based on demands for protein-folding. But in cancer cells that need to grow and invade, Subunit 2 seems to be on all the time. Based on our new research, we can work to discover markers that identify cancer cells in which Subunit 2 is increasing, making these cells susceptible to our nanomedicine.” The next phase of Dr. Khaled’s Subunit 2 research was advanced by gifts from the Catherine McCaw-Engelman and Family Cancer Research Collaborative and the Hardee Family Foundation. Based on her latest findings in Scientific Reports, Dr. Khaled is next turning to detecting circulating cancer cells in blood with high levels of Subunit 2. Such testing could give physicians another indicator of whether the patient’s cancer is spreading. “What I want to do is get these guys,” Dr. Khaled said of her work to stop spreading cancer cells. “With this study, we are one step closer.”

Dr. Matthew Shlapack Orlando Heart & Vascular Center Dr. Matthew Shlapack is a BoardCertified Endocrinologist who has been practicing in Florida for eight years. He has joined Orlando Heart and Vascular Center as part of our continuation of care model, which is designed to meet the medical needs of the Orlando Community. Dr. Shlapack completed both his Internal Medicine Residency and his Endocrinology Fellowship at The University of South Carolina, School of Medicine. He attended Ross University Medical School. He graduated from The University of Maryland, College Park with bachelor’s degrees in both Neurobiology/ Physiology, as well as psychology. During his years working in Florida, Dr. Shlapack has been part of several community outreach programs focusing on a range of Endocrine-Related Health Issues. He specializes in a wide range of

Endocrine Conditions, including diabetes, thyroid disease and cancer, osteoporosis, and parathyroid disease. “Being a physician means providing compassionate care with every visit and always staying at the cutting edge, to ensure that my patients benefit from the newest breakthroughs,” said Shlapack. Dr. Shlapack’s clinic is located at 11616 Lake Underhill Rd. Orlando, FL 32825, Suite 205 Patients who are interested in schedrla ndom e d(407) i c a l482-7788 news.com uling with ohim should call or visit our website at OHVC.net

GrandRounds Community Health Centers Receives National Recognition for Second Consecutive Year Central Florida based Community Health Centers, Inc. was, recently, announced as a Best and the Brightest Company to Work For® by National Association for Business Resources (NABR), for the second consecutive year. This program awards companies that excel at employee relations, use innovation to motivate employees, implement creative compensation programs and more will be recognized by NABR at the National Best and Brightest Illuminate Summit in Dallas, Texas in March 2021. The 2019 national winning companies were assessed by an independent research firm which reviewed a number of key measures relative to other nationally recognized winners. The Best and Brightest Companies to Work for Winners are not ranked. The Best and Brightest Program honored 540 national winning organizations from across the country out of 5,000 nominations. With over 20 years of experience conducting the Best and Brightest competitions, NABR has identified numerous best Human Resource

practices and provided benchmarking for companies that continue to be leaders in employment standards. “With the war on talent hitting the door steps of the Best and Brightest, this achievement means even more than it did a year ago. As we continue to raise the bar, these companies rise to the challenge through cultural innovation, maximizing their workforce potential,” said Jennifer Kluge, President and CEO, Best and Brightest Programs. “On behalf of our leadership team, we are pleased to accept the award for The Best and Brightest Companies to Work For®. This competition identifies and honors companies that deliver exceptional human resource practices and an impressive commitment to their employees. We will continue to focus on happy, purpose-filled team members while delivering quality and compassionate primary healthcare services to Central Florida’s diverse communities,” states Debra Andree, MD, President & CEO of Community Health Centers, Inc.

Orlando Health Arnold Palmer Hospital for Children Receives Trauma and Children’s Surgical Verification from the American College of Surgeons Orlando Health Arnold Palmer Hospital for Children has received both Trauma Verification and Children’s Surgical Verification from the American College of Surgeons (ACS), making it the only pediatric facility in Florida to hold both verifications and one of only 14 in the country. Established by the ACS in 1987, the Committee on Trauma’s Consultation/Verification Program for Hospitals acknowledges a facility’s ability to address the trauma needs of all injured patients. The ACS does not designate trauma centers, however, which is a function of government entities. The ACS Children’s Surgery Verification Committee assesses a surgical program’s safety processes, quality improvement and ability to provide a multidisciplinary medical approach. Hospitals must pass a site visit and meet a number of standards specific to each program in order to receive verification. “Achieving these verifications from the

American College of Surgeons is a testament to the commitment of our clinical staff to provide the best care for all of our patients,” said Don Plumley, MD, medical director of pediatric trauma and chief quality officer at Orlando Health Arnold Palmer. “Parents can rest assured that when urgent medical attention is needed, their children are in the most qualified hands with our trauma and surgery teams.” The ACS is a scientific and educational association of surgeons that was founded in 1913 to improve the care of the surgical patient by raising the standards of surgical education and practice. The College has over 72,000 members and is the largest association of surgeons in the world. Longstanding achievements have placed the ACS in the forefront of American surgery and have made it an important advocate for all surgical patients.

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MARCH 2020

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AdventHealth at Forefront of Groundbreaking Device for Heart Failure Patients A new device that uses the power of the brain and nervous system to fight cardiovascular disease is giving new hope to the millions of Americans suffering from heart failure. Physicians at AdventHealth Orlando, who are among the earliest in the U.S. selected to use the Barostim Neo, say the pacemaker-like device is among the greatest advancements in treating heart failure, which costs the U.S. more than $30 million annually. The Barostim Neo works to combat heart failure using neuromodulation — a growing trend in medical therapy that uses impulses from the brain to trigger physiological changes in the body. As the first neuromodulation device used to fight cardiovascular disease, the Barostim Neo stimulates a group of cells called baroreceptors to balance the body’s out-of-control fight or flight response when the heart is overstimulated. A three-phase clinical trial concluded that patients implanted with the Barostim Neo had improved blood pressure, heart rate and quality of life. These patients were more likely to return to their normal lives — exercising, going to work and participating in hobbies as they once did before being diagnosed. Dr. Nirav Raval, medical director of thoracic transplant at AdventHealth Transplant Institute, is the principal investigator for the study for AdventHealth. He was on the ground floor of the device’s development, first getting involved in early 2012. “Investments in research and novel technologies are improving lives in ways

we’ve never seen before,” Raval said. “With a growing number of Americans suffering with heart failure, it’s become increasingly important to develop less invasive, cost-effective devices to extend lives. The Barostim Neo is a step in that direction — improving heart failure to give patients the ability to enjoy better quality of life for a longer period of time.” AdventHealth Orlando is the highest enrolling trial site in Florida, and the team has implanted four Barostim Neo devices to date. The hospital’s cardiovascular program treats more cardiovascular surgery patients than any other hospital in the state, according to the American Health Care Association. “The Barostim Neo gave me my life back,” said Eric Berkowitz, a patient in the clinical trial at AdventHealth Orlando. “The device allows me to walk a two-mile track with my dog without panting and once again participate in the activities I’ve always enjoyed.” Currently, the only way to receive the Barostim Neo is through an ongoing trial. For more information about the device, visit www.beathf.com.

Neulife Rehab Announces New President, Tera Welch NeuLife Rehab in Mount Dora, FL, one of the nation’s leading CARF Accredited residential post-acute rehabilitation centers and the largest free-standing facility of its kind in the southeastern U.S. specializing in the treatment of individuals with brain and spinal cord injuries and diagnoses, announced its new President, Tera Welch, has already made a significant impact since coming on board at NeuLife on January 6, 2020. Ms. Welch has expertise in executive and sales and marketing leadership, with an extraordinarily successful history of growth and expansion in the very challenging investment management industry. Meeting with NeuLife’s talented, highly experienced and deeply passionate and caring team, Ms. Welch shared her

initial objectives: streamlining the referral and admission process; expanding NeuLife’s specialized rehabilitation, care, and related services to meet the needs of individuals served; building upon established and generating new relationships with payor and referral sources; and enhancing all business development platforms including marketing, sales, and education.




Central Florida Provider Practices Dramatically Improve Care Team Collaboration & Reduce Physician Burnout with Andor Health

AMA Playbook to Aid Record-Sharing with Patients

The American Medical Association (AMA) has created a new online resource to direct physician practices through the legal complexities and operational challenges of providing patients with access to their digital health information. The Patient Records Electronic Access Playbook makes it easy and efficient for medical practices to integrate record-sharing fulfillment with dayto-day operations. The four-part playbook compiles an extensive catalogue of educational information and reference resources with practical tips, case scenarios, and best practices for protecting patients’ privacy while empowering patients and their caregivers with convenient electronic access to their complete medical record. “As technology plays an increasingly important role in collecting and exchanging health data, the AMA believes that providing patients with improved information access and better information privacy are not mutually exclusive goals,” said AMA Board Chair Jesse Ehrenfeld, M.D., M.P.H. “Patients deserve both, and the new playbook is an important example of the AMA’s commitment to ensuring patients can easily access their personal health information that has been entrusted to physicians.” Patients have the right to access their own medical information and providing patients with electronic access is a step toward improving the overall efficiency of the medical care team.  The AMA playbook dispels the myths and misconceptions from an array of complex federal and state laws surrounding patient electronic access to medical information. Navigating this puzzle of legal requirements has been a source of significant confusion among patients, third parties and especially medical practices focused first and foremost on delivering patient care. The playbook offers authoritative information to help medical practices better understand the pertinent laws and how they govern key topics for patient record sharing. These topics include: • Amounts and types of information, • Forms and formats for sharing records, • Patient requests and Involvement of third parties, • Timing for record request fulfillment, • Denial of record request access, • Permissible charges, and • Confidentiality of substance use 29


MARCH 2020

disorder records. To help medical practices integrate legal compliance with patient care operations, the playbook offers a set of steps to make the fulfillment of patient record requests clearer and more efficient. The steps are designed to help medical practices understand the capabilities of their electronic health record (EHR) systems, keep key points in mind, and promote greater use of EHRs among patients. The Patient Records Electronic Access Playbook adds to a growing list of AMA resources designed  to help physicians navigate and succeed in a continually evolving health care environment. In 2018, the AMA launched its first playbook offering guidance to medical practices on the most efficient path for applying and adopting digital health solutions.

Two Central Florida providers, Orlando Internal Medicine and the Digestive and Liver Center of Florida, are among dozens of physician practices that have selected Andor Health’s ThinkAndor™ mobile platform to improve care team communication and collaboration across multiple care settings. “ThinkAndor provides our physicians with a single, unified view of patients for clinical team collaboration across all care settings,” said Pradeep K. Vangala, MD, Founder of Orlando Internal Medicine, a comprehensive physician practice providing care for a large volume of patients across ambulatory, acute-care, long-term acute care and skilled nursing facilities. Currently, Orlando Internal Medicine’s physicians and staff are spending hours of their day manually communicating with other care team members and tracking patients as they transition from one care facility to another using different electronic medical record (EMR) systems at each facility. “With ThinkAndor, we are anticipating an overall 60% reduction in work effort required to view critical information, resulting in increased clinical care capacity, reduced physician burnout and improved outcomes for patients,” added Dr. Vangala, who also serves as Chair of Internal Medicine at AdventHealth Orlando, Medical Director of Select Specialty Hospitals in Orlando and Regional Medical Director for Select Specialty

Hospital System. Primary care doctors spend approximately two hours on administrative tasks, such as excessive EHR data entry and documentation, for every hour spent in direct patient care, contributing to high rates of burnout and stress, according to research. “We have selected ThinkAndor to help us reduce no-shows through better care team collaboration in our outpatient centers, resulting in increased operational efficiency and improved patient and staff satisfaction,” said Srinivas Seela, MD, a board-certified internist and gastroenterologist with the Digestive and Liver Center of Florida. Powered by artificial intelligence and voice technology, the ThinkAndor platform delivers critical, context-sensitive intelligence from disparate EMR systems across multiple care settings. ThinkAndor continually monitors all the signals across EMR systems, pushing actionable intelligence to clinicians just in time. As a result, clinicians have access to a single view of relevant patient information, regardless of EMR or care setting, enabling real-time mobile care team collaboration across the continuum of care. “We are pleased to support Orlando Internal Medicine’s efforts to improve care team collaboration across the continuum of care while reducing administrative burdens on doctors so they can spend more time providing quality care for patients,” said Marlin Hutchens, President of Andor Health.

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Orlando Health Imaging Centers gives Summerport residents a new, closer option Access to specialized diagnostic imaging services is easier for West Orange County residents thanks to Orlando Health’s newest Orlando Health Imaging Centers – Summerport, which opened on February 27. To celebrate the opening of the new facility, a ribbon cutting ceremony was held on Thursday, February 20 with Orlando Health team members, community members and elected officials. The event unveiled a stateof-the-art diagnostic center inside an existing 60,000-square-foot medical pavilion located at the intersection of County Road 535 and West Lake Butler Road, directly across from the Summerport community. “Orlando Health is committed to serving our patients well. The medical pavilion and now this imaging center are examples of the strides in making health care more accessible to West Orange County residents,” said Mark Marsh, president of Orlando Health

– Health Central Hospital. “This location will provide superior access and be very convenient for patients in Summerport and the neighboring communities who may need multiple services.” Created in 2014 to address Central Florida’s increasing imaging needs, the Orlando Health Imaging Centers is a for-profit joint venture between Orlando Health and the Medical Center Radiology Group (MCRG). The newest Orlando Health Imaging Centers – Summerport offers high-quality services such as 3D mammography/tomosynthesis, bone densitometry, digital x-ray, wide-bore 3T MRI and 128-slice CT. All images are read by board-certified radiologists experienced in numerous sub-specialties. Results are then sent directly to physicians to provide patients with same-day results. Dr. Wei-Shen Chin, president of MCRG, stated that the strategic relationship

between Orlando Health Imaging Centers and his organization supports the goal for expanding quality outpatient services and developing an unparalleled level of care. The Orlando Health Imaging Centers – Summerport is the sixth imaging facility to open in the Orlando Health network. The organization provides services at centers located in Altamonte Springs, Ocoee, Lake Mary and Spring Lake. Additionally, to continue supporting the needs of the growing Central Florida community, Orlando Health will soon open two new imaging centers. The first is located at 1111 W. Fairbanks Ave. in Winter Park and the second at 1800 S. Orange Ave. in downtown Orlando. Both centers are scheduled to open in Spring 2020 and will feature state-of-the-art diagnostic imaging in a warm, welcoming, patient-centered environment.

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March 2020

Orlando Health South Lake Hospital Partners with Cecil E. Gray School to Educate on Heart Health Orlando Health South Lake Hospital sponsored the purchase of 130 heart rate monitors for Cecil E. Gray Middle School in Groveland, Florida, to help educate students on the importance of understanding heart health. “We here at Gray Middle School are very excited that Orlando Health South Lake Hospital has agreed to partner with us in the education of our students in regard to heart health,” said Principal Pam Chateauneuf. “Through the hospital’s generosity, students taking one of our Physical Education courses are able to track their progress on heart monitors donated by the hospital. Both of our P.E. teachers, Coach Jimmy Co-

nard and Coach Stephanie Hauff, will now be able to create and implement lessons that are not only engaging for their students, but also connect how physical activity impacts one’s heart health.” This new partnership will have a direct impact on the school’s students in some of the most critical areas of healthcare needs including obesity and heart health. According to Orlando Health South Lake’s most recent community health needs assessment, Lake County’s middle school rates for diabetes and obesity are still rising. This program provides an engaging tool for the physical education staff to help address childhood obesity and heart health.

DOH-Marion Holding Women’s Health Forum on Depression

Mental health topics can be less understood and less spoken about compared to physical health topics due to stigma and other issues. This can lead to people not being aware of important distinctions, such as when someone may not just be sad or acting differently, he or she may be depressed. At a March 14 event, attendees can learn how to become more aware of the signs and symptoms of depression and learn what to do next if they or a loved one may be dealing with it. The Department of Health in Marion County will host a Women’s Mental Health 31


MARCH 2020

Forum on Faces of Depression on Saturday, March 14, from 10 a.m. to 1 p.m. The event will be held at the department’s Ocala office (1801 SE 32nd Ave.) and feature personal stories with speakers Nancy Castillo and Shameka Cook on facing depression and how attendees can become more aware of depressions’ signs and symptoms. Presented by Woman 2 Woman International, the event is free for women ages 18 and up and will have free food, giveaways and more. To attend, RSVP today at www.eventbrite.com/e/94847029017. For more information, call 352-653-5122.

Physical education instructors will track these results over the next three years to highlight the positive health outcomes of participating students. Lake County Schools is the 19th largest public school district in the state serving approximately 42,000 students. With more than 5,800 teachers, administrators. Nearly 500 students will be tracked based on the rotation of students in and out of the physical education classes each semester. Many of these students do not have access to recreational facilities or gyms outside of school. Through this program, students will develop a personal fitness plan, learn how to track their own heart rates and increase their ability to make healthy choices.

Cecil E. Gray Middle School physical education students warm up in class wearing their heart rate monitors.

Orlando Health South Lake is proud to be a part of this opportunity to help provide students at Cecil E. Gray Middle School the training and tools to improve their health and wellness.

Chronic Health Condition Management Classes Available

Managing chronic health conditions can be overwhelming, but it’s a reality that many residents face. Per the Centers for Disease Control and Prevention, 78 percent of US adults age 55 and over have at least one chronic condition, 47 percent have two chronic conditions, and 19 percent have three. Fortunately, the Florida Department of Health in Marion County is hosting classes in Ocala and Marion Oaks starting in March to help alleviate the stress of chronic illness by helping residents get the tools they need to age as healthfully as possible. Residents are invited to join the “Live a Healthy Life with Chronic Conditions” workshop series to take a step toward a healthier tomorrow. Sponsored by Elder Options, Florida Department of Elder Affairs, Florida Health Network and the Florida Department of Health, the six-class series will help individuals learn more about the changes they can make to their daily habits to best manage

their chronic condition and promote healthy aging. The workshops will be held: • Thursdays, March 5 to April 9, from 1:30 to 3:30 p.m. at One Health Center, 1714 SW 17th St., Ocala, FL 34471 To register, contact Brenda Williams at 352812-2059. • Tuesdays, March 10 to April 14, 2020, from 9 to 11 a.m. at Marion Oaks Community Center, 280 Marion Oaks Lane, Ocala, FL 34473 To register, contact Kari Coates at 352-4382831. The sessions are open to anyone to attend; individuals who are age 65 and older and/or Medicare recipients are particularly encouraged to go to the classes. Interested residents should pre-register to ensure sufficient class materials are available. To register or find out more information, contact Demi Danso at 352-644-2618 or Demi.Danso@FLHealth.gov. orlandomedicalnews


NorthCentralFlorida GrandRounds Ocala Health Full-Service Emergency Department in Trailwinds Village in Operation Residents of Sumter County have additional access to emergent care now that Ocala Health has opened its new Trailwinds Village ER, a freestanding ER located on 466A at 6131 Seven Mile Dr., Wildwood, FL 34785. The $13 million project employs approximately 30 full-time healthcare professionals. The 24/7, full service freestanding emergency department features 11 emergency room beds and is capable of caring for all ages. The 11,630-square-foot freestanding ER is expected to serve more than 11,500 patients in its first year. “While continuing to expand our Ocala Regional and West Marion campuses, we saw an opportunity to bring emergency care closer to the residents of Sumter County,” says Chad Christianson, Ocala Health CEO. “Over the last few years, we have seen more patients from Sumter County and Lake County choosing Ocala Health for their healthcare services. We believe this freestanding emergency room will provide our patients a more convenient, higher level experience for emergent care. In order to compliment the emergency care, Ocala

Health also has a location in The Villages in which specialists in neurosurgery and complex general surgery are available to see patients. We also have a pre-admission testing space in the area so we can provide convenient, close to care access for patients. We are excited about the opening of Trailwinds Village ER and plan to expand healthcare services in this area so we can best meet the needs of this growing community.” As a means to improve access to local high-quality care, this is Ocala Health’s third freestanding emergency department. Ocala Health opened its first freestanding emergency department in Summerfield (Summerfield ER) in October 2016 and opened its second freestanding emergency department (Maricamp ER) on Maricamp Road in Ocala in August 2019. Ocala Health’s outpatient facilities include Family Care Specialists, a primary care network of six locations throughout Marion County; Advanced Imaging Centers; a freestanding Wound and Hyperbaric Center; a Senior Wellness Community Center; and three surgical and physician specialty practices.

National Organ Donation Recognition

AdventHealth Waterman, AdventHealth Daytona Beach and AdventHealth DeLand have earned national recognition for their efforts to increase organ, eye, and tissue donor registrations, through the Workplace Partnership for Life (WPFL) hospital organ donation campaign. “Receiving this recognition is a wonderful reflection of the hard work our teams put into raising awareness for the need for organ donors on a national scale,” said Julie Vincent, chief clinical officer for the AdventHealth operations in Volusia, Flagler and Lake counties. “There is a critical and growing need for registered organ, eye, and tissue donors. Every 10 minutes, another person is added to the organ transplant list, and by working to increase the number of potential donors, we can help give hope to those in dire need of a new organ. Someone’s life could be saved because of a wonderful gift of an organ from a stranger.” The WPFL is a national initiative that unites the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), and the 32


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organ-donation community with workplaces across the nation in spreading the word about the importance of donation. Across the nation, nearly 1,500 organizations participated in the 2019 campaign. AdventHealth Waterman was one of 226 facilities to earn the gold-level designation. The WPFL hospital organ donation campaign challenges healthcare organizations to educate their staff, patients, visitors, and communities about the critical need for organ, eye, and tissue donation and provide opportunities to register as donors. Each hospital earned points for completing awareness and registry activities. Since its inception in 2011, the campaign has generated more than 492,000 registrations. This year’s Hospital Organ Donation Campaign added more than 48,000 registrations to state registries and the Puerto Rico registry, which also includes registrations from the U.S. Virgin Islands. For more information about the Hospital Campaign, visit www.organdonor.gov/ hospitals.

Neulife Rehab Announces New President, Tera Welch NeuLife Rehab in Mount Dora, one of the nation’s leading CARF Accredited residential post-acute rehabilitation centers and the largest free-standing facility of its kind in the southeastern U.S. specializing in the treatment of individuals with brain and spinal cord injuries and diagnoses, announced its new President, Tera Welch, has already made a significant impact since coming on board at NeuLife on January 6, 2020. Ms. Welch has expertise in executive, sales and marketing leadership, with an extraordinarily successful history of growth and expansion

in the very challenging investment management industry. Meeting with NeuLife’s talented, highly experienced and deeply passionate and caring team, Ms. Welch shared her initial objectives: streamlining the referral and admission process; expanding NeuLife’s specialized rehabilitation, care, and related services to meet the needs of individuals served; building upon established and generating new relationships with payor and referral sources; and enhancing all business development platforms including marketing, sales, and education.

AdventHealth Waterman Receives National Breast Cancer Accreditation AdventHealth Waterman has received a three-year accreditation from the National Accreditation Program for Breast Centers (NAPBC), a quality program of the American College of Surgeons (ACS). AdventHealth Waterman received this designation for meeting national standards of excellence for providing comprehensive, patient-centered, multidisciplinary care and demonstrating highquality clinical outcomes for patients with breast disease. “We are very proud to be the first and only accredited breast center in Lake County,” said Abel Biri, AdventHealth Waterman CEO. “Our breast care team is passionate about providing outstanding care to breast cancer patients and this is demonstrated in achieving this national recognition for quality care.” NAPBC-accredited centers demonstrate excellence in program leadership, clinical services, research, community outreach, professional education and quality improvement. Patients receiving care at a NAPBCaccredited center have access to information on clinical trials and new treatments, genetic counseling, and patient-centered services, including care navigation. “Our cancer care navigators help patients by coordinating appointments with our breast care team specialists, providing personalized education about cancer treatment and follow-up care, and assisting with access to resources such as psychosocial support, nutritional counseling and financial assistance,” said Leslie Maxwell, AdventHealth Waterman Cancer Institute director. In addition to care navigation, receiving care at a NAPBC-accredited center

AdventHealth Waterman has received a threeyear accreditation from the National Accreditation Program for Breast Centers (NAPBC), a quality program of the American College of Surgeons (ACS). Pictured here from left to right, AdventHealth Waterman oncology certified nurses Charissa Wynn and Eileen Bascombe, oncology nurse navigator–certified generalist, were instrumental in the process to obtain the NAPBC designation.

like AdventHealth Waterman ensures that patients have access to: • Comprehensive care, including a full range of state-of-the-art diagnostic and treatment services • A multidisciplinary team approach to coordinate the best treatment options and • Information about clinical trials and new treatment options.



March 2020

Couple’s Heartfelt Gift Delivers $1.3M to Health First Foundation

Allen S. Henry wasn’t just thinking of giving to a cause that he could see benefit in his lifetime - he had the foresight to make sure his impact carried well into the future. That’s why the late Brevard County resident and his widow, Sandra, who are well known to the community, made a $1.3 million philanthropic donation through a planned gift arrangement to benefit Brevard’s wellness and health. Put in place by Allen, who passed away in March 2019, the gift will make a mark in heart care, hospice services and the education of Brevard-based nurses. “This is one of the largest single gifts ever made to Health First and its fundraising arm, the Health First Foundation,” said Michael Seeley, Foundation President. “To recognize this special gift, we are proud to name the Cardiovascular Intensive Care Unit in the Heart Center at Health First’s Holmes Regional Medical Center in their honor.

Aging Matters in Brevard Joins Nationwide March for Meals Celebration Aging Matters in Brevard has announced that it would be participating in the 18th Annual March for Meals – a monthlong, nationwide celebration of Meals on Wheels and our senior residents who rely on the vital service to remain healthy and independent at home. Greg Pallone, Brevard County Reporter/Anchor for Spectrum News 13, will serve as Honorary Chairman of the awareness campaign to help fight senior hunger and isolation in Brevard County. Aging Matters in Brevard’s celebration will include various activities throughout the month of March. “The services we provide are a lifeline for seniors in Brevard County and the need is rapidly increasing,” said Josh Jensen, president and CEO of Aging Matters in Brevard. “Together, we can keep our senior neighbors well-nourished, feeling safer and more connected to our community as they age.” “A large percentage of our patients receive care in their homes. Our staff members – chaplains, nurses, social workers, and aids witness the tremendous impact that the Meals on Wheels program makes for our home-bound patients. We are honored to support the March for Meals campaign so that this service which brings comfort to the body and a friendly visit to help nourish the spirits can grow to meet the needs of our community,” said Joe Killian, President and 33


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The Henrys have long understood the value of having quality healthcare close to home. Sandra said “there’s a peace of mind that comes from having an estate plan in place, knowing your charitable wishes will be carried out.” Both Sandra’s and Allen’s parents suffered from cardiac disease, so the cause was dear to the couple. “Allen had heart problems, too, so he especially wanted to make sure that excellent cardiac care was available locally,” Sandra added. While the majority of the gift is designated for the Heart Center at Holmes Regional, the Henrys also made arrangements for a generous gift to Hospice of Health First, as well as funding endowed scholarships for Camp Bright Star and Health First nurses seeking advanced nursing degrees. Camp Bright Star is a Hospice program held

CEO of Hospice of St. Francis. March for Meals “Community Champions Week” will be March 16 through 20. During this special week, prominent community figures from all over Brevard will help deliver meals, speak out for seniors, and raise awareness about the power of Meals on Wheels. The annual March for Meals celebration commemorates the historic day in March of 1972 when President Nixon signed into law a measure that amended the Older Americans Act of 1965 to include a national nutrition program for over the age of 60. Since 2002, community-based Meals on Wheels programs from across the country have joined forces for the annual awareness campaign to celebrate this successful public-private partnership and garner the support needed to meet the growing need for this vital service. “The month of March is a fitting time to not only celebrate the successful history of Meals on Wheels, but also bring us together to support a solution that will strengthen communities into the future,” said Ellie Hollander, President and CEO of Meals on Wheels America. “With 12,000 Americans turning 60 each day, now is the time to invest in these vital programs so that we can provide every senior in need with the nutritious meals, friendly visits and safety checks that will enable them to live healthier and independent in their own homes.” For more information on how to volunteer, contribute, or speak out for the seniors in Brevard this March, visit www.agingmattersbrevard.org/events/marchformeals.

twice a year for grieving children. Originally from Iowa, Allen moved to Brevard to work at Radiation Inc., and then

Harris Corporation in 1972. At Harris, he served in many roles, including Engineering Vice President and General Manager of the Government Communication Systems Division, and President of the Electronic Systems Sector until his retirement in 1996. Allen served with distinction on the Health First Board of Trustees from 1999 to 2009, a position that kept him up to date on community medical needs and cardiac issues. “We are honored and inspired by the Henrys’ generosity,” said Steve Johnson, Health First President and CEO. “As a not-for-profit community healthcare system, we depend on community support to help provide the best healthcare possible. We miss Allen’s leadership and his friendship, but his legacy is alive and well at Health First - and will help provide quality care for future generations.”

Parrish Medical Center Receives the 2020 Women’s Choice Award® as one of America’s Best Hospitals for Obstetrics Parrish Medical Center has been named as one of America’s Best Hospitals for Obstetrics by the Women’s Choice Award®, America’s trusted referral source for the best in healthcare. The award signifies that Parrish Medical Center is in the top 17% of 4,982 U.S. hospitals offering obstetrics. The methodology for the America’s Best Hospitals for Obstetrics is unique in that it combines national accreditations, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey results and hospital outcome scores with primary research about women’s healthcare preferences. It is the only award recognizing excellence in obstetric services based on robust criteria that consider patient satisfaction and clinical excellence. The America’s Best Hospitals for Obstetrics distinction is based on the following specific criteria: • The percentage of patients reporting through the HCAHPS survey that they would definitely recommend the hospital • Patient safety ranking based on 11 Centers for Medicare and Medicaid Services’ measures of infection

and complication rates • Low rates of early elective deliveries (between 0-1%) • Baby-Friendly USA designation, a World Health Organization (WHO)/ United Nations Children’s Fund (UNICEF) initiative to support best practices for breastfeeding education and counseling • Level III and Level IV neonatal intensive care designations to provide comprehensive care for the most complex and critically ill newborns. “Pregnancy is one of the most special times in za woman’s life,” said Delia Passi founder and CEO of the Women’s Choice Award. “New moms have many choices when it comes to having their baby, so choosing the best birthing experience is right up there with choosing the best doctor. We’ve made it easy for moms to vet out the hospitals that are proven to deliver an outstanding experience.” Parrish Medical Center is one of 428 award recipients representing the hospitals that have met the highest standards for obstetrics across the U.S. For more information on the America’s Best Hospitals for Obstetrics visit https://www. womenschoiceaward.com/ best-hospitals/



Volusia/Brevard GrandRounds Zumpano Patricios Return as the Presenting Sponsor for Jess Parrish Medical Foundation Golf Classic in April Jess Parrish Medical Foundation (JPMF) has announced the law firm of Zumpano Patricios as the presenting sponsor for the annual Fran Gerrett Memorial Golf Classic on Friday, April 3. More than 200 golfers are expected to play in the two-course tournament with all proceeds benefiting The Children’s Center (TCC), a service of Parrish Healthcare, and one-stop childhood development resource center. TCC provides a safe and healing environment for special needs and/or typically developing children to learn and grow, along with an array of health, education and human services under one roof. “Zumpano Patricios is honored to partner with Jess Parrish Medical Foundation for the sixth year as presenting sponsor of the Fran Gerrett Memorial Golf Classic,” said Joseph I. Zumpano, managing shareholder at Zumpano Patricios. “It is gratifying to know that our contribution is providing access to high-quality care that develops Strong Families for Life and will continue to provide future generations of children in North Brevard with the programs and services necessary to help them reach their fullest potential.” Registration begins at noon with a shotgun start at 1 p.m. Tournament players can choose between two golf courses – the Ron Garl and Lee Trevino-designed La Cita Golf & Country Club nestled amongst 100year old oak trees or The Great Outdoors with the beautiful natural environment of the St. Johns wildlife refuge. Course selection is first-come, firstchoice with paid registration. The tournament format will be a four-player scramble with fun contests, including a chance to win a $1,000 cash prize when purchasing a raffle ticket for $20. Participants need not be present to win. Winners will be announced immediately following the awards ceremony. The tournament is a fun-filled event which allows you to golf and give back at the same time. Fran Gerrett served as the director of Materials Management at Parrish Medical Center for 24 years. Fran passed away in 2012, but the annual golf tournament lives on as a tribute to his longtime dedication to our community and favorite charity, The Children’s Center. The golf classic is organized by community leaders and volunteers. Event co-chairs are Kathy Myer and Greg Sparkman. Other members of the golf committee include Santi Bulnes, Amy Craddock, Anita Currie, Lori Duester, Leigh Spradling and Suzanne Yarbrough. The foundation welcomes all businesses and organizations to participate and support the event. A variety of sponsorship opportunities are available beginning at $500. Individual player costs are $85, which includes golf, lunch and dinner. For more information about sponsor-



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ship packages or to purchase general admission and raffle tickets, please call Jess Parrish Medical Foundation at (321) 269-4066 or visit www.parrishmedfoundation.com/golf.

Parrish Medical Center Offers Free Community Classes and Support Groups Parrish Medical Center is offering free classes and support groups for community members. See the upcoming March 2020 support groups listed below: AWAKE Sleep Disorders Support Group Celebration: Monday, March 9, 6-8 p.m., Parrish Healthcare Center, 5005 Port St. John Parkway, Port St. John Caregiver Support Group: Thursday, March 5 and 20, 9:30-11:30 a.m., Heritage Hall, 931 N. Washington Ave., Titusville Caregiver Academy: Thursday, March 12, 10-11 a.m., Heritage Hall, 931 N. Washington Ave., Titusville Diabetes Support Group: Thursday, March 12, 3:30-5 p.m., Heritage Hall, 931 N. Washington Ave., Titusville Diabetes Community Education Class: Thursday, March 19, 3-5 p.m., Parrish Medical Center, 951 N. Washington Ave., Titusville Fearless Café: Wednesday, March 4, 10-11 a.m., Heritage Hall, 931 N. Washington Ave., Titusville HealthBridge | Active Living: Tuesday, March 3, 9:30-11 a.m., Parrish Medical Center, 951 N. Washington Ave., Titusville We believe in blending the art of healing with the science of advanced medicine to keep your body in motion. Parrish Health & Fitness Center Manager Tammy Shelley will give attendees tips on how to make active living a lifestyle and Director of Athletic Training Kellie Way will teach how to be safe while doing so. Everyone is invited to participate in chair exercises and ergonomic training. MAK Gathering (Moms and Kidz) Support Group: Mondays and Wednesdays (March 2, 4, 9, 11, 16, 18, 23, 25 and 30), 10-11:30 a.m., The Children’s Center, 5650 S. Washington Ave., Titusville Parkinson’s Support Group of North Brevard: Thursday, March 19, 2-4 p.m., Heritage Hall, 931 N. Washington Ave., Titusville Pulmonary Hypertension Support Group: Tuesday, March 10, 3-5 p.m., Grace United Methodist Church, Merritt Island Stroke-Heart Survivors Group: Tuesday, March 17, 2-4 p.m., Heritage Hall, 931 N. Washington Ave., Titusville Parrish Partners Cancer Support Group: Monday, March 16, 4-5:30 p.m., Parrish Medical Center, 951 N. Washington Ave., Titusville NAMI (National Alliance on Mental Illness) Family Support Group: Wednesday, March 4, 6-7:30 p.m., Palm Point Behavioral Health, 2355 Truman Scarborough Way, Titusville The support groups are free, but space is limited. For more information, and to preregister, visit parrishhealthcare.com/ events.

Parrish Cancer Center Welcomes Radiation Oncologist Dr. Uzma Malik Parrish Cancer Center welcomes Dr. Uzma Malik to the community. Dr. Malik is a board-certified radiation oncologist who specializes in the use of ionizing radiation and external beam radiation in the fight against cancer. The National Cancer Institute reports that nearly 40 percent of Americans will be diagnosed with cancer at some point during their lifetimes. That statistic means that nearly 300,000 Brevard County residents will eventually need cancer treatment. Radiation oncology is one of three primary approaches in the treatment of cancer; the other two being surgical and medical oncology. Dr. Malik’s more than 20 years of experience serves to enrich the full spectrum of oncology services available at the Parrish Cancer Center. “I look forward to providing my patients with world-class cancer treatments using the very latest in radiation oncology technology available anywhere within a compassionate healing environment,” said Dr. Malik. Dr. Malik received her medical education and specialty training at The Aga Khan University in Pakistan and the University of Western Ontario, Victoria Hospital, London, Canada. Most recently, Dr. Malik held the position of Director of the Department of Radiology at the Geisinger Henry Cancer Center in Wilkes-Barre, PA . Her expertise and accomplishment in the field was recognized by the International Association of Oncologists naming her of the Top Oncologists. For more information about Dr. Malik and the Parrish Cancer Center, visit parrishhealthcare.com or call 321-529-6202. Parrish Cancer Center is part of Parrish Healthcare’s nationally certified integrated system of care and is located at 845 Century Medical Drive, Titusville. Parrish Cancer Center Welcomes Radiation Oncologist Dr. Uzma Malik

Parrish Medical Center and American Heart Association Partner to Bring Resuscitation Quality Improvement (RQI)® to Brevard Parrish Medical Center (PMC) is pleased to announce a partnership with the American Heart Association and Laerdal Medical® to save more lives following a cardiac arrest with a new CPR simulation training program called Resuscitation Quality Improvement® or RQI®. “Poor-quality CPR is a preventable harm,” said PMC Vice President Communications, Community and Corporate Services Natalie Sellers. “We’re proud to be the first in Brevard to offer the gold standard in CPR simulation training to our care partners with RQI®, a performance improvement program, which

Parrish Cancer Center welcomes Dr. Uzma Malik to the community. Dr. Malik is a board-certified radiation oncologist who specializes in the use of ionizing radiation and external beam radiation in the fight against cancer. The National Cancer Institute reports that nearly 40 percent of Americans will be diagnosed with cancer at some point during their lifetimes. That statistic means that nearly 300,000 Brevard County residents will eventually need cancer treatment. Radiation oncology is one of three primary approaches in the treatment of cancer; the other two being surgical and medical oncology. Dr. Malik’s more than 20 years of experience serves to enrich the full spectrum of oncology services available at the Parrish Cancer Center. “I look forward to providing my patients with world-class cancer treatments using the very latest in radiation oncology technology available anywhere within a compassionate healing environment,” said Dr. Malik. Dr. Malik received her medical education and specialty training at The Aga Khan University in Pakistan and the University of Western Ontario, Victoria Hospital, London, Canada. Most recently, Dr. Malik held the position of Director of the Department of Radiology at the Geisinger Henry Cancer Center in Wilkes-Barre, PA . Her expertise and accomplishment in the field was recognized by the International Association of Oncologists naming her of the Top Oncologists. For more information about Dr. Malik and the Parrish Cancer Center, visit parrishhealthcare.com or call 321-529-6202. Parrish Cancer Center is part of Parrish Healthcare’s nationally certified integrated system of care and is located at 845 Century Medical Drive, Titusville.

serves to support resuscitation quality and skill mastery in accordance with the gold standard recommended by the American Heart Association every time, ” said Sellers. PMC’s Clinical Education Specialist Ericka Jacobs, added “Recently, I heard a saying that I believe exemplifies RQI and PMC’s commitment to our community; ‘practice doesn’t make perfect, perfect practice makes perfect.’ “We can do CPR every single day, but if we aren’t doing it correctly then we are promoting a cycle of poor performance and even worse patient outcomes. RQI stops this cycle,” said Jacobs. According to the American Heart Association, every year 475,000 people die from cardiac arrest in the U.S. As recognized patient safety leaders, PMC envisions a world where no one dies from cardiac arrest. The implementation of the RQI simulation CPR training program is an important step toward achieving that goal.



Volusia/Brevard GrandRounds “The more we as healthcare providers can practice these life-saving skills, the more competent and confident we become when a matter of seconds can save a person’s life following cardiac arrest,” said Parrish Medical Center Emergency Department Medical Director Greg Cuculino, MD. “Parrish Medical Center care partners have the skills, technology, and competence they need to deliver the highest quality care to patients—blending the art of healing with the science of advanced cardiovascular medicine,” added Dr. Cuculino.

Downtown Fit Loop Groundbreaking Ceremony In February, the Rotary Club of Downtown Ormond Beach hosted a groundbreaking ceremony for Phase 1 of the Downtown Fit Loop project at Fortunato Park, which will include a 10-station exercise apparatus. A more than $170,000 investment in the community’s health, the Downtown Fit Loop will provide outdoor exercise equipment in the parks at the four corners of the Granada Bridge. A two-mile pathway between the parks, using the under-bridge connections and walkways across the bridge, gives users the option to walk or run the loop without crossing the street. Upon completion of construction, the Rotary Club of Downtown Ormond Beach will gift the project to the City of Ormond Beach. The groundbreaking ceremony featured remarks by Leisure Services Director Robert Carolin, Mayor Bill Partington, Club President Brandon Perry and AdventHealth Daytona Beach CEO Ed Noseworthy. As the presenting sponsor, AdventHealth Daytona Beach contributed $45,000 to cover half of the cost of Phase 1 & 1b. Also in attendance were City Manager Joyce Shanahan, City Commissioners Susan Persis and Dwight Selby, Past Commissioner Carl Persis, AdventHealth Daytona Beach Chief Operating Officer David Weis, gold donor Nancy Lohman, Rotarians and friends.

Rotary is a global network of 1.2 million professionals, neighbors, friends, leaders, and problem-solvers who see a world where people unite and take action to create lasting change – across the globe, in our communities, and in ourselves. Over 110 years, Rotary has worked to fight disease, including nearly eradicating Polio worldwide; provide clean water, sanitation, and hygiene; save mothers and children; support education; and promote peace.

Internal Medicine Physician Joins AdventHealth’s Employed Physician Group Internal medicine physician Dr. Michael DeSouza has joined AdventHealth Medical Group. As an AdventHealth Medical Group physician, DeSouza joins AdventHealth’s employed group of physicians with more than 300 providers, including 160 primary care doctors and specialists in Volusia, Flagler and Lake counties. DeSouza has had a private practice in the West Volusia community for 25 years before joining AdventHealth Medical Group. He specializes in wellness and preventive health for adults, diagnostic dilemmas, chronic disorders and complex health conditions, infectious diseases and elder care. He also provides joint injections and minor skin surgery. DeSouza earned his medical degree from St. John’s Medical College in Bangalore, India. He completed his internship and residency at the Our Lady of Mercy Medical Center in Bronx, New York. His practice accepts new patients and most insurance plans. His office is located at 2521 Junior St., Orange City and can be

AdventHealth Daytona Beach Names Physician of the Quarter

AdventHealth Daytona Beach recognized Dr. Thomas Seale as the physician of the quarter. Seale is an interventional radiologist at AdventHealth Daytona Beach. As an interventional radiologist, Seale uses minimally invasive image-guided measures to diagnose and treat diseases and performs a range of interventional medical procedures. He was nominated for this recognition by staff. 35


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“Dr. Seale is an outstanding role model and physician who successfully balances the art and the science of medicine,” one team member wrote in a nomination form. “He is kind, meticulous and gives the very best care to each and every patient.” “Dr. Seale is amazing to work with,” another colleague wrote. “He’s passionate, supportive and continues to be a positive influence to his team and his patients.”

Parrish Medical Group Addresses Digestive Health with New Specialist Physician A hesitancy shared by many people to speak about gastrointestinal problems – even with their physicians – means many are living with discomfort that can be alleviated, a principal reason why Parrish Medical Group (PMG) in Titusville has added a gastrointestinal specialist who makes understanding his patients’ concerns the focal point of his practice. Dr. Khalid George, a board-certified and fellowship-trained gastroenterologist, has joined PMG to treat patients dealing with digestive disorders that include heartburn, gallstones, Irritable Bowel Syndrome (IBS), pancreatitis, ulcers, and more. According to a national survey by Harris Interactive, 74% of Americans regularly suffer from episodes of digestive distress. That figure totals nearly 450,000 Brevard County residents. Dr. George says that digestive problems are common, but most people are embarrassed to talk about them even with their primary care providers. Instead, they live with ongoing conditions that adversely affect quality of life, or worse. “Even the most common digestion problems, like bloating, diarrhea, and cramping, can indicate more serious underlying diseases,” says Dr. George. “Ignoring problems doesn’t make them go away. In fact, something like treating

heartburn yourself with over-the-counter medicine can, overtime, mask heart disease or even esophageal cancer. “Our treatment goals are to improve people’s lives by giving them relief whenever possible and to keep minor problems from becoming serious issues,” Dr. George said. “I enjoy working with patients in a way that gives them confidence in their treatment and a willingness to share with me whatever it is with which they are dealing.” Dr. George completed internal medicine residency at Henry Ford Hospital |Wayne State University, completed GI fellowship at providence-providence park |Michigan State University. He received his medical education at St. George’s University School of Medicine and undergraduate at University of Toronto. “Gastroenterology services are important to have close to home, delivered by a physician with excellent credentials in whom patients can have trust,” said Dr. George. Dr. George’s experience includes treating inflammatory bowel diseases such as Crohn’s Disease and ulcerative colitis, Irritable Bowel Syndrome (IBS), and pancreatic and liver disease. He is a proponent and provider of colon cancer screening, the third most common cancer in both men and women in the United States.

U.S. Air Force Thunderbirds Visits Kids at AdventHealth Daytona Beach In town to perform a stadium flyover during the DAYTONA 500, the U.S. Air Force’s official air demonstration squadron, also known as the Thunderbirds, visited patients at AdventHealth Daytona Beach. The Thunderbirds first visited the hospital’s 10-bed inpatient pediatric unit that is brightly colored and inspired by the spirit of Daytona Beach, featuring designs of ocean waves, palm trees, and dolphins, as well as cars racing on a track, chairs in the shape of tires and tool chests, and blimps. Patient Alexander Arnold, 6, of Bunnell, shared that he planned to sit by the window to watch the Thunderbirds practice for the flyover during the DAYTONA 500. The surprise visit especially made the day for Eugene Lamont Gore Jr. in the hospital’s eight-bed pediatric ER that provides 24/7 emergency care for children. The six-year-old from Daytona Beach shared that he wants to become a pilot when he grows up. In the 16-bed Level II neonatal intensive care unit (NICU), the Thunderbirds met some of AdventHealth Daytona Beach’s smallest patients, sixday-old twins Ava and Harper Schoppert and their parents Leah Woodward

and Nick Schoppert. Caring for newborns 32-weeks and older, AdventHealth Daytona Beach’s is the only NICU in Volusia County with private, family-centered rooms, allowing parents to stay 24-hours a day with their babies. The DeLand family welcomed the chance to meet the airmen, as they have family members who also served in the U.S. Air Force. The next stop on the Thunderbirds tour was the hospital’s 32-bed inpatient rehabilitation center, greeting patients who were also military veterans. Established in 1953, “America’s Ambassadors in Blue” are the third-oldest formal flying aerobatic team in the world – where they tour both domestically and internationally, performing aerobatic formation and solo flying in specially marked aircraft.



Volusia/Brevard GrandRounds

AdventHealth New Smyrna Beach Foundation Recognizes Eagles for On-Going Support Congressman Visits AdventHealth Fish Memorial PICTURE and CAPTION ONLY Congressman Waltz Visits: On Feb. 20, Congressman Michael Waltz toured AdventHealth Fish Memorial, stopping by the emergency department which is slated to open a six-bed pediatric emergency department this spring. Pictured here, Waltz (left) and AdventHealth Fish Memorial CEO Rob Deininger (right), talk with volunteers Bev Frenzel and Pat Blanchfieldat the hospital’s information desk.

On Feb. 18, the AdventHealth New Smyrna Beach Foundation presented the Edgewater Aerie #4242 Fraternal Order of Eagles with an appreciation plaque for donating over $37,000 over the last three years to support various hospital programs including cancer, cardiology and diabetes services, as well as patients with Parkinson’s disease. Afterwards receiving the plaque, Todd Hook, president of the Edgewater Aerie #4242 Fraternal Order, presented the AdventHealth New Smyrna Beach Foundation with an additional donation of $4,500. Since its inception in 1995, the AdventHealth New Smyrna Beach Foundation has provided more than $1 million to improve the health of the community by supporting the hospital and enhancing the technology available locally. To learn more or support the AdventHealth New Smyrna Beach Foundation, call Call386-424-5015.

AdventHealth New Smyrna Beach Foundation Donates $200,000 to Fight Breast Cancer Locally On Feb. 18, the AdventHealth New Smyrna Beach Foundation donated $200,000 to support the hospital’s purchase of the state-of-the-art 3D mammography technology. This new technology will replace AdventHealth New Smyrna Beach’s 2D mammography equipment. At an overall cost of a half-million dollars, the AdventHealth New Smyrna Beach Foundation donation is a significant contribution. The 3D mammography technology equipment will be the only unit of its kind in southeast Volusia County and will help fight



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breast cancer locally. “We have been so moved by the outpouring of support. With the generosity of our community, as well as hospital employees, physicians, and volunteers, we are able to purchase the 3D mammography technology which can diagnose about 40% more malignant tumors than the traditional 2D technology,” said Dr. Pepper Day, medical director of imaging at AdventHealth New Smyrna Beach. “This advanced technology will help us catch breast cancer tumors much earlier, reduce the number of dreaded ‘callbacks,’ and ultimately help save lives.” In August 2019, the AdventHealth

New Smyrna Beach Foundation kicked off its largest-ever capital campaign, named “Lighting the Way,” with a goal to raise $200,000 for the 3D mammography equipment. Through a community-wide drive that included a challenge to local businesses, multiple public speaking engagements, and many local citizens, the hospital’s foundation has reached its goal. The local businesses that supported this initiative include: Abundant Health Day Spa, AdventHealth New Smyrna Beach Auxiliary, Baker’s Table, Edgewater Aerie #4242 Fraternal Order of Eagles, Hair by Mary, Holiday Day Charity Ball sponsors,

local fire departments, Mind Body Soul, Nature in Beauty, New Smyrna Beach High School Medical Academy, Settle Wilder Funeral Home, Superwash Express, The Canal Street Merchants, and The Med Spa. Since its inception in 1995, the AdventHealth New Smyrna Beach Foundation has provided more than $1 million to improve the health of the community by supporting the hospital and enhancing the technology available locally. To learn more or support the AdventHealth New Smyrna Beach Foundation, call Call386-424-5015.



Profile for Orlando Medical News

Orlando Medical News March 2020  

A Step by Step Path to Excellence Resources and culture key steady improvement at Health Central

Orlando Medical News March 2020  

A Step by Step Path to Excellence Resources and culture key steady improvement at Health Central