Orlando Medical News January 2021 by Orlando Medical News

JANUARY 2021

Proudly Serving Central Florida, North Central Florida & Volusia-Brevard

Three Trends

Shaping Healthcare in 2021 For the Better, If Well-Managed

MAKING A CHANGE IN A TRYING TIME Dr. Luis Serrano moves to a new area and practice in the middle of a pandemic.

YOUR FRONT OFFICE: The Bridge Between Service Provided and Payment

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JANUARY 2021

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CONTENTS || FEATURES

A Major Change in a Trying Time Dr. Luis Serrano moves to a new area and practice in the middle of a pandemic.

PUBLISHER John Kelly jkelly@orlandomedicalnews.com

FEATURES

5 6 7

———————

COVER STORY Three Trends Shaping Healthcare in 2021 – For the Better, If Well-Managed PHYSICIAN SPOTLIGHT Making a Change in a Trying Time Dr. Luis Serrano moves to a new area and practice in the middle of a pandemic.

AD SALES John Kelly, 407-701-7424 ——————— EDITOR PL Jeter editor@orlandomedicalnews.com ——————— CREATIVE DIRECTOR Katy Barrett-Alley kbarrettalley@gmail.com ———————

Your Front Office: The Bridge Between Service Provided and Payment

CONTRIBUTING WRITERS John Fogarty Dorothy Hardee

EOCC MEDICAL CITY A Fresh Start 2021

Cannabis as a Beneficial Replacement Therapy for Psychotropic Drugs with Treating Neuropsychiatric Symptoms of Severe Alzheimer’s Dementia

Brian Hazelgren Meaghan Hislop Janelle Hom Jeff Kiser Michael C. Patterson Norbert Rainford, MD Karen Rumbley

Joeseph T. Shen, MD

Why the COVID-19 Vaccine Alone Isn’t Enough

Raffi B. Shen ———————

How Has the COVID-19 Pandemic Impacted Your Practice?

Protect Your Lungs in 2021 – Now is the Time to Quit Smoking and Vaping

SOCIAL MEDIA DIRECTOR Jennifer Cerna ——————— ADVENT UNIVERSITY INTERN Noelle Kelly ———————

Introduction to Multifunction Cardiography

CIRCULATION jkelly@orlandomedicalnews.com ———————

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All editorial submissions and press releases should be emailed to editor@orlandomedicalnews.com

NORTH CENTRAL FLORIDA & VOLUSIA/BREVARD GRAND ROUNDS

——————— Subscription requests or address changes should be emailed to jkelly@orlandomedicalnews.com

Orlando Medical News January 2021 is published monthly by K&J Kelly, LLC. ©2021 Orlando Medical News. All Rights Reserved. Reproduction in whole, or in part without written permission is prohibited. Orlando Medical News will assume no responsibility unsolicited materials.

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JANUARY 2021

Three Trends Shaping Healthcare in 2021 – For the Better, If Well-Managed BY JEFF KISER

The first wave of the coronavirus pandemic essentially gutted a big part of the U.S. healthcare system, like family and pediatric practices, obstetrics and gynecology clinics and internal medicine. By the end of May, almost a fifth of primary care practices had shut their doors and two in five had laid off or furloughed staff.

fraudulent claims in October. Cyber liability steps up,

it didn’t allow telemedicine to be practiced indepen-

pain as patients put off care through traditional office

Florida’s primary care community shared the national

too, requiring extra rigor in creating technologically

dently, without proper state credentials. Meeting the

visits for fear of contracting COVID-19. But one of

sound platforms, well-protected Internet connections

continuing heightened demand for telemedicine will

central Florida’s largest medical groups, Orlando Family

and thorough employee training in security protocols.

also continue the boom in related contracted healthcare

Physicians (OFP), jumped fast on what would become

Healthcare continues to rely on third-party electronic

services into 2021.

one of the most significant healthcare trends in 2020 –

medical record management and cloud-based stor-

and one that’s expected to continue strong into 2021:

age, so organizations remain vulnerable to security

times have resulted in credentialing and privileging pro-

telehealth. In expanding its capabilities, OFP not only

breaches. It makes a strong case for ensuring your cyber

tocols being relaxed, a risk at any time. This potentially

was able to manage more patient visits, but was one of

insurance is at the right limits and that your cyber risk

can degrade a practice’s quality and make professional

the few provider groups in the region to accept new

management efforts are adequate.

liability insurance very costly for everyone. In a pan-

patients at the time.

There’s a downside, though. The pressures of the

demic crisis, though, when the pressure’s on, it can be

Telehealth was boosted by a lifesaver thrown out by

2. PANDEMIC may speed shift from volume to value-based payment model

the Centers for Medicare and Medicaid Services, allowing for virtual visits and in-person visits to be paid at

One reason for the straits of many healthcare practices

the same rate. It’s been a bonus when you consider the

during the pandemic was the billing model that many

following trends and issues that were brought into sharp

have yet to move away from: volume-based payment for

focus as a result of the pandemic crisis. The industry

service. Plus, there was a lack of parity in reimbursements

will be challenged to manage them and rebuild as 2021

between virtual and traditional office visits. It put the

progresses:

spotlight on a long-standing deficiency of the U.S. healthcare system – the fee-for-service payment model, where

1. TELEHEALTH – a potential opportunity, but be wise to the risks

quality of healthcare provided still tends to matter less than number of office visits, lab tests, surgeries, etc. (i.e.,

It took a pandemic for technology that previously got a

fewer patient visits equaled decreased payments).

lot of talk but not much adoption to finally get accepted.

The pandemic was a harsh lesson, but it may speed up

It’s proven to be a safe way for primary and specialty

the trend over the next five years toward the CMS re-

care practices, hospitals and others to consult with and

imbursement form of bundled payments, or value-based

remotely monitor patients. But practices and their profes-

care. By whatever name, the end goal is to generate bet-

sionals must be wary of the inherent risks, as well.

ter health outcomes through a shared risk approach with

Consider:

set prices built around “bundles” of services like com-

If this hasn’t happened already, it should be a top

prehensive primary care, joint replacement or oncology

priority for 2021: Update risk management policies and

care. When costs come in below the target, a share of the

procedures to reflect added telemedicine services. These

savings is returned; when they are over, a share is paid

should cover documented standards of care for telemed-

back. Protections like stop-loss insurance help against

icine evaluated against the use of the technology by each

the downside risk.

provider. The issue is overreach and ability to maintain standard of care – the professional’s ability to distinguish

3. MOUNTING PERSONNEL ISSUES pressure credentialing processes

an ordinary skin lesion from melanoma, and to advise when an in-person evaluation is needed.

Telemedicine’s resurgence caused a general influx of

Cyber and billing fraud are risks too. The Depart-

requests for telemedicine services and appointments.

ment of Justice has the antenna up for escalating

While CMS opened the door wider to telemedicine’s

telemedicine claims fraud, charging 86 medical

availability across state lines with the coronavirus,

professions with submitting $4.5 billion in allegedly

ORLANDOMEDICALNEWS.COM

JANUARY 2021

too easy to check the license but skim over a bad pattern of claims. And under the “vicarious liability” theory of law, third party employers – clinics, private practices and hospitals – can be sued for their contractors’ negligence. The best protection is due diligence based on best practices for credentialing and privileging. Credentialing must be done before the doctor or nurse is allowed to provide care, while privileging must be timely, so the organization’s governing body approves privileges before care is provided. The approval process should also be reviewed by counsel for updates or changes. And look for potential red flags, like unusually high loss runs in lower-risk practices, job hopping and license suspensions in higher risk specialties. Professional liability coverage is under too much pressure to risk a bad hire. The big challenge for healthcare in 2021 will be in successfully marshaling the resilience to emerge from the other side of the pandemic whole – and better positioned than ever to balance the opportunities and risks ahead. As Chief Sales Officer for HUB Florida, Jeff is responsible for overall leadership and results of the sales organization. In 2003, he joined SellersKuykendall, which became part of HUB International Florida in 2014. Jeff specializes in placing Property & Casualty business, establishing new carrier relationships and growing/managing a P&C book of business. He has served as President of Independent Insurance Agents, Volusia County; and on the board of the Orlando Chamber of Commerce, Blankner School Foundation, and Florida Citrus Sports Foundation. He graduated with a BSBA from the University of Florida and since then, earned designations as a Certified Insurance Counselor (CIC), Chartered Property and Casualty Underwriter (CPCU) and Certified Risk Manager (CRM).

PHYSICIAN || SPOTLIGHT PRESENTED BY

Making a Change in a Trying Time Dr. Luis Serrano moves to a new area and practice in the middle of a pandemic. A pandemic is not the time to be moving and joining a practice, but in that challenging atmosphere, Dr. Luis Serrano was recently welcomed to help expand Osceola Surgical Care Specialists’ dedicated services in the Kissimmee area as a general surgeon with subspecialties in bariatric surgery and minimally invasive foregut surgery to treat conditions of the upper gastrointestinal (GI) tract. Here, we introduce Dr. Serrano to Central Florida’s medical community through an informative Q&A:

and rectal surgeon, Dr. Philip Kondylis. I enjoy seeing residents learn and grow in their own careers.

When did you know you wanted to be a physician?

What are the main reasons patients are referred to you?

Dr. Serrano: Growing up in Quito, Ecuador, I saw a huge population in need, which is ultimately what made me want to help people. I began to look up to physicians and thought they were amazing. As soon as I saw my first surgery in my third year of medical school, I knew I wanted to be a surgeon. My work is technical and complex, but many of the treatment plans I provide are also straightforward. I appreciate that someone can come to me with a medical problem, and I can often deliver relief and improve their quality of life with just one procedure.

Dr. Serrano: Gastroenterologists often refer patients to me for pathologies affecting the esophagus, including obstruction, narrowing or functional immobilization of the esophagus, as well as food regurgitation into the esophagus and upper GI bleeding due to ulceration or laceration of the esophageal mucosa. I commonly perform Nissen fundoplication (or Lap Nissen), a laparoscopic procedure performed for patients with GERD, as well as hiatal hernia surgery, Heller myotomy procedures, and the entire spectrum of upper GI surgery. Primary care doctors can refer patients to me for weight loss surgery, hernia surgery, gallbladder surgery and any other general surgeries their patients may need.

Can you tell us about your journey to become a surgeon here in Orlando? Dr. Serrano: I was born and raised in Ecuador, but because my mother was American, I had dual citizenship. My family traveled to the U.S. a lot growing up, which inspired me to move here as an adult. After attending medical school at the Universidad Internacional del Ecuador, I ultimately decided to train in general surgery at East Tennessee State University. Tennessee reminded me a lot of my home – the people were very family-oriented, there were beautiful mountain views, and I had plenty of opportunities to hike. Following my training, I wanted to stay in the Southern U.S. and further explore both bariatric and minimally invasive surgery. I found a great fellowship at the University of South Florida that checked both boxes. After completing my fellowship, I wanted to get into practice doing upper GI and bariatric surgery, which is how I discovered the role with Osceola Surgical Care Specialists.

Are there any common misconceptions patients have regarding GI issues? Dr. Serrano: When it comes to digestive issues, such as reflux and GI motility disorders, patients often ignore their discomfort and chalk symptoms up to “bad genetics.” However, there’s so many things we can do

Besides appealing to your subspecialties in bariatric and minimally invasive foregut surgery, what made this new role attractive to you? Dr. Serrano: Being affiliated with HCA Healthcare meant that I would have opportunities to work with residency programs at Osceola Regional Medical Center, as well as medical students at UCF Lake Nona Medical Center, our newest Central Florida hospital set to open in early 2021. Academically, receiving mentorship and mentoring others was always a huge part of my journey. Having been taught by great professors and mentors myself, I feel it’s my duty to give back. So far, I’ve been very involved in helping teach residents alongside colon

ORLANDOMEDICALNEWS.COM

JANUARY 2021

to help. If a surgical procedure is required, the robotic platform has been a game changer. While these were once considered major surgeries, patients now enjoy a shorter stay in the hospital – often between 24 to 48 hours – and can return to normal activities in just a few short weeks. While something like chronic reflux may not seem life-threatening, chronic exposure of acid within the esophagus can lead to a condition known as Barrett’s esophagus, in which the flat pink lining of the swallowing tube that connects the mouth to the stomach becomes damaged. Not only does this cause constant discomfort and trouble sleeping, but it can also predispose patients to esophageal cancer. If something feels off, it’s always in a patient’s best interest to seek medical guidance and investigate treatment options.

You started your new role amid the COVID-19 pandemic. What’s that been like? Dr. Serrano: The pandemic has certainly presented challenges. We quickly adapted our policies and procedures to ensure patient safety and comfort. In lieu of the traditional in-person info sessions, we’ve also had to get creative to market our surgical offerings to the community. The biggest challenge has been building personal relationships with other physicians and residents. Normally, you’d be inviting your new colleagues to lunch, but social distancing has limited this. Instead, I’ve improvised by setting up virtual and socially distanced meetings.

CONTINUED P.7

Your Front Office:

continued

Dr. Luis Serrano How do you maintain a positive work/life balance?

The Bridge Between Service Provided and Payment The average calculated cost to send a patient’s claim to insurance companies is $6.50. Every time a claim is not accepted for processing or denied, the cost doubles. This cost will cut into the optimal revenue that is obtainable from each service provided. Many denials can not only loose the office money, but also can cause negative revenue costing the provider money for treating the patient. Critical information required to bill an insurance company includes patient name, date of birth, address, gender, insurance policy number, group number if any, company name, claims submission address, subscriber name and relationship to patient. It is best if copies of the patient’s ID and insurance card can be obtained; both front and back. In the case of specialist practices where referrals are required, referring doctor’s name and NPI number must be obtained. If authorization is required, it is very important to obtain these BEFORE services are rendered. Only in the case of emergencies will insurance companies post-date an authorization, and that too, usually within 24 hours. If your scheduler allows for online pre-registration or if you have the ability to check patient eligibility prior to a visit or during patient check-in, it is best to do so. This will also permit you to verify and collect any co-pays at the time of the visit. If your practice relies on patient completed forms, patient handwriting is not always legible. Therefore, new patient packets should be checked by staff and information confirmed while the patient is in the office. The information required and a practice’s options to gather these can vary dramatically by the type of

BY KAREN RUMBLEY

Everyone is aware of how important the front office staff is in a medical office. This is the first person that will make an impression (good or bad) on how efficient your office is. It is always good to have someone who is friendly and shows patients individual attention and concern for whatever brings them to your office. A friendly trustworthy relationship between the front desk person and the patient is significant in the beginning stages of the provider/patient relationship. Your front office staff is also that most important bridge between patient registration and successful billing. It is crucial this person have the knowledge provided to them to collect all necessary information in order to assure proper payment for all services provided. Practices usually look to the billing department for proper collections. The front office is equally important to the financial well-being of your practice. There are many basic rules to follow when billing to insurance companies. For example, a patient may have Medicare but also have Tricare and not know who their primary carrier is. It is the office staff who will provide all insurance information to the data entry and billing departments for the practice and must give correct information. They should be provided the training to identify which insurance should be listed as the primary payer to enable clean billing. A simple typo or billing to the wrong insurance carrier can hold up the processing of a claim and delay payment.

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Dr. Serrano: When life gets busy, I remember the advice of one of my mentors: family comes first. With a two-year-old daughter and a son on the way in February 2021, my wife and I strive to live by this motto. It doesn’t matter how great a job I’m doing at work if I’m not also showing up in my personal life. If my family is happy, then I’m happy – and I’m a better doctor. It’s a snowball effect.

Do you have any unique hobbies? Dr. Serrano: I have a variety of active hobbies, including running, cycling and all things sports. I enjoy playing guitar and adding to my music collection. As my family gets settled in Orlando, I’d also like to pick up martial arts again. It’s something I enjoyed as a young child in Ecuador. Dr. Serrano practices at Osceola Surgical Care Specialists, an affiliate of Osceola Regional Medical Center and the HCA Healthcare North Florida Division – Orlando Market. Phone 407.483.3376

practice, systems used and staffing. A generic Front Office Checklist of information required can be found at https://www.medusahcs.com/billing-checklist-for-officestaff/. Implementing this checklist will not only act as an educational tool, but also ensure that proper information necessary for clean billing is obtained. For those requiring assistance developing a custom checklist based on your practice’s capability and workflow, we will assist you free of cost if contacted before January 31, 2021. To request a copy of the “Front Office Checklist” or for additional information contact Suresh Thekkenmar 800244-6550 or solutions@medusahcs.com. Karen Rumbley serves as the Director of Operations for MedUSA Healthcare Services. She prides herself on creating efficient revenue cycle solutions for the company and their diverse clientele, including Anesthesia, Neurology, Surgical, Family Practices. Physiatry, Behavioral and many other types of health care providers. Karen has been in the health care industry since 1986 with a wide variety of revenue cycle management roles. She served as Regional Director of Business Office Services for the North Florida Region of Consulate Health Care as well as Billing Operations Manager for the Central Florida Region of AdventHealth prior to joining MedUSA. Visit www.medusahcs.com

EOCC || MEDICAL CITY

EAST ORLANDO CHAMBER OF COMMERCE

PRESENTED BY

CALENDAR:

A Fresh Start 2021

Testimonial Tuesday

BY DOROTHY HARDEE, CHAMBER ADMINISTRATOR

(2nd Tuesday of the month)

TUESDAY, JANUARY 12 9:00 – 12:00 PM

“Expect the unexpected.” Bear Bryant

East Orlando Chamber office  12301 Lake Underhill Road, Ste. 245, Orlando, FL 32828  Sponsorships Available (2 doz. Donuts)

After Hours at Orlando Lighting Systems

and connect you with others helping your business thrive. Testimonial Tuesday features our members on a live broadcast allowing them to share personal and professional information with listeners. The Member

If we have learned nothing else from 2020, it was to

TUESDAY, JANUARY 12 5:00 – 7:00 PM

expect the unexpected. What started out as a strong year, 2020 became a blur of never-ending masks, quaran-

Orlando Lighting Systems 10970 Piping Rock Circle, Orlando, FL 32801

tines, shortages, fatigue, zoom meetings and, well you get the picture. I don’t know anyone that is not ready to put

The Hybrid Member Academy: Roadmap to Member Success

this year behind us. The East Orlando Chamber pivoted quickly early in

WEDNESDAY, JANUARY 3 8:30 AM – 10:30 AM

the pandemic and has incorporated a mixture of virtual

Hybrid Event - East Orlando Chamber office  12301 Lake Underhill Road, Ste. 245, Orlando, FL 32828

and hybrid events to meet the needs of businesses and

Healthcare Council Collaborative Virtual Panel Discussing & Networking

focused on industry and the needs of our members mak-

the community. Cautiously welcoming 2021, we are ing recovery possible. Our Healthcare Collaborative will partner with the Physicians Society of Central Florida, Orlando Medical News and Health Council of East Cen-

Three Things You Should Know: COVID19 Vaccines & Being Better Prepared for 2021

tral Florida to bring a monthly virtual meeting address-

THURSDAY, JANUARY 14 7:45 AM – 9:00 AM

ing “3 Things You Should Know” for healthcare. January 14th, we will examine COVID 1 vaccine &

Virtual Event | Registration required

Being Better Prepared for 2021 featuring our experts

Testimonial Tuesday On Location

Rick Larson (Rick Larson Law), Michael Muszynski,

Featuring Goodfella’s Pizzeria and

MD, FAAP (Florida State University College of Medi-

The Orlando Law Group

cine) and Donna J. Walsh, MPA, BSN, RN (Seminole

TUESDAY, JANUARY 19 11:00 – 11:30 AM

County Health Department). With the COVID vaccines in full swing for essential

Goodfella’s Pizzeria and Italian Restaurant 11873 E. Colonial Drive, Orlando, FL 32826

workers and at-risk individuals, can an employer require

EOCC Spark 365 Brain Trust After Hours

practices emerging for employers to consider in 2021?

an employee to become vaccinated? What are the best Rick Larson will share his 35 years of organizational

TUESDAY, JANUARY 19 4:00 – 5:30 PM

insights and legal compliance strategies as a Florida employment and Human Resources attorney addressing

East Orlando Chamber office  12301 Lake Underhill Road, Ste. 245, Orlando, FL 32828  Member Exclusive with Limited space

these complex issues. Significant developments of our scientific understanding of COVID 19 is ever changing We will examine the

Coffee Club Nona

science behind the vaccines, how they differ and how

(3rd Thursday of the month)

these differences affect the vaccine strategy thanks to

Business Optimization 2021 Panel Discussion

Michael Muszynski, MD FAAP, Professor Emeritus of

THURSDAY, JANUARY 21 8:30 – 9:30 AM

Clinical Sciences at the Florida State University College

Sam’s Club Lake Nona  11920 Narcoossee Road, Orlando, FL 32832  FREE to EOCC Members | $10 for Non-Members

of Medicine. Donna J. Walsh, MPA, BSN, RN with Florida Department of Health in Seminole County will round out our

Central Bark Ribbon Cutting

panel discussing the efficacy and delivery of the vaccine.

FRIDAY, JANUARY 22 10:00 – 11:00 AM

Following the conversation, attendees will have the opportunity for breakout networking with our panel.

Central Bark East Orlando 5221 Young Pine Road, Orlando, FL 32829

“Today is your opportunity to build the tomorrow you want.” Anonymous

Quarterly Chamber Luncheon

Pete Folch with Second Wind – Finish Strong, Inc. will

Board Installation & 2020 Chamber Awards

inspire us as we celebrate our 2020 Chamber champions

WEDNESDAY, JANUARY 27 11:30 AM – 1:00 PM

during our annual recognition luncheon and installation of our 2021 Board of Directors. The Honorable Judge

Bonefish Grill Waterford 12301 Lake Underhill Road, Orlando, FL 32828 Registration required.

Eric Dubois will install our board as Karen Jensen (Orlando Health) passes the gavel to our 2021 Board Chair,

EOCC Spark 365 Brain Trust

Martha Santoni (Nemours Children’s Hospital). Rede-

THURSDAY, JANUARY 28 8:00 – 9:30 AM

fine the possibilities for your success, attending the East Orlando Chamber January luncheon, January 27, 2021

East Orlando Chamber office  12301 Lake Underhill Road, Ste. 245, Orlando, FL 32828  Member Exclusive with Limited space

Please visit EOCC.org for a complete listing of January events

The East Orlando Chamber is here to help with unique offerings to help elevate your businesses visibility

from 11:30 AM – 1:00 PM at Bonefish Grill Waterford. Register today for a memorable kick off to a New Year.

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JANUARY 2021

Academy shows new members how to use the valuable resources provided with hands-on training to jump start their chamber journey. Taking it one step further, the EOCC Spark 365 Brain Trust is an intimate meeting of the minds helping to decode problems, design solutions and offer leads members desire. We have an exciting lineup for 2021 including our February 3rd Women in Successful Endeavors (WISE) luncheon featuring Women in Tech moderated by Avani Desai, President of Schellman & Company, Inc. hosted at The Celeste Hotel. OPTIC – Orlando Professional Technical Innovation Council is virtual March 12th from 8:00 AM – 12:00 PM focusing on Teleworking | Tele managing, inspiring employees and offering leadership presented in partnership with Full Sail University. Connect 4 for Property Professionals is also returning in collaboration with Orlando Regional Realtors Association and so much more. For more information or to register call (407) 2775951 or visit our website at eocc.org. The East Orlando Chamber of Commerce everywhere East of I-4.

Cannabis as a Beneficial Replacement Therapy for Psychotropic Drugs with Treating Neuropsychiatric Symptoms of Severe Alzheimer’s Dementia BY MICHAEL C. PATTERSON

therefore decrease NPs of Alzheimer’s. Cannabis and cannabinoid therapy are becoming more mainstream within the medical community due to their extremely low side effects and positive results in relieving symptoms of many different diagnoses. More research will continue to be done on AD using cannabinoid therapy. The early results are extremely positive, which can increase AD patient and caregiver physical and emotional health, increasing overall quality of life, and a decrease in AD related health care expenses related to severe AD (falls, fractures, decrease in polypharmacy by taking less prescription medication, 24/7 supervised care)

A recent study published by the US National Institutes of Health (NIH) and Frontiers of Psychiatry found that the use of a synthetic cannabinoid medicine (dronabinol) decreased Neuropsychiatric symptoms (NPs) in a clinical study of a female patient with severe Alzheimer’s Disease (AD).

Medical Cannabis Does Not Create Cognitive Decline in Seniors A recent study published in the September 2020 edition of the Drug and Alcohol Review, determined that the use of medical cannabis does not create a cognitive decline in senior citizens. The link to the study is here: https://onlinelibrary.wiley.com/doi/10.1111/dar.13171 The study was performed by Sharon R. Sznitman PhD, Senior Lecturer, Simon Vulfsons MD, Director,

The link to the study is here: Cannabinoid as Beneficial Replacement Therapy for Psychotropics to Treat Neuropsychiatric Symptoms in Severe Alzheimer’s Dementia: A Clinical Case Report (nih.gov) Alzheimer’s Disease is a debilitating neurogenerative disease that affects approximately 17 percent of people in the world from ages 75-84. Neuropsychiatric symptoms (NPS) such as delusions, agitation, anxiety, and hallucinations are present in up to 95 percent of patient in all stages of dementia. As someone with a tremendous amount of experience as an occupational therapist working in an Alzheimer’s nursing home for 3 years and treating Alzheimer’s patients for over 20 years, I can tell you that it is one of the worst diseases for humanity I have ever encountered. Currently, there is no prescription drug that has been approved specifically for the treatment of NPs. The clinical case study involved is from a female patient diagnosed with AD with continuous cognitive decline and dementia related behavioral symptoms. Between 2008 and 2019, the patient was examined every 6 months at the memory clinic of the Medical University in Innsbruck, Austria. During each visit, the patient’s cognitive state and pharmacological treatment were evaluated via the neuropsychiatric inventory (NPI). In 2018, the patient progressed to severe AD stage and presented with progressive NPs (anxiety, delusions, agitation, aggressive behavior, and suspected pain due to long immobility). At this time, off label treatment with low-dose dronabinol (synthetic THC) was initiated. Once lowdose dronabinol use commenced, the patient’s emotional state improved, while disruptive behavior, aggression, and sedation decreased significantly. Furthermore, the patient was decreased from 6 psychotropic drugs to 3 after starting dronabinol due to no longer requiring the added psychotropic drugs.

Analysis The results in this case study are consistent with anecdotal results seen in patients all over the world using THC or synthetic THC medical cannabis. There is evidence that cannabinoid therapy can break up amyloid plaques in the brain (which are caused by AD), and

ORLANDOMEDICALNEWS.COM

JANUARY 2021

David Meiri PhD, Lecturer, Galit Weinstein PhD, Senior Lecturer at Israel’s Haifa University School of Public Health. The study included 125 cannabis users who were 50 years and older. Out of the 125 study participants, 63 had Israeli government permission to use cannabis and 62 did not have permission. Each participant was put through a multitude of tests consisting of CogState computerized brief battery used to assess cognitive performance of psychomotor reaction, attention, working memory and new learning. Regression models and Bayesian t‐tests examined differences in cognitive performance in the two groups. Furthermore, the associations between medical cannabis use patterns (dosage, cannabinoid concentrations, length and frequency of use and hours since last use) with cognition were assessed among medical cannabis licensed patients. Patients were tested before use of medical cannabis and after use of medical cannabis. The result of the study showed no detectable difference in cognitive ability before or after use of medical cannabis. Dr. Sharon Sznitman and Dr. Galit Weinstein

CONTINUED P.11

Why the COVID-19 Vaccine Alone Isn’t Enough BY MEAGHAN HISLOP

office or healthcare facility gets vaccinated, it’s not the isolated environment it may seem. We don’t live in a bubble, and each and every one of us goes home to a family and/or interacts with the public at some point. While social distancing, personal hygiene and increased ventilation are important, the more human traffic an area gets, and the more spaces people touch (including chair arm rests, door handles, pens, coffee pots, copy machines, phones, etc.), the more these areas should be disinfected. Whole space disinfection is vitally important to help disinfect not just one surface, but all of these surfaces at once. Even when employed on a regular basis, partial disinfection may not be enough to prevent transmission. Hand-wiping surfaces and equipment using solutions with 99.9 percent effectiveness rates (and that’s only IF used properly with very specific dwell times on the surface) may leave behind many viable pathogens. While some exposure to germs can help keep our immune system healthy, exposure in the doctor’s office, in an ambulance, or even in a hospital room is not the time or place to be challenging one’s immune system. Even

As millions of Americans begin getting, or making appointments to get, the new COVID-19 vaccines, our lives and businesses are on their way to getting back to “normal.” But even so, it’s important to understand that while the approved vaccines show strong efficacy rates, we can’t let our guard down just yet on disinfection and other measures to stop the spread of disease. Not only is there a lot we still don’t know about these vaccines as they relate to transmission, but with all the focus on SARS-CoV-2, it’s easy to forget that there are still a lot of other viruses and bacteria in our world which can cause significant illness and potential outbreaks. With fewer cars on the road due to COVID-19 restrictions, data indicates there have been fewer auto accidents. Despite this, we continue to wear seatbelts while driving. In that same vein, even though the COVID-19 vaccines are starting to be distributed, this doesn’t mean we should let our guard down toward disinfection and other safety measures. Both Pfizer-BioNTech and Moderna, the FDA approved vaccines, achieve the primary goal of preventing severe disease, with an impressive effectiveness around 95 percent for both. As the trials for both primarily focused on symptomatic patients, the vaccine’s potential effects on transmission from asymptomatic individuals remains to be seen. The UK distribution, and ongoing clinical trials, of the AstraZenica vaccine may help answer these questions for that vaccine, but ultimately more data is needed to understand if these vaccines will prevent transmission as well as preventing severe disease. For the moment, we don’t have a hardline answer about how the vaccine could influence asymptomatic cases, and specifically, if those individuals could still unknowingly transmit the virus even after vaccination. While we should all be optimistic given the demonstrated effectiveness of both the Moderna and Pfizer vaccines, we don’t yet know enough to fully let our guard down. Keeping in mind too, that many at-risk individuals will be unable to get the vaccine at all, either because they are immunocompromised, or because they may have vaccine-related allergies. So, it seems until the vaccine has widespread adoption and we better understand the effects on transmission, we need to continue to protect the community around us through preventive measures, including disinfection of office spaces, patient rooms, waiting rooms, ambulances and more. It’s important to keep in mind that best laid plans aren’t foolproof when it comes to highly contagious disease. In fact, despite reaching this vaccine rollout period, there remains a concern for increased transmission due to a false sense of security that being vaccinated may give people. Even if everyone in an

more thorough disinfecting systems with higher kill rates often use chemicals and ingredients that are surprisingly toxic to humans and can cause corrosion of equipment and surfaces. And then how do you even know the effective kill rates are achieved? With the proper disinfection system, not only are patients thoroughly protected, but equipment and office materials are not compromised or harmed. In addition, the best systems create and maintain an optimal Pathogen-Kill Zone™ that reaches every nook and cranny, even where eyes can’t see, and hands and UV light can’t reach. For example, a Hybrid Hydrogen Peroxide (HHP) system can kill 99.9999 percent of dangerous germs*, including impacting SARS-CoV-2 (COVID-19); and sync to a state-of-the-art app for remote operation, real-time job tracking and reporting, so it’s no longer just guessing whether or not the space has been properly disinfected, but there are provable and measurable results for quality control. These systems, such as the HHP from CURIS System in Oviedo can deliver a ten times stronger, safer, and more thorough kill than UV light.

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Cannabis as a Replacement Therapy

Why the COVID-19 Vaccine Alone Isn’t Enough While COVID-19 has been one of the worst pandemics to occur during most of our lifetimes, there may be a silver lining for healthcare and emergency services. If nothing else, this pandemic has opened up the door for the industry to enhance its common disinfection practices every step of the way and to be more thorough and more efficacious in fighting the environmental transmission of disease and infection. So even when the COVID-19 pandemic is (hopefully) in the history books, we still need to be concerned with stopping the occurrence and transmission of diseases such as MRSA, flu, Candida, and others, and we need to stay vigilant for similar threats in the future. Epidemiologists agree that this is unlikely be the

noted that the results of the study do not show any widespread change on cognition in older chronic pain patients. Considering use of medical cannabis is increasing in older populations, this study could be a first step toward a better risk-benefit assessment of the use of medical cannabis with Seniors. The researchers also noted that “previous studies have shown that medical cannabis can have long-term effects on the brain when consumed at a young age. Those affects are not necessarily the same when consumed in old age.”

Analysis Senior Citizens are the fastest growing demographic of users of medical cannabis in the United States. With over 435,000 medical cannabis patients in Florida and the average age of a medical cannabis patient over 50 years old, many Seniors are currently using medical cannabis. However, these numbers could be considered the “tip of the iceberg.” As more senior citizens become comfortable using medical cannabis for their diagnoses with less side effects and more relief than traditional pharmaceutical medications, we will see many more seniors starting to use medical cannabis into 2021 and beyond. Physicians and health care organizations need to educate seniors on the benefits of medical cannabis and begin to track the data related to outcomes of seniors who take cannabis as a medicine. Not only is medical cannabis safer than traditional pharmaceuticals (for most patients), but it is also more cost effective for health care organizations (ACOs) for cost of care per patient. The evidence is in the data. As more ACOs and health care entities start to track the data around use of medical cannabis and see better outcomes and decreased cost of healthcare within their system, you will see more acceptance of medical cannabis as a medicine within the current healthcare community. 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

FOUNDER

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last pandemic we will need to deal with. And while too many of us were caught off guard for COVID-19, there is a lot we can be doing today to make sure we are not caught off guard again. Remember, even with all we’ve done over the years to fight tuberculosis, still today about 10 million people per year contract the disease and 1.4 million people died from it in 2019. So even post COVID-19, don’t throw away your masks, don’t stop watching your hands, and by all means, don’t stop cleaning and performing the most advanced disinfection. *Kill of c.diff in a tri part soil load Meaghan Hislop is the research biologist for CURIS Decontamination System. Visit www.curissystem.com

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How Has the COVID-19 Pandemic Impacted Your Practice? BY JOHN FOGARTY AND BRIAN HAZELGREN

providers and the evaluation of healthcare costs. During semi-structured interviews with 48 CCM beneficiaries or their caregivers, beneficiaries reported general satisfaction with CCM services and would recommend the service. Many beneficiaries felt that participating in CCM services had provided them with more timely access to their CCM practice. Beneficiaries appreciated having ready access to a nurse or care manager who could communicate with the physician or schedule an appointment more quickly than the patient could have. As one beneficiary explained, "I felt like I had an in to the doctor, like there was somebody else to help me through that process rather than just calling the main number, and then you wait on hold and then they have to type it in the computer and then they have to get it to the doctor." Another beneficiary described how prompt attention from her primary care office helped prevent a potentially dangerous drug interaction. "When I had a blood test, my iron was low, so the doctor said that I should go to the drugstore and buy some iron medicine...I was just looking at it one day and it said on there do not take iron medicine with the thyroid medicine, that it could have serious repercussions. I called (the nurse) and asked her… Within five minutes, she had talked to the doctor and he had given her different instructions, she relayed them to me and we changed the medicine and it was all done in 15 minutes."

“The viability of physician practices remains under threat as the battle against the COVID-19 pandemic takes a new turn with record levels of cases being reported across the United States. A new nationwide physician survey issued in October by the American Medical Association (AMA) shows medical practices have been economically stressed by the public health crisis with a 32 percent average drop in revenue. “Physician practices continue to be under significant financial stress due to reductions in patient volume and revenue, in addition to higher expenses for supplies that are scarce for some physicians," said AMA President Susan R. Bailey, MD. If you are a physician in your own practice, most likely you have experienced significant challenges over the past few months. If you have plans to increase your practice revenue and build a legacy practice, you'll want to read more. Brian Hazelgren consults with physicians around the globe on increasing practice efficiencies and revenue. He reveals the first time ever combined "Triple Play" essential components of healthcare and the movement that is disrupting and positively impacting healthcare in a huge way. A Triple Play in baseball is a rare, magical moment when teamwork, skill, and timing all combine to deliver a beautifully harmonious 1-2-3 sequence! This Triple Play program combines CM/RPM/ Medication Management working together to enhance patient care and substantially increase revenue for your practice. The entire goal of combining these three services is to provide improved care for your patients by, keeping them out of the ER, and dramatically cutting down on acute care readmissions. "There are practices bringing in $200,000+ annually with just 300 Medicare patients on this program," states Hazelgren. Today, we want to focus on Chronic Care Management. Chronic Care Management (CCM) - Medicare CPT Code 99490 — provides a new stream of revenue of $42* (national CMS average) or more per patient per month. A team of care coordinators works with your Medicare patients to record and archive an electronic record of 20 minutes or more of non-face-to-face visits with your patients. This service was launched by CMS in 2015 and is really catching fire and improving patient care. In 2017, Mathematica Policy Research services studied the impact the CCM program was having on patient care, practice impact, and overall cost of healthcare impact. They reviewed two years of data from the start of the program in January 2015 through December 2016. The study focused on three major areas – the impact of the program on the patient care,

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One beneficiary described how the monthly phone calls helped him and his wife, who was also receiving CCM services, to remain mindful of their health. "We think about our health more and what we're doing, right or wrong with these phone calls, that we're getting every month now. It's a good thing." In future articles, we will cover the impact on the practice and healthcare costs. This is an essential addition to your practice to add the most impressive business system and structure to improve patient satisfaction and increase revenue. There is a distinct advantage for you to be first in your area to implement these services - because only one provider's NPI number is associated with the patient's ID. There are less than 6 percent of eligible Medicare patients on the system today, but it is catching fire, and new patients are being enrolled daily. Don't miss your opportunity to take advantage of revenue on the table.

John Fogarty is regional Developer for RX2Live. He has spent 21 years in nuclear generation, transmission and distribution. He holds a master’s in International Management. He became an RX2Live developer to improve patient care and help providers and practices succeed. Contact him at jfogarty@rx2live.com Brian Hazelgren is CEO of RX2Live - a medical services and practice management company. Brian is a Best-Selling author and speaker, and has helped medical professionals generate over $1.3 Billion in new income streams over the past two decades. To learn more about these medical services bundled together for physicians, you can reach Brian at bhazelgren@rx2live.com or visit www.rx2live.com.

Protect Your Lungs in 2021 – Now is the Time to Quit Smoking and Vaping FR0M JANELLE HOM

but in an interview with Bloomberg News, FDA spokesman Michael Felberbaum said, “People with underlying health issues, such as heart or lung problems, may have increased risk for serious complications from COVID-19. This includes people who smoke and/or vape tobacco or nicotine-containing products.” Additionally, people who vape may engage in behaviors that could expose them to COVID-19, such as removing their masks to vape, sharing vapes with others and touching their face more often. One of the most popular resolutions at the beginning of each year is the desire to quit smoking, with more than 70 percent of smokers reporting they want to quit. With the help of the American Lung Association, more than a million people have achieved success with their goal to quit smoking. For youth, our Vape-Free Schools Initiative focuses on helping schools navigate the public health crisis of youth vaping by equipping school personnel with key trainings and resources. The program includes trainings to implement INDEPTH®, an alternative to suspension program, Not-On-Tobacco, (N-O-T®) a youth-centered vaping/ tobacco education and cessation program, as well as an assessment and guidance on implementing a comprehensive tobacco-free school policy.

The COVID-19 pandemic has underscored the importance of lung health. Smoking is a risk factor for severe illness from COVID-19, which makes 2021 an even more opportune time to begin the journey to quitting once and for all. The Centers for Disease Control (CDC) has identified that smokers might be at increased risk for severe illness from COVID-19. We know that smoking and vaping causes harm to the lungs, leaving lung tissue inflamed, fragile and susceptible to infection. In addition, tobacco use has been proven to harm the immune system and airway lining cells that contain cilia on their surface. which are our essential defenders against viruses like COVID-19. Without them working properly, our lungs are more vulnerable. One study suggests that smokers may be at a 2.4 times higher risk for severe illness than non-smokers, and another found that current and former smokers were about twice as likely to experience disease progression compared to nonsmokers. We don’t have any studies yet that conclusively link vaping to a higher risk of severe COVID-19 symptoms,

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For adults, the Lung Association’s Freedom From Smoking program is ranked as one of the most effective cessation programs in the country. The program has helped hundreds of thousands of people quit smoking for good and is now available in a variety of formats – online, in-person clinics and over the phone. The COVID-19 pandemic presents an opportunity for people, when they’re ready, to find the proven quit smoking support they need. Quitting tobacco will immediately improve your health and might also decrease your odds of severe illness from COVID-19. It’s the perfect way to set yourself up for a healthy new year and healthy years to come. We encourage Orlando residents to start your journey to a tobacco-free life. Learn more at Lung.org/quit-smoking. Janelle Hom is the Executive Director of the American Lung Association in Florida. Email her at Janelle.Hom@lung.org. Visit www.Lung.org

Introduction to Multifunction Cardiography BY RAFFI B. SHEN, NORBERT RAINFORD, MD, AND JOSEPH T. SHEN, MD

the greatest tools of our arsenal are worse than a flip of a coin. It is within this medical and industrial context, that we address this deficiency in our field by introducing a viable alternative in the form of the Multifunction Cardiogram (MCG) (7), a noninvasive, bedside, radiation and drug free diagnostic tool that requires no stress or strenuous physical activity from the patient to quantitatively assess lesions across all stages of the disease from microvascular level, early non-obstructive to later stages of significantly obstructive spectrum, capable of monitoring the effectiveness of any form of therapeutic intervention affordably, quickly in 10 minutes at bedside, and without the usual confines of human error. After 20 years and the work of two generations of mathematicians, computer engineers, and physicians, MCG Technology stands as the first embodiment of a mathematical and empirical application of systems theory to a dynamic biological environment, expressing the physiological state of the heart with a primary focus on the level of its ischemic burden, regardless the cause, whether it is large coronary artery obstruction or microvascular metabolic disease. The digital, deep machine learning platform is capable of describing the functional, dynamic state of the heart without relying on merely anatomical information. The development team’s greatest priority has been ischemic burden measurement, but additional markers needed to be used to describe the heart within a functional/physiological context, and to do that, the mathematical expressions of the communication between two standard ECG leads over multiple cycles were used, converting the digitized signals into a frequency domain via multiple nonlinear mathematical functions, thus the term “multifunction” cardiography. This, combined with systems analysis principles, advanced and proven digital signal processing methods, Lagrangian Mechanics Mathematics, empirical clinical data-mining, evidence driven deep machine learning, and specialty artificial intelligence algorithms have created, to our knowledge, the first example of a commercially available information technology solution in the discipline of “Clinical Computational Electrophysiology” (7). MCG Technology fills the knowledge gap left empty by other diagnostic tools, able to deliver high levels of unprecedented diagnostic accuracy, ranging from 89

Coronary artery heart disease (CAD) is a leading, major cause of death and disability in developed countries, responsible for around one-third of all deaths among individuals over the age of 35 (1-3). About half of all middle-aged men and one-third of middleaged women in the United States will develop some manifestation of CAD in their lifetime (4) with several unrecognized drivers and causes of the persistence of this morbidity despite our general knowledge of major risk factors based on population data such as the Framingham Heart Study. The lack of adaptable, inexpensive, noninvasive, and accurate modalities to detect CAD in its early stages as well as the lack of potent monitoring of the effects of diet and other lifestyle interventions has been a major factor in this information gap. The current state of diagnostic testing is dismally poor, with accuracy from both normal ECG testing, rated at less than 15-30 percent, and other “gold standard” modalities such as stress testing, nuclear scintigraphy, stress echocardiography, and other various types of noninvasive cardiac stress imaging stress tests rated at 38-40 percent, either missing patients with critical issues entirely, or misattributing diagnosis leading to unacceptably high false positive rates, leading to a significant number of patients undergoing unnecessary coronary angiography at a rate of nearly 60 percent.(4)Patients who are given a false positive diagnosis are exposed to potential risks involved with invasive procedures and radiation exposure without expected commensurate clinical benefit because of this inadequacy (5). Women, more than men, die from cardiovascular disease simply due to the lack of a better tool. Compounding this, there is an emerging consensus of the role of non-obstructive coronary disease and microvascular disease being the cause of clinical manifestation of ischemic heart disease, further burying the relevance of conventional testing for obstructive CAD. A review in Circulation, 1995, by Erlin Falk demonstrated that the progression to plaque rupture and myocardial infarction (MI) over time occurs most frequently in patients with obstruction of 50 percent or less (6), far lesser than what most current conventional tools would be generally able to detect as a “problem.” To put it lightly, between the normal ECG testing rates having 30 percent accuracy at best, and the other “gold standards” maybe reaching 40 percent, that means all

REFERENCES: 1. Rosamond W, Flegal K, Furie K, et al. Heart disease and stroke statistics–2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2008;117:e25.

8. Weiss WB, Narasimhadevara SM, Feng GQ, Shen JT. Computer- enhanced frequency-domain and 12-lead electrocardiography accurately detect abnormalities consistent with obstructive and non-obstructive coronary artery disease. Heart Dis. 2002;4:2-12.

2. Nichols M, Townsend N, Scarborough P, Rayner M. Cardiovascular disease in Europe 2014: epidemiological update. Eur. Heart J. 2014;35:2950.

9. Grube E, Bootsveld A, Yuecel S, et al. Computerized twolead resting electro-myocardium analysis for the detection of coronary artery stenosis. Int J Med Sci. 2007;4:249-263.

3. Benjamin EJ, Virani SS, Callaway CW, et al. Heart disease and stroke statistics-2018 update: a report from the American Heart Association. Circulation. 2018;137:e67.

10. Grube E, Bootsveld A, Buellesfeld L, et al. Computerized two-lead resting electro-myocardium analysis for the detection of coronary artery stenosis after coronary revascularization. Int J Med Sci. 2008;5(2):50-61.

4. Patel MR, Peterson ED, Dai D, et al. Low diagnostic yield of elective coronary angiography. N Engl J Med. 2010;362:886895. 5. von Bertalanffy’s L. General System Theory: Foundations, Development, Applications (Revised Edition) ISBN-10: 0807604534 6. | ISBN-13: 978-0807604533. New York, NY: George Braziller Inc.; March 17, 1969. 7. | ISBN-13: 978-1-975115_28-9 Personalized and Precision Integrative Cardiovascular Medicine, Chapter 12

11. Hosokawa J, Shen JT, Imhoff M. Computerized 2-lead resting ECG analysis for the detection of relevant coronary artery stenosis in comparison with angiographic findings. Congest Heart Fail. 2008;14:251-260. 12. Strobeck JE, Shen JT, Singh B, et al. Comparison of a two-lead, computerized, resting ECG signal analysis device, the MultiFunction- CardioGrams or MCG (a.k.a. 3DMP), to quantitative coronary angiography for the detection of relevant coronary artery stenosis (>70 percent) – a meta-analysis of all published trials performed and analyzed in the US. Int J Med Sci. 2009;6:143-155.

percent to as high as 100 percent accuracy for patients affected by heart diseases at all stages, from its earliest to its latest (8-21). Compare this, to the 10-year, $100 million Ischemia trial (22), in which around 15 percent of patients alone included in both the interventional and conservative treatment arms of this landmark study, using the best of the best tools in diagnostic cardiology’s currently available arsenal, still suffered Major Adverse Cardiac Events (MACE). If even the gold standard and most expensive available diagnostic tools from the best institutions can still have such an unacceptably high rate of MACE, then perhaps it is time for a new 100 percent empirical evidence based diagnostic platform to step in, one that doesn’t require assumptions driven by “expert opinions.” This is probably the most important difference between MCG Technology and the rest of the mainstream diagnostic tools. This technology presents a significant opportunity to early detect and timely monitor patients at risk of suffering MACE, especially those prone for sudden cardiac death, enabling clinicians to identify, treat, and reverse the deadly disease trends of these at-risk patients, and more than likely save their lives. For more information, contact Amy Spahic at livewellrxjax@gmail.com, phone 904-624-8142

13. Strobeck JE, Mangieri A, Rainford N, et al. A pairedcomparison of the MultiFunction Cardiogram (MCG) and sestamibi SPECT myocardial perfusion imaging (MPI) to quantitative coronary angiography for the detection of relevant coronary artery obstruction (≥70 percent) – a single-center study of 116 consecutive patients referred for coronary angiography. Int J Med Sci. 2011;8(8):717-724. 14. Strobeck JE, Rainford N, Arkus B, Imhoff M. Comparing Multifunction-Cardiogram and Coronary Angiography for Detection of Hemodynamically Relevant Coronary Artery Stenosis (>70 percent) in Women. Treat Strategy. 2010:83. 15. Amano T, Shinoda N, Kunimura A, et al. Non-invasive assessment of functionally significant coronary stenoses through mathematical analysis of spectral ECG components. BMJ/Open Heart. 2014;1:e000144. doi:10.1136/ openhrt-2014-000144. 16. Takeshita M, Shinoda N, Takashima H, et al. Noninvasive mathematical analysis of spectral electrocardiographic components for coronary lesions of intermediate to obstructive stenosis severity–relationship with classic and functional SYNTAX score. Catheter Cardiovasc Interv. 2015;86(1):21-29. doi:10.1002/ccd.25924.

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17. Tetsuya A, Norihiro S, Hiroaki T, et al. Impact of noninvasive mathematical analysis of spectral electrocardiographic components on the prediction of recurrent cardiac ischemic events after coronary intervention, An Abstract submitted for 2015 PCI TCT San Francisco. 18. Kawaji T, Shiomi H, Morimoto T, et al. Noninvasive detection of functional myocardial ischemia: multifunction cardiogram evaluation in the diagnosis of functional coronary ischemia study. Ann Noninvasive Electrocardiol. 2015;20(5):446-453. 19. Imhoff M, Rainford N. It all depends on your references: electrophysiology compared to angiography. Ann Noninvasive Electrocardiol. 2015;20(5):506-507. 20. Supplement Annals of Emergency Medicine Volume 76 Number 44 October 2020 An abstract# 97- Evaluation of Multifunction Cardiogram for low risks patients press tin g to the emergency room with chest pains. 21. https://www.ischemiatrial.org/ischemia-study-resultspresented-aha-2019 22. https://www.ischemiatrial.org/ischemia-study-resultspresented-aha-2019

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Kari Vargas named President and CEO for AdventHealth Winter Garden and CEO for AdventHealth’s West Orange and South Lake Market

Kissimmee VA Clinic Moves to New Facility ORLANDO, Fla. – The Kissimmee VA CommunityBased Outpatient Clinic is opening its new clinic on Dec. 14 located at 701 Union Street, Kissimmee Fl 34741. The new clinic is located 1.2 miles from the current clinic. The facility provides double the space of the current clinic in order to expand clinical care. Services provided at the clinic include primary care, mental health, a dedicated women’s health area, telehealth rooms, psychiatry, social work, integrated whole health, and a lab area. The clinic provides new services for minor surgical procedures such as biopsies, cryotherapy and joint injections. “We are excited to welcome our Veterans to this brand-new facility,” said Timothy J. Cooke, Director/ CEO of the Orlando VA Healthcare System. “With the increase of Veterans in the Kissimmee area, the additional space will accommodate our current needs as we plan for additional Veterans to come to the VA for care.”

Kari Vargas has been named president and CEO for AdventHealth Winter Garden and CEO for the West Orange and South Lake market located in AdventHealth’s Central Florida Division. Vargas will report to Jennifer Wandersleben, CEO of Acute Care Services forOrange, Osceola, Seminole and Polk counties. “I know Kari’s experience in leading operations, strategic planning and diverse teams will serve her well as she steps into this new role,” said Terry Shaw, president/CEO for AdventHealth. “With the continued growth we’re seeing in the West Orange and South Lake markets, Kari’s leadership and expertise will further our delivery of faith-based, wholeperson care across these communities.” In this role, Vargas will oversee the day-to-day operations of AdventHealth Winter Garden and will lead the overall expansion of the West Orange and South Lake markets, developing and executing strategies that support the total network of care and building influential relationships with key constituents, communities and consumers. “Kari is a forward-thinking leader that understands how to lead provider and care teams toward operational excellence,” said Wandersleben. “Kari’s passion for our mission fuels her ability to collaborate and bring teams together to continue expanding our promise of wholeness across the communities we serve.”

Stevens Construction begins Aspire Health Partners Access Center Renovation

Vargas joined AdventHealth in 2000 and has served in various leadership roles, including vice president of business development at AdventHealth Orlando and vice president of business development and strategy for the Central Florida Division. Most recently, Vargas served as vice president and chief operating officer at AdventHealth Orlando where she had oversight and responsibility for the strategic development and overall operational performance for the campus. “I am honored to work for a company that sets a bold vision for the future and I’m excited for the work we get to do in the West Orange and South Lake communities,” said Vargas. “I look forward to building relationships and partnering with our providers and care teams as we continue Extending the Healing Ministry of Christ to our surrounding communities.” Vargas received her bachelor’s degree in biology from the University of Central Florida. She also holds a master’s degree in business administration with a concentration in management from Rollins College. Vargas is involved in her community, serving on the boards of the Second Harvest Food Bank of Central Florida and Support Our Scholars.

Daryl Tol Abruptly Resigns CEO Position at AdventHealth ORLANDO, Fla., Jan. 6, 2021 — In a surprise announcement, Daryl Tol, president and CEO of AdventHealth’s Central Florida Division, has shared his decision to resign from his leadership role at AdventHealth. No reason for the move has been announced. Tol was appointed president and CEO of the Central Florida Division in 2015. “I want to thank Daryl for his many years of service to AdventHealth and his leadership both to our organization and the communities we serve, especially during the greatest challenge the health care industry has faced in more than a century,” said Terry Shaw, president and CEO of AdventHealth. “Daryl’s decision was certainly unanticipated and he will be greatly missed. I have valued my working relationship with Daryl and appreciate the many things he has accom-

ORLANDO, Fla. (Dec. 7, 2020) – Aspire Health Partners, Inc., a nonprofit 501(c)(3) behavioral healthcare organization, has selected Stevens Construction for the interior renovation of the Access Center located at 1800 Mercy Drive in Orlando, announced Michael Waskiewicz, Orlando division manager. Stevens Construction is providing a 5,360-square-foot renovation within the existing facility to allow for better social distancing as patients begin their screening services within the community mental health center. Delivering the project with a fast-track schedule, Stevens Construction is building eight new, expansive patient bays, a nurse station and additional support areas. Stevens Construction is performing the project while the Aspire Health Access Center remains occupied, operational and continues to serve the community. The renovations are being funded by Orange County Government through federal Coronavirus Aid, Relief and Economic Security (CARES) funds. The project will be licensed and inspected by the Agency for Healthcare Administration (AHCA), which ensures compliance of Florida healthcare facilities. The Stevens Construction project team includes project manager, Bruce Chartrand; superintendent, Anthony LaFata; and project administrator, RoseMarie Aldred. The architect of record is Jeffrey Smith, AIA of RS&H. About Stevens Construction With offices in Orlando, Tampa and headquartered in Fort Myers, FL, Stevens Construction specializes in providing construction management, general contracting and consulting services to clients and design professionals. Other services include site and design team selection, budgeting, project scheduling, permitting, cost and quality control and warranty service. The company builds healthcare, commercial and hospitality facilities. For information, visit www.stevensconstructioninc. com or call 239-936-9006.

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plished during his tenure with AdventHealth. I have full confidence in our team to continue to save lives, innovate and help curb the spread of COVID-19 in our community.” Work is underway to select a permanent replacement within the next few weeks. “I have been blessed to serve AdventHealth for 20 years and help lead this company in Extending the Healing Ministry of Christ,” added Daryl Tol. “AdventHealth is blessed with strong, capable leaders who will continue this important work into the future.” Jennifer Wandersleben, a regional CEO for the Central Florida Division, will provide divisional leadership until a successor is named.

JANUARY 2021

ORLANDO || GRAND ROUNDS

AdventHealth Breaks Ground on New Offsite Emergency Room in Marion County The AdventHealth West Florida Division announced plans to open a new offsite emergency room (ER) in Marion County. The new ER will provide more access to health care services in the growing communities of Belleview and The Villages. Construction has started on a $18 million, 13,000 square-foot, 12-bed facility that will be located at 5934 US 441, Belleview, FL 34420. The location will be a full-service ER, and will be open 24 hours a day, seven days a week for patients and EMS paramedic teams. AdventHealth Belleview ER will be staffed with board certified emergency medicine physicians as well as nurses who specialize in emergency care for adults and children. The ER will also offer state of the art, on-site diagnostic imaging services including x-ray, ultrasound, CT scans and onsite laboratory

AdventHealth Ocala Awarded a 'B' from Leapfrog 2020 AdventHealth Ocala was awarded a ‘B’ in the fall 2020 Leapfrog Hospital Safety Grade, a national distinction recognizing AdventHealth Ocala’s achievements protecting patients from harm and providing safer health care. The Leapfrog Group is an independent national watchdog organization committed to health care quality and safety. The Leapfrog Hospital Safety Grade uses up to 27 measures of publicly available hospital safety data to assign grades to more than 2,600 U.S. acute-care hospitals twice per year. The Hospital Safety Grade’s methodology is peer-reviewed and fully transparent, and the results are available to the public. “How we care for our community makes a difference and the scores will reflect that,” said Patricia Price, Interim Chief Nursing Officer of AdventHealth Ocala. “We are continuing to implement key strategies to improve patient safety, reduce infections and create a culture of safety to make sure we are providing the best care possible to every patient, every time. Thanks to our dedicated administrators and care team members, we can continue to create a high quality, safe environment for anyone needing our care.” The Safety Grade assigns an ‘A’, ‘B’, ‘C’, ‘D’ or ‘F’ grade to all general hospitals across the country and is updated every six months. It is based on a hospital’s performance in preventing medical errors, injuries, accidents, infections and other harms to patients in their care.

services so patients can receive real-time results, enabling better diagnosis and treatment. “The addition of AdventHealth Belleview ER is a testament to our commitment to expand and elevate the quality of the care in the communities we serve,” said Joe Johnson, President and CEO of AdventHealth Ocala. “This new emergency room will provide more convenient access for families to receive the best emergency care when they need it most.” AdventHealth Belleview is slated to open Fall 2021. The construction and opening of the ER is expected to provide more than 100 jobs in Marion County. This will be the second offsite emergency in Marion County. AdventHealth West Florida Division also operates AdventHealth TimberRidge ER in Ocala.

AIM ImmunoTech's Drug Ampligen Awarded Orphan Drug Designation for the Treatment of Pancreatic Cancer OCALA — AIM ImmunoTech Inc. (NYSE American: AIM), an immuno-pharma company focused on the research and development of therapeutics to treat immune disorders, viral diseases and multiple types of cancers, announced that the U.S. Food and Drug Administration on December 17, 2020 granted Orphan Drug Designation status to AIM’s drug Ampligen (rintatolimod) for the treatment of pancreatic cancer. The Orphan Drug Designation program provides orphan status to drugs and biologics which are defined as those intended for the treatment, prevention or diagnosis of a rare disease or condition, which is one that affects less than 200,000 persons in the United States or meets cost

recovery provisions of the act. The status helps incentivize the treatment of therapies to treat unmet medical needs by providing a company with seven years of exclusivity rights once a drug reaches market. Pancreatic cancer is the fourth leading cause of cancer deaths in the United States and the only cancer, among those most commonly diagnosed, with a five-year survival rate at just six percent, according to the Pancreatic Cancer Action Network. AIM recently announced receipt of statistically significant positive pancreatic cancer survival results from a multi-year Early Access Program conducted at Erasmus University Medical Center in the Netherlands. The

median overall survival was approximately two-fold higher – that is 200% – in the Ampligen arm, as compared to a historical control cohort matched for age, gender, stage of disease and number of cycles of Folfirinox therapy. “This study data demonstrates that Ampligen has the potential to extend the survival rates of people suffering with pancreatic cancer significantly when compared to the traditional standard of care for this deadly disease,” said AIM CEO Thomas K. Equels. AIM ImmunoTech Inc. is an immuno-pharma company focused on the research and development of therapeutics to treat multiple types of cancers, immune disorders, and viral diseases, including COVID-19, the disease caused by the SARS-CoV-2 virus.

ORMC Named Top 50 Cardiovascular Hospital “Cardiovascular services is a foundational service at Ocala Health and this recognition reflects our continued commitment to deliver the highest quality of care for the cardiovascular patients in the communities we serve,” says Chad Christianson, CEO, Ocala Health. “In the coming weeks, Ocala Regional Medical Center will be opening a cardiovascular unit that includes 34 inpatient beds dedicated to Cardiac ICU services and Ocala Health will also be celebrating the addition of a cardiac cath recovery space and new cath lab at West Marion Community Hospital. As being named the only top 50 cardiovascular hospital in the region by Fortune and IBM Watson Health, this is further proof that these additional investments highlight the best in class service Ocala Health provides for our community’s cardiovascular patients. We look forward to continuing to invest in best in class facilities that complement the high quality service we provide.” This year's study included 980 U.S. hospitals with cardiovascular service lines. Based on comparisons between the study winners and a peer group of similar hospitals in the study, the winners delivered better outcomes while operating more efficiently and at a lower cost. Extrapolat-

OCALA, FL— Ocala Regional Medical Center was this week named as one of the nation’s top performing hospitals by Fortune and IBM® Watson Health®. The annual Fortune/IBM 50 Top Cardiovascular Hospitals study spotlights leading short-term, acute care, non-federal US hospitals that treat a broad spectrum of cardiology patients. The study is designed to identify impartial, actionable, and attainable benchmarks for hospital and clinical leaders as they work to raise their own organizations’ standards of performance in cardiac care. “This achievement is a demonstration of the patientfocused approach adopted by our multi-disciplinary team in the care of patients and families in need of heart surgery. We are motivated to continue the pursuit of excellence on behalf of our patients,” says Omeni Osian, MD, Cardiothoracic Surgery Medical Director, Ocala Health. Paul Urban, MD, FACC, Medical Director Cardiac Catheterization Laboratory and Chest Pain Center at Ocala Health says, “We are very proud to be recognized as a 50 Top Cardiovascular Hospital. This award demonstrates our continued commitment to providing the highest quality care for patients with heart attack, heart failure and coronary stenting procedures.”

ORLANDOMEDICALNEWS.COM

ing the results of this year's study, if all Medicare inpatients received the same level of care as those treated in the award-winning facilities: • More than 7,000 additional lives could be saved • More than 5,000 heart patients could be complication-free • More than $1.6 billion in inpatient costs could be saved

“With more than 120 million American adults living with some form of cardiovascular disease, cardiovascular services are among the most critical in healthcare,” said Ekta Punwani, 100 Top Hospitals Program Lead, IBM Watson Health. “Hospitals are constantly working to improve clinical and operational performance, and the exceptional organizations on this list demonstrate the standard for top performing cardiac care. Their benchmarks serve as a real-world checkpoint for cardiovascular care across the U.S.” The annual report highlights the top-performing cardiovascular hospitals in the U.S. based on a balanced scorecard of publicly available clinical, operational, and patient satisfaction metrics and data.

JANUARY 2021

VOLUSIA-BREVARD | | GRAND ROUNDS

Halifax Health | UF Health Welcome Endocrinologist to Diabetes Program

New Officers Named to Parrish Medical Center’s Board of Directors 30 years of experience as a certified public accountant working on audits for governmental entities. Treasurer: Peggy Crooks, retired banking executive. Secretary: Elizabeth Galfo, MD. Dr. Galfo is the Chief Medical Officer of Hospice of St. Francis, and has served as the Medical Director for the organization since 1997. Member-at-Large and Immediate Past Chair: Herman Cole, Col, USAF (Ret). In addition to the board officers, the nine-member board of directors includes Billie Fitzgerald, Maureen Rupe, Jerry Noffel, and Ashok Shah, MD.

TITUSVILLE — Parrish Medical Center’s board of directors, in accordance with its bylaws, held an election of officers during its January board meeting. The election resulted in the following office appointments: Chairman of the Board: Robert L. Jordan, Jr. Mr. Jordan has served as a member of the Board of Directors since 1998, most recently serving as Vice Chairman. Mr. Jordan is chairman, president & CEO of Genesis VII and has more than 31 years of experience in the Aerospace field and holds numerous board positons in the public and private sectors. Vice Chairman: Stanley Retz, CPA. Mr. Retz has more than

Melbourne Regional Medical Center Forms Partnership with TEPAS Breast Center nology and expertise of our two organizations in a coordinated environment”, said Ron Gicca, President of Melbourne Regional Medical Center - a private 119 bed acute care hospital in Brevard County. “TEPAS and Melbourne Regional Medical Center want to ensure that patients needing breast cancer services and treatment can achieve their needs in timely and coordinated care without duplication of services.” TEPAS coordinates treatment and care with medical oncology, radiation oncology, plastic and reconstructive surgery, physical therapy, hyperbaric oxygen therapy, breast prosthesis, nipple tattooing and hair restoration. TEPAS offers an inviting, comforting and compassionate environment for women undergoing breast cancer surveillance and diagnostic studies and is accepting new patients.

Melbourne Regional Medical Center and TEPAS Breast Center are announcing a partnership to provide breast imaging and advanced breast care services to the Space Coast community. TEPAS Breast Center, established in 2007, is Brevard’s first comprehensive breast center offering advanced breast care services including 3D Mammography, 4D breast ultrasound, image guided breast biopsies, clinical consultation, support services and more. Led by a team of board-certified radiologists and a breast surgeon, TEPAS Breast Center was created to deliver more accurate prevention, early detection, diagnosis and support services in an environment of compassionate and coordinated care and support. “Partnering with TEPAS, allows us to bring together tech-

UF Health Vascular Surgery at Halifax Health Earns Vascular Testing Accreditation by the IAC Health demonstrates the facility’s ongoing commitment to providing quality patient care in vascular testing. There are many factors that contribute to an accurate diagnosis based on vascular testing. The training and experience of the technologist performing the procedure, the type of equipment used and the quality assessment metrics each facility is required to measure, all contribute to a positive patient outcome. Accreditation by the IAC indicates that UF Health Vascular Surgery at Halifax Health has undergone an intensive application and review process and is found to be in compliance with the published standards, demonstrating a commitment to quality patient care in vascular testing. Comprised of a detailed self-evaluation followed by a thorough review by a panel of medical experts, the IAC accreditation process enables both the critical operational and technical components of the applicant facility to be assessed, including representative case studies and their corresponding final reports.

UF Health Vascular Surgery at Halifax Health, with board-certified vascular surgeons Robert J. Feezor, MD, and Michael Yacoub, MD, located in Daytona Beach, Florida, has achieved a three-year term of accreditation by the Intersocietal Accreditation Commission, or IAC, in Vascular Testing in the area(s) of Peripheral Venous Testing, Peripheral Arterial Testing, and Extracranial Cerebrovascular Testing. IAC accreditation is a “seal of approval” that patients can rely on as an indicator of consistent quality care and dedication to continuous improvement. Cardiovascular diseases are the No. 1 cause of death in the United States. On average, one American dies every 39 seconds of cardiovascular disease ― disorders of the heart and blood vessels. Stroke, a disorder of the blood supply to the brain, is the third leading cause of death and the leading cause of disability in the country, with nearly 800,000 new strokes occurring annually. Early detection of life-threatening heart disorders, stroke, and other diseases is possible through the use of vascular testing procedures. This latest accreditation awarded to UF Health Vascular Surgery at Halifax

ORLANDOMEDICALNEWS.COM

JANUARY 2021

Endocrinologist, Poonam Kapadia, M.D., has joined the Halifax Health – UF Health group of medical practices headquartered at Halifax Health Medical Center of Daytona Beach. Kapadia is a board-certified internist with specialty training in endocrinology, diabetes and metabolism. Her clinical interests include the management of diabetes and thyroid disease, as well as adrenal and pituitary pathology. She is committed to spending quality time with her patients, in hopes of building rapport and giving patients the tools and education to be successful in managing their diabetes care while minimizing complications from this chronic disease. Endocrinology services opened on Monday, November 2 in temporary offices. In the second quarter of 2021, Kapadia will move to be a part of the new 2,800-square-foot Lohman Diabetes Center of Excellence at Halifax Health Medical Center in Daytona Beach. The Center of Excellence will be located in the renamed Lohman Professional Building. “I am very excited to be a part of this new diabetes center and serve the patients of Volusia County. Diabetes has such a profound impact on patients’ lives, not only on their physical health, but also on the psychosocial components,” said Kapadia. “A need for additional comprehensive diabetes care has been identified here, and I am truly excited to help fulfill that need.” Nancy and Lowell Lohman are making a $4 million donation to establish the center. It is conceived as a one-stop resource center for diabetes patients seeking access to world-class endocrinologists, on-site lab work, educational and lifestyle coaching, and more. “I am so grateful for this unique opportunity,’’ Kapadia said. “With the generous donation from the Lohman family, we will be better equipped to help our patients and fulfill the mission of managing diabetes care for Volusia County.” Kapadia received a bachelor’s degree and graduated with honors from Washington University in St. Louis with a double major in biology and anthropology. She earned her medical degree from the Morsani College of Medicine at the University of South Florida and completed an internship in internal medicine at Emory University in Atlanta. She also received training in internal medicine at the University of Central Florida. Kapadia completed a two-year fellowship in endocrinology, diabetes, and metabolism, at the University of Florida College of Medicine – Jacksonville. “I went to medical school to help people, and I was drawn to the field of endocrinology because of the longitudinal relationships we develop with patients,” Kapadia said. “I look forward to creating lasting relationships with my patients and helping them achieve better health outcomes.” Along with practicing medicine, Kapadia, who was raised in Orlando, Florida, said she enjoys trying new recipes, traveling and spending time with her husband and young son. For further information on the Lowell and Nancy Lohman Diabetes Education Prevention Network, please visit halifaxhealth.org/diabetes.

Orlando Medical News January 2021

Articles inside

NORTH CENTRAL FLORIDA & VOLUSIA/BREVARD GRAND ROUNDS

ORLANDO GRAND ROUNDS

Introduction to Multifunction Cardiography

EOCC MEDICAL CITY A Fresh Start 2021

How Has the COVID-19 Pandemic Impacted Your Practice?

Cannabis as a Beneficial Replacement Therapy for Psychotropic Drugs with Treating Neuropsychiatric Symptoms of Severe Alzheimer’s Dementia

Your Front Office: The Bridge Between Service Provided and Payment

Why the COVID-19 Vaccine Alone Isn’t Enough

PHYSICIAN SPOTLIGHT Making a Change in a Trying Time