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If Not Now, When? Engaging patients and bringing them back
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CONTENTS || FEATURES
Stress in Tough Times VICKI GARNER, LMHC, DISCUSSES THE EFFECTS OF THESE UNCERTAIN TIMES As the COVID-19 pandemic has grown, increased mental health issues for Americans, which began almost immediately, have caused high levels of emotional distress.
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Marketing: If Not Now, When?
Engaging patients and bringing them back
Almost every practice has its numbers. Patient volume down, revenue down and reserves often too thin to hold on to the entire staff.
patients and staff, need to be informed that in some
“I would say that the marketing team is critical to the day to day operation of the business because you can’t communicate without them at this point. And that goes
cases there might be Saturday and Sunday hours just to get through the backlog. “I think the biggest takeaways have been being able to
also to the employee side and employee engagement.
really pivot fast from a website and social media stand-
How do we communicate with employees of large prac-
point to stay relevant and engaging with your employees,
death to fear and uncertainty and has resulted in hard-
tices? How do we keep furloughed employees or em-
because if you lose your employees, you lose everything,”
ship in all corners of the economy. Healthcare included.
ployees who are working at home right now engaged in
COVID-19 has spread everything from sickness and
A report from Medical Group Management Associa-
what’s happening in the practice. Three months ago, we
tion 97 percent of practices have experienced a negative
were at almost full employment. Now we’re at double
financial impact and on average they report a 55 percent
digit unemployment numbers and it might be easier for
decrease in revenue and 60 percent decrease in patient
them just to stay at home and get a different job than
volume due to COVID-19.
trying to come back to a practice,” said Thompson. For example, it was just a few weeks ago that elec-
Patient visits are, of course, the lifeblood of successful practices. But fear of exposure to the virus and uncer-
tive surgeries were not being performed and there
tainty of what will happen in the process of going to a
has been a backlog of cases built up. That means that
clinic or hospital, and in some cases policy limitation of
practices have to ramp up staff quickly and everyone,
The Telemedicine Element in the Equation Marketing has also changed as a result of expanded use of telemedicine. “We knew about telemedicine/telehealth, but the regulatory environment was so strict and the reimburse-
service, is keeping patients at bay. Now that we are seeing the economy reopen, albeit on rocky footing, getting patients back to the practice is slow going.
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“Now more so than ever before, marketing is critical because patients are going online to get up to the minute information. Being able to communicate with your patients in the place and at the time they want to be communicated with, is really the difference maker between the practices that are going to get through this successfully and not through this successfully,” shares Jennifer Thompson, president of Insight Marketing Group in Orlando.
In a recent Central Florida Medical Group Man-
Fabricio Lorenzi, MD and RX2Live franchisee, Ana Paula Martins Lorenzi open RX2Live franchise, specializing in Healthcare services in Orlando
agement Association podcast with Daniel Williams, Thompson said that marketing communications with patients in a quick, real time status is best done through your website and social media. If a new office protocol is established or the CDC makes a new recommendation
or even if, because of the surge in COVID cases, elective communicate with patients and employees to communicate changes as quickly as possible.
Providing a personal touch for your patients and delivering monthly recurring revenue. • Better Patient Outcomes
407-883-6356 MLorenzi@RX2Live.com Spanish & Portuguese Fluent
surgeries are put on hold again, it’s the best method to
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• Increased Revenue • Improved Quality Measures
“How do we prepare the patients who are still coming in for an appointment where they’re going to be maybe
Rami Packard Franchisee
waiting in their car versus sitting in the waiting room?
How do you prepare them for a doctor who might be in
RPackard@rx2live.com English Fluent
gloves and wearing masks and is requiring them to wear a mask? How do you teach them how to use telemedi-
Providing lab testing, PPE supplies, kits, and equipment to help fight the spread of Covid 19.
cine? Patient readiness has come into play and it requires
COVID 19 TESTING & PPE SUPPLIES
us to step up our communication skills and at the same
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time, be very deliberate because what we’re putting out
• Accurate Results
there, people are paying more attention to now than
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they’ve ever paid attention to before,” she said. It’s not just patients with whom the practice needs to
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thought that you could come up with some standard posts that you put out there on social media; maybe something for a holiday or doctor’s day, breast cancer awareness month or blog posts. And for a long time, that was good enough. But, she said, as social media changed
CONTINUED ... Marketing: If Not Now,When?
and the way algorithms changed, it just doesn’t work. “You have to be in social media. You have to do things in the moment, which really requires a pretty intensive time commitment and strategy and planning to engage with your patients on a regular basis. Practices that have been doing this and have done it right, are reaping the
ments were so poor that it didn’t ever really feel like
rewards and benefits right now. And those are the prac-
anyone was truly going to invest fully into it… then that
tices working to come out on the other end of this that
changed literally overnight,” said Thompson.
are much more successful as a result. I’ve got a client
She pointed out that learning to help practices inte-
who’s a fertility doctor and has a really strong audience
grate telemedicine into their service was a “deep dive”
and right now he’s not seeing patients, but he’s been do-
to understand, but it was also a real game changer for
ing a series of live Facebook and Instagram events since
practices and it has allowed them to continue bring-
about the end of March. The first one he did ended up
ing in revenue and at the same time stay relevant with
having about a hundred people, give or take, on the call
their patients. The question is, will the rules for its use
on Facebook live and he’s going through it with all of
continue to be as flexible as they have been?
these people who are prospective parents chatting with
“I was very optimistic yesterday. I actually downloaded
him asking him questions that he’s answering. Social
a 118-page telehealth grant. There’s about $300 million
media is your chance to stay relevant with your patients
that the government has agreed to provide as a reim-
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so that later on, when they do need you, they’re going to
bursement to providers who get on with telemedicine,”
come to you,” Thompson pointed out.
said Thompson. “It’s really aimed at rural practices and
Thompson says it’s never too late to get started. Pick a
for-profit hospitals and those providing care to the indi-
social channel. She suggests Facebook because “all your
gent population. But that $300 million investment tells
patients are on it. Even if you have a patient population
me that we’ve kind of gotten to the point of no return.
30 or older, they’re on it. Your website is your front line
So, I’m really excited for the first time ever in what
ITIL Foundation Certified
of defense. That is your opportunity to get the most
telehealth is going to bring to this industry.”
relevant information out there.
Thompson is looking at what telemedicine is going to
Make sure you’re keeping your information on your
mean in the future, past this pandemic.
website correct. Do not forget about using your Google
“I’ve had some docs who are saying ‘well, I don’t want
My Business pages. What I mean by that is when some-
to do these telehealth appointments,’ but then you’ve
body Googles your practice looking for information, are
got the patient side. I think the genie’s out of the bottle
you open? The Google My Business listing is going to
and you’re not getting the genie back in the bottle. I was
pop up on that front page. And if it says your office is
talking to an orthopedic hand surgeon about the future
S U B S C R I B E TO D AY ORLANDOMEDICALNEWS.COM
open, but in fact your office is closed and maybe you put
of telehealth and I asked if he was going to continue
that on your website, but you didn’t change your Google
seeing patients (this way). He’s a younger guy and he
My Business page, you’re sending a very mixed message
said ‘absolutely, because not only did it work during this
to your audience. You need to remember all those direc-
process, but now I’ve got a backlog of surgery and I’m
tory listings that are driving people to your website as
going to do my post-ops through telehealth.”
well,” she said.
Another advantage has been the benefit it has had on
Thompson says now’s a great time to try new things.
the issue of burnout.
“I think that if you try new things, you’re going to be
“For the first time, in a long time, the docs were able
better off for it. I have a large ophthalmology practice I
to work from home a little bit because they’re using
work with. They had to shut down every office location
telehealth. They were spending a little bit more time
that they had, and they had to send all 350 or so em-
with their family and the schedule was a little relaxed. And so you can’t just expect these physicians to pivot completely and come back to the 60 plus hour weeks
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ago, they slowly opened and they said, ‘You know what?
• Spinal Cord(ABI Injury Dual • Brain Injury & &TBI) & Diagnosis Stroke Program
employees to communicate what reopening is. We’re go-
reprieve and it tackles the physician burnout dilemma
ing to have to implement telehealth just to survive. And
head on. Does this help you attract the next younger
we’re going to put our waiting rooms in the parking lot.
breed of physician and will the physician expect this?”
• Outcome-Focused Neurobehavioral Program
ployees home. When they reopened a couple of weeks We’re going to use Facebook private groups with our
because telehealth now affords them a little bit of a
SUSTAINED SUCCESSFUL SUSTAINED OUTCOMES SUCCESSFUL
And we’re going to text people when it’s time for them
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to come in.’ Had this pandemic not forced them to try
Social Media Changes
all those things, they wouldn’t have seen all the opportunities to improve their practice. Those things are now
“I think social media, right now, is one of your most important tools for the practice. I’ve been preaching for
going to be part of their day to day, even in this new
years that there’s a difference between being “on” social
normal. So, if we can look at it as a positive and learn
media and being “in” social media,” she said.
from this experience, we’re all going to be better off in the long run for it.”
Thompson says for years there has been a school of
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PROVIDER || SPOTLIGHT
Stress in Tough Times Vicki Garner, LMHC, discusses the effects of these uncertain times and drug use increasing. Is this the experience your group has been seeing?
The problem of child abuse could be much greater than even feared. This is the same for domestic violence if the victim is trapped in the home with her (or his)
Vicki Garner, LMHC: Mental health call in centers
do not, as a rule, get reports of domestic violence or sexual abuse or even so much drug abuse. They would
As the COVID-19 pandemic has grown, increased mental health issues for Americans, which began almost immediately have caused high levels of emotional distress.
get calls for behavioral health services. We have seen some increase in requests for counseling services for
OMN: What are the most common specific anxieties and fears you are hearing from patients as a result of the COVID crisis?
the following problems: anxiety, depression, alcohol and other substances abuse, childhood disorders such as ADHD, fear and isolation and acting out. There have been reported increases in some areas of
In a poll conducted by the Kaiser Family Foundation,
increased calls to law enforcement for domestic vio-
more than half of Americans – 56 percent – reported
lence and child abuse, but this is yet to be determined
that stress related to the outbreak has led to at least one
as to how much COVID will impact this while school
negative mental health effect. Those include trouble
is out. Since children are not leaving their homes, with
eating or sleeping, increased alcohol intake, frequent
Garner: Fear of contracting the virus or fear of someone they love contracting virus. Fear of dying once contracting the virus. Fear of losing one’s job, home and way of life. The unknown is a big stressor to many people. The young people who were cheated out of graduations, proms and other meaningful rites of passage feel very depressed and sad but are sometimes
no teachers or other mandatory reporters to intervene.
headaches/stomachaches, shorter tempers, and other issues. Among frontline health care workers and their families, 64 percent reported a worsened state of mental
PROVIDING ORLANDO-DAYTONA BEACH PHYSICIANS
health. Reports were similar for 65 percent of those who
had lost income. Orlando Medical News talked with Vicki Garner, LMHC, who is the director of behavioral health at
FOR 15+ YEARS!
CAYA Healthcare. Garner has been a behavioral healthcare executive in the Central Florida area for over 25 years, working
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to develop and implement programs and services that
15-minute or less Response (or We Credit $50)
streamline the system of care and reduce the stigma of mental illness. She has an enviable record of accomplishment and
12+ Yrs. experience supporting EHR applications AllScripts, Intergy (Greenway), eClinicalWorks, etc.
advocacy for mental health. She worked on the Mayor’s task force that brought
Medical-Grade Cybersecurity Expertise
Florida’s first Central Receiving Center to Orange County and later worked on a statewide task force to revise
Security Awareness Training
the Baker Act into what is now Senate Bill 12, requiring
$5M Cybersecurity Insurance for Your Practice
every county to have a Central Receiving Center. Garner has been a strong advocate for mental health
Our systems are protected 24-7 and we are alerted immediately if there is any suspicious activity. We once had a serious event, and ADT worked long and hard into the late hours – their actions saved us a lot of headache and money. They educate us on computer security, and we consult with them on third-party vendors; they recommend the best products within the scope of our company’s best practice.
funding. She developed a jail diversion program with Orange County leadership, implemented Florida’s first Assertive Community Treatment Team and was honored by Governor Scott in 2016 for her leadership in assisting
Kathy Mandry, West Orange Endocrinology, Ocoee, FL
the community’s mental health needs in the aftermath of the Pulse nightclub tragedy. She has presented at numerous state and national
Atlantic Data Team is Very Serious about Defending their Customers from Computer Disasters.
conferences and on many panels regarding multiple behavioral health issues. OMN: We are seeing reports sourcing some mental health call-in centers that say there is as much as double the number of calls as usual and reports of domestic violence, sexual abuse
407.205.1098 or 386.677.9295
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EOCC || MEDICAL CITY
EAST ORLANDO CHAMBER OF COMMERCE
What Comes Next:
Virtual Menu Includes: Virtual Scattergories After Horus
Reopening Healthcare Facilities
Featuring Alzheimer’s Association
WEDNESDAY, JULY 1, 2020 4:30 – 5:30 PM
if anyone is feeling poorly. For larger systems dealing
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to have a pre-surgical COVID test to ensure they are vi-
The Member Academy: Roadmap to Member Success
rus free. If a patient fails to have the test, the procedure
with surgery or major procedures, patients are required
is automatically cancelled. Any positive results would require a 14- day quarantine followed by a COVID test afterwards to clear the patient. As for Marketing, attendees were hungry for ways
WEDNESDAY, JULY 8, 2020 9:00 – 10:00 AM Powered by Powernet
How to Create Irresistible Offers with Will Perry
BY DOROTHY HARDEE
in which to connect with patients leveraging technol-
COVID-19 is causing us to have to rethink how we are doing business in 2020.
ogy and target marketing opportunities. While email is the quickest form of communication, it is by no means the best as we all get inundated with a record number of email communications daily. It was recommended
No doubt, it is the single greatest disruption of our
WEDNESDAY, JULY 8, 2020 11:00 AM – 12:00 PM
lifetime. A few months ago, healthcare providers locked
building your book of business. This would result in a
down their facilities to prevent the spread of the virus,
touchpoint of 50 patients weekly with approximately
shutting down key clinical service lines and cancel-
20-25 scheduling appointments.
ing patient appointments keeping in line with federal
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With a month of Phase 2 under our belts and everyone anxious to get the economy moving, it is not easy for healthcare facilities to simply flip a switch and resume normal operations. During the East Orlando
FRIDAY, JULY 10, 2020 10:00 – 11:00 AM
Chamber’s June Healthcare Council Collaborative
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healthcare professionals were given an opportunity to
EOCC 2020 Debate Orange County District 5
discuss areas of concern in facilitated breakout rooms.
TUESDAY, JULY 14, 2020 6:00 – 7:00 PM
using technology and telehealth to connect with patients
Virtual Meet & Greet hosted by The Bridge at Orlando,
Each small group addressed employee safety, protocols and any back-up plan in the event of an employee diagnosis. They also discussed how the practice was in addition to any challenges encountered by patients or staff. Finally, from the marketing perspective, how
Streaming on Social Media
they were connecting with patients to reschedule visits
Virtual Chamber Luncheon: Intergenerational Engagement with Ann Beecham
and procedures. Plus, if staff was having to take on multiple roles to build the book of business and any incentives to encourage success. As participants shared feedback highlights from each breakout, the takeaways were impressive. We expected adherence to the CDC guidelines with social distanc-
WEDNESDAY, JULY 15, 2020 11:30 AM – 12:30 PM
ing, temperature checks and masks. But some went further to ensure overall safety to include using cars as a
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waiting area or preliminary room for a brief doctor visit.
Non-Profit Council Roundtable: Revenue Generation Through 3rd Party Fundraising
Doorbells were installed to alert staff of a visitor before
EOCC Member Exclusive
the practice and patients.
entering the facility. One person per elevator was implemented, as well as stairwell sanitation, something few had considered. While we have seen an uptick in the number of practices using Telehealth, there were still several seeking to determine the best platform for The greatest discussion surrounded small practices
WEDNESDAY, JULY 22, 2020 9:00 – 10:00 AM
and need to be proactive in prevention measures since an outbreak would close their entire business. Dr. Co-
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lin Bartoe, Functional Neurology Chiropractic Center,
Latte with Leaders
and his team are diligent about temperature checks, sanitation measures, using technology when possible, masking and communicating the need to self-quarantine
EOCC Member Exclusive conversation with your Orange County Political leaders
FRIDAY, JULY 24, 2020 9:00 – 10:00 AM Powered by Powernet
Given the feedback from our event, it made me wonder how others are dealing and possibly thriving during
and local government guidelines.
EOCC Advocacy Advisory Council Meeting
to reach out to possibly 5-10 patients daily to begin
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this crisis. The Harvard Business Review looked at how Geisinger Health System is moving away from their pre-
EOCC || MEDICAL CITY
CONTINUED ... Vicki Garner, LMHC
vious business model, embracing a strategic and operational innovative approach rather than a damage-mitigation exercise focused on solely restoring revenues. They have implemented in-house patient and employee testing to prevent transmission, as well as dedicated staff for contact tracing. They have ramped up Telehealth visits going from 40 per day to more than 4,000 per day, and waving co-payment associated with these visits for their members, helping to shift patient perception. They encourage use of a mail-order prescription service resulting in cost reductions and greater adherence by patients. In addition, the use of work-from-home capabilities has expanded their talent pool and reduced costs for real estate from administrative space to clinical space. Geisinger has promoted the transition to a value-based payment model rewarding prevention and good outcomes rather than increased procedures. COVID-19 shows us that if it is to be, the transition must be meaningful and well beyond what has been seen to date. What are your thoughts on the focus of prevention and good outcomes? Is this a model your practice could embrace to weather a similar crisis in the future? Be part of our next Healthcare Council Collaborative when we offer a Virtual peer to peer referral forum and breakout for Central Florida physicians. Mark your calendar for Thursday, August 6th at 8:00 AM to participate. The East Orlando Chamber has launched a NEW opportunity for EOCC Members to address the need for direct primary care. We have partnered with Avalon Insurance Services, Inc. to offer exclusively for members and employees of those companies a Direct Primary Care (DPC) program. The DPC membership model (Healthcare 2U) provides affordable and convenient access to excellent primary medical care, wellness, and chronic disease management for individuals ages 2 to 65. It also accepts pre-existing conditions within management ranges. Through this proprietary Private Physician Network (PPN), it is breaking down the barriers to convenient access to quality primary care with a focus on promoting healthy living while preventing disease. In addition to doctor visits, urgent care visits and annual physicals with four labs plus unlimited chronic disease management for 13 chronic disease states (within manageable range), the plan also offers Telehealth services online or by phone 24/7/365. The plan has a prescription benefit program covering over 200 medications for $1 each and a list of others between $5 and $10, saving you big. Healthcare2U is not insurance. It provides an annual healthcare membership based on the Direct Primary Care model consisting of a flat and affordable fee. The program is available nationwide. For those with no insurance, this is a great option. Need more? Check out the Clever RX Prescription Savings Card for EOCC members, saving you up to 80 percent on prescription drugs at virtually all major pharmacies. For those concerned about membership renewals, we offer a payment options for most of our levels so you can continue investing in your business. Give us a call at 407277-5951. We are working remotely, but always available by phone, email or virtually. Remember, we are in this together and the East Orlando Chamber is thinking differently for members. #EOCCCares. Dorothy Hardee is the administrator of the East Orlando Chamber of Commerce.
shamed on social media, therefore making them feel worse. Those who have actually lost jobs feel despair and worthlessness, hopelessness and that all is lost. OMN: Are the stories you are hearing generalized and/or non-specific or somewhat detailed revealing that people have been spending a lot of time focusing on their fears? Garner: Every story is different. People process their fears and anxieties based on their coping skills. One person may have a good support system with good coping skills and needs some additional time and a few additional tools to get through this rough time. Others are completely shattered and need a complete array of services to learn how to cope one step at a time. There is no cookie cutter approach to treatment for people who are experiencing anxiety due to any reason. OMN: How is the feeling of loss of control over one’s life playing a part?
more serious and threatening? Garner: When anything a person is doing that interferes with their normal daily activities of life, then that becomes time for family and friends to worry. Is the person not sleeping, or eating? Is he or she excessively talking about the virus or staying up all day or night on the internet researching conspiracy theories? If they say or do anything that appears they are thinking of hurting themselves or someone else, you must get help immediately. But, if their anxieties or worries are just that, normal worries about this scary virus that we all have around us, then let them talk about it. It is scary, it is something we all have to deal with and it is awful. If they continue to do what they have to do, go to work if they have a job, care for themselves, their house, their kids or dog if they have them and seem overall ok, then let them be. Eventually we will all be ok, someday. OMN: What are the treatments/drugs being prescribed to help people cope, especially those who have previously not relied on pharmaceutical support?
Garner: Loss of control is one of the worst feelings a human being can feel. Some individuals have a higher tolerance for experiencing it than others. When someone cannot tolerate the feeling, they may feel anxious, sad, depressed or completely despondent. If attempts to take control of one’s life don’t work or aren’t possible, like during the times of a pandemic when quarantines are in place and jobs are furloughed or lost, this may make some individuals very prone to these feelings. They should seek professional counseling and talk about ways to learn to cope with them. If they don’t, they may turn to alcohol or drugs or other self-destructive methods to cope which do much more harm in the long run.
Garner: For short term, situational anxiety related to job loss, the economy and societal issues, it would be unlikely that pharmaceutical support would be the first line of treatment. Evidence-based practice calls for a variety of counseling techniques to assist a person in building coping skills and reframing situations to assist in symptom reduction. Only in an extreme situation of a severe panic attack resulting in hospitalization would a short-term medication regime possibly be recommended. The majority of anti-anxiety medications are highly addictive and are only for very short-term use. If anti-depressants are called for, it would be after a diagnosis of major depressive disorder for over six months.
OMN: What part does pre-COVID PTSD in patients play in the current situation for those patients?
OMN: Is the reopening of the economy creating its own set of issues for patients who now fear going out?
Garner: COVID in and of itself would not cause PTSD but could exacerbate someone who had preexisting trauma or PTSD. If a person has experienced trauma surrounding isolation, being sick, hospitalized or losing loved ones this virus could trigger those past traumas and make the memories come back causing the associated feelings or symptoms to return. If a person has been diagnosed with PTSD and has not had successful treatment to resolve it, then isolation, job loss, being quarantined with someone or people you don’t necessarily want to be with could cause PTSD symptoms to return, such as insomnia, exaggerated startle response, anxiety, depression, hypervigilance or substance abuse to name a few. If you or someone you know is suffering with these symptoms it is very important to seek professional help as soon as possible to keep these symptoms from getting worse and to alleviate suffering.
Garner: Reopening the economy is not a problem for the patients who fear going out. They will continue to stay home and are well advised to do so, if they can. Absolutely nothing has changed with the virus or how it is spread. The world is opening back up specifically for the economy, nothing else. People who go out risk getting sick and those who fear going out know that. They are the ones who won’t get sick.
OMN: What are signs for family members and healthcare workers to look for that indicate normal anxiety has turned into something
OMN: What are you seeing in terms of anxiety, fear and burnout in our healthcare workers and what are you advising them? Garner: These are the people we need to worry about most. They are on the front lines, day in and day out. They are the healers, the counselors and caregivers. They work even when they aren’t working. They see it all, hear it all and take it home each night. We need to take care of them and remind them we are here for them. They need respite and love. We advise them to take care of themselves and rest when they can.
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Patient-Centered Wound Care BY DR. NILMA ELIAS SANTIAGO
• Clinicians must never forget that the patient is part of the healthcare team, the most important member to be exact. When the patient is treated as a nonparticipant and passive member or his/her feelings and expectations are not taken into consideration, the outcomes are impacted. Patient-centered care in wound management can be very challenging. How can a clinician effectively accomplish this goal? The practitioner must have an honest discussion with the patient about what they need, what are the wound treatments available, what are the barriers to compliance, and the feasibility of the interventions proposed, including family support, and financial assistance. This means that the patient must actively participate in the conversation and be encouraged to ask the right questions. The conversation must include education about the etiology of the wound, the healing process, prognosis, types of treatment, the interdisciplinary team, nutrition, mobility, functional limitations, and community resources, especially when the patient cannot afford the best treatment options. This communication improves patient’s adherence to the clinician’s recommendations and health outcomes.
Ask a patient with a chronic wound how they feel about it and they will tell you the emotional, psychological, financial, and physical toll the wound has created in their lives. Most of them will say something like having this wound has been a nightmare, a horrible experience, expensive, an emotional drain, a physical limitation, or I’m just tired of dealing with this wound. Though patients may receive the most advanced and effective wound care treatments, more often than not, services are planned without considering their personal preferences, their community resources, and the stress any treatment plan might put on them and their caregivers. Therefore, many patients with chronic wounds feel disconnected believing that their needs and wants are not aligned with those of their providers. Furthermore, the label of “non-compliant patient” can arise when the patient does not follow the clinician’s recommendations. How-
• Besides, the patient’s self-efficacy and accountability also improve.
ever, the patient might just not adhere to the treatment recommendations if these are not financially, emotionally, and physically feasible and not necessarily because they are stubborn or difficult. Patients often receive specific instructions from their practitioners about how to manage their wounds. Unfortunately, clinicians fail at times to ask if the recommendations provided align with the patient’s current lifestyle and living situation. What if the patient lives alone and cannot manage the wound, or is the sole caregiver of a family member not having extra time to do so? Or if the patient is working and has to go on medical leave, how will this affect their income and how will the wound medical expenses be covered? Most wound clinicians don’t even ask the patient these questions. Therefore, the clinician should establish a patient-centered wound care plan that aligns with the wants, needs, and personal situation of the patient without sacrificing the best possible outcomes. Patient-centered care includes the values, needs, and desires of the patients. It is accomplished when the provider includes the patient in their healthcare discussions and decisions. • Literature has established the following components of patient-centered care: establishing a therapeutic relationship; share responsibility and power with the patient; getting to know the person; empowering that person; trust, respect, and communication. • When a clinician creates good rapport, patients gain trust allowing an open discussion about their wants, needs, and available treatments. Hence, the best possible outcomes can be achieved. Nevertheless, this can become utopia without a plan and realistic goals. The plan should include patient empowering and compassionate care; sensitivity to patient’s needs; partnership with the patient and other practitioners for interdisciplinary collaboration; effective case management and use of resources.
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Effective wound management requires a comprehensive plan incorporating patient-centered care. This will create a good understanding between the patient and the practitioner and strong relationships to ensure success. The best possible outcomes only occur with communication, collaboration, and partnership. The first partner must be the patient. Dr. Nilma Elias Santiago is a physical therapist certified in wound care, lymphedema, and ostomy management. She is the owner of the Integumentary Physiotherapy Clinic. She can be reached at email@example.com.
References 1. Constand, M.K., MacDermid, J.C., Dal Bello-Haas, V. et al. Scoping review of patient-centered care approaches in healthcare. BMC Health Serv Res 14, 271 (2014). https://doi.org/10.1186/1472-6963-14-271 2. Sharma T, Bamford M, Dodman D. Person-centred care: an overview of reviews. Contemp Nurse. 2015;51(2–3):107–120. 3. The Eight Principles of Patient-Centered Care. One View website. https://www. oneviewhealthcare.com/the-eight-principles-of-patient-centered-care/. Updated March 15, 2015. Accessed March 6, 2020. 4. Finney Rutten LJ, Hesse BW, St Sauver JL, et al. Health Self-Efficacy Among Populations with Multiple Chronic Conditions: the Value of Patient-Centered Communication. Adv Ther. 2016;33(8):1440-1451. doi:10.1007/s12325-016-0369-7
Medical Cannabis Providing Relief from PTSD-related Symptoms BY MICHAEL C. PATTERSON
In the soon to be released September 2020 issue of Journal of Affective Disorders, a study done by the University of Pennsylvania School of Medicine, Department of Psychiatry, and Washington State University, Department of Psychology demonstrated that cannabis provides temporary relief from PTSD-related symptoms. However, it may not be an effective long-term remedy or cure. The link to the study is below.
Further data analysis revealed the following: Higher
found to have increased PTSD symptoms or negative
doses of cannabis (i.e. more puffs/inhalation) predict-
side effects from taking cannabis. As a physician con-
ed greater symptom relief for anxiety and intrusive
sidering prescribing cannabis as a symptom treatment
thoughts than lower doses. Also, the longer the study
for PTSD, this is a very important factor to consider.
went on, participants used more cannabis per session.
This study validates that cannabis is a safe medical
This may indicate an increased tolerance to cannabis
treatment for PTSD symptoms and should be con-
sidered as a safe alternative to heavier FDA approved
The conclusion of the study indicates that cannabis provides transient relief from PTSD symptoms,
https://www.sciencedirect.com/ science/article/pii/ S0165032720306364
but long-term cannabis use may not improve the severity of PTSD. In other words, cannabis is help-
Lifetime prevalence of PTSD is known to affect
ing decrease major PTSD symptoms, but cannabis is
approximately 8 percent of the U.S. population (over
not a cure for PTSD.
26 million people). PTSD among women is almost
3 times more prevalent than men. The effects of PTSD can be debilitating and even life threatening
This study is important for what it says, but just as
via suicides and attempted suicides. With the con-
important for what it does not say. No participant was
medications with profound side effects and addictive tendencies. 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 firstname.lastname@example.org
tinued legalization of medical cannabis at the state level in the U.S., there are more citizens that can access medical cannabis. Also, with almost every legal medical cannabis state approving PTSD as a qualify-
ing diagnosis, the options for approved medicine have never been greater.
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Questions to Ask When Upgrading/Building MRI or Radiology Facilities Part Five
BY MARK BAY
to be hired and a building permit would be required lengthening the duration and the cost of the project considerably. Replacing the shield would be the next step in this process and then returning the magnet to the shield room, completing the shield once the magnet is in place and then recalibrating and recommissioning of the magnet. Along with construction costs involved this would become impractical for most operations and the disruption to patients and staff would be unattractive to most facility managers. Also, transport and storage increases the risk to the dated magnet as well. The alternative to the above involves choosing the right team first. Having a mold inspection and remediation contractor that is sensitive to the physical environment they would be working in is first and foremost. If there is not an experiential understanding of the sensitivity of a copper shield, the dangers involved in working near a strong operational magnetic field and the physical environment of a hospital then the following methods of remediating this mold condition would
In our continuing series of MRI Construction articles, we will look at an ongoing case study in which some or all the circumstances may apply in any retrofit or upgrade that you might be considering. It will certainly add to the list of questions to ask. This case situation began with the addition of a second, new MRI room two years ago adjacent to an existing MRI room that has been operational since the midnineties. Yes, in the last century. During the construction of the new MRI room and the replacement of the buildingâ&#x20AC;&#x2122;s roof (due to leaks and age of the roof) some amount of mold was discovered to be present in the roof cavity above the existing shield. The problem at that time was determined to not be severe enough to be dealt with at that time or due to budget and/or time constraints the decision was made to close the cavity and address this situation later. Having now arrived at â&#x20AC;&#x153;laterâ&#x20AC;? there are some challenges that have arisen that were likely not anticipated when the decision to move on was made. The first of these is how to remediate the mold without damaging the shield as all the work and removal of contaminated construction materials is directly above the shield. Another challenge is that the shield is about 25 years old which means it is a copper shield and not as hardy as a multi-layered steel shield and can be damaged much more easily by the work above. An additional challenge is that now there is an operational MRI room opposite the subject one and the control room is shared. Access to the new MRI during construction for patients who may not be ambulatory requires protecting the approach to this area from dust, debris, personnel as well as noise. Maintaining a comfortable atmosphere is paramount to alleviating patient anxiety which is common with an MRI. Other challenges this situation poses is the remediation of the mold itself, sanitizing the roof cavity above the shield and removal of the contaminated materials without exposing uncontaminated areas to the debris or allowing the shield to get wet from common mold removing chemicals. Conventional wisdom would lead to removal of the magnet, replacing the dated shield with a new shield and then either reinstalling the existing magnet or upgrading to a new or refurbished magnet. This operation could be cost prohibitive in that the magnet would need to be ramped down and maintained on life support off-site, requiring an opening in the side of the building to allow rigging and transport of the magnet. Because this construction operation likely requires structural design, a design team would need
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be foolhardy. The first order of business is the base line test to establish the level of RF protection the existing copper shield currently offers. The next order of business is the mold inspection itself. Air quality samples, moisture tests, as well as samples for laboratory analysis would be taken in the MRI room, the cavity between the Acoustic Ceiling and then the roof deck cavity itself where there is known mold. Once the type of mold is identified and the quantity of particulate matter in the air calculated, the extent of the contamination, as well as if there are any areas of moisture present are identified, a remediation plan will be developed. Considering that one does not want to introduce moisture to the copper shield, a dry chemical and mechanical remediation plan is in order in this space. An access in the copper shield can be provided near the front edge of the MRI room
Yeas and Nays of an IT Managed Service Provider for Your Medical Practice YEAS:
BY JAY A. COHEN
In today’s very competitive environment, meeting customer demands is extremely vital for every business. Unfortunately, it is not always possible to meet these demands when resources are scarce. This is where Managed Service Providers (MSP) prove handy. MSPs have a unique team of IT experts that provide a variety of vital services to their clients. Outsourcing your IT needs can potentially help businesses to cost-effectively manage their current needs while supporting growth and productivity over time. If you are contemplating outsourcing your IT tasks, you are in the right place.
What are managed services? Managed services are great for small enterprises that are exploring their outsourcing options regarding their IT needs. MSPs provide support for your firm’s technology needs at a monthly flat fee. Providers of managed services proactively monitor your company’s network, reduce IT-related problems, and diagnose and trouble-
expensive. You’ll need to pay upfront fees as well as
Unrivaled experience: If your business employs an ‘IT
a few dollars monthly, depending on the size as well
expert’, chances are this guy isn’t knowledgeable in all
as the technical needs of your business. However, you
IT areas. On the other hand, MSPs usually boast highly
should also know that MSP will equally save you in
skilled professionals dedicated to every single function of
other areas as well.
IT. Simply put, MSPs are better equipped all round.
Scope: It is imperative to note that MSP’s scope of
Tech provided: With some plans, your MSPs firm
work doesn’t always cover all areas of technology. In-
provides all the technology your business needs, including software, servers, and workstations. You only need to
stead, it usually gives a list of software it supports. Lack of physical presence: Most MSP firms are not lo-
utilize these services and pay for them. While this can be
cal to your company. This implies that if a problem such
costly, it also means no capital expenditures for the tech,
as a desktop malfunction occurs, you may have to tackle
enabling your business to channel its capital in other
it on your own. However, if you sign up with a local
company, it can offer onsite support. Sadly, you’ll have to pay an extra amount for physical visits to your office.
Change in the model: If used appropriately, MSPs should mitigate technical issues. It regularly monitors
The Bottom Line:
various aspects of IT such as applications, hardware, internet, and security, notifying you if any issue is detected. So, you are not paying for someone to fix your IT-related problems. Instead, you are paying them to prevent your company from experiencing issues MSPs can provide you with assurances that their
Every small organization should critically analyze all the factors involved in paying for an MSP. Hopefully, this article helps you make the most informed decision according to the demands of your business. Jay Cohen is a successful IT strategist, CEO, International Author and Speaker with over 25 years of experience in technical and customer support industries. Cohen has led large and small development and deployment robust technical solutions. He has expertise working in technology, financial, real estate, healthcare, government contracting and telecommunication services. Offering a unique combination of strategic technology vision, business acumen, and tactical leadership to consistently deliver to plan and bring value to the organization. Visit www.jaycollc.com or email him at email@example.com
monitoring platform is HIPAA Compliant
NAYS: It can be costly: Outsourcing MSP services can be
shoot problems that arise on your network. Thanks to cloud computing, a significant number of IT work can be outsourced.
Why do businesses need managed IT services? One of the major reasons why companies prefer managed service providers is because they negate risks. As opposed to outsourcing IT when an issue pops up, managed services guarantee consistent monitoring of a network. What’s more, tasks such as updating, and maintenance are tackled by a managed service provider. As a manager, this allows you to focus on other aspects of your business instead of worrying about the firm’s IT. The potential managed service provider should equally evaluate both the current and future IT requirements. The company advises on what type of services or products a business needs to implement in the next year. TM
Yeas and Nays of MSPs: What sets MSPs apart is that they are intended to support numerous facets of IT and centralize IT for smaller businesses. An MSP can effectively handle a company’s help desk queries, networking, desktop support, project management as well as server upkeep. What’s more, MSPs support a lot more customers than an independent professional or computer store would have. This results in certain benefits such as increased resources and extensive knowledge to draw from. Regardless, there are some factors small businesses need to take into account before subscribing to an MSP. For example, you need to figure out whether it fits your budget or not, whether you need somebody onsite who can troubleshoot emerging technical issues or not, among other considerations.
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The Sneeze Guards are Everywhere! BY DOUG MINTZ
We are living in very challenging times right now. The COVID-19 virus continues to spread all over the country. Yes, there are select “hot spots,” but with air travel and the freedom of movement we love and enjoy in this country, you never know where this epidemic can hit next. The fact is, COVID-19 (the invisible enemy) is costing clinic owners millions of dollars in lost revenue due to public fear, personal time off for employees who also fear this situation, and actual sick time off for employees that contract the virus. Individuals are out of work for well over a week if not two when recovering from this ailment. As clinic owners, public perception is your reality. That said, it is critical that you protect your patients and employees now! There are a multitude of safe distancing solutions for patient waiting room areas, executive offices, nursing stations, and open-plan office layouts with cubicles in them. That said, businesses can take the “band-aid” mindset and throw up a few sneeze guards with wire and drywall screws (yes, I’ve seen this) or clinic owners can make lemonade from lemons by installing quality room dividers and panel stacking units that make an aesthetic statement and most importantly keep everyone separated and safe. One example for cubicles are fabric stackers/tiles that can be attached to existing cube walls, raising their privacy heights an additional 24 or 30 inches. They are available
in several thickness and dozens of fabric selections. This option also has some acoustic benefits to dampen sound in the workplace. A second example is frosted or clear acrylic shields that can be attached to the tops of cube walls, again raising privacy heights the same 24 or 30 inches, while still allowing light through them. A third product option is customizable room dividers that are designed for separation versatility and functionality. The applications are endless, including the formation of small meeting rooms, collaboration and huddle spaces, break rooms, patient waiting rooms, and private work areas. All these spaces can be created without expensive and disruptive construction costs. The panels can be designed individually, then connected to construct the separation space that works best for you. These dividers are framed in beautiful lightweight decorative aluminum, and many materials can be integrated into these designs including fabrics, frosted and clear acrylic, and decorative acrylics. Caster options are also available on these screens for easy mobility and quick & flexible on-site space “tweaking.” One last product offering worth mentioning is desk screens that can be mounted onto existing desks in private offices to offer separation and safe distancing between doctors
CONTINUED ... Questions to Ask When Upgrading/Building MRI or Radiology Facilities (to be patched later) to allow debris to be passed down for disposal, minimizing the movement above the shield. The less movement above the shield in the confined space of the roof cavity, the less chance of a puncture. If there were an inadvertent puncture the copper shield could be patched by the team expert in shielding. Only shielding contractors with experience in copper shielding should be used. All the above would be preceded by the construction of a temporary wall (lumber) inside the MRI room and sheeting the wall with thick mil plastic sheathing. This will separate the magnet from any work and in the event a stray screw, nail or tool were dropped it would be stopped at the temporary wall before being able to damage the magnet. Building and installing the protective wall should only be done by those who have worked near an operational magnet before. Stainless steel fasteners would be added protection in the construction of the wall. Once the removal of contaminated debris is com-
pleted and the cleaning and sanitizing of all components within the roof cavity is complete, a final air quality and moisture test will be conducted. If all levels are satisfactory, the construction crews can demobilize, and the MRI can be put back in operation, mold free. Assembling an expert team, having confidence in the experience and creativity of that team, knowing the types of equipment you have, taking proper precautions and planning the project thoroughly can save tens of thousands of dollars. Every project is unique and likely has more than one solution. This project is a delicate and tedious process that requires expertise, excellence, patience and meticulous planning. Mark Bay is owner and CEO of Tri-Bay Construction LLC, a Commercial Contracting firm located in Oviedo. Mark is an alumnus of Columbia University and has over 30 years’ experience in the construction business including numerous MRI and radiology facilities throughout Florida. Tri-Bay Construction has partnered with an internationally renowned shielding company, radiology facility designers, equipment suppliers, equipment transporters and subcontractors offering a unique team approach to imaging facility construction. Visit www.tribay.com or email firstname.lastname@example.org
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and patients, nurses and patients, or office managers and their internal customers; their staff. These desk dividers are also available in many materials including fabrics and easy-to-clean acrylics. All the above options are available in a relatively short time frame. Some products can be installed within 7-10 days. More elaborate products and designs will take 4-6 weeks from order date to the day of installation. What is most important is these products will put patients and employees at ease. Peace of mind is what it will take to build and increase your business back to its full potential. I believe these COVID challenges will continue well into the first quarter of 2021. If this is the case, can your clinic afford to operate at income levels 30 – 50 percent off the norm? The short answer to this question for most doctors is no. Doctors, managers, and owners need to seriously consider these investments to bring back their revenue streams as quickly as possible. Doug Mintz is president of CPOF Inc. – Cubicles Plus Office Furnishings. Mintz has been in the office furniture industry for over 20 years. After working three years for a family-owned dealership, he ventured out on his own in 2001 and founded CPOF Inc. His focus is primarily on the patient’s waiting room experience, as well as the ergonomic health and wellbeing of clinic employees. Visit www.CubiclesPlusOF.com or email Doug@CubiclesPlusOF.com
GRAND || ROUNDS
Lake-Sumter Medical Society’s Executive Director Making the Rounds Delivering Masks Carol Millwater Ryan, executive director at LakeSumter Medical Society, heard about the Florida Department of Health securing 16 million non-medical grade masks and put in a request for 200,000 of them on behalf of local physicians who needed them for their patients. To her surprise, DOH granted her request in full. She says she has found that supplies are still short, costs are jacked up and physicians are feeling the pinch. The real challenge has been personally delivering boxes of 2000 masks to each doctor in the two counties. She’s found it a tall order but one that’s been met with enthusiasm and gratitude. After dropping off another 32,500 masks on June 30, one doctor, Kenneth Stark, MD, exclaimed, “you guys are saving lives! I can’t believe this!” Another benefit has been learning of the extraordinary effort most doctors are making to help each other out. She has been able to help make connections to help doctors find other doctors willing to swap supplies to help meet each other’s needs.
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St. Cloud Regional Medical Center Joins Orlando Health Orlando Health has completed the acquisition of the 84-bed St. Cloud Regional Medical Center and its associated healthcare operations in St. Cloud, Florida
Tampa-Based Real Estate Developer Announces Plans for Lake Nona Site Onicx is pleased to announce the plans for East Park
Onicx has offices in Tampa, Miami and New York
Village, a new mixed-use development in Lake Nona,
and over 40 employees driving its success. They have
Florida. Located at 10735 Moss Park Rd., this land has
been listed on the Inc. 5000 list three consecutive
been owned by Onicx since 2013 and planning is now
underway for a 50,000 square foot class A medical
Onicx is a full-service development and investment
office building, 15,000 square feet of retail space, 264
company that solves complex real estate challenges
multifamily rental units and a 150-key hotel.
through innovative building solutions and creative
“We are extremely excited about this project,” stated
financial structures. Our services include design, financ-
Dhvanit Patel, CEO at Onicx. “Our core business has
ing, construction, construction management, leasing,
been healthcare for many years, and we are excited to
and property management. Our expertise in healthcare
bring this mixed-use development to the residents of
allows us to deliver the flexible environments our
Lake Nona and the surrounding areas to provide them
physician clients and partners need to provide optimal
with excellent new healthcare, living, hospitality and
care to their patients.
Onicx also specializes in mixed-use developments
Jack O’Leary, Director of Strategic Partnerships at
that integrate residential, medical, hospitality and retail
Onicx said, “we are currently leasing space for the
to create modern, inviting environments that offer
medical office building and based on current market
efficiency and convenience. Onicx has a strong track
conditions in the area, we expect the space to fill up
record of delivering high quality projects at competi-
tive pricing while yielding market-beating returns
Groundbreaking depends on preleasing activity, but
for investors. For more information please visit www.
the Onicx team estimates that groundbreaking will be
from an affiliate of Community Health Systems. Orlando Health has held a 20 percent minority interest in the hospital for more than 15 years and with this transaction, the facility will now be referred to as Orlando Health St. Cloud Hospital. “We are excited about fully integrating into the Orlando Health network,” said Brent Burish, president of Orlando Health St. Cloud Hospital. “This regional alignment further advances our ability to make a positive impact on the health of each and every person we serve in St. Cloud and Osceola County, particularly in today’s dynamic healthcare environment.” Since 1964, St. Cloud Hospital has been providing high-quality healthcare to the county and surrounding areas. David Strong, president and chief executive officer of Orlando Health, shared the importance of a good healthcare system and stated the expanded relationship signals Orlando Health’s commitment to serving the St. Cloud and Osceola County community well. “We are thankful to have St. Cloud Hospital become an important part of our organization.” Strong said. “As Orlando Health thoughtfully expands its services, we look forward to increasing our presence in the Osceola region and working together with team members and physicians to continually improve patient experience
sometime in early 2021.
and clinical quality outcomes.”
CBD Fact: ANXIETY
ill, or dying from coronavirus. Far more Americans (62%)
most 70% reported improved sleep in the first month, but
are anxious about the possibility of family and loved ones
the results for sleep varied over time. NonaOils clients
Floridians are being bombarded with Covid 19 Virus
getting coronavirus. This is according to a new national
are enjoying varied levels of relief from their anxiety. Visit
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sunlight, isolation, mask, no mask, etc. ANXIETY…Nearly
half of Americans (48%) are anxious about the possibility
The Permanente Journal reported a 2019 study using
of getting coronavirus (Covid 19) and nearly four in ten
CBD to treat people who were struggling with anxiety and
Americans (40%) are anxious about becoming seriously
sleep. Almost 80% of people’s anxiety improved, and al-
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GRAND || ROUNDS
Shepherd’s Hope and Nemours Children’s Health System Will Provide Free Back to School Physicals for Uninsured and Under-insured Children
Orlando Health Counters Misinformation Circulating on Social Media
Rabies Alert Until Sept. 6 Issued in Part of Orange County
Shepherd’s Hope and Nemours Children’s Health System will provide free back-to-school physicals for local uninsured and under-insured children at four Shepherd’s Hope Health Centers from July 27 - August 6. This is the seventh year this community service has been provided by the partnership. The free back-to-school physicals include general health assessments and sports physicals with a Nemours specialist, as well as vision and hearing
The Florida Department of Health in Orange
screenings at select locations. Immunizations will be
County is issuing a rabies alert for an area of Orange
offered at the Longwood Health Center.
County, Florida. This alert is for a two-mile radius cen-
To qualify, children up to age 18 must be unin-
tered around Hendry Drive and Okaloosa Avenue, and
sured or under-insured. Appointments are necessary.
Health is at or near capacity presumably due to the surge of COVID-19. According to Kena Lewis, director of public affairs and media relations, “In mid-March, as patient volumes
will last for 60 days or until further notice.
Following the completion of their physical exam,
Claims are circulating on social media that Orlando
The alert is in response to a cat that tested positive
declined and fewer beds were needed, Orlando Health
they will receive the required Florida Department
for the disease. The identified cat may have infected
began consolidating units to reduce the number of
of Health form (DOH 3040) which meets the state
other animals in the area. Contact with feral cats, stray
beds – including ICU beds – that were staffed and in
requirement for enrollment in public or private
dogs and all wildlife particularly raccoons, bats, foxes,
operation. The current operational bed count is what
skunks, otters, bobcats and coyotes should be avoided.
we report to AHCA and what appears on their web-
For eligibility assessment and appointments, call
site. That number is NOT Orlando Health’s total bed
If you or a family member has been bitten or
407-876-6699 ext. 221. Se Habla Español. For fur-
scratched by a cat in the rabies alert area of Orange
capacity. Across all of our operations, we have nearly
ther information, visit www.ShepherdsHope.org.
County or if you know anyone bitten or scratched by
3,300 beds. Nearly 200 of those are ICU beds and we
a cat, you should seek medical attention immediately
have the capacity to surge up to 500 ICU beds if it
and contact Orange County Animal Services at (407)
becomes necessary. We are carefully monitoring the
increases in patient volumes. If the need for additional
Physicals will be conducted at these Shepherd’s Hope Health Centers:
beds grows, Orlando Health will re-open units and make other necessary adjustments in order to meet the
needs of the community.”
Health Center 455 Ninth St., Winter Garden Monday, July 27, 1-4 pm Saturday, August 1, 11 am-2 pm Thursday, August 6, 1-4 pm Longwood
WEDNESDAY, Topic: HUMAN TRAFFICKING AUGUST 19
Health Center 600 N. US Highway 17-92, Longwood Tuesday, July 28, 9 am-12 pm Thursday, July 30, 4-7 pm Wednesday, August 5, 1-4 pm
Dr. Diebel, Jr. Memorial Health Center
9837 E. Colonial Drive, Orlando
Founder of Paving the Way Foundation pavingthewayfoundation.org
Tuesday, August 4, 4-7 pm Thursday, August 6, 4-7 pm
PLEASE RSVP AT CFMGMA.COM
Downtown Health Center
101 S. Westmoreland Drive, Orlando Wednesday, July 29, 5-7 pm Monday, August 3, 5-7 pm
J U LY 2 0 2 0
SOROSIS OF ORLANDO
501 E. LIVINGSTON STREET ORLANDO, FL 323803