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AdventHealth Nicholson Center Testing Next-Generation Universal Robotic System New Versius® Surgical Robot from CMR Surgical allows more dexterity and control ORLANDO--The AdventHealth Nicholson Center has been participating in early trials of the next-generation universal robot, the Versius® Surgical Robotic System, for minimal access surgery. The robot developed by CMR Surgical is designed to

ON ROUNDS PHYSICIAN SPOTLIGHT Dr. Jason Atienza ... 3 Questions to Ask When Upgrading/Building MRI or Radiology Facilities, Part 2 ... 5

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be more versatile and less expensive than existing surgical robots. “We at the Nicholson Center have had the privilege of working with CMR Surgical on early trials with physicians and OR teams in using the new Versius surgical robot,” said

instruction to two dozen clinical teams from around the country. In the process, we became experts in using the device and discovered some of its unique capabilities.” Currently, Nicholson is the only medi(CONTINUED ON PAGE 2)

PUBLISHER’S LETTER

Greetings from Your Orlando Medical News Team Moving into the Holiday Season, we wish you and your family the very BEST! We are sincerely grateful for your continued readership and support. The past couple of weeks you may have noticed OrlandoMedicalNews.com performing a little slower than usual; not its normal high performing self. The Good News…we have been transitioning to a Highly Engaging Content Engine site to better serve you, our valued audience. What is Content Engine? It is a high performing content management system for text, images, audio files, video clips and all the other digital assets used

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• Social-integration, Email Marketing and SEO optimization • Expansion into Volusia-Brevard, and North Central Florida with Local Content Please visit www.OrlandoMedicalNews. com and tour the Content Engine. Please reach out to me with your thoughts and comments: JKelly@orlandomedicalnews.com, or 407-701-7424, as each is VALUED. Best regards, John Kelly, Publisher, Orlando Medical News Volusia Brevard Medical News North Central Florida Medical News

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Roger Smith, PhD, Chief Technology Officer at the AdventHealth Nicholson Center, a minimally invasive surgical training facility. “Throughout the late summer and early fall, (2018) our trainers worked with CMR’s engineering and education teams to provide

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AdventHealth Nicholson Center Testing Robotic System continued from page 1 cal facility in the U.S. with the Versius system. The vision behind CMR Surgical, which is based in the United Kingdom, is to make minimal access surgery universally accessible and affordable, transforming the existing market for surgical robotics while also addressing the millions of people who still undergo open surgery each year. The company expects the Versius to reset expectations for robotic surgery by providing a versatile system that is portable, transportable and affordable. Smith said the design of the arm of the Versius reflects significant improvements. “We have all become accustomed to robotic systems with arms that are all attached to a single base,” Smith said. “The Versius arms are mounted on independent small bases. Each base has a footprint of just 18” by 18” at the bedside, making it easy for the human team to work side-byside with the device. It is jointed in a pattern very similar to the human arm. Each arm begins with a shoulder joint, followed by an elbow at the mid-point, and a wrist at the distal end. These make positioning and controlling the arm very intuitive as they match the geometry of a human arm.” The Versius uses an open surgeon console similar to several of the newer robotic devices that have emerged in recent years. “Both engineers and clinicians expect this design to provide greater situational awareness for the surgeon who is leading activities and directing personnel in the OR,” Smith said. Previously the surgeon inserted his or her face into a viewing device that brought the images in and took up their whole field of view, which can be a positive visual fea-

Mark Slack, CMO, CMR Surgical ture because you feel like you’re inside the patient. But Smith said it limits your communication with the rest of the OR team. “With this open console, the concept is you sit back from a 3D monitor and you certainly see the patient on the 3D monitor, but you also see the rest of the room and you see the operating table and you see the other members of the team,” Smith said. “Several companies right now are exploring this idea of open console and whether it is advantageous to the teamwork that happens in the OR. Mark Slack, Chief Medical Officer, CMR Surgical, said work began on the Versius in 2014 with the objective of building a better surgical robot by designing a robot to do surgery rather than adapting an industrial robot to do surgery, which is what most of the others have done. They surveyed physicians and asked them what they considered the biggest inhibitors to wider adoption of robotic surgery. The biggest issues were cost, ease of use and size. Slack said the fundamental differences between Versius and most other sur-

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gical robots is that it holds an instrument end on, much as you would hold a knife or a fork, which gives great diversity of movement of the wrist and means a massive arm is not needed. “The second fundamental difference is that our instruments don’t need to rotate because the wrist of our robot rotates, which means we can make the instruments both simpler and smaller,” Slack said. “So, we can get away with the 5.8-millimeter instruments and it can be cheaper because it has less movement in it. We wanted it small, modular, mobile and versatile, which we do believe we have achieved.” While the cost of the Versius has not yet been determined, Slack said they aim to get as close to straight stick surgery as they can in price. One way the Versius could be more affordable is CMR has an option where, instead of selling the robot, the company can negotiate a fee for the use of the robot and all of the necessary instruments and supplies to do a set number of procedures. By paying a fee to use the robot for a year,

a hospital doesn’t have to come up with a big capital investment. “They’re hoping that that will create an entree for smaller hospitals that literally can never muster up the millions it takes to get started,” Smith said. “This could also be attractive to countries with nationalized healthcare systems, like in Europe, where they have the same issue. They don’t have a system that accumulates revenue so they can buy equipment every year. So, in countries like the United Kingdom and the other EU countries, they’re thinking that they will get adoption because it will be more affordable to pay for a year’s worth of use of the robot.” CMR Surgical successfully completed its first series of surgical procedures in humans in May. Thirty laparoscopic procedures were completed as part of a clinical trial at Deenanath Mangeshkar Hospital & Research Center in Pune, India, by Dr. Dhananjay Kelkar and his team. The surgeries consisted of minor, intermediate and major gynecological and upper gastrointestinal procedures. No adverse events were reported as a result of the use of Versius after a 30 day follow up. “As the first surgeon to conduct a laparoscopic procedure in a clinical setting using Versius, I can say that the system has been shown to be highly effective and has significant potential for bringing minimal access surgery to patients here in India, and around the world,” Kelkar said. “The Versius Surgical Robotic System is flexible and fits easily into our busy operating environment. We have a high demand for surgical care and are committed to bringing the most innovative technologies to our patients.” Slack said the first in-human series was a significant milestone in bringing Versius to operating theatres around the world. “These initial results are positive and we look forward to further advancing our mission to bring the benefits of minimal access surgery to everyone who needs it,” Slack said. “This series is part of our drive for the responsible introduction of surgical robotic systems that put safety and effectiveness above all else.” The company received a European CE Mark in March for the Versius Surgical Robotic System. For further information, visit www.cmrsurgical.com

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Sidebar for ... ADVENTHEALTH NICHOLSON CENTER TESTING NEXTGENERATION UNIVERSAL ROBOTIC SYSTEM

One in Five Surgeons Set to Retire Early Due to Physical Toll

Survey exposes the physical impact on surgeons of conducting minimal access/keyhole procedures that threaten to shorten surgical careers and put further pressure on health systems

CONSIDER THESE POINTS: • Nearly 20 percent of surgeons in the UK and the U.S., and 15 percent of surgeons surveyed in Germany think they may need to retire early due to physical impact of conducting laparoscopic surgery. • Approximately three in four UK surgeons (76 percent) have experienced back pain while performing laparoscopic surgery; • 78 percent of surgeons in the United States and 61 percent of surgeons in Germany have experienced muscular or back pain while performing laparoscopic surgery • 16 percent of surgeons in the UK, 13 percent of surgeons in the U.S., and 10 percent of surgeons in Germany, have had to consult with a healthcare professional due to musculoskeletal injuries • 37 percent of UK surgeons believe they reach the peak of their operating ability after 50. Up to a fifth of surgeons in the UK (19 percent), U.S. (20 percent) and Germany (15 percent) predict they are likely to retire early because of the physical strain of conducting minimal access/keyhole surgical procedures, according to a survey of over 450 surgeons across Europe and the U.S. The survey, commissioned by CMR Surgical, recruited general, gynecological and colorectal surgeons who regularly perform laparoscopic surgery, which is proven to reduce pain, scarring and

patient recovery time. Despite having proven benefits, minimal access techniques are not used in almost half of all cases worldwide, with up to 6 million patients globally not receiving the benefits of this type of surgery. The technique can be difficult to conduct and physically gruelling for a surgeon to do, where the surgeon stands in physically difficult positions to conduct procedures including hysterectomy, hernia-repair and colectomy. The survey has revealed that 30 percent of surgeons experienced discomfort during surgery due to the awkward positions undertaken, with three in four surgeons having experienced back pain when performing laparoscopic surgery. In addition, up to 16 percent of surgeons have had to consult with a healthcare professional as a result of musculoskeletal injuries from conducting minimal access/keyhole procedures. The physical strain of conducting minimal access procedures is further adding to an existing workforce crisis. Many health systems, including in the UK and the U.S., are facing chronic workforce shortages so prolonging the working life of a surgeon is pivotal to the continued delivery of sustainable healthcare. A recent study found that when it comes to the National Health Service, the biggest employer in Europe, over half (53 percent) of senior doctors (consultants) said that

there are frequently gaps in hospital medical coverage that raises significant patient safety issues. The picture is similar in the U.S, with a study showing that by 2050 there will be a deficit of over 7,000 general surgeons. There is a common misconception about what the peak working age is for a surgeon. The survey has revealed that 90 percent of surgeons surveyed believe surgeons reach the peak of their operating ability by the age of 54. However, studies have shown that the peak age for a surgeon is actually 55-60 years old. According to the survey, one in five surgeons believe they will have to retire early, the equivalent to over 3,000 surgeons in the UK losing key experienced surgeons from health systems that are already stretched. Commenting on the survey’s findings Adrian Park, MD, professor of surgery at Johns Hopkins University School of Medicine said: “Surgeons of all stripes are reporting musculoskeletal pain and injuries as a result of going to work every day. It is hard to imagine that those responsible for any other workplace, let alone one where the stakes are so high, such as in surgery, would tolerate rates of “worker injury” such as are now being reported by surgeons. Surgeons need to be supported to conduct minimal access procedures sustainably in order to protect the future of the surgical workforce, for the benefit of surgeons, hospitals

and most importantly, patients.” “It is unacceptable that to conduct laparoscopic surgery and offer its benefits to patients and healthcare providers, we neglect the impact this is having on the surgical workforce. Surgical robotics can play a role in extending surgical careers, by allowing surgeons to perform laparoscopic surgery with a choice of ergonomic solutions more typically found in offices across the world. With a workforce crisis facing health systems around the world, now is the time to act in order to protect our surgical workforce of the future.” commented Mark Slack, chief medical officer at CMR Surgical. THE SURVEY ALSO REVEALED: • The most common areas of discomfort are the back, neck and shoulders for surgeons. • Surgeons who perform colorectal surgery are significantly more likely to consider early retirement than those who perform gynecological surgery. • Over a quarter of surgeons surveyed frequently experience muscular or back pain as a result of surgery. • Surgeons who are under 5’ 3” or over 6’ 1” are most likely to experience muscular or back pain during, or as a result of, surgery. For further information, and references please visit www.cmrsurgical.com.

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PHYSICIANSPOTLIGHT

Better Care, Better Results: Treating the Whole Patient

Dr. Jason Atienza, Corporate Medical Director, Rehabilitation Medicine Simple fact: Doctors try to make their patients better. A less simple fact: Jason Atienza, MD, MBA, is a physician who tries to make doctors better. Better at engaging their patients, that is. Dr. Atienza is the Corporate Medical Director, Rehabilitation Medicine, for Orlando Health. In his world, quality care doesn’t end with the patient’s discharge from the hospital. It’s up to him and his team to improve access to rehabilitation services, improve the quality of care rehabilitation patients receive, and to ensure that patients who are undergoing rehabilitation (and their families) – whether they are hospital inpatients, outpatients or those in in-home health care – are experiencing the best rehabilitation experience possible. This makes Dr. Atienza responsible for thousands of patients. He has to see the big picture, and that seems like a natural role for someone who was drawn to the idea of rehabilitative medicine as a way to treat the whole person. Beyond the administrative side of Dr. Atienza’s responsibilities is what he describes as a “back to basics” effort on strengthening the doctor-patient relationship. That effort, which he started with Les Torres, Director of Service Excellence with Orlando Health Medical Group, is now a program called Partners in Care, which emphasizes improving the interpersonal skills of doctors. “We started this program a year ago, and already we are seeing results.” “For several years we have had a program that helps non-physician team members to provide a better experience for our patients and families, but there has never been a program at Orlando Health to specifically address physician engagement until now,” said Dr. Atienza. So, the Partners In Care program focuses on individual coaching with doctors to emphasize the importance of establishing an appropriate “bedside manner” and a higher level of personal engagement with the patients and families. “The most tangible results are improved patient experience scores and patient compliance with a treatment plan,” explained Dr. Atienza. The more engaged a patient is in their care, the more involved they are and the more likely they will follow through with their care. It’s been shown that patient experience has a direct correlation with the quality of care and with patient outcomes. In the program’s first year, working with 30 physicians, Dr. Atienza said patient satisfaction scores have shown a 29 percentile increase. Dr. Atienza grew up in Los Angeles, the youngest of three children. His parents both worked nights for the U.S. Postal Service, and they ingrained a strong work ethic in their children. “I was a self-starter,” 4

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he said. That’s putting it mildly. He went to medical school at The George Washington University in Washington, D.C., and to Stanford University for his residency. Board certified, he joined Orlando Health four years ago and took on his current role last year. Dr. Atienza and his wife have two sons. “They are one and two years old, and according to my wife they are both going to be doctors. I guess they don’t have a choice about it.” “I started off in medical school thinking I would go into primary care,” he explained. As the first doctor in his family, that was the practice area in which he had the most familiarity. Then he discovered physiatry or rehabilitative medicine. “The physicians in this field seemed a little different,” he said. “They just seemed more engaged with their patients than other doctors. They thought of the patients globally, not just about their medical condition today, but their overall functional improvement. They had a real holistic approach. In this field, you can really see a wide variety of patients who have one thing in common: They require functional restoration. “What I have focused on is the opportunity to build programs within rehabilitation because there is such a high need. Rehabilitation services is quite broad in

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scope and plays an important role in making length of stay more efficient while decreasing readmissions,” Dr. Atienza said. “It is essentially for any patient that has some sort of functional loss that they regain key abilities.” This broad mandate can include patients with ailments affecting the brain, spinal cord or nerves, and also orthopedic, trauma, surgical, and cancer patients. “Part of the reason my role developed is because our service line has continued to

grow,” said Dr. Atienza. “We now have four inpatient rehab units, including an acute inpatient rehab facility at Orlando Regional Medical Center, as well as three skilled nursing facilities, numerous outpatient facilities and home-health services. As we grow, we have had to develop a clearer direction and increase the quality of the care we provide.” “In our rehabilitation service line, we have patients who not only come back for (CONTINUED ON PAGE 7)

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Questions to Ask When Upgrading/Building MRI or Radiology Facilities, Part 2 By MARK BAY

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As promised, we will now address some specific questions for when you have found an existing Radiology Facility or an empty space in an existing building and need to retrofit the space to fit your needs and/or equipment. The following are general rules of thumb and the most important rule of thumb is probably that every space is unique and the solutions available for each space are also unique. Before you commit to a lease for any space you may want to answer some of the following questions by consulting with an MRI/radiology experienced contractor/designer. Is MRI/Radiology construction different or specialized compared to standard commercial office construction? The short answer is yes. Much of the construction of an MRI/Radiology facility is the same as standard commercial medical office space. Where the construction is specialized is in the materials used in the specific equipment rooms, the sequence of construction, the space required for ancillary equipment, power requirements as well as some additional engineering design requirements. MRI is an acronym for Magnetic Resonant Imaging. The magnetic field of an MRI is extremely powerful and requires space outside the MRI room to be protected from the powerful magnetic field as well as special precautions required for any item inside the room that can affect the quality of the images produced. Even the slightest variation or error in construction can equate to distorted images and costly repairs. Additional items requiring special attention are used inside the MRI room itself and its location within the existing building. Prior investigation and knowledge of these unique variables are paramount to choosing a facility as well as keeping your project within your budget. Is the space you are considering an existing radiology facility or is the facility being converted from another commercial use such as an office or retail space? An existing radiology facility requiring an equipment upgrade may not require interior design alterations but simply a capability to remove existing equipment and replace with upgraded equipment. In this case a structural engineer may not be required. A commercial office space being converted to a radiology facility will at most times require a complete design team including architects and specialty engineers. What is the construction type of the existing building? The exterior wall construction of an existing building can have an impact on the design budget as well as construction. The thickness of the concrete slab in the existing building will also have to be evaluated.

Because of the weight of an MRI, a conventional four- or five-inch concrete slab may need to be partially removed so a sufficiently thick concrete slab can be installed with proper non-metallic reinforcing steel. If the building has an existing fire sprinkler system, location of the MRI equipment in relation to the main fire sprinkler piping will need to be considered. The fire sprinkler system itself will need to be altered in and above the MRI room which is a costly alteration. Choosing an existing building and changing the use of the space may look attractive at first glance, especially if the rent for that space is more attractive than another location, but the type of construction from the roof down to the foundations can adversely affect your budget if the right questions are not asked. Construction cost overruns can quickly add up if a space is selected by location or rent costs alone. A careful evaluation of the space being considered prior to committing to a lease is vital to a successful project. How long will design and permitting take? Most times design and permitting, if starting from scratch, will take longer than the actual construction. The state of the economy is often the most influential variable. When an economy is growing, and the construction industry is booming, designers and labor are in short supply. It is sometimes weeks before a design team is assembled and begins consultation and preliminary drawings. Once the team is assembled, without a central point of accountability, keeping a design schedule becomes the biggest challenge. Every designer has multiple projects and to them one is not more important than another. To owners, theirs is the most important and should be worked on first. One method of keeping this phase of the project on schedule is to hire a construction manager or have an experienced chosen contractor act as a construction manager in the design phase. The perception is that this is an unnecessary cost and a manager is not needed because the project “is not big enough.” If there is a manager during this design and permitting phase of the project, the benefit far outweighs the cost. Delays are costly whenever they occur. When a contractor or an experienced construction manager participates in the design phase, communication between design team members can be more efficient, many logistical and construction issues are eliminated before they happen, plan coordination is more efficient between design team members and the owner, and quite often plan review time is reduced significantly because many of the “issues” that would be brought up by plan reviewers have already been addressed and revisions to plans and resubmittals to permit(CONTINUED ON PAGE 8)

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EAST ORLANDO CHAMBER OF COMMERCE

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EOCC Friday Escape Friday, Nov 1, 3:00 – 5:30 PM PARK PIZZA & BREWING COMPANY

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RX for a Healthy Holiday: Giving & Giving Back to Help Others By DOROTHY HARDEE

La Crema de Nona Networking in Lake Nona (Every Tuesday)

Tuesday, Nov 5, 8:30 – 9:30AM GRAFFITI JUNKTION

9344 N Narcoossee Rd., Orlando, FL 32827

Coffee Club East at Bonefish Grill Lake Underhill Featuring Rene Cantu, Equality Florida

Thursday, Nov 7, 8:30 – 9:30 AM BONEFISH GRILL LAKE

12301 Lake Underhill Road, Orlando, FL 32828

OPTIC – Big Data: Information Security – Social Engineering Featuring Ean Meyer, CISSP

Friday, Nov 8, 8AM – 12:30 PM FULL SAIL UNIVERSITY BLD. 3B

175 University Park Drive, Winter Park, FL 32792 *4-hour workshop includes lunch. Registration required.

Veterans Day Parade City of Orlando 2019 Saturday, Nov 9, 11AM – 1PM Downtown Orlando

2019 Local Charities Luncheon: Lights, Camera, Action

Featuring Adam Pickett, Founder & President – Accelergy Consulting

Wednesday, Nov 13, 11AM – 1:15PM HOLIDAY INN EAST ORLANDO UCF

1724 N Alafaya Trail, Orlando, FL 32826

PRESENTED BY

Tis the Season of giving and giving back. For healthcare professionals, you may feel you give of yourself through a rigorous clinical schedule, but experts and clinical assessment have shown that giving back and volunteering helps improve the body and mind, simply making you feel good. Sean Alemi, MD, shared that “the residual effects of good acts have been found to improve employee resilience.” He feels strongly that when you apply this to the field of medicine, “volunteering has the power to make a serious impact in improving physician burnout.” According to a study conducted by the University of California, physician burnout has increased from 45 percent to 54 percent in the past 3 years. A multitude of factors contribute to this rise in burnout, including the rising operating costs, burdensome administrative requirements, demands from patients, to name a few. Taking a step back to see and fulfill the needs of those in need can help provide a new perspective and offer a renewed sense of being with countless rewards. Julia Malanka, Marketing Manager at Rendia, shared that helping in the community can help doctors attract new patients, by volunteering among your target audience. It not only gets your name in the community but positions you as an expert. Event sponsorship also illuminates you and your practice combating negative doctor stereotypes. Millennials are also very attracted to those who are philanthropic. In a recent poll conducted by Morning Consult for Fortune, nearly two-thirds of millennials preferred

companies that made cash contributions to charity or have other philanthropic programs. Believe it or not, one doctor discovered that despite taking on more patients volunteering to help the underserved, his passion for medicine was revived. Need more evidence that it is simply the right thing to do? Robert Emmons, PhD, and leading researcher on the science of gratitude says, “When you give, it is more than giving your time and resources; fundamentally, it is about giving of your whole self. Become of this, gratitude is healing.” In addition to literally making the brain “light up” when expressing gratitude, which associates with pleasure, reward and connecting with others, it also has health benefits including:

• Lower blood pressure

• Improved immune function • More efficient sleep • Reduced stress • Increased HDL and decreased LDL, among others With all this evidence, are you ready to put a little spring in your step and song in your heart this holiday season? The East Orlando Chamber hosts the Annual Local Charities luncheon November 13th at the Holiday Inn East UCF Area, showcasing the good work and immediate needs of six local non-profit organizations. Adam Pickett, Founder and President of Accelergy Consulting will offer an inspirational message encouraging support for each cause. This year, our highlighted charities and needs include: (CONTINUED ON PAGE 8)

Coffee Club Goldenrod

“Let’s Make A Deal” Networking Activity!

Thursday, Nov 14, 8:30 – 9:30 AM BALDWIN FAIRCHILD DIGNITY MEMORIAL 2420 Harrell Road, Orlando, FL 32817

Misters & Sisters Great Lunch Adventures Thursday, Nov 14, 11AM – 12:30PM GUACAMOLE GRILL

2822 S Alafaya Trail, Orlando, FL 32828

Coffee Club Semoran

Kyle Davis (Integrity Financial) presents College Education: Cracking the Financial Aid Code

Thursday, Nov 21, 8:30 – 9:30 AM BONEFISH GRILL ORLANDO GATEWAY

5463 Orlando Gateway Vlg. Cir, Orlando, FL 32812

EOCC Connect 4 After Hours Connecting Property Professionals & Ancillary Services Featuring Andy Tolbert, the SaferAgent on Realtor Safety

Thursday, Nov 21, 4:30 – 6PM BONEFISH GRILL

12301 Lake Underhill Road, Orlando, FL 32828

Please visit www.EOCC.org for a complete listing of November's events. 6

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PUBLISHER John Kelly jkelly@orlandomedicalnews.com ——

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EDITOR PL Jeter editor@orlandomedicalnews.com ——

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CONTRIBUTING WRITERS Dorothy Hardee, Mark Bay, Dr. Estée Davis, Becky Gillette and Rami Packard ——

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LIPSCOMB UNIVERSITY INTERN Noelle Kelly ——

CIRCULATION jkelly@orlandomedicalnews.com ——

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

Regenerative Medicine: Stem Cells & Recruitment Therapy By RAMI PACKARD DR. ESTÉE DAVIS

and

Stem Cell Universe with Stephen Hawking: “Today we are on the brink of a new age in medicine. An age where we will be able to heal our bodies of any illness, all because of cells inside us which have special powers. They are called stem cells.” Stem cells are the basic cellular building blocks of the body’s tissues and vital organs. They have the ability to regenerate into additional stem cells or differentiate into specialized cells. This remarkable ability makes them invaluable in medical treatments. When injected into a patient’s body, stem cells can repair or replace the patient’s damaged or diseased cells, improve health and even save lives. With nearly a third of the US suffering from chronic pain and over a million patients a year having joint replacements, affordable stem cell therapy brings a welcome and viable alternative to the non-reversible trauma of surgery and a non-invasive drug-free treatment method for many internal medical conditions. REGENERATIVE MEDICINE is a game-changing area of medicine with the potential to fully heal damaged tissues, offering solutions and hope for people who have conditions that were once thought to be beyond repair. While some people may have ethical issues with embryonic stem cell therapy, most everyone agrees that the use of amniotic stem cell therapy raises no ethical or moral

questions. There is a network of participating hospitals that invites mothers to donate umbilical cord tissues that are otherwise discarded after a healthy and normal birth. One of the most fundamental and profound characteristics of stem cells is that, at their origin, they are undifferentiated. They are not specialized to carry out any one specific function, like red blood cells that are designated to carry oxygen throughout the body or heart muscle cells that are designated to contract to pump blood. Stem cells can give rise to specialized cells through a process called differentiation. This way they can become any kind of cell your body needs, including blood cells, nerve cells and muscle cells. The following two sources of Stem Cells are currently not FDA approved, and are available to patients as a cash only service. There are sources available from approved labs that are very affordable for the patient and the physician, if you just know where to look. Umbilical Cord Blood Stem Cell Therapy. Umbilical Cord Blood Stem Cells are derived from umbilical cords and the placenta donated by mothers after normal and healthy child births. This cord blood contains hematopoietic (blood) stem cells and can be used to treat leukemia, blood and bone marrow disorders and immune deficiencies. Wharton’s Jelly Stem Cell Therapy. Wharton’s Jelly is the connective tissue of a human umbilical cord. Wharton’s Jelly is an abundant source of adult stem cells (MSC)

and has gained attention recently from studies showing its great potential in regenerative medicine. The MSCs within Wharton’s Jelly are multi-potent stem cells, meaning, they can differentiate into several different types of cells to bring healing to various parts of the body including: cartilage, bone, muscle, fat, liver, brain and heart cells. Did you know there is an FDA-approved and insurance reimbursable regenerative medicine option called stem cell recruitment therapy? This recruitment therapy is currently being covered by Medicare, UH Medicare Advantage, Tricare and Worker’s Comp. Some Commercial plans are also covering this therapy. Amniotic fluid stem cell recruitment therapy. Amniotic flowables have anti-inflammatory properties (Cytokines & Growth Factors) similar to cortisone and steroid shots. This mixture creates an extra-cellular matrix to recruit the body’s stem cells to reconstruct and regenerate the injured tissue that is causing pain. By using amniotic fluid, arthritis, tendonitis, bursitis and other soft tissue injury patients have another option to repair tissue damage without needing painmasking injections and/or surgery. Here are the following types of injuries that are treatable through the use of amniotic fluid: • Spinal – Neck pain, mid or lower back pain, sacroiliac joints • Joint – Knees, hips, shoulders, elbows, wrists, ankles, fingers and toes (CONTINUED ON PAGE 8)

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EOCC | RX for a Healthy Holiday: Giving & Giving Back to Help Others, continued from page 6 Alzheimer’s Association Central and North Florida Chapter: They need $75 Gift Cards to provide a 10 x 10 tent; 2- New Costco 3 in 1 Convertible Hand Trucks; Paper, frames and watercolor paints for their Early Onset Paint Program. They also hope an organization will consider a $2,000 gift towards a New Stage Backdrops for their annual Walk. Food For The Poor: They need $25 to provide 20 chicks; $30 for the purchase of school supplies and a soccer ball; $31 for clothing and shoes for orphaned and abandoned children; $40 for 100 lbs. of rice and beans and $73 to help feed one child for the year. For organizations seeking a larger impact, become a $1,200 Impact Partner Sponsor for their 2020 Celebration of Hope Gala. Kiwanis of Avalon Park: They are asking for Diapers, Canned food, Formal dresses, Kids meal certificates, Gift cards for Teacher of the Month. Orlando Sports Foundation Cure Bowl: They hope you can help them with $75 Gift Cards for an iPad Pro Cover; 2- Office Depot Gift Cards and for U.S. Postage. Also, a $100 Gift Card toward their Board Lunch. They also hope an organization will consider the purchase of an iPad Pro. Your generosity would be greatly appreciated. Scott Coopersmith Stroke Foundation: They need multiple $75 Uber Ride and Uber Eats Gift Cards for the survivors they support. Also asking your organization to support them as a Silver Sponsor during

PHYSICIANSPOTLIGHT

their annual gala valued at $1,000. Wycliffe Bible Translators: are committed to seeing a Bible translation program in every language still needing one by 2025. They are asking for $50 to offer translated materials in print, audio and through a Scripture app; $25 to upload Scripture videos on to social media & video platforms; $65 to provide the Old Testament Children’s Bible stories as well as impact two communities in Samo Matya and Samo Maya; $35 to translate chapters from Mark & Corinthians for the deaf community in Columbia. They also hope an organization will consider a $1,000 gift to finish the Book of Acts, the script for the “JESUS” film and 19 foundational Old Testament Stories from Genesis and Exodus to be shared in the Congo. Interested in supporting one of our featured Charities? Join us for the Local Charities Luncheon, November 13th from 11:00 AM – 1:15 PM at the Holiday Inn East UCF Area. Learn more about their organizations, take one of their “Wish Ornaments” fulfilling a smaller need or “adopt” one of their larger projects supporting them as an organization. It’s the best way to kick off the holiday season. Not able to attend the luncheon? Drop by the East Orlando Chamber office between November 14th and December 2nd to fulfill any remaining needs. Call for more information at 407-277-5951 or visit eocc.org. Do it for them and do it for your health.

• Soft Tissue – Plantar fasciitis, tennis elbow, rotator cuff syndrome, Achilles tendon Stem Cell & Stem Cell Recruitment Therapy are two rapidly advancing forms of therapy with little to no downtime for your patient. Recruitment Therapy is reimbursable and FDA-approved, while Stem Cells (as of today) are a cash pay option to successfully treat your patient’s ailments, often times at a lower cost than an insurance reimbursed medical procedure in an institutional type setting. Please reach out to me to learn more about either option. There are only a few labs across the country that can provide you with all your needs including training, NOVEMBER 2019

are starting without an architect, you should consider 90-180 days before construction can begin depending on the project and the collaborative efficiency of your design team. Mark Bay is owner and CEO of TriBay 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 mark@tribay.com

Dorothy Hardee is the administrator of East Orlando Chamber of Commerce. Contact her at DorothyH@eocc.org

- Health Central, Center for Rehabilitation. We have just updated our acute inpatient rehabilitation facility at ORMC, formerly known as Orlando Health Rehabilitation Institute; it is now the Orlando Health ORMC Institute for Advanced Rehabilitation as we have upgraded our certifications, equipment and processes. We also have plans to strategically expand our outpatient rehab presence as the Orlando Health ambulatory footprint continues to grow in Central Florida.”

Regenerative Medicine: Stem Cells & Recruitment Therapy, continued from page 7

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ting authorities are reduced or unnecessary. In a booming construction industry, the trend is that review takes longer and more submittals (revisions) are required, lengthening the process. The complexity of the plans can also be a factor. This is another argument for having a construction manager or contractor part of the design and permitting team. Quite often a contractor or construction manager will be familiar with the jurisdictional body and can help expedite the process by alerting the design team of items to include that might not ordinarily be included. If you

Dr. Jason Atienza, continued from page 3

their follow-up visits, they have developed life-long relationships with us,” said Dr. Atienza. They come back for reunions. They give testimonials and share their stories with others. They feel that they are not in this alone because they feel like the team here is part of their extended family.” It’s a family that’s getting bigger. In fact, Dr. Atienza says the biggest challenge he faces is the operational growth of the rehabilitation medicine service line. “We are getting set to open a large facility at Orlando Health

8

Questions to Ask When Upgrading/ Building, continued from page 5

education and billing options for your practice. Rami Packard is a Regional Developer for RX2Live and assists the growth of medical practices and helps keep their patients well. She also assists with senior and corporate wellness programs. Visit https://livewell.rx2live.com/ or contact her at rpackard@rx2live.com Dr. Estée Davis, PharmD, owns an RX2Live franchise in Melbourne, FL. RX2Live is the only Medical Services Franchise to offer over 18 services for all physician types including specialists and nurse practitioners. She specializes in improving care scores while increasing revenue with NO out of pocket costs to the practice. To learn more about how your practice can benefit from implementing medically necessary procedures into your daily routine, contact or visit edavis.rx2live.com

EOCC’s RX Helping YOUR Practice Succeed!

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The Effect of Adult Use/ Legalization of Cannabis on the Florida Medical Marijuana Industry By MICHAEL PATTERSON

In February 2020, the Florida Supreme Court will review a petition from a group called “Regulate Florida,” to be placed on the ballot in November 2020 to legalize the use and cultivation (home grow) of cannabis to adults over 21. There is a second petition for cannabis legalization gaining signatures for 2020 from a group called “Make it Legal Florida.” Their petition does not include the ability to grow cannabis at home (home grow). Either way, it seems that all of us will be voting on some sort of full cannabis legalization next year. If legal cannabis becomes a reality in the Sunshine State in 2020, what will happen to the state’s Medical Marijuana program? A lot of physicians have been asking me this question lately, and there is some good news for physicians who write MMJ recommendations and bad news. Let’s start with the bad news. Based on other states like Colorado who legalized adult-use cannabis in 2012, the medical cannabis patient numbers will consistently and steadily decline commencing at the passage of adult-use. At its peak, Colorado had over 100,000 medical cannabis patients in the system. As of 2019, the patient numbers are approximately 30,000 and declining. Now, let’s discuss the good news. If adult-use cannabis is legalized in 2020, depending on how the eventual law is written, it would not go into effect until January 2022.

In 2016, 71 percent of Florida voted in favor of legalizing medical marijuana. In 2017 the Florida legislature passed legislation on how to implement this new constitutional amendment, and it was signed into law by former Governor Rick Scott. However, some parts of the law have still not been implemented as of today due to the bureaucracy that is our state legislative system. So, if you are a physician currently recommending MMJ or looking to get into the industry, there are still potentially more than two years left in a pure medical cannabis system. You have time to begin thinking about options to adjust to a new legal market. Also, adult-use cannabis will have a tax, medical cannabis currently has no tax (that is not expected to change with adult-use legalization). By having a tax on recreational cannabis, it will cause customers to pay more (sometimes 30 percent more) without a medical card. This will encourage your patients to stay in the medical system for longer due to the fact the #1 most common complaint about medical cannabis is cost. If you are looking to evolve your business model with the introduction of recreational/adult-use cannabis, consider the following: • Preserve your patient base through the development of TRUST. Start edu-

cating your patients and the public now about medical cannabis and the benefits. I know that may sound extremely obvious, but ensure you have a complete education

strategy. The more you can gain your patients’ ultimate trust and the public’s trust that you are a professional physician/ group they can visit to explore the use of cannabis as a medicine (and not be judged or shamed), the better your retention rate. Once adult-use comes and is implemented, these people who trust you and your team will stick with you longer than running to the recreational market right away. • Get into medical cannabis research studies- Network with current licensed

medical marijuana companies in Florida to be involved in medical cannabis research studies. The more “pharmaceutically based” you can make your practice in dealing with medical cannabis, the better your chances to attract new patients (over the next 2 years) and keep patients if adult-use is legalized.

• Develop a new pricing model around WELLNESS - The $300-$350 per visit

fees for a physician MMJ recommendation are numbered. You must begin looking at your long-term pricing strategy focused on wellness and value. Look at services you can offer in conjunction with a MMJ recommendation visit that adult-use stores cannot. Focus on combining MMJ recommendations into a “wellness” visit where you incorporate an entire list of services to give the patient tools to a healthy life (blood work, BMI, nutrition counseling, DNA testing to determine the best can-

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nabis medicine for each patient, hormone replacement, stem cell treatment, CBD counseling, extensive review of all current prescription meds, etc.) The average age for a MMJ patient in Florida is approximately 50 years old. Most of the people who will start using cannabis for medical purposes are not using it currently. • Focus on VALUE- When, not if, canna-

bis is legalized for adult-use there will be millions of people in Florida who want to try cannabis to help a medical ailment (primarily senior citizens). There are projected to be over 2 million monthly cannabis users in Florida 3-5 years after full adult-use legalization. Currently, 40 percent of people who use recreational cannabis use it for medical reasons (problems with sleep being the most commonly cited medical condition). However, these new users will be too scared to go into a store “blind” not knowing anything. Keep in mind the “reefer-madness” ideology for over 80 years has really created fear in the use of cannabis (in any form) by senior citizens across the country. But at same time, seniors are tired of all of the side effects of their current prescription medications and are open to trying cannabis (with physician oversight).

• Fight to have a seat at the 2021 legislative “table”- when the law is written

to implement legal adult-use cannabis (if it passes in 2020), have representation to implement changes in the current law for MMJ recommendations to make it easier to receive a MMJ recommendation. • Allow full telehealth for MMJ recommendation visits via digital devices for all required visits. • Allow ARNPs and PAs to recommend MMJ, not just MDs or DOs. • Increase the list of qualifying diagnoses to receive MMJ or remove the list all together. • Allow Florida doctors to recommend MMJ for any condition they feel would provide more benefit than harm (which is currently the Oklahoma MMJ law) • Eliminate the mandatory state-wide MMJ patient registry. People don’t like being on “lists.” It seems too much like “big-brother.” Edit the law to allow the Department of Health to collect deidentified data (for future research) but not personal information. The one constant in healthcare is change. Medical Marijuana is no different. The industry in Florida is evolving rapidly and providing opportunity for groups who can provide value and trust for their patients. 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

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The Lines of Office Compliance Have Never Been So Blurred, Or Carry Such Liability By TONY COWAN

What was once a very simple designation of “medical office” has been blurred. Just the term medical office used to mean a doctor’s office with clinical exam rooms where basic diagnostics, laboratory, and simple noninvasive minor procedures could be performed. The space was designed to include strategically located clean and dirty areas, and the patients flowed in and out of each as needed without even noticing the intentional layout of the structure. Compliance was maintained by training the staff in compliant behaviors that were in place from the opening of the medical office – no changes in operations meant no compromise to compliance occurred. Why are those simple days of compliance gone? Today, a doctor’s office can be a beauty salon on one side, a weight loss clinic on the other, with a surgical room in the middle – all while still being known as a doctor’s office. The owner or owners are working hard to stay relevant and profitable in the dramatically changing landscape that is today’s healthcare industry. The once simple, clean and dirty designations are lost, and what the patient flows through is far more about aesthetics and spaces defined by convenience than any kind of state or federally compliant design. Status quo inertia is no longer adequate to maintain compliance. This problem is not an issue of putting up with overly enthusiastic regulations. People are getting

infections and tragically dying from officebased treatments and procedures.

HOW IS IT THAT WE GOT TO THIS POINT?

The rise of medical equipment generating new revenue is a key challenge in offices maintaining compliance. Today, keeping the doors open requires more than just office consults. Patients need treatments and those treatments must generate revenue. The problem is that the equipment representative selling the newest laser or other moneymaking technology is not concerned about your sterile processing. They happily train the physician and staff, handing off the scope and saying it needs to be sterilized after each use, which meets their obligations. The dilemma is the new ‘money-maker’ was never considered during the design of the facility. The added table-top sterilizer or ultrasonic cleaner gets set-up next to the treatment bed, or on the counter in the breakroom because there is nowhere else in the practice to put them. As incidental as this may seem, failing to maintain compliant cleaning practices will be an issue with the new unannounced inspections the state can start in 2020. The risks of new treatments that are poorly supported by the traditional medical office is nothing compared to the ever-expanding medical office approved surgeries. Over the last ten years, seemingly boundless new procedures are performed in officebased surgery (OBS). Equipment repre-

sentatives are sure to tell you about having the right patient monitor, oxygen and defib units. However, it is not their job to warn you about functional space requirements to maintain compliant practices for these procedures. So how does a medical office add money-making equipment and perform revenue generating procedures, while ensuring they are maintaining a regulatory compliant facility that reduces the patient’s risk and the office’s exposure to liability? The quick answer is OBS compliance has never been so compromised. That should not be news to doctors, nurses, or staff of a medical office. It is certainly not news to the state, who passed Senate Bill 732. This bill created section 458.328,FS Office Surgery Registration as of January 1, 2020. This allows for annual inspections by the Department of Health, which may be unannounced, and it empowers the Board of Medicine to impose fines and even revoke the designated physician’s license where failure to meet regulations are identified. The risks to the physician, their patients, and their practice is real, and the state is serious about taking action where non-compliance is determined. Medical office compliance for OBS and the “Medical Office” has never been more important. Getting focused on developing and implementing policies and procedures that address regulations, standards, and best practices, as well as the functional design issues of the space is fundamental. Seriously taking on compliance can reveal

simple solutions when the practice takes the time to identify the issues and options for addressing them. The practice cannot fix what is not identified as flawed. Establishing compliance is not difficult but it takes work. Actions like relocating equipment and setting-up protocols can create compliant space by distinguishing behaviors and designating operations. This is worth the work it takes. Time and focus, can reduce liability, improve patient care, and perhaps even save the physician’s license. When compliance is done right, it can improve patient flow and improve the bottom line. It is not too late for many offices who perform OBS to fall in line and avoid fines and penalties from the new regulations. However, if the physician owner of the practice is waiting for the letter from the state advising them they have 45 days to respond, they will have crossed the line and there will be nothing blurry about it. Tony Cowan is a Healthcare Risk Manager, the Director of Emergency Response Technologies for Clinics on Wheels™ at World Housing Solution, Inc. An experienced healthcare consultant, he supported hundreds of surgery centers to attain on-budget, on-time openings, passing state licensure, Medicare certification, and accreditation. Currently he develops and delivers mobile clinics to rural or disaster impacted areas that are medically compliant, can pass accreditation, and become part of the medical public health infrastructure for communities in need. Contact him at tonyc@worldhousingsolution.com

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Five Ways Employees Drive Us Crazy By WENDY SELLERS

Let’s dive into the five ways employees drive managers CRAZY and how to deal with it in order to improve communication, set boundaries and get stuff done. #1 THEY DO NOT LISTEN

Employees don’t follow directions; they never follow up and they forget information. Why? Well, you are probably talking at them rather than have a conversation with them. Perhaps you are giving too much detail or not enough. Here is a great example of confusing instructions while driving a vehicle. There are these fancy things at an intersection now called roundabouts. If you are using a driving direction app, Waze to be specific, and go through two similar roundabouts, one set of directions says, “take the 2nd exit” while the next one says, “go straight.” Why not be consistent? Clarity really is the key in communication. Here is the thing – people process information differently. Your job is to figure out how their invisible responder works and deliver to their level (not your level). Be clear with deadlines and when you expect status updates. #2 THEY MAKE SO MANY MISTAKES

Who reading this has ever made a mistake? Yes, all of us have. I make mistakes daily.

Before you put them in HR jail, verify your communication details and remove judgement. Treat people like humans. Not too long ago, I was fed up with my employee. Every week, she took three hours on a report that should have taken 15 minutes. Ultimately, I was the problem. I hired the right person but then changed the expectations of her job including adding report writing. She did not have this skill, so she needed time to learn it and I needed to not only back off but provide the time she needed to learn report writing. #3 THEY HAVE NO COMMON SENSE

I am sorry to tell you, but common sense is not a sense at all. It is a skill. Skills are not innate. You are not born with them, this isn’t Maybelline! When employees don’t get the tools and training to do their jobs well, they fail. Essentially, employees are set up for the failure rather than success. You set them up for failure. Your job as a manager is to be checking for confirmation that they actually understood your marching orders and to provide the tools and resources they need to be successful. #4 THEY HAVE ENTITLEMENT MENTALITY

Well, don’t go blaming the youngest generation on this. At one point, it was baby

boomers who felt entitled. They wanted equal pay and rights for women in the workplace. How dare them! You see, it is always the youngest people who affect change. Their parents tell them they can do anything and be anything. Then we as society get upset when they actually believe it and put in the effort to change the world. You see, we are more alike than different. We all want more, expect more and strive for more. With that said, if an employee’s knowledge skills and abilities do not fit the job or project need – they will never work out. End of story. Your job as a manager is also to hire the right person, train them for the job at your company, and hold them accountable by setting boundaries in the form of behavior and performance expectations.

Talk about the Mission, Vision and Values often – explain it in interviews and in team meetings. Talk about them in performance conversations. Use them as reasons to tell employees yes - or in some cases, no. The bottom line is that employees feel unappreciated. When employees feel like the sacrifices they make, the extra effort they put in, and the great job they do is taken for granted, they gradually learn that what they do doesn’t matter. So, they stop doing it.

#5 THEY JUST DON’T CARE

Wendy Sellers, MHR, MHA, SHRMSCP, SPHR   has a  master’s degree in Human Resources, a  master’s degree in Health Care Administration, is a passionate HR Consultant,  Trainer, Advisor, Leadership Coach, Author, and Speaker. She has worked with hundreds of corporations and associations conducting management training, leadership development and HR advisory services leading to positive and productive corporate cultures. She has experience as an HR Executive and Practitioner, an HR Advisor, a Board Advisor/ Board Member, and an adjunct faculty member. Visit www.thehrlady.com

Why should they care about you and your company when you don’t explain anything? How does the employee tie into accomplishing the company or department goal? Do they know this? Or is that so super-secret that it is on a need to know basis? Let’s put it this way, employees think “l can’t care about the purpose until I understand it.” According to Harris Interactive, only 37 percent actually understand your purpose. That is astounding! So how do you fix this?

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Can a Husband and Wife Medical Practice Truly Work? What’s the Key? By QUINTIN L. GUNN, Sr., CSO

Let me say at the outset that this was a very challenging article to write. However, it was absolutely necessary in light of the consistent stories I have heard as a Practice Development Consultant, not to mention the professional and personal toll that a dysfunctional husband and wife practice can have on their staff and their marriage. What I’ve seen over the last fifteen years while advising and working in the Cosmetic and Aesthetic medical practice industry is, at times, shocking. And while this may not happen or apply across the board for all husband and wife teams, for the great majority of medical practices where the husband is the doctor and the wife is the practice manager or doctor partner, we find many employee casualties and discontent in the practice among the staff. What are the typical issues and challenges that happen where the husband is the doctor and the wife is the practice manager?

• Employees get confused as to whom they should listen to and who is truly in charge • A wife can become jealous of female employees that work closely with the doctor

• While emotions can be used to inspire and encourage, emotional considerations must be avoided when it comes to making business decisions • Often internal conflict of loyalties can occur if one or the other is charged with all employee selection, firing, and payroll of staff • Good Cop, Bad Cop routine causes the staff to be paralyzed in decision making • Husband and Wife personal and family conflicts get brought into the practice • The practice is brought to a stand-still when both are attending family events or go on vacations leaving no decision maker on site • Employees are exposed to the business disagreements between husband and wife • Inability to separate work life and family life which causes marital discord and makes for an uncomfortable work environment • Bullying or abusive attitude toward employees because the husband is the doctor/owner • Staff is required to do free services for family members and friends which could affect commissions for Aestheticians, Skincare specialist, or other staff who work for commissions or who work from a bonus

structure, which in turn build resentment. • When the doctor fails to demonstrate authority or leadership and defers to the wife this can lead to employees losing respect for the doctor or both • A set schedule for the practice manager/ wife as she is an employee also and she is required to use the same guidelines for time off request to ensure the practice does not suffer in her absence. • Staff were requested to take care of personal business matters for the doctor or practice manager/wife during business hours or off the clock after hours What we just listed is a partial profile from what employees have told us over the years and have experienced. Many have said that they would never work in that type environment again. This type of practice arrangement is often done to create cost savings. It is much better to have the wife as a Marketing Director/Coordinator, Nurse, or in some other complimentary business away from the practice. What is the Key to Success in This Type of Practice?

on each one interviewing the prospective candidate and viewing their credentials • Weekly staff meetings with both the doctor and the practice manager/wife to ensure transparency • Establish proper professional communication within the practice, leave personal attitudes and issues at home, the practice is not the place to air your family issues • Create an environment where the staff feel comfortable to address either of you about their concerns without feeling or worrying about retaliation from the other • Have clearly defined chain of command within the practice about whom the staff should speak to about problems and stick to that Jointly keep the staff informed about changes to process and procedures and get staff input if the proposed changes will affect their work routine and hours of operation. The key for this type of practice is communication, separation of work life and home life, transparency, and a clear chain of command, and last, treat the staff like you would want to be treated if you were in that type of practice.

• A unified approach to patient selection, staff interaction, and management • All hiring should be a joint decision based

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

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REAL ESTATE:

Three Common Mistakes Healthcare Professionals Make By DOUG PRICE

#1: Believing the landlord or seller will simply offer their best terms

Real estate is the second highest expense behind payroll for most healthcare practices. The benefits of capitalizing during lease negotiations can include a healthy raise through increased profitability, reduced debt, a nicer office and more. On the contrary, if negotiations are not handled properly, the results can be decreased profitability; resulting in the need to produce tens to hundreds of thousands of additional dollars just to pay the same bills that should have cost dramatically less. While there are many key concepts and strategies you should always do prior to and during any lease or purchase negotiation, there are an equal or greater number of mistakes you should avoid. Having represented thousands of healthcare professionals over the last decade, we have gathered some of the most common mistakes healthcare professionals make during lease and purchase negotiations with the goal of helping others avoid the same mistakes. Here are three of the most common mistakes:

Landlords and sellers are in business to make money. They are no more likely to voluntarily reduce lease rates or give up any extra money through concessions as you would be to voluntarily reduce your reimbursement from an insurance company or cut your patient fees if you didn’t have to. While it sounds pleasant to hear a landlord talk about giving a ‘fair deal’ or ‘reasonable price,’ your odds of getting either are bleak without truly understanding the market, entering the negotiation process with multiple other options and having the needed guidance to capitalize. Trusting a landlord or seller without the help of professional representation will most likely result in the forfeiture of tens to hundreds of thousands of dollars that could have stayed in your checking account. Case in point: if you were about to sell your home and a fair price was $400,000… but your agent told you a buyer would pay $500,000… what would you list or sell it for? The “fair” price of $400,000… or the most you could get for it? Exactly. You would sell it for the most you could. Your landlord will treat you the same way. They will charge you the highest they can while giving you the least they can get away with.

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#2: Determining market value by asking what your neighbors are paying

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Several years ago, we were reviewing the lease terms of a doctor who had been in a building for 20 years. In looking at his lease, he was paying $30 per SF, and had not received any free rent or tenant improvement allowance in his last negotiation. When we posed the question: “Do you believe $30 per SF with no concessions is a

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good deal?” His response was, “I believe so.” “Why, we asked?” His response: “There are four other healthcare practices on this floor. We all know each other and talk about our leases. We are all paying $30 per SF and the landlord has told all of us they don’t give free rent or tenant improvement allowances.” Our response: “I understand the logic behind that approach… but what if I told you we just did a lease with a brand-new tenant on the first floor at $21 per SF ($1,800 per month in savings if it were your lease rate), while also obtaining 3 months of free rent and over $100,000 in tenant improvement allowance!” The bottom line is that landlord got away with convincing five different practices the market was far higher than it really was and that they didn’t deserve any concessions. Imagine finding out that you have been overpaying by $1,800 per month for the last 5 to 10 years and forfeiting money that could have completely renovated your space? This scenario happens every day to uneducated tenants who consult with other uneducated tenants and compare terms that were the result of having no posture, no knowledge of the market and not applying leverage through representation. #3: Not knowing market availability and comps

The foundation of a successful negotiation starts with understanding what your other viable options are, how they compare to each other and how to execute on them. When dealing with landlords or sellers, many healthcare providers try to bluff their way into and through negotiations. A savvy landlord or seller can often read a bluff from a mile away. Here is the problem with this approach: it communicates you are too busy,

you don’t know who to hire and you don’t know what you could achieve. Trying to wing it in these scenarios will not work! This approach typically results in less respect from a landlord and the exact opposite results you were hoping for. Also, overly aggressive offers or unrealistic requests can compound the problem, as can emotional responses to the conflict inherent in most high-dollar negotiations. If you are going to be successful in your next negotiation, understanding market availability and comps is the first place to start. You can hire representation to do this for you, or you can invest dozens of hours yourself into the process. These are just samples of the common mistakes you should seek to avoid when looking at your real estate decisions. Unfortunately, there are several more you need to avoid. Summary

Don’t be taken advantage of during your next purchase or lease negotiation. There is too much on the line. Losing tens to hundreds of thousands of dollars affects your income and can also impact the quality of care you provide. Hire professional representation to level the playing field, start the transaction at the proper time, know the market and top available options and negotiate with multiple owners. If you do these things you are very likely to capitalize on your second highest expense. Doug Price is an agent with CARR Healthcare, the nation’s leading provider of commercial real estate services for healthcare tenants and buyers. Every year, thousands of healthcare practices trust CARR to achieve the most favorable terms on their lease and purchase negotiations. CARR’s team of experts assist with start-ups, lease renewals, expansions, relocations, additional offices, purchases, and practice transitions. Healthcare practices choose CARR to save them a substantial amount of time and money; while ensuring their interests are always first. Contact Doug at Doug.Price@carr.us

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Vaccinations and Screenings for Inflammatory Bowel Disease Patients By SRINIVAS SEELA, MD; DR. AMISH PATEL; RITHVIK SEELA

Patients with inflammatory bowel disease (IBD) are at an increased risk for developing vaccine-preventable illnesses such as influenza, pneumococcal pneumonia, and hepatitis B virus. This risk is further exacerbated by immunosuppressant medications used to treat IBD. Patients with IBD are not vaccinated at the same rate as general medical patients. It has been shown that IBD patients are less likely to receive adequate preventive care when it comes to vaccinations and screenings. This is largely due to the fact that preventive health measures change based on a patient’s specific medical regimen and the communication between primary care providers and gastroenterologists may not be as clear. This is especially important when taking into consideration a large proportion of IBD patients are on immunosuppressive therapies such as corticosteroids, immunomodulators, and biologics. Not only does an impaired immune system significantly increase the risk of acquiring a preventable infection, it has also been shown that the IBD alone can increase the risk for certain pneumonias. Gastroenterologists should familiarize themselves with health maintenance measures pertaining to patients with IBD. Prevention of many of these infections can be achieved by the timely and judicious use of vaccinations. Many things can be done to improve vaccination rates for IBD patients, starting with patient and physician education. A study performed by the Crohn’s and Colitis Foundation determined that a physician recommending a particular vaccine was highly predictive of an IBD patient receiving that certain vaccine. Information regarding recommendations for vaccinations in IBD

PREVENTATIVE HEALTH RECOMMENDATION

DOSAGE

PRECAUTIONS

Influenza

1 dose annually

Use trivalent inactivated and not live inhaled for patients and household contacts

Measles, Mumps, Rubella (MMR)

Live contraindicated

Herpes Zoster

2 doses after age 50

Varicella

Live contraindicated

Pneumococcal

- 1 dose of PCV13 - 2 doses of PPSV23

Meningococcal

- 2 doses of MenACWY + 1 dose every 5 years - 3 doses of MenB

TDAP

1 dose ages 11-64 + Td booster every 10 years

Hepatitis A

2 doses

Check titer before administering

Hepatitis B

3 doses

Check titer before and after administering

Human Papilloma Virus (HPV)

3 doses

Ages 11 - 26

Screening for Cervical Cancer

Annual

Screening for Depression and Anxiety

Periodically

Screening for Melanoma and Non-Melanoma Skin Cancer

Periodically & Regularly after age 50

Screening for Osteoporosis

At time of diagnosis & periodically after

Smoking Cessation

Discuss at every visit

patients is available on various gastroenterology society websites and if an office does not carry, or is unable to receive certain vaccines, they should be referred back to their primary care or local pharmacy with explicit recommendations or prescriptions. It is imperative to note that data has shown no relationship between receiving

vaccinations and current IBD activity rendering them completely safe. All patients with IBD should receive appropriate vaccinations, ideally before immunosuppressive therapy is initiated. Live-attenuated vaccinations should be avoided up to 6 weeks prior to starting and three months after discontinuing immunosuppressive therapy.

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If conventional risk factors present

It is very important for patients with IBD planning to travel to visit the gastroenterologist. Vaccinating the traveling patient with IBD is a clinical situation with which gastroenterologists should be familiar. Prior to travel, it is recommended that patients schedule a visit with an infectious disease clinician or a university traveler’s clinic to discuss where they will be traveling and for how long. Both the patient and the practitioner can review travelers’ health information from the CDC and World Health Organization to assess what infections may be endemic to the region that the patient will be visiting. One infection of particular concern for traveling patients is yellow fever, a flavivirus transmitted by the Aedesmosquito. The virus is highly endemic in Sub-Saharan Africa and South America. The yellow fever vaccine is a live vaccine and, thus, is contraindicated in patients receiving immunosuppressive therapy. The vaccine is recommended for patients traveling to areas with a high prevalence of the disease, as some countries require proof of vaccination upon entering.  Patients should stop immunosuppressive therapy for at least 4 months prior to vaccination. If patients cannot stop their immunosuppressive therapy, they should be strongly advised against traveling to regions where yellow fever is endemic. Other live vaccines that must be con(CONTINUED ON PAGE 16)

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Your Advocate – Your Shield Healthcare Law

By FRASER COBBE

Stark, Anti-Kickback Statue, The Florida Patient Self-Referral Act

Regulatory Law

Florida Boards of Medicine, Dentistry, Pharmacy & Nursing

Business Law

Medical Business, Contracts, Ambulatory Centers (“ASC”), Transactions & Business Relationships

C B G L AW. N E T

Gregory A. Chaires, Esq.

Dr. Richard J. Brooderson, Esq.

Proven Solutions Needed for Out-of-Network Care

JoAnn M. Guerrero, Esq.

A l t a m o n t e L a k e s i d e Pa r k • 2 8 3 C r a n e s R o o s t B l v d . , S u i t e 1 6 5 • A l t a m o n t e S p r i n g s , F L 3 2 7 0 1

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The Physicians Society of Central Florida (PSCF) has been actively engaged in the ongoing debate in Congress over how to address out-of-network care and protect patients from the financial implications of receiving treatment from a physician that is not in their insurance carrier’s network. Our concern is that any insurance company driven solution may negatively impact patients on a much larger scale. There is consensus in Washington, D.C., that we need to protect patients from the impact of receiving a surprise medical bill from a physician they believed to be in their insurance carrier’s network. The PSCF supports that position. The difficult choice before Congress is how to accomplish that goal without jeopardizing access to care and further deterioration of networks and local marketplaces. There are proven models in states like New York and Texas that have provided a mechanism for insurers and health care providers to mitigate disputes without providing perverse incentives for insurance carriers to further narrow their networks.

If the insurance industry is allowed to pay out-of-network physicians their average in-network contracted rate, they will be incentivized to further manipulate local markets by narrowing their networks and dropping higher quality physicians that may currently have the ability to negotiate higher reimbursement. Such actions would result in decreased quality, reduced access to care, higher out-ofpocket costs, and more out-of-network billing for routine care, which is the total opposite of the stated goals of this initiative. We seek a solution similar to the State of New York which has seen a 30 percent reduction in out-of-network billing as they utilize charge-based benchmarks which encourage insurers to come to the table and negotiate reasonable contracts and expand networks. Congress should pursue proven solutions that will protect patients and not result in a one-sided victory for insurance companies. For more information please contact the PSCF at 844-234-7800 - Ext 5000. Fraser Cobbe is the Executive Director of the Physicians Society of Central Florida

Vaccinations and Screenings for Inflammatory Bowel Disease Patients, continued from page 15

Does your lease expire in the next 24 months? If so, allow our team of expert negotiators to save you a substantial amount of time and money.

DOUG PRICE Agent | Florida 407.717.0716 doug.price@carr.us

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NOVEMBER 2019

sidered for traveling IBD patients include MMR, typhoid fever, and poliomyelitis. Hepatitis B immune status should be checked in patients prior to travel in regions where hepatitis B virus is endemic (e.g., Southeast Asia, China, Africa). If patients are immunosuppressed and their titers are below 10 mIU/mL, a hepatitis B booster should be administered. Inactivated vaccines include, but are not limited to, Japanese encephalitis virus, rabies, typhoid fever, poliomyelitis, and hepatitis A virus.   There is no contraindication to using live vaccines in household members of immunosuppressed IBD patients. To improve the vaccination rates, the ideal time to assess a patient’s health maintenance needs and administer appropriate vaccinations is during the patient’s initial visit to a gastroenterologist. During this initial visit, timing of vaccinations should be considered if there are plans to start immunosuppressive therapy in the near future. If vaccination services are not available in the office, the primary care provider should be sent concise recommendations for vaccines to administer. The majority of practices and hospital systems currently use electronic-based health records (EHRs). EHRs can facilitate documentation of vaccinations and can also serve as a tool for providing physicians with alerts and reminders regarding vaccine ad-

ministration. Taking care of patients with IBD often involves making complex medical decisions. Gastroenterologists are typically the primary provider for patients with IBD; therefore, it is essential to have a broad understanding of the issues surrounding administering vaccinations to patients with IBD. Clinicians should recognize the increased risk of vaccine-preventable illnesses that IBD patients face and understand which vaccines can and cannot be administered to IBD patients on immunosuppressive therapy. Providers should take an active role in evaluating their office practice for assessing a patient’s vaccination history and administering appropriate vaccinations. Srinivas Seela, MD, co-founder of Digestive and Liver Center of Florida, finished his fellowship in Gastroenterology at Yale University School of Medicine. He is an Assistant Professor at the University of Central Florida School of Medicine, and a teaching attending physician at both the Florida Hospital Internal Medicine Residency and Family Practice Residence (MD and DO) programs. Dr. Amish Patel is a medical student at Kansas City University School of Medicine and Biosciences. Rithvik Seela is a sophomore at Stanford University.  Visit www.dlcfl.com for more.

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The Role of the Employee Benefits Broker By JOSEPH C. FILICE

Today most business owners and/ or HR managers do not have the time to spend focusing on employee benefits. Most understand the value and importance of employee benefits and how they help attract and retain the best talent in the market while creating a competitive advantage for the company, but simply do not have the time to spend researching and marketing employee benefits packages. Employee benefits brokers are state licensed individuals who assist with this process. Employee benefit brokers design a customized benefit plan, educate employees, implement the plan, assist with the administration and servicing while ensuring compliance. Employee benefit brokers are insurance brokers who specialize in employee benefits and are required to be licensed through their respective state of residency and in all states where they are conducting business. One of the main roles of an employee benefits broker is to design a customized benefit package for their client that meets the unique demographics and needs of their staff while ensuring compliance for the business. This plan is designed with the direction of the business owner and/or HR to meet the needs

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of their employee population while assuring affordability for both the company and the employees. This process is done through marketing the prospective benefit package through multiple major insurance carriers in the market to ensure the most competitive plans at the most competitive price. Once the plans have been to market and the business owner has chosen the benefit package to offer to their employees, the implementation of these benefits occurs. The first step in implementation is education. The employees need to be properly educated on what benefits are being offered and have a comfortable understanding of the benefits and the relative pricing. Brokers assist the company in this education process through group meetings, one on one meetings, marketing material and online resources. After proper education, the employee can now confidently elect the benefits they feel meet their unique needs and those of their dependents. This process is done through both traditional paper elections and, more popular today, through electronic election. A good employee benefits broker is like an extension of the company’s HR team whether the company has 2 employees or over 2,000 employees. Throughout the year

an employee benefits broker should be hands on in the assistance of service and administration related to the employee benefits package being offered. This can range from adding and terminating employees on and off the plan and bill, reconciling invoices, assisting with claims, answering questions from employees, directing a wellness plan, introducing technology partners where applicable and continually educating employees. Most benefit packages renew annually. This time period is referred to open enrollment. During open enrollment your broker is a pivotal part of the process. Employee benefit brokers need to market your plans to ensure you are receiving the most competitive benefits at the most competitive pricing. Once the broker has presented the options to the company and they have chosen their plans for the new policy year, the process of employee education and implementation occurs again. The broker’s responsibility of employee education is never complete. They are continually striving to educate the employees on their options presented so that these employees can fully understand the benefits being offered and determine what is a good fit for themselves and their dependents. This was a very high overview of the

role of an employee benefits broker and the services they provide to businesses. Whether your company has 2 employees or over 2,000 employees, an employee benefits broker should design a customized benefit plan for your staff. This plan should be designed to meet the unique needs of your employee population while being in line with the company goals and ensuring compliance. Employee benefit brokers should be conducting employee education year-round and should act and serve as an extension of the company’s HR team for all service and administration related to the employee benefits being offered. As with your plans being offered, you should also market your employee benefits broker to make sure you are confident with the partnership you have chosen and to ensure you have the best employee benefits broker for your unique company and employee population. Contact your local employee benefits broker today to learn more about the services offered and how they can help! Joseph C. Filice MBA, is the owner of Avalon Insurance Services, LLC located in Avalon Park Florida. Joseph has been in the insurance industry for more than 13 years and is a proud member of the National Association of Health Underwriters (NAHU). Email him at jfilice@avaloninsuranceservices. com. Visit www.avaloninsuranceservices.com

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.com


MAT – It’s Time By COLETTA DORADO

The last few months, I have received quite an education on medication-assisted treatment (MAT) and why it is considered a best practice in addiction treatment. In the editorials that I have written for the Orlando Medical News, I have shared the education that I have received attending national addiction treatment conferences and learning from experts and advocates about why medication and counseling in recovery treatment is considered a best practice. MAT combines the prescription of withdrawal-curbing medicines (usually buprenorphine, methadone, or naltrexone) with therapy to treat Opioid Use Disorder (OUD). Evidence suggests that treatment programs with medication have higher rates of retention and lower rates of relapse than treatment programs without medication. This engages more of the licensed physicians with waivers within each community to now be involved in treating more individuals in need. Only 23 percent of treatment programs report using an FDA-approved medication, and only 47 percent of U.S. counties even have a physician who is waived to prescribe buprenorphine. Today, many physicians will turn away or fire a patient that may be using an approved medication in recovery instead of treating the whole person. Many in recovery have other health needs that should not be neglected. Many have co-occurring diagnoses that require long term care. MAT in the recovery plan, improves patient and clinical outcomes, and has the support of CMS and the medical payer community that wants to see better outcomes.

SO WHY AREN’T PHYSICIANS PROVIDING MAT?

Fear of tarnishing their brand, for one. Native American advocate David A. Patterson Silver Wolf wrote in March, “Physicians whose practices focus on patients with opioid use disorder don’t have to worry about their ‘brand’ being harmed because it is tied to this treatment and this patient population. But a typical primary care physician in Manhattan or suburban Atlanta or rural Nevada might worry about the potential trouble that patients with addictions might cause in their waiting rooms. With primary care’s business model relying on patient satisfaction, a small issue like patients getting upset and protesting which TV channel is playing in the waiting room could significantly affect a physician’s bottom line.” Bickering over the TV channel pales in comparison to the thought of a patient with an OUD overdosing in the bathroom, as some Boston treatment centers have experienced. This stigma toward addiction treatment is, of course, largely misguided. Since 2003, one of the defining characteristics of officebased opioid treatment (OBOT) is that medication can be prescribed in the primary care setting. This alone sets the use of buprenorphine in MAT a world apart from the “back alley” methadone clinics many people picture when thinking of MAT. With more various and safer MAT medications (less likely to become addictive or cause overdose), as well as safeguards such as the requirement to provide counseling services in order to prescribe MAT, the validity of MAT has since been widely affirmed and supported in the addiction treatment community. To those physicians considering entering addiction treatment, it remains a promis-

ing and under-tapped business opportunity. For one, MAT – like addiction treatment broadly – is highly fragmented. The industry consists mostly of several thousand small clinics and solo providers. This means barrier to entry is rather low for new organizations, or existing organizations just starting MAT. Additionally, most communities are underserved. With more than 25 million people suffering from substance use disorders in the United States, only about 10 percent receive the treatment they need, and most U.S. counties do not even have a physician with the waiver necessary to provide buprenorphine. It also shouldn’t be overlooked that there’s a large sum of money in medicationassisted treatment. Major private payers, Medicaid, and Medicare, all cover MAT. Moreover, just in 2019, billions of dollars are pouring into addiction treatment in the United States. This includes the following: • $1.4 billion in State Opioid Response (SOR) grant programs from Health and Human Services

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• Billions in settlements, such as the $572 million sum that one household-name drug manufacturer was ordered to pay to the state of Oklahoma • $50 billion, the approximate settlement that major distributors will pay out. In short, there is a large amount of funding devoted toward addiction treatment, as well as to MAT specifically. Addiction is a long-term disease that requires a strong medical component. This highlights another important aspect of MAT: in addition to improving your organization’s outcomes, it improves your patients’ outcomes. Reducing withdrawal symptoms as part of the recovery process produces statistically higher rates of retention in patients. In controlled studies, as many of 75 percent of patients receiving buprenorphine tested negative after a year, compared to 0 percent of those receiving placebos. The final reason physicians should consider entering MAT is that specialty specific EHRs exist to simplify the clinical and medical documentation for reimbursement required. Treatment plans are unique, scheduling for induction, stabilization and maintenance can easily be supported with the right technology. As others have experienced, I too have lost a loved one to addiction. That is why we have dedicated ourselves to support the healthcare community with a software solution, AZZLY Rize™ that can be the foundation for small, medium or large organizations. A clinic set up to serve MAT for a specific demographic or for a general population requires a specialty electronic health system that supports the detailed documentation and follow up required. The AZZLY® Rize™ solution is an all-in-one electronic health record (EHR) and revenue cycle management (RCM) software designed to drive efficiency, support growth, and eliminate the complexity around addiction treatment and behavioral healthcare needs. I encourage you to explore this opportunity to serve more in need in your community wherever that may be. The addiction and behavioral healthcare industry needs more primary care and internal medicine physician involvement to treat the whole person, which is what you do best. Coletta Dorado is the Founder and CEO of AZZLY®, Inc. With more than 30 years business process experience, Dorado and her team are passionate about delivering a powerful EHR and Billing Solution for addiction treatment and behavioral healthcare providers. Based in the GuideWell Innovation Core, in Lake Nona Medical City, email hello@ azzly.com or visit azzly.com to learn more.

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Five Ways You Can Change Your Clinical Setting Now to Affirm Pronouns By JAN KAMINSKY, PhD, RN

Often, we see the deployment of the use of incorrect gender pronouns as a distressing form of abuse against gender diverse individuals. Recently, Virginia teacher Peter Vlaming filed a lawsuit claiming that he was wrongfully fired because he refused to use a student’s correct pronouns. This student, a minor child, expressed great distress at the aggressive actions taken by this educator. Vlaming was fired specifically for his insubordination when the district compelled him to use the student’s pronouns and he refused to do so. Now, he is causing further pain to the student and their family through filing a lawsuit claiming that he was being forced to use pronouns and that amounted to acting against his religious beliefs. This type of deliberate misgendering is patently offensive. It lacks a basic understanding of the implications of the act of “misgendering” a transgender, gender fluid, or non-binary person. Misgendering refers to calling a person by a pronoun that is not consistent with the pronouns that they have chosen for themselves. It also can be used to imply that someone is a gender that they are not. This is a dehumanizing action that has been used in a variety of ways including to reinforce gender roles, to humiliate the person to whom one is referring, or to question if a person’s biologically assigned sex “matches” the gender with which they identify. Deliberately misgendering a transgender person is an act of psychological violence against that person, their community, and other transgender and gender diverse individuals who may read or view articles based on the Vlaming case. Psychological harm can occur when transgender folks are repeatedly misgendered, and in school environments it demonstrates to younger gender diverse people that their gender identity and self-identification are not to be respected. Misgendering contributes to a culture in which hating and disrespecting transgender people is normalized, and this can add to the all-too-frequent violence against non-binary, gender fluid, and transgender people. Using the correct pronouns and not questioning the validity of such is an easy and respectful thing to do. In a clinical setting, what does that look like?

REPRINTS: If you would like to order a reprint of a Medical News article in a PDF format or request an additional copy of an issue, please email: jkelly@orlandomedicalnews.com for information.

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NOVEMBER 2019

Ask patients what pronouns they use.

Keep in mind that a patient’s pronouns may change from visit to visit, so it’s good to be aware that you may want to ask more frequently than just once. Don’t make assumptions about pronouns based on outward appearances. Record pronouns on medical records, both paper and electronic. Make it a

non-issue in the office by asking all patients and clients what their pronouns are and recording them in both paper and electronic medical records.

Add pronouns to staff and provider name badges. This is a simple addition

that can make gender diverse patients and clients feel affirmed and welcomed.

Save some gender-neutral words to use in a pinch. Consider using “they/

them” pronouns when you don’t know someone’s pronouns or calling groups of people “folks” or “y’all.” Consider using the patient’s name instead of pronouns when you’re speaking about them to colleagues if you’re having trouble with their pronouns.

gendered the patient or client are not helpful and can actually make things worse for them. All people deserve to have their gender, pronouns, and other aspects of their essential identity correctly, accurately, and respectfully used by their health care providers and others with whom they interact. It’s easier than you might think!

Jan Kaminsky, PhD, RN is the Director of Education for Rainbow Health Consulting, which works with health care providers and health-related organizations to train employees on how to better serve their LGBTQ+ clients, patients, and families. To contact or learn more about how your organization can support your LGBTQ+ patients, go to www. RainbowHealthConsulting.com or email Jan@RainbowHealthConsulting.com.

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Anxiety, Sleep and the Use of CBD By CONNIE ORTIZ

CBD oil is derived from hemp – industrial hemp. It’s grown specifically with low levels of THC. However, just because CBD has the legal limit of .3 percent THC, does not mean that it can’t or won’t show up on a drug test. There is a possibility of testing positive. The best choice for those who are in a job that is tested would be a Broad Spectrum with zero THC. Nona Oils will soon be carrying a 1500mg and 500mg Broad Spectrum. According to Anxiety and Depression Association of America, anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults, ages 18 and older, or 18.1 percent of the population; and 70 million with sleep disorders. According to Pubmed.gov, (http:/www. ncbi.nlm.nih.gov/pubmed/30624194, Cannabidiol (CBD) in Anxiety and Sleep: A Large Case Series), there were 72 adults presenting with primary concerns of anxiety or poor sleep. Forty-seven had anxiety and 25 poor sleep. Anxiety scores decreased within the first month in 57 patients using CBD. Sleep scores improved within the first month in 48 patients.

Their conclusion: Cannabidiol may hold benefits for anxiety related disorders. There may not be many studies done here in the U.S., but many that use CBD have given testimonies on how CBD helps them with both anxiety and sleep. We have all been told how important a good night sleep is for our health and there have been many studies showing the importance of a full night of sleep. But how many of us have no problem falling asleep, but staying asleep is another issue, or we lay there and our brains just will not shut off. I have been there - I’m the one that can fall asleep but staying asleep for a full night, well that’s another story. I’ve been taking one of my new gummies about 45 minutes before bed and have been sleeping through the night. For me this is a blessing! There are a variety of choices when it comes to CBD – oils taken sublingually, gummies, capsules, vaping (as long as it’s from a trusted source) or pre-rolls. Connie Ortiz, CEO of Nona Oils, is a Certified Health and Wellness Coach, as well as Certified CBD Coach, through the CBD Training Academy. As a Certified CBD coach, she helps clients find the best form of CBD for their lifestyle and helps determine dosage. Email her at hello@nonaoils.com

Local Entrepreneur Releases Her First Best Selling Book Di-Anne Elise founder of Media Resources Enterprise, a business communication consultant in the areas of marketing, business development, public relations and an author, has contributed in a book with other authors that has reached the bestselling list status on Amazon. Di-Anne’s has joined other authors in contributing, sharing insights and inspiring other people to seek to live beyond purpose with the bestselling book “Living Beyond Purpose”. Di-Anne and the contributing authors wrote this book in hopes that other people, would find something to take away. Something that would inspire others to seek to live beyond purpose. To understand that what we are going through does not define us but can undoubtedly refine us. Sometimes it’s easy to feel like life has no purpose. Other times we can live without being fulfilled, regardless of how much we accomplish. There is a reason why and a solution to fill the void.

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Di-Anne has been a contributor in the medical field by revolutionizing marketing at its best. With her passion for branding and purpose, she has helped not only hospital medical groups but also health professionals educate the public in order to get a better understanding on how they could improve their patients’ lives. DiAnne has been able to impact the medical community by providing business communication and marketing creative services in order to inform and make a difference in the medical health community. Join Di-Anne Elise and other contributing authors along with Best Selling Author Mike Rodriguez, as they share how you were created with precision, purpose, and your own unique talents. We were also given the ability to know, act on, and use those talents to become great and strong in your own way, for God's purpose. To contact Di-Anne Elise email her at info@dianneelise

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November 2019

AdventHealth Waterman Hospital

AdventHealth Waterman’s Lou Guzzi, MD, Publishes Research on Kidney Health Technique is dubbed the “Waterman Protocol” TAVARES – In August 2017, Dr. Lou Guzzi began a process that led to a new and fascinating way of determining kidney failure risk in ICU patients. Now, research has been released, and Guzzi, a critical care physician at AdventHealth Waterman, who was the lead author of the research paper, along with 7 others, published that research in “Critical Care Medicine.” Guzzi and his colleagues examined how the first FDA-approved biomarker test to assess risk for acute kidney injury is currently being used clinically. “How it started out was, we as critical care doctors have struggled for years to find a way to early assess whether kidneys are going into failure or not. And our whole world of medicine is changing with our biomarkers; early markers that say there’s something going on. And I was presented in a meeting a biomarker called NephroCheck, which is two proteins in the kidney. I thought what a great marker to assess to see 21

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if we have early AKI in some of our sepsis patients, cardiac patients. I built a protocol around it, and then a lot of other places started jumping on saying, wow, you’re onto something here,” said Guzzi. Guzzi and the team invited a group of kidney experts to a panel discussion on the biomarker test. “We all sat in a room in San Diego and wrote a paper on our observations and the European observations. I went to Munich and got the same team involved and everybody came together and said, this makes total sense. Now, it’s pretty much becoming the standard of care,” he said. The results from the panel discussion showed that clinical experts in Europe and North America have developed similar practices for using the biomarker test. Patients undergoing major surgery or patients with sepsis, as well as patients who are in crisis, tend to be a priority for testing kidney stress. For these patients who tested positive, managing fluids and drugs that are potentially

toxic to the kidneys are a priority. Conversely, patients who tested negative were considered candidates for “fast-track” protocols. Guzzi’s technique has been dubbed the “Waterman Protocol” and he has already given multiple lectures in the U.S., in addition to presentations in Italy, Germany and in two webinars in London. The article was published in June. Click here to read it. Guzzi earned his MD at Georgetown University School of Medicine in 1986 and completed his residency at Walter Reed National Military Medical Center AdventHealth Waterman is located in the heart of Lake County and was founded in 1938 by Frank Waterman. The hospital has 287 beds and is one of six hospitals Flagler, Lake and Volusia counties that compose AdventHealth Central Florida.

Dr. Lou Guzzi, critical care physician at AdventHealth Waterman, was the lead author in a paper published in "Critical Care Medicine." The paper looked at a new and fascinating way of determining kidney failure risks in ICU patients, dubbed the "Waterman Protocol."

GrandRounds AdventHealth Names Chief Clinical Officer

LAKE and VOLUSIA - AdventHealth has selected Julie Vincent to serve as vice president and chief clinical officer for the company’s Central Florida Division – North Region. Effective Nov. 18, Vincent will lead clinical efforts and provide executive oversight for the chief nursing officers and chief medical officers for the AdventHealth operations in Flagler, Lake and Volusia counties. Vincent replaces Trish Celano who was recently promoted to associate chief clinical officer and chief nursing executive for the entire AdventHealth organization. Vincent has 15 years of leadership experience and previously served as the assistant vice president nursing for AdventHealth Orlando between 2012–2015. Most recently, she was the vice president and chief nurse executive of the Kettering Health Network, encompassing 1,523 beds in Dayton, Ohio. In this role, Vincent oversaw six chief nursing officers and was responsible for the clinical outcomes at eight inpa(CONTINUED ON PAGE 22)

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GrandRounds tient acute hospitals and four freestanding emergency departments. A registered nurse, she has extensive experience providing intensive nursing care, as well as intraoperative, procedural and preoperative nursing services. At Southern Adventist University in Collegedale, Tennessee, she earned an Associate Degree Nursing, Bachelor of Science Nursing, Master of Science Nursing, and Master of Business Administration. In addition, she earned a Doctor of Nursing Practice from the University of Central Florida. She is a member of the American Organization of Nurse Executives, American Association of Critical Care Registered Nurses, and Sigma Theta Tau International Honor Society. Additionally, she is an advisory board member of the Sinclair College nursing program, as well as the Wright State University College of Nursing and Health. She was also the president of the Central Florida Organization of Nurse Executives in 2015.

Donor Milk Gives Infants a Healthy Start at LRMC Breastmilk is the recommended form of nutrition for all newborn babies. New mothers at Leesburg Regional Medical Center (LRMC) are educated and supported to provide breast milk to their infants. However, medical circumstances arise that sometimes require supplementation and in many instances, a mother’s own milk may be unavailable or insufficient. The Life Center for Women at LRMC is now able to prescribe pasteurized donor human milk to those families who need it. “We are thrilled to partner with Mothers’ Milk Bank of Florida so that every baby has access to mother’s milk,” said Lisa Wallace, registered nurse and lactation counselor at the Life Center for Women at LRMC. “We are committed to providing the best care possible to our infants, and we know that human milk – when collected and pasteurized by non-profit milk banks to hospital-grade levels – is the future of postpartum care.” The American Association of Pediatricians has found that donor milk represents a safe and effective approach to obtaining, pasteurizing, and dispensing human milk for use in the hospital setting. Human milk is the standard food for infants and young children, including premature and sick newborns, with rare exceptions. Human milk provides optimal nutrition, promotes normal growth and development, and reduces the risk of illness and disease. The unique composition of human milk cannot be duplicated. Pasteurized donor milk retains many of its beneficial properties and helps protect the baby from infection. “Human milk is easily digested and contains the necessary nutrients, enzymes, growth factors and hormones essential for growth and development,” continued Wallace. “The Life Center for Women at LRMC is pleased to be able to help breastfeeding families provide a consistent, high standard of care to their newborn babies.” 22

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AdventHealth Names Director of Strategic Program Management LAKE and VOLUSIA – Katie Palacios has been selected to serve as the director of strategic program management for the AdventHealth facilities in Flagler, Lake and Volusia counties. In this new role, Palacios is responsible for organizing and driving leadership strategies forward and ensuring alignment for strategic priorities across the AdventHealth Central Florida Division. Palacios has five years of experience and began her career at AdventHealth Hendersonville in North Carolina. She most recently served as the senior manager for CREATION Life at AdventHealth’s corporate offices. In this role, she was responsible for aligning employee wellness efforts across the entire AdventHealth organization using the framework of CREATION Life, a lifestyle transformation program that was created to help people improve their overall wellbeing, reach their goals, and live a full and complete life. As one of the nation’s largest faith-based health care systems, this role impacted AdventHealth’s 80,000 employees at nearly 50 hospitals within about a dozen states. A Longwood resident, Palacios earned a Bachelor of Science in corporate/community wellness management from Southern Adventist University, as well as a master’s degree in public health from Andrews University.

American Heart Association Recognizes Central Florida Health for Workplace Health Achievement

The results of the American Heart Association 2019 Workplace Health Achievement Index were announced this month and Central Florida Health achieved Gold level recognition for taking significant steps to build a culture of health in the workplace. Central Florida Health is the not-for-profit healthcare system comprised of Leesburg Regional Medical Center, The Villages® Regional Hospital, TVRH Rehabilitation Hospital, Alliance Labs and the LRMC Senior Behavioral Health Center. The American Heart Association created the index with its CEO Roundtable, a leadership collaborative of more than 40 CEOs from some of America’s largest companies who are committed to applying evidence-based approaches to improve their employees’ overall health. The index uses science-based best practices to evaluate the overall quality and comprehensiveness of their workplace health programs.

“This is the third consecutive year that our organization has earned Gold level recognition,” says Juli Romero-Gomez, RN, Coordinator of the Health You, Healthy Us wellness program at Central Florida Health. “It is an exceptional accomplishment which acknowledges the culture of health in our workplace.” Studies show that worksites with a culture of health with comprehensive, evidence-based policies and programs, and senior leadership support are more likely to have engaged employees and a healthier, more productive workforce. “Each year, the point requirement for the Index goes up and our organization must have new initiatives in order to maintain our gold status,” continued Juli. “This award is a true testament to all of the hard work and healthy changes being made individually and system-wide at Central Florida Health.”

Local Businesses Partner with Waterman Foundation to Support Cancer Care

New Executive Director of Network Development and Marketing AdventHealth Waterman has selected Nick Bejarano to serve as the executive director of network development and marketing. In his new role, Bejarano is responsible for directing strategy, business development, marketing, advertising and physician relations at AdventHealth Waterman. Bejarano has 16 years of experience in marketing and most recently served as the administrative director of marketing and communications at Good Shepherd Health Care System in Oregon. In his previous role, he was responsible for managing the customer experience program, crisis communication and physician relations, as well as marketing and public relations. A Tavares resident, Bejarano earned a Bachelor of Business Administration in marketing from Southern Adventist University.

Local businesses in Lake County have teamed-up with the AdventHealth Waterman Foundation to raise funds for cancer care. During the month of October, several area businesses will donate a portion of sales, while others will sell tags for AdventHealth Waterman’s signature lawn flamingos. These funds will be used to provide cancer education and screenings, including mammograms for those in need. The participating businesses include: Bella Toscana Med Spa, 1699 Mayo Dr., Tavares Danny Len Buick GMC, 17605 US-441, Mount Dora SuperWash Express, 18805 US-441, Mount Dora Lake/Bay Pharmacy, 710 N. Bay St., Eustis Gator Harley-Davidson, 1745 US-441, Leesburg AdventHealth Waterman, Gift Shop, 1000 Waterman Way, Tavares

All supporting businesses will post signage reading “Support Cancer Care Here,” with the AdventHealth Waterman logo.

“We are proud to do our part to support patients impacted by cancer locally,” said Rodney Len, owner and president of Danny Len Buick GMC. “It feels good to know the money we raise during October will stay right here in Lake County, making a difference for our friends, family and neighbors. So many are affected by this disease.” In 2018, AdventHealth Waterman cared for more than 700 newly diagnosed cancer cases. Of those in Lake County who were diagnosed with cancer, 13.5% were below poverty level. For these patients, the AdventHealth Waterman Foundation provided over 130 screening mammograms through donated funds. If you are interested in partnering with the AdventHealth Waterman Foundation, contact Jenna Krager at jenna.krager@adventhealth.com. orlandomedicalnews

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November 2019

AdventHealth Fish Memorial Celebrates the Final Foundation Pour for $100 Million Patient Tower Expansion AdventHealth Fish Memorial celebrated the final pour of foundational concrete for the hospital’s $100 million patient tower. Hospital staff celebrated this milestone by placing their handprints in the concrete slab that will remain visible in the tower’s stairwell even after construction is completed. “It is an exciting day. There will be a number of other milestones as we continue this project, but this is honestly one of the most important ones,” said Rob Deininger, AdventHealth Fish Memorial CEO. “There’s certainly a sense of excitement today, from our staff and our community, to see the project moving along, knowing that construction will be completed about a year from now.” Now that the foundational concrete is

completed, the four-story tower will take shape as it begins to rise from the ground. When construction is completed, the patient tower will include a state-of-the-art 20-bed labor and delivery unit, as well as enhanced cardiac, intensive care and surgical services. This construction project will also fully privatize all patient rooms at AdventHealth Fish Memorial, while increasing the number of licensed beds from 175 to 225. Furthermore, the expansion will significantly increase the size of AdventHealth Fish Memorial’s emergency department, while also adding pediatric emergency care. The new construction will add 120,000 square feet to the hospital’s footprint, grow-

ing the facility to a total of 384,839 square feet when completed. “This will significantly transform the level of care available to our community. With an investment of this size, and the services we are bringing, it will transform the level of care available locally,” Deininger said. “The impact that this investment will have on this community, I think it will welloutlive any of our lifetimes.” The architect is Orlando-based RLF Architects. Birmingham, Ala.-based Brasfield & Gorrie is the general contractor. Construction is expected to be completed by the end of 2020. To learn more about this construction project, visit www.YourPatientTower.com

AdventHealth Fish Memorial staff and community members placed their handprints in the final concrete slab of the hospital’s $100 million patient tower. These handprints will remain visible in the tower’s stairwell even after construction is completed.

GrandRounds Volusia County Medical Society Offering Provider Counseling VCMS is providing access to completely confidential and autonomous counseling sessions to help providers release the stress that comes with the territory. No identifying information is shared with or reported to the VCMS. The counselors confirm that the physician holds a valid Florida Medical License and practices in Volusia County. VCMS will pay for up to three counseling sessions with any of the certified counselors enrolled in our program. The certified counselors are experienced in coaching healthcare professionals

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and offer flexible hours and availability. If you or a colleague could benefit from this service, please pick up the phone and call one of the program counselors. Delicia Haynes, MD 386-492-1064

Dr. Haynes has offered her time for physician members who need to talk things through or who could simply use a friendly confidential ear. No appointment needed. Just pick up the phone and call. Or visit her personal website for additional support: www.drdeliciamd.com

Karen Ste. Claire Spicer, PhD 386-322-4676 drkarenspicer.com

Amanda Nixon 386-255-0044

laureloakscounseling.com/amanda-nixon

Dawn Parr Chappell 386-299-3606 dawnparrchappel.com/

This program is generously supported by AdventHealth Daytona Beach and Halifax Health.

Parrish Medical Center Designated a Breast Imaging Center of Excellence Parrish Healthcare is marking 10 years as an accredited breast imaging center of excellence, a decade in which more than 92,000 exams have received the “highest level of image quality and safety,” according to the nation’s premier imaging accrediting organization.

In 2009, Parrish Medical Center (PMC) first earned American College of Radiology (ACR) Breast Imaging Center of Excellence designation. Today the earned accreditation is in the name of Parrish Healthcare, an integrated care organization that includes PMC, Parrish Medical Group orlandomedicalnews

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GrandRounds physicians, Parrish Healthcare diagnostic centers, and other health care providers working together to ensure well-coordinated, unified patient care. “The difference between talking about imaging excellence and proving it is a great deal of hard work by professionals with one objective: protecting the health of patients,” said Drew Waterman, Vice President of Ambulatory Services. “ACR accreditation is hard to achieve. The standards are high, and they should be high. “Accreditation is a voluntary program, and we challenged ourselves to achieve that goal,” Waterman said. “To earn accreditation for 10 straight years is important to us in that imaging patients derive the greatest benefit from a center of excellence.” ACR accreditation is achieved only by breast imaging centers that have demonstrated excellence in “all the college’s voluntary, breast-imaging accreditation programs and modules, in addition to the mandatory Mammography Accreditation Program,” the ACR says on its website.

The accreditation process includes peer-review evaluations by imaging experts who are board-certified physicians and medical physicists. The accreditation evaluation saw Parrish Healthcare achieve high practice standards in image quality, personnel qualifications, facility equipment, quality control procedures, and quality assurance programs. “Parrish Healthcare is proud to be one of only two breast imaging centers in Brevard County to be designated a Breast Imaging Center of Excellence, and the only one in north Brevard,” Waterman said. The ACR, headquartered in Reston, Va., is a national organization serving more than 32,000 diagnostic/interventional radiologists, radiation oncologists, nuclear medicine physicians, and medical physicists with programs focusing on the practice of medical imaging and radiation oncology, as well as the delivery of comprehensive healthcare services.

Local Students Get a Hands-On Demo, Learn About Robotic Surgical Technology at AdventHealth Daytona Beach

As part of the celebration for da Vinci Xi technology, AdventHealth Daytona Beach hosted students from Mainland High School and Embry-Riddle Aeronautical University and provided a hands-on experience with the new surgical system.

Last month, Mainland High School and Embry-Riddle Aeronautical University students visited AdventHealth Daytona Beach to get a behind-the-scenes look at the hospital’s new da Vinci® Xi surgical system, an advanced technology to perform roboticassisted minimally invasive surgery. The STEM (science, technology, engineering and math) students from Mainland High School and the department of human factors and behavioral neurobiology students from ERAU had the opportunity to participate in a hands-on demonstration, using a virtual reality simulator and the robotic surgical technology to manipulate small rubber bands within a foam model called “sea spikes.” This learning opportunity was part of a celebration of AdventHealth Daytona Beach and AdventHealth Palm Coast’s new surgical option for patients. Called the da Vinci Xi, this versatile and flexible robotic system enables surgeons at both hospitals to perform 24

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minimally invasive surgeries with smaller incisions, less pain and faster recoveries. The da Vinci Xi surgical system enables Dr. Steven Bower, Dr. Steven Brown, Dr. John Cascone, Dr. Evan Fynes, Dr. Farhaad Golkar, Dr. Patrick Manganon, and Dr. Katherine Williams to perform robotic-assisted minimally invasive surgery for colorectal, general surgery, gynecologic, thoracic, and urologic procedures. The term “robotic” doesn’t mean that robots are performing surgery. Instead, the surgeon operates by guiding the da Vinci Xi instruments via a console. The da Vinci Xi system translates a surgeon’s precise hand movements at the console in real time, bending and rotating the instruments during the procedure. The tiny instruments move like a human hand, but with a greater range of motion, making it possible for surgeons to operate through one or a few small incisions. The da Vinci Xi system also delivers highly magnified, 3D high-definition views of the surgical area.

Device at Rockledge Regional Provides 3D Breast Scans with Superior Patient Comfort Rockledge Regional Medical Center is offering patients the next generation of mammogram technology: an intricate, 3D scan that examines tissue like individual pages in a book. The GeniusTM 3D MammographyTM machine is a sophisticated tomography device that has the enhanced ability to detect potential areas of concern earlier and with more precision than ever before. The device has been in use at Rockledge Regional Medical Center since August. “This new technology is similar to a CAT scan, as it allows the radiologist to examine the image of the breast tissue layer by layer,” said Michelle Hackett, lead mammographer at Rockledge Regional Medical Center, a member of the Steward Health Care family. Hackett has worked at the hospital for 28 years and is exceptionally skilled and experienced, having performed mammograms for 22 of those years. “The new 3D scan reveals fine details that the older scans can overlook,” she said. In addition to zeroing in more effectively on abnormalities, the device also reduces false positives that would ordinarily require the patient to return for a second mammogram. For example, sometimes breast tissue gets compressed unevenly during the 2D procedures and falsely resembles an abnormality. That means unnecessary call-backs and anxiety. “This helps reduce those callbacks,” Hackett said. “Before, when something appeared abnormal, patients would have to come back in. With tomography, we can tell right away if things look normal or if they need a biopsy. The image is crystal clear and infinitely better than the older technology.” The new device scans in only four seconds. “It also really provides enhanced detail and safety for women who have dense tissue, fibrocystic breasts that are hard to penetrate with the 2D machine,” Hackett said. The machine features two innovations that help make it the premier and only mammography device of its kind in Brevard County: the SmartCurveTM breast stabilization system and the Affirm® Upright Biopsy Guidance System. The SmartCurve, which holds the breast in place for the scan, has a curved paddle designed to provide more comfort to the patient than the flat plates. The Affirm system is an attachment that performs biopsies while the patient is seated rather than lying facedown on a table – also enhancing comfort. “Something as simple as the morecomfortable paddle has the potential to save lives,” Hackett said. That’s because some women worry about the discomfort of a mammogram and avoid coming in to get checked. The ability to perform biopsies on

seated patients is an advantage for women with mobility issues, such as back problems. “Some women are not able to lie on their stomachs for an extended period of time,” said Hackett, adding that Rockledge Regional is the first in the county to offer this upright-biopsy technology. “We’re hoping the women who have been avoiding mammograms will now come in due to the significant improvement in patient comfort with this state of the art technology,” she said.

Rockledge Regional, Steward Health Care Welcome Harry Diaz, MD, Family Physician When it came time for Harry Diaz, MD, to decide on a career path, he had an in-house role model. “My father was a doctor for 41 years and he practiced right up until his last day,” said Dr. Diaz. “I used to help him around the office. That guided me into medicine, it’s the main reason I’m a physician. Health care is all I’ve ever known.” Rockledge Regional Medical Center, a member of the Steward Health Care family, is pleased to welcome Dr. Diaz. “It’s a pleasure to have Dr. Diaz on our team,” said Andy Romine, president of Rockledge Regional Medical Center. “His depth of experience, his skills and his love for people is an asset to us and to the community.” Board-certified in family medicine, Dr. Diaz has a special clinical interest in treating such chronic health conditions as diabetes, hypertension and elevated cholesterol, as well as diagnosis and treatment of acute illnesses. Dr. Diaz earned his medical degree from Universidad Central Del Caribe in Bayamon, Puerto Rico. He began practicing medicine in 1987, completing his residency in family medicine at San Pablo Hospital, also in Bayamon. His career has taken him to Omaha, Neb.; Melbourne and Viera. As a family medicine specialist, Dr. Diaz sees patients whose ages range from newborn through geriatric. He treats a wide variety of conditions and can perform minor surgery. “When you’re at home, sick, and you need to see a doctor, that’s me,” he said. “I like to talk to people a lot, so I enjoy seeing patients – whether it’s grandparents, their kids or their grandkids. I like the family dynamic and working within the community, getting to know people.”

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Profile for Orlando Medical News

Orlando Medical News November 2019  

AdventHealth Nicholson Center Testing Next-Generation Universal Robotic System New Versius® Surgical Robot from CMR Surgical allows more dex...

Orlando Medical News November 2019  

AdventHealth Nicholson Center Testing Next-Generation Universal Robotic System New Versius® Surgical Robot from CMR Surgical allows more dex...